间歇性雄激素剥夺疗法 (iADT) 可减轻前列腺癌 (PC) 患者连续 (c) ADT 的一些副作用，但其对 ADT 相关合并症的相对影响尚不确定。我们评估了 iADT 和 cADT 的实际使用情况，以及非转移性 (nm) PC 患者心血管和内分泌/代谢事件的相关风险。这项回顾性纵向队列研究包括 nmPC 患者，使用促性腺激素释放激素激动剂（戈舍瑞林、戈舍瑞林、美国监测、流行病学和最终结果-医疗保险数据库（2010-2017）中的组氨瑞林、亮丙瑞林和曲普瑞林）或拮抗剂（地加瑞克），连续保险期限≥36个月，除非发生死亡，并且未接受化疗或随访期间（截至 2019 年）的下一代激素疗法。检查主要不良心血管事件（MACE [心肌梗塞、中风、心肌病/心力衰竭、肺栓塞、缺血性心脏病、全因死亡率]）和内分泌/代谢事件（糖尿病、高胆固醇血症、骨折和骨质疏松症）的风险队列之间。治疗加权 Cox 回归模型的逆概率估计了结果的调整后风险比 (HR)。 在 10,655 名符合条件的患者中，2,095 名 (19.7%) 接受了 iADT，8,560 名 (80.3%) 接受了 cADT。 iADT 和 cADT 队列的中位随访时间为 43.9 个月和 48.4 个月，中位 ADT 持续时间（不包括 iADT 间隙）分别为 22.0 个月和 13.5 个月。与 iADT 相比，接受 cADT 的患者发生 MACE 的风险较低（HR 0.90；95% 置信区间 [CI] 0.83-0.96）。未观察到内分泌/代谢事件风险存在差异（HR 0.97；95% CI 0.92-1.03）。亚组分析发现，有心血管疾病史的患者中 MACE 的差异得以维持（HR 0.90；95% CI 0.83-0.98），而在没有心血管疾病史的患者中则消除了差异（HR 0.94；95% CI 0.82-1.08）。与接受 iADT 的患者相比，接受 cADT 的 MACE 风险较低，且内分泌/代谢事件的风险相似。需要对这两种方案进行进一步的研究评估，以便为治疗决策提供信息。版权所有 © 2024。由 Elsevier Inc. 出版。

Intermittent androgen deprivation therapy (iADT) alleviates some side effects of continuous (c) ADT in patients with prostate cancer (PC), but its relative impact on ADT-associated comorbidities is uncertain. We assessed real-world use of iADT and cADT and associated risk of cardiovascular and endocrine/metabolic events in patients with nonmetastatic (nm) PC.This retrospective longitudinal cohort study included patients with nmPC initiating systemic ADT with gonadotropin-releasing hormone agonists (goserelin, histrelin, leuprolide, and triptorelin) or antagonists (degarelix) in the US Surveillance, Epidemiology and End Results-Medicare database (2010-2017), who had ≥ 36 months of continuous insurance coverage, unless death occurred, and did not receive chemotherapy or next-generation hormonal therapies during follow-up (through 2019). Risk of major adverse cardiovascular events (MACE [myocardial infarction, stroke, cardiomyopathy/heart failure, pulmonary embolism, ischemic heart disease, all-cause mortality]) and endocrine/metabolic events (diabetes, hypercholesterolemia, bone fractures, and osteoporosis) were examined between cohorts. Inverse probability of treatment-weighted Cox regression models estimated adjusted hazard ratios (HRs) of the outcomes.Of 10,655 eligible patients, 2,095 (19.7%) received iADT and 8,560 (80.3%) cADT. Median follow-up was 43.9 and 48.4 months and median ADT duration (excluding iADT gaps) was 22.0 and 13.5 months for the iADT and cADT cohorts, respectively. Patients receiving cADT had a lower risk of MACE vs. iADT (HR 0.90; 95% confidence interval [CI] 0.83-0.96). No difference in risk of endocrine/metabolic events was observed (HR 0.97; 95% CI 0.92-1.03). Subgroup analysis found that the difference in MACE was maintained in patients with a history of cardiovascular disease (HR 0.90; 95% CI 0.83-0.98) and eliminated in patients without (HR 0.94; 95% CI 0.82-1.08).Patients with nmPC who received cADT had a lower risk of MACE and similar risk of endocrine/metabolic events vs. those who received iADT. Further research assessing both regimens is needed to inform treatment decisions.Copyright © 2024. Published by Elsevier Inc.