A net-work meta-analysis of the cardiac safety for next-generation hormonal agents in treating castration-resistant prostate cancer: How to choose drugs appropriately?

Researchers have shown that using next-generation hormonal agents (NHA) for castration-resistant prostate cancer (CRPC) would lead to increased risk of cardiac adverse effects, making clinician choices more complex.We systematically searched Pubmed, Cochrane Library, and Embase databases for research published before October 2022. Agents were ranked according to their effectiveness based on cardiac adverse effects using the surface under the cumulative ranking curve.A total of 21 Randomized Controlled Trials (RCT) with 19, 083 patients were included in present study. Our results showed that abiraterone and enzalutamide could lead to a significantly higher hypertension rate compared with placebo; whereas no significant difference was detected between four NHAs and placebo in ischemic heart disease incidence. All four NHAs could significantly increase the risk of cardiotoxicity.NHAs are generally acceptable in terms of cardiovascular disease compared to placebo in patients with CRPC.