EAU 2021: The Efficacy and Safety of Relugolix Compared to Degarelix in Advanced Prostate Cancer Patients: A Network Meta-Analysis of Randomized Trials

(UroToday.com) Relugolix is a novel oral LHRH agonist, compared to the LHRH agonist degarelix which had to be injected. Degarelix is associated with high rates of injection site-reaction. Recently, the FDA approved relugolix, an oral GnRH antagonist, for the treatment of advanced prostate cancer patients.

 

This abstract is a systematic review and network meta-analysis aimed to compare the efficacy and safety of relugolix versus degarelix. They performed a systematic search using PubMed and Web of Science databases in January 2021 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) extension statement for network meta-analysis. Studies that compared the efficacy (12-month castration rate with testosterone ≤50 ng/dl) and safety (adverse events (AEs)) of relugolix or degarelix and control group (GnRH agonists) were included. They used the Bayesian approach in the network meta-analysis. 

Due to the relatively newer natures of these medications, only four studies (n= 2,059) met eligibility criteria. The main efficacy analysis was conducted for two different treatments (relugolix and all doses of degarelix vs. GnRH agonists); relugolix (RR 1.09, 95% CrI: 0.95-1.23) and degarelix (RR 0.98, 95% CrI: 0.91-1.06) were not associated with different 12-month castration rates. In the subgroup analysis, degarelix 480 mg was significantly associated lower castration rate (RR 0.46, 95% CrI: 0.07-0.92). In the all efficacy ranking analyses, relugolix achieved the best rank.

The safety analyses showed that relugolix (RR 0.99, 95% CrI: 0.6-1.6) and (RR 0.72, 95% CrI: 0.4-1.3), and degarelix (RR 1.1, 95% CrI: 0.75-1.35) and (RR 1.05, 95% CrI: 0.42-2.6) were not associated with either all or serious AEs rates, respectively.

In the ranking analyses; degarelix achieved the worst rank of all AEs and the best rank of SAEs. Relugolix (RR 0.44, 95% CrI: 0.16-1.2) and degarelix (RR 0.74, 95% CrI: 0.37-1.52) were not associated with different CVEs rate; however, both were associated with lower CVEs than GnRH agonists in the ranking analyses.

 

The ranking analysis is below:

  EAU 2021_ Motlagh_relugolix  

 

Based on these results, they found that the efficacy and safety of relugolix is comparable to those of degarelix, albeit no injection site-reaction. Such data should be interpreted with caution until large scale direct comparison studies with a longer follow-up are available.

 

Presented by: Reza Sari Motlagh, MD, Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria

 

Written by: Thenappan (Thenu) Chandrasekar, MD – Urologic Oncologist, Assistant Professor of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, @tchandra_uromd on Twitter during the 2021 European Association of Urology, EAU 2021- Virtual Meeting, July 8-12, 2021.

 

 

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