Brian Lam, Jo E Rodgers, Benyam Muluneh, Darrian Proco, Young E Whang, Katherine P Morgan
{"title":"醋酸阿比特龙导致转移性前列腺癌患者高血压的实际发生率和严重程度。","authors":"Brian Lam, Jo E Rodgers, Benyam Muluneh, Darrian Proco, Young E Whang, Katherine P Morgan","doi":"10.1177/10600280231223213","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Abiraterone acetate (AA) is used in treatment of patients with metastatic prostate cancer. Despite the survival advantage, AA is associated with hypertension due to mineralocorticoid excess syndrome.</p><p><strong>Objective: </strong>We conducted a single-center retrospective analysis to evaluate the real-world incidence and severity of AA-induced hypertension.</p><p><strong>Methods: </strong>Electronic health records were used to collect baseline characteristics and prostate cancer history. Patient data, including blood pressure at each 4 (±2)-week interval, were collected for 24 weeks after the initiation of AA therapy. The primary endpoint was the incidence and severity of AA-induced hypertension. The secondary endpoints include effect of different prednisone dosing regimens and prostate cancer types on hypertensive incidence and the impact of clinical pharmacists' involvement in managing AA-induced hypertension.</p><p><strong>Results: </strong>A total of 142 patients who met our inclusion criteria received AA for metastatic prostate cancer, 73 (51.4%) with metastatic castration-resistant prostate cancer (mCRPC), and 69 (48.6%) with metastatic castration-sensitive prostate cancer (mCSPC). Of all, 43.7% experienced all-grade hypertension, and 28.2% experienced grade 3-4 hypertension. There was no difference in incidence of hypertension between patients receiving 5 mg of prednisone daily and those receiving 5 mg of prednisone twice daily. All-grade hypertension occurred in 39.7% of mCRPC and 47.8% of mCSPC patients (<i>P</i> = 0.33). Thirty-two percent of patients were actively managed by a clinical pharmacist and had an overall trend of reduced hypertension severity after 12 weeks.</p><p><strong>Conclusion and relevance: </strong>This single-center, retrospective cohort study found that real-world metastatic prostate cancer patients who received AA had substantially higher incidence and severity of hypertension compared with clinical trials regardless of prednisone dose. In patients with mCRPC and mCSPC, the role of prednisone dose in hypertension incidence and severity warrants further investigation. Overall, results indicate the need for closely monitoring hypertension and optimization of anti-hypertensive therapy by multidisciplinary teams in metastatic prostate cancer patients receiving AA.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"994-1002"},"PeriodicalIF":2.3000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Real-World Incidence and Severity of Hypertension Caused by Abiraterone Acetate in Patients With Metastatic Prostate Cancer.\",\"authors\":\"Brian Lam, Jo E Rodgers, Benyam Muluneh, Darrian Proco, Young E Whang, Katherine P Morgan\",\"doi\":\"10.1177/10600280231223213\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Abiraterone acetate (AA) is used in treatment of patients with metastatic prostate cancer. Despite the survival advantage, AA is associated with hypertension due to mineralocorticoid excess syndrome.</p><p><strong>Objective: </strong>We conducted a single-center retrospective analysis to evaluate the real-world incidence and severity of AA-induced hypertension.</p><p><strong>Methods: </strong>Electronic health records were used to collect baseline characteristics and prostate cancer history. Patient data, including blood pressure at each 4 (±2)-week interval, were collected for 24 weeks after the initiation of AA therapy. The primary endpoint was the incidence and severity of AA-induced hypertension. The secondary endpoints include effect of different prednisone dosing regimens and prostate cancer types on hypertensive incidence and the impact of clinical pharmacists' involvement in managing AA-induced hypertension.</p><p><strong>Results: </strong>A total of 142 patients who met our inclusion criteria received AA for metastatic prostate cancer, 73 (51.4%) with metastatic castration-resistant prostate cancer (mCRPC), and 69 (48.6%) with metastatic castration-sensitive prostate cancer (mCSPC). Of all, 43.7% experienced all-grade hypertension, and 28.2% experienced grade 3-4 hypertension. There was no difference in incidence of hypertension between patients receiving 5 mg of prednisone daily and those receiving 5 mg of prednisone twice daily. All-grade hypertension occurred in 39.7% of mCRPC and 47.8% of mCSPC patients (<i>P</i> = 0.33). Thirty-two percent of patients were actively managed by a clinical pharmacist and had an overall trend of reduced hypertension severity after 12 weeks.</p><p><strong>Conclusion and relevance: </strong>This single-center, retrospective cohort study found that real-world metastatic prostate cancer patients who received AA had substantially higher incidence and severity of hypertension compared with clinical trials regardless of prednisone dose. In patients with mCRPC and mCSPC, the role of prednisone dose in hypertension incidence and severity warrants further investigation. 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引用次数: 0
摘要
背景:醋酸阿比特龙(AA)用于治疗转移性前列腺癌患者。尽管具有生存优势,但 AA 与矿物质皮质激素过量综合征导致的高血压有关:我们进行了一项单中心回顾性分析,以评估 AA 引起的高血压的实际发生率和严重程度:方法:使用电子健康记录收集基线特征和前列腺癌病史。在开始 AA 治疗后的 24 周内收集患者数据,包括每 4 (±2) 周间隔的血压。主要终点是 AA 引起的高血压的发生率和严重程度。次要终点包括不同泼尼松剂量方案和前列腺癌类型对高血压发病率的影响,以及临床药师参与管理 AA 引起的高血压的影响:共有142名符合纳入标准的转移性前列腺癌患者接受了AA治疗,其中73人(51.4%)患有转移性抗性前列腺癌(mCRPC),69人(48.6%)患有转移性抗性前列腺癌(mCSPC)。在所有患者中,43.7%患有全度高血压,28.2%患有3-4度高血压。每天服用 5 毫克泼尼松和每天服用两次 5 毫克泼尼松的患者的高血压发病率没有差异。39.7%的mCRPC患者和47.8%的mCSPC患者出现全等级高血压(P = 0.33)。32%的患者由临床药剂师积极管理,12周后高血压严重程度总体呈下降趋势:这项单中心回顾性队列研究发现,与临床试验相比,无论泼尼松的剂量如何,接受 AA 治疗的真实世界转移性前列腺癌患者的高血压发病率和严重程度都要高得多。在 mCRPC 和 mCSPC 患者中,泼尼松剂量在高血压发生率和严重程度中的作用值得进一步研究。总之,研究结果表明,有必要对接受 AA 治疗的转移性前列腺癌患者进行密切监测,并由多学科团队优化抗高血压治疗。
Real-World Incidence and Severity of Hypertension Caused by Abiraterone Acetate in Patients With Metastatic Prostate Cancer.
Background: Abiraterone acetate (AA) is used in treatment of patients with metastatic prostate cancer. Despite the survival advantage, AA is associated with hypertension due to mineralocorticoid excess syndrome.
Objective: We conducted a single-center retrospective analysis to evaluate the real-world incidence and severity of AA-induced hypertension.
Methods: Electronic health records were used to collect baseline characteristics and prostate cancer history. Patient data, including blood pressure at each 4 (±2)-week interval, were collected for 24 weeks after the initiation of AA therapy. The primary endpoint was the incidence and severity of AA-induced hypertension. The secondary endpoints include effect of different prednisone dosing regimens and prostate cancer types on hypertensive incidence and the impact of clinical pharmacists' involvement in managing AA-induced hypertension.
Results: A total of 142 patients who met our inclusion criteria received AA for metastatic prostate cancer, 73 (51.4%) with metastatic castration-resistant prostate cancer (mCRPC), and 69 (48.6%) with metastatic castration-sensitive prostate cancer (mCSPC). Of all, 43.7% experienced all-grade hypertension, and 28.2% experienced grade 3-4 hypertension. There was no difference in incidence of hypertension between patients receiving 5 mg of prednisone daily and those receiving 5 mg of prednisone twice daily. All-grade hypertension occurred in 39.7% of mCRPC and 47.8% of mCSPC patients (P = 0.33). Thirty-two percent of patients were actively managed by a clinical pharmacist and had an overall trend of reduced hypertension severity after 12 weeks.
Conclusion and relevance: This single-center, retrospective cohort study found that real-world metastatic prostate cancer patients who received AA had substantially higher incidence and severity of hypertension compared with clinical trials regardless of prednisone dose. In patients with mCRPC and mCSPC, the role of prednisone dose in hypertension incidence and severity warrants further investigation. Overall, results indicate the need for closely monitoring hypertension and optimization of anti-hypertensive therapy by multidisciplinary teams in metastatic prostate cancer patients receiving AA.
期刊介绍:
Annals of Pharmacotherapy (AOP) is a peer-reviewed journal that advances pharmacotherapy throughout the world by publishing high-quality research and review articles to achieve the most desired health outcomes.The articles provide cutting-edge information about the most efficient, safe and cost-effective pharmacotherapy for the treatment and prevention of various illnesses. This journal is a member of the Committee on Publication Ethics (COPE). Average time from submission to first decision: 14 days