Time trends of drug-specific actionable adverse events among patients on androgen receptor antagonists: Implications for remote monitoring

Authors

  • Lauren Fleshner Division of Urology, University Health Network, University of Toronto
  • Alejandro Berlin Division of Medical Oncology, University Health Network, University of Toronto
  • Karen Hersey Division of Urology, University Health Network, University of Toronto
  • Miran Kenk Division of Urology, University Health Network, University of Toronto
  • Katherine Lajkosz Division of Urology, University Health Network, University of Toronto
  • Susan Nguyen Division of Urology, University Health Network, University of Toronto
  • Jacob Wise Division of Urology, University Health Network, University of Toronto
  • Sophie O'Halloran Division of Urology, University Health Network, University of Toronto

DOI:

https://doi.org/10.5489/cuaj.7437

Keywords:

Prostatic neoplasms, abiraterone, enzalutamide, hospitalization, oral systemic therapy

Abstract

Introduction: In light of COVID-19, reducing patient exposure via remote monitoring is desirable. Patients prescribed abiraterone/ enzalutamide are scheduled for monthly in-person appointments to screen for adverse events (AEs). We determined time trends of drug-specific actionable AEs among users of abiraterone/enzalutamide to assess the safety of remote monitoring.

Methods: A chart review was conducted on 828 prostate cancer patients prescribed abiraterone and/or enzalutamide. Data were collected to determine time to actionable first AEs, including hypertension, elevated liver enzymes (aspartate transaminase [AST], alanine transaminase [ALT]), hyperbilirubinemia, and hypokalemia. Survival analysis was used to determine time to AEs.

Results: In this study, 425 and 403 patients received enzalutamide and abiraterone, respectively. In total, 25.6% of those who took enzalutamide experienced an AE, compared to 28.8% of patients on abiraterone. For patients using abiraterone and experiencing an AE, cumulative incidence of AEs at three, six, nine, and 12 months were: 67.2%, 81.9%, 90.5%, and 93.9%, respectively. Among enzalutamide users experiencing an AE, cumulative incidence of AEs at three, six, nine, and 12 months were 51.4%, 70.7%, 82.6%, and 88.1%, respectively. The AEs associated with enzalutamide were hypertension and liver dysfunction (77.1% and 22.9%, respectively). In the abiraterone group, associated AEs were liver dysfunction (47.4%), hypertension (47.4%), and hypokalemia (5.2%).

Conclusions: Attaining AEs secondary to abiraterone/enzalutamide decreases over time and tends to occur within the first six months of therapy. Most actionable AEs can be remotely monitored. Given COVID-19, remote monitoring after six months of initiating abiraterone or enzalutamide appears appropriate.

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Published

2021-10-18

How to Cite

Fleshner, L., Berlin, A., Hersey, K., Kenk, M., Lajkosz, K., Nguyen, S., Wise, J., & O’Halloran, S. (2021). Time trends of drug-specific actionable adverse events among patients on androgen receptor antagonists: Implications for remote monitoring. Canadian Urological Association Journal, 16(3), E146–9. https://doi.org/10.5489/cuaj.7437

Issue

Section

Original Research