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Increased risk of pneumonia in patients receiving gonadotropin-releasing hormone agonists for prostate cancer.

ABSTRACT: This study aimed to investigate the relationship between the use of gonadotropin-releasing hormone (GnRH) agonists and subsequent risk of pneumonia in patients with prostate cancer (PC) using a population-based dataset.We obtained the data from Taiwan's Longitudinal Health Insurance Database 2000. We included 2064 PC in this study. Of the sampled PC patients, 1207 received treatment with GnRH agonists. We individually traced each PC patient for a 1-year period to identify those who were hospitalized with pneumonia. We performed a Cox proportional hazard regression to explore the association between the use of GnRH agonists and the risk of pneumonia during the 1-year follow-up period.Incidence rates of pneumonia during the 1-year follow-up period were 4.35 (95% confidence interval (CI): 1.89∼9.64) per 100 person-years and 2.14 (95% CI: 1.31∼3.32) per 100 person-years for PC patients who did and those who did not receive treatment with GnRH agonists, respectively. The log-rank test suggested that there was a significant difference in the 1-year pneumonia-free survival rate between PC patients who did and those who did not receive treatment with GnRH agonists (p<0.002). After adjusting for age, monthly income, and the Charlson Comorbidities Index score, PC patients who received treatment with GnRH agonists were more likely to have been hospitalized for pneumonia during the 1-year follow-up period than PC patients who did not receive treatment with GnRH agonists (hazard ratio: 1.92, 95% CI: 1.10∼3.36).PC patients who received treatment with GnRH agonists had an increased risk of pneumonia.

SUBMITTER: Chung SD

PROVIDER: S-EPMC4074122 | biostudies-other | 2014

REPOSITORIES: biostudies-other

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Project description:Androgen deprivation therapy (ADT) is the main treatment approach in advanced prostate cancer and in recent years has primarily involved the use of gonadotropin-releasing hormone (GnRH) agonists. However, despite their efficacy, GnRH agonists have several drawbacks associated with their mode of action. These include an initial testosterone surge and testosterone microsurges on repeat administration. GnRH antagonists provide an alternative approach to ADT with a more direct mode of action that involves immediate blockade of GnRH receptors. Antagonists produce a more rapid suppression of testosterone (and prostate-specific antigen [PSA]) without a testosterone surge or microsurges and appear to offer an effective and well tolerated option for the hormonal treatment of prostate cancer. Comparisons with GnRH agonists have shown GnRH antagonists to be at least as effective in achieving and maintaining castrate testosterone levels in patients with prostate cancer. Furthermore, with antagonists, the lack of an initial testosterone surge (which may cause clinical flare) may allow more rapid relief of symptoms related to prostate cancer, avoid the need for concomitant antiandrogens to prevent clinical flare (so avoiding any antiandrogen-associated adverse events) and allow GnRH antagonist use in patients with high tumour burden and/or acute problems such as spinal cord compression. Although several antagonists have been investigated, only degarelix and abarelix are currently available for clinical use in prostate cancer. Currently, degarelix is the most extensively studied and widely available agent in this class. Degarelix is one of a newer generation of antagonists which, in a comprehensive and ongoing clinical development programme, has been shown to provide rapid, profound and sustained testosterone suppression without the systemic allergic reactions associated with earlier antagonists. This review examines the currently available data on GnRH antagonists in prostate cancer.

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Increased risk of pneumonia in patients receiving gonadotropin-releasing hormone agonists for prostate cancer.

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