Risk of heart failure with abiraterone versus enzalutamide amongst patients diagnosed with metastatic castration-resistant prostate cancer: A systematic review and meta-analysis.

Abstract

e24029 Background: Abiraterone and enzalutamide are key androgen receptor-targeted therapies for metastatic castration-resistant prostate cancer (mCRPC); however, their comparative cardiovascular safety, particularly the risk of heart failure (HF), remains unclear in older patients. This systematic review and meta-analysis evaluates the HF risk associated with abiraterone versus enzalutamide in this population. Methods: A comprehensive literature search was conducted using PubMed, Google Scholar, and a snowballing approach to identify studies reporting HF outcomes in older mCRPC patients treated with abiraterone or enzalutamide. Random-effects models were used to estimate pooled risk ratios (RRs) with 95% confidence intervals (CIs), accounting for between-study variability through I² heterogeneity statistics. Sensitivity analyses and publication bias assessments were performed. Results: Four studies with 9,444 patients (mean/median age range: 70–80 years) met inclusion criteria. Pooled analysis demonstrated a significantly increased risk of HF with abiraterone compared to enzalutamide (RR: 1.58, 95% CI: 1.11–2.26, p = 0.01), with moderate heterogeneity (I² = 71.76%). Leave-one-out sensitivity analysis confirmed the robustness of the findings. Conclusions: This meta-analysis highlights a higher HF risk with abiraterone versus enzalutamide in older mCRPC patients. Given the significant cardiovascular burden in this population, careful risk stratification and monitoring are warranted when selecting treatment. Further large-scale prospective studies are needed to confirm these findings.