Gonadotropin-releasing hormone antagonist associated with lower cardiovascular risk compared with gonadotropin-releasing hormone agonist in prostate cancer: A nationwide cohort and in vitro study

Dong Yi Chen, Po Jung Su, Lai Chu See, Jia Rou Liu, Cheng Keng Chuang, See Tong Pang, Chi Nan Tseng, Shao Wei Chen, I. Chang Hsieh, Pao Hsien Chu, Yung Chang Lin, Cheng Lung Hsu, John Wen Cheng Chang, Miao Sui Lin, Jong Hwei S. Pang, Ming Jer Hsieh*, Wen Kuan Huang*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

11 Scopus citations

Abstract

Background: We aimed to determine whether cardiovascular (CV) risk in patients with prostate cancer (PCa) differs between those who receive gonadotropin-releasing hormone (GnRH) agonist (GnRHa) therapy and those who receive GnRH antagonist therapy. Methods: Using the Taiwan National Health Insurance Research Database, we analyzed data by comparing 666 participants receiving GnRH antagonists and 1332 propensity score-matched participants treated with GnRHa in a 1:2 fashion during the period from May 1, 2015, to September 30, 2018. Cox proportional-hazards models were used to estimate the treatment effect on CV outcomes. Furthermore, we conducted an in vitro study to investigate the effect of a GnRHa (leuprolide) or a GnRH antagonist (degarelix) on matrix metalloproteinase-9 (MMP-9) expression and invasion ability in THP-1 differentiated macrophages. Results: GnRH antagonist therapy was associated with a lower risk of composite CV events of myocardial infarction, ischemic stroke, or CV death (hazard ratio [HR], 0.48; 95% confidence interval [CI], 0.25–0.90) than GnRHa therapy, with a mean follow-up period of 1.21 years. Significantly lower risks of CV death (HR, 0.21; 95% CI, 0.06–0.70) and all-cause mortality (HR, 0.77; 95% CI, 0.61–0.97) were observed in the GnRH antagonist group. In the in vitro study, leuprolide, but not degarelix, significantly increased the expression of MMP-9 activity and the invasive ability of THP-1 differentiated macrophages through gelatin zymography and the matrix invasion assay, respectively. Conclusion: GnRH antagonists were associated with reduced risk CV events compared with the GnRHa among patients with PCa, which may be through effects on macrophages.

Original languageEnglish
Pages (from-to)902-912
Number of pages11
JournalProstate
Volume81
Issue number12
DOIs
StatePublished - 01 09 2021

Bibliographical note

Publisher Copyright:
© 2021 Wiley Periodicals LLC

Keywords

  • GnRH antagonist
  • GnRHa
  • androgen deprivation therapy
  • degarelix
  • leuprolide
  • prostate cancer

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