PMID-29438592 – GnRH Agonists Equivalence Systematic Review
Bolton EM, Lynch T. Are all gonadotrophin-releasing hormone agonists equivalent for the treatment of prostate cancer? A systematic review. BJU Int. 2018;122(3):371-383.
Quick Reference
| Property | Value |
|---|---|
| PMID | 29438592 |
| DOI | 10.1111/bju.14168 |
| Year | 2018 |
| Journal | BJU International |
| Study Type | Systematic Review |
| Evidence Level | I |
| Sample | 16 direct comparative trials |
| Peptide(s) Studied | Leuprolide, Goserelin, Triptorelin |
Key Findings
- Sixteen direct comparative trials evaluated goserelin, triptorelin, and leuprorelin (leuprolide) for prostate cancer
- Studies reporting on efficacy endpoints did not show major differences in testosterone or PSA suppression among GnRH agonists
- Some studies suggested differences in short- or long-term testosterone control quality, injection site reactions, and clinical perceptions
- Despite similar castration effects, definitive equivalence cannot be concluded due to insufficient evidence
- Existing studies were underpowered for survival outcome measures
Study Design
Systematic review following PRISMA guidelines of all published head-to-head comparative trials of GnRH agonists in prostate cancer. Included randomized and non-randomized comparative studies evaluating goserelin, triptorelin, and leuprolide.
Limitations
- Included studies had small patient populations
- Most studies were not adequately powered for survival outcomes
- Heterogeneity in study design, endpoints, and follow-up duration
- Publication bias may favor studies showing differences rather than equivalence
Clinical Relevance
While GnRH agonists appear broadly similar in their ability to achieve castrate testosterone levels, this review highlights an important evidence gap: true therapeutic equivalence has not been definitively established. This has implications for formulary decisions, insurance coverage, and clinical practice. The review supports current guidelines that treat GnRH agonists as a class rather than preferring individual agents.
Related
#research #systematic-review #peptide #sexual-health #evidence-level-I