The skeletal effects of gonadotropin-releasing hormone antagonists: a concise review

2020 ◽  
Vol 21 ◽  
Author(s):  
Nur-Vaizura Mohamad ◽  
Ima-Nirwana Soelaiman ◽  
Kok-Yong Chin
Keyword(s):  
Prostate Cancer ◽  
Bone Loss ◽  
Animal Studies ◽  
Fragility Fractures ◽  
Gonadotropin Releasing Hormone ◽  
Prolonged Treatment ◽  
Gnrh Antagonists ◽  
Releasing Hormone ◽  
Gonadotropin Releasing Hormone Antagonists ◽  
Skeletal Effects

: Prolonged treatment with gonadotropin-releasing hormone (GnRH) agonists is known to induce bone loss among prostate cancer patients. However, evidence on the skeletal effects of GnRH antagonists is relatively less well-known. This review aims to examine the effects of GnRH antagonists on bone health. GnRH antagonists are an effective treatment for hormone-dependent conditions, such as advanced prostate cancer and endometriosis. They induce a competitive and reversible GnRH-receptor blockage, thereby suppressing the release of gonadotropins and sex hormones. The sex hormone ablation results in undesirable side effects, including accelerated bone loss. In animal studies, treatment with GnRH antagonists is reported to cause deterioration of bone microstructure. Human clinical trials revealed significant bone loss at the spine, hip and femur in patients treated with GnRH antagonists. Thus, osteoporosis and the resultant fragility fractures pose a significant impact on health and quality of life of GnRH antagonist users. Thus, early preventive measures of bone loss are critical in preventing fractures and its associated morbidity in these patients.

The cardiovascular effects of gonadotropin-releasing hormone antagonists in men with prostate cancer

2021 ◽  
Author(s):  
Filipe Cirne ◽  
Nazanin Aghel ◽  
Jo-Anne Petropoulos ◽  
Laurence Klotz ◽  
Daniel J Lenihan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cardiovascular Events ◽  
Gnrh Antagonist ◽  
Cardiovascular Effects ◽  
Cardiovascular Death ◽  
Gonadotropin Releasing Hormone ◽  
Gnrh Agonists ◽  
Gnrh Antagonists ◽  
Releasing Hormone ◽  
Gonadotropin Releasing Hormone Antagonists

Abstract Aims The aim of this study was to determine whether gonadotropin-releasing hormone (GnRH) antagonists (an emerging class of drugs to suppress testosterone synthesis in the treatment of prostate cancer) cause less adverse cardiovascular events than the more commonly use GnRH agonists. Methods and results We conducted a systematic review to identify all randomized, controlled trials in which a GnRH antagonist was compared with a GnRH agonist in men with prostate cancer. We identified 10 eligible studies including two different GnRH antagonists, degarelix (n = 1681) and relugolix (n = 734), which were compared with the GnRH agonists, leuprolide (n = 714) and goserelin (n = 600). The pooled risk ratios (95% confidence intervals) among GnRH antagonist recipients for adverse cardiovascular events, cardiovascular death, and all-cause mortality were 0.57 (0.39–0.81); 0.49 (0.25–0.96); and 0.48 (0.28–0.83), respectively. Important limitations of the included trials were their short duration of follow-up, unblinded study design and (in most of the studies) the identification of adverse cardiovascular events through safety reporting mechanisms rather than as a pre-specified outcome. There was no evidence of heterogeneity of findings among the studies. Conclusions There is consistent but methodologically limited data to suggest that GnRH antagonists—a relatively new class of androgen deprivation therapy for prostate cancer—cause significantly less cardiovascular adverse effects than the more frequently used GnRH agonists.

scholarly journals Randomized Controlled Trial of Annual Zoledronic Acid to Prevent Gonadotropin-Releasing Hormone Agonist–Induced Bone Loss in Men With Prostate Cancer

2007 ◽  
Vol 25 (9) ◽  
pp. 1038-1042 ◽  
Author(s):  
M. Dror Michaelson ◽  
Donald S. Kaufman ◽  
Hang Lee ◽  
Francis J. McGovern ◽  
Philip W. Kantoff ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lumbar Spine ◽  
Zoledronic Acid ◽  
Bone Loss ◽  
Gnrh Agonist ◽  
Controlled Trial ◽  
Gonadotropin Releasing Hormone ◽  
Mineral Density ◽  
Releasing Hormone ◽  
Increase Fracture Risk

Purpose Gonadotropin-releasing hormone (GnRH) agonists decrease bone mineral density (BMD) and increase fracture risk in men with prostate cancer. Annual zoledronic acid increases BMD in postmenopausal women, but its efficacy in hypogonadal men is not known. Patients and Methods In a 12-month study, 40 men with nonmetastatic prostate cancer who were receiving a GnRH agonist and had T scores more than −2.5 were randomly assigned to zoledronic acid (4 mg intravenously on day 1 only) or placebo. BMD of the posteroanterior lumbar spine and proximal femur were measured by dual-energy x-ray absorptiometry. Results Mean (± SE) BMD of the posteroanterior lumbar spine decreased by 3.1% ± 1.0% in men assigned to placebo and increased by 4.0% ± 1.0% in men assigned to zoledronic acid (P < .001). BMD of the total hip decreased by 1.9% ± 0.7% in men assigned to placebo and increased by 0.7% ± 0.5% in men assigned to zoledronic acid (P = .004). Similar between-group differences were observed for the femoral neck and trochanter. Serum N-telopeptide, a marker of osteoclast activity, decreased significantly after zoledronic acid treatment. Conclusion In men receiving a GnRH agonist, a single treatment with zoledronic acid significantly increased BMD and durably suppressed serum N-telopeptide levels for 12 months. Annual zoledronic acid may be a convenient and effective strategy to prevent bone loss in hypogonadal men.

scholarly journals Bone Loss in Men with Prostate Cancer Treated with Gonadotropin-Releasing Hormone Agonists1

2001 ◽  
Vol 86 (6) ◽  
pp. 2787-2791 ◽  
Author(s):  
S. Aubrey Stoch ◽  
Robert A. Parker ◽  
Liping Chen ◽  
Glenn Bubley ◽  
Yoo-Joung Ko ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Bone Loss ◽  
Gonadotropin Releasing Hormone ◽  
Releasing Hormone

scholarly journals Review on Antagonists

2015 ◽  
Vol 6 (1) ◽  
pp. 1-10
Author(s):  
Divya Sardana
Keyword(s):  
Intrauterine Insemination ◽  
Gonadotropin Releasing Hormone ◽  
Poor Responders ◽  
Polycystic Ovaries ◽  
Gnrh Antagonists ◽  
Normal Cycle ◽  
Releasing Hormone ◽  
Significant Difference ◽  
Gonadotropin Releasing Hormone Antagonists ◽  
Hormone Antagonists

ABSTRACT Gonadotropin-releasing hormone (GnRH) antagonists have been a breakthrough in reproductive medicine. The third generation antagonists (cetrorelix and ganirelix) do not have histamine releasing capability in the used doses. The competitive blockade of GnRH receptors by GnRH antagonists leads to an immediate but reversible arrest of gonadotropin secretion. Antagonists can be used as single-dose or multiple dose protocol in a fixed or flexible approach during ovarian stimulation to prevent premature luteinizing hormone surge. The stimulation remains close to the normal cycle, and more convenient and friendly to the patient with lesser dose and duration of stimulation. Recent Cochrane analysis suggests that there is no significant difference in the live birth rate when antagonists are compared with agonists (OR 0.86) and there is a significant reduction in the incidence of ovarian hyperstimulation syndrome (OHSS) (OR 0.43) with the use of antagonists. Gonadotropin-releasing hormone antagonists are of special benefit for use in patients with polycystic ovaries where agonist trigger can be used and OHSS can be prevented completely. Gonadotropin-releasing hormone antagonists have particular advantage in poor responders with lesser pituitary suppression in the early part of cycle. Gonadotropinreleasing hormone antagonists can be used in modified natural cycle, intrauterine insemination cycles, and frozen embryo transfer cycles. Novel uses of antagonists include suppression of established OHSS, and in various gynecological conditions (endometriosis, fibroids, precocious puberty). How to cite this article Sardana D. Review on Antagonists. Int J Infertil Fetal Med 2015;6(1):1-10.

Current and emerging gonadotropin-releasing hormone (GnRH) antagonists for the treatment of prostate cancer

2021 ◽  
pp. 1-9
Author(s):  
Mohamad Moussa ◽  
Athanasios Papatsoris ◽  
Athanasios Dellis ◽  
Mohamed Abou Chakra ◽  
Charalampos Fragkoulis
Keyword(s):  
Prostate Cancer ◽  
Gonadotropin Releasing Hormone ◽  
Gnrh Antagonists ◽  
Releasing Hormone
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