Duration of treatment in prostate cancer patients treated with abiraterone acetate or enzalutamide
Journal of Managed Care and Specialty Pharmacy. 2017;23(2):225-235
Abiraterone acetate (AA) and enzalutamide (ENZ) are oral therapies offering survival benefit to metastatic castration-resistant prostate cancer (mCRPC) patients. Despite the availability of multiple treatment options for mCRPC, there is a lack of information on the effect that being initiated on AA or ENZ has on the combined prostate cancer treatment duration.
To compare the combined duration of prostate cancer treatments of patients initiated on AA with that of patients initiated on ENZ.
Truven Health MarketScan Research Databases from March 2012 to December 2014 were used to identify males with prostate cancer initiated on AA or ENZ (index therapy). Baseline characteristics were assessed during the 6 months pre-index. Inverse probability of treatment weights (IPTWs) were used to reduce baseline confounding. Treatment duration spanned from the index date to the earliest of treatment discontinuation (defined as a > 60-day gap in treatment), 24 months post-index, health plan disenrollment, or end of data. Weighted Kaplan-Meier and Cox proportional hazard models were used to compare the combined duration of mCRPC treatments (AA, ENZ, chemotherapy, sipuleucel-T, and radium 223) and any prostate cancer treatments (mCRPC, hormonal, and corticosteroid treatments) between patients initiated on either AA or ENZ.
A total of 2,591 patients initiated on AA and 807 patients initiated on ENZ were selected for the study. Patients' characteristics were generally well balanced after IPTW. At 3 months, patients initiated on AA were associated with fewer discontinuations of mCRPC treatments (hazard ratio [HR] = 0.73, P = 0.004) or of any prostate cancer treatments (HR = 0.61, P = 0.002), compared with patients initiated on ENZ. This result was maintained at 6, 9, 12, 18, and 24 months for mCRPC treatments (HR = 0.75, P < 0.001) and for any prostate cancertreatments (HR = 0.69, P < 0.001). Median duration of mCRPC treatments was 4.1 months longer for patients initiated on AA compared with those initiated on ENZ (18.3 vs. 14.2 months, P < 0.001) and similarly, the median duration of any prostate cancer treatment was longer for patients initiated on AA compared with those initiated on ENZ (not reached vs. 22.2 months, P < 0.001).
In this study, patients initiated on AA, compared with those initiated on ENZ, had a longer combined duration of mCRPC or prostate cancer treatments.