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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Oncol. | doi: 10.3389/fonc.2018.00543

Retrospective analysis of patients with prostate cancer initiating GnRH agonists/antagonists therapy using a German claims database: epidemiological and patient outcomes

 Marie C. Hupe1*, Peter Hammerer2, Miriam Ketz3, Nils Kossack4, Christiane Colling5 and  Axel S. Merseburger1
  • 1Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Germany
  • 2Abteilung für Urologie und Urokologie, Klinikum Braunschweig, Germany
  • 3D-to-D Data to Decision AG, Germany
  • 4WIG2 GmbH Wissenschaftliches Institut für Gesundheitsökonomie und Gesundheitssystemforschung, Germany
  • 5Ipsen Pharma GmbH, Germany

Objective: The objective of this study was to obtain real-world information on gonadotropin-releasing hormone agonist/antagonist (GnRHa) therapy in patients with advanced prostate cancer (PCa).

Materials and methods: Anonymized, routine healthcare claims data from approx. 75 German statutory health insurance funds from 2010–2015 (n=4,205,227) were analyzed. Patients had an enrolment of 1 year before GnRHa, 1 index quarter of initial GnRHa prescription and ≥2 years of follow-up.

Results: In total, 2,382 patients with PCa were eligible. The most frequent index therapy was leuprolide in 56.6%. The rank order of PCa comorbidity prevalence was consistent over time (% at index and 3-years of follow-up): hypertension (71.5; 85.0), hyperlipidemia (45.2; 60.8), cardiovascular disease (CVD) (35.7; 54.1) and diabetes (28.3; 36.2). Comparing pooled therapy classes (agonists, hybrids and antagonist), no significant differences in the incidence of CVD or diabetes were observed. For hypertension, there was a significant increase for agonists (16.4%) compared to antagonists (6.9%, p=0.022) and leuprolide hybrid group (11.6%, p=0.006). During the follow-up period 23.9% of all PCa patients died. There were no significant differences concerning mortality rate and discontinuation rates between the cohorts. In total, 11.0% of all patients discontinued GnRHa after first prescription; the mean time to first switch to another GnRHa therapy was 100 days earlier for hybrids than for agonists (p=0.016).

Conclusion: This comparative retrospective analysis provides real-world information about healthcare characteristics and treatment patterns, highlighting the impact of different GnRHa on clinical outcomes for patients with advanced PCa in Germany.

Keywords: advanced prostate cancer, retrospective health service research, German claims database, GnRH agonist, GnRH antagonist, androgen deprivation therapy

Received: 29 Aug 2018; Accepted: 05 Nov 2018.

Edited by:

Masaki Shiota, Kyushu University, Japan

Reviewed by:

Ari Adamy, Santa Casa Hospital, Brazil
Kouji Izumi, Kanazawa University, Japan
Eiji Kashiwagi, Kyushu University, Japan  

Copyright: © 2018 Hupe, Hammerer, Ketz, Kossack, Colling and Merseburger. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Marie C. Hupe, Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Luebeck, Germany,