• Laurence Klotz, Kurt Miller, E David Crawford, Neal Shore, Bertrand Tombal, Cathrina Karup, Anders Malmberg, and Bo-Eric Persson.
• Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada. Electronic address: laurence.klotz@sunnybrook.ca.
• Eur. Urol. 2014 Dec 1; 66 (6): 1101-8.

BackgroundStudies comparing the gonadotropin-releasing hormone antagonist, degarelix, with luteinising hormone-releasing hormone (LHRH) agonists indicate differences in outcomes.ObjectiveTo assess differences in efficacy and safety outcomes in a pooled analysis of trials comparing degarelix with LHRH agonists.Design, Setting, And ParticipantsData were pooled from five prospective, phase 3 or 3b randomised trials (n=1925) of degarelix and leuprolide or goserelin in men requiring androgen deprivation therapy for the treatment of prostate cancer. Patients received either 3 mo (n=467) or 12 mo (n=1458) of treatment.InterventionMen were randomised to receive degarelix (n=1266), leuprolide (n=201), or goserelin (n=458).Outcome Measurements And Statistical AnalysisUnadjusted Kaplan-Meier analyses were supported by the Cox proportional hazards model, adjusted for disease-related baseline factors, to estimate hazard ratios (HRs) of efficacy and safety outcomes. The Fisher exact test compared crude incidences of adverse events.Results And LimitationsProstate-specific antigen (PSA) progression-free survival (PFS) was improved in the degarelix group (HR: 0.71; p=0.017). For patients with baseline PSA levels >20 ng/ml, the HR for PSA PFS was 0.74 (p=0.052). Overall survival (OS) was higher in the degarelix group (HR: 0.47; p=0.023). OS was particularly improved with degarelix in patients with baseline testosterone levels >2 ng/ml (HR: 0.36; p=0.006). In terms of disease-related adverse events, there were, overall, fewer joint-related signs and symptoms, musculoskeletal events, and urinary tract events in the degarelix group.ConclusionsThese data indicate clinical benefits with degarelix, including a significant improvement in PSA PFS and OS, as well as reduced incidence of joint, musculoskeletal, and urinary tract adverse events, compared with LHRH agonists.Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

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