Comparing the risk of cardiovascular disease following GnRH agonist and GnRH antagonist therapy for patient with prostate cancer: a systematic review and meta-analysis.

INTRODUCTION To compare the risk of cardiovascular disease (CVD) following gonadotropin-releasing hormone (GnRH) agonist and GnRH antagonist therapy for patient with prostate cancer (PCa). EVIDENCE ACQUISITION We searched PubMed, Web of science, Opengery, Cochrane library databases and international congress reports for studies published before December 2019. This meta-analysis was conducted using Stata version 12.0. Relative ratios (RRs) and their credible intervals (CI) were applied for the cardiovascular safety evaluation of androgen-deprivation therapy (ADT) medical interventions, including GnRH agonist and GnRH antagonist therapy. In addition, fixed-effect or random-effect models were applied in the statistical analyses according to the heterogeneity. EVIDENCE SYNTHESIS Six articles including 32,997 participants were analyzed with a random effects model. The results of meta-analysis showed that compared with GnRH agonist, the incidents of CVD was equal to GnRH antagonist therapy for patient with PCa (RR 0.98, 95% CI 0.94-1.02). When considering, under sub-group analysis with randomized controlled trials (RCTs) or controlled clinical trials (CCTs), no statistical differences in risk of CVD were found in two sub-group analyses. No evidence of publication bias was found in our meta-analysis by a funnel plot (Pr> | z |=0.26). CONCLUSIONS This meta-analysis indicates that compared treatment with GnRH antagonist, risks of CVD in PCa patients was the same as GnRH agonist. Further RCTs are strongly required to provide more definitive evidence.