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Abiraterone acetate, enzalutamide and their sequence for castration-resistant prostate cancer

Adherence, survival and hospitalization analysis of a medical claims database

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Summary

Objective

To analyze drug adherence, overall survival (OS) and hospitalization rates of patients with castration-resistant prostate cancer (CRPC) treated with arbiraterone acetate (AA), enzalutamide (ENZ) and their sequence in a real-life setting.

Methods

The database of the largest public insurance company in Austria was analyzed. All CRPC patients with at least one prescription of AA and/or ENZ between September 2013 and August 2016 in the pre-chemotherapy and post-chemotherapy setting were extracted and matched to the Austrian death and hospital admission statistics. Drug adherence was estimated by the medication possession ratio (MPR).

Results

Data of 457 patients (mean age: 74.4 ± 8.5 years) were analyzed. The mean MPR was 90% for AA, 85% for ENZ and 88% for the sequence therapy cohort. The median overall survival (OS) of the entire cohort was 21 months: 15 months for AA, 24 months for ENZ, 26 months for the sequence group, and 10 months for the sequence group after switching. In the post-chemotherapy setting, the median OS was 14 months in AA treatment (mean: 15.8 ± 0.9 months), 19 months in the ENZ treatment (mean: 17.2 ± 1.4 months) and 25 months in the sequence group (mean: 22.7 ± 0.8 months). Median OS in the pre-chemotherapy setting was 25 months (mean: 21.5 ± 1.1 months), 18 months in AA treatment group (mean: 18.9 ± 1.5 months) and 17 months in ENZ treatment group (mean: 18.2 ± 1.9 months). Only 43 (9.4%) patients were not hospitalized during the course of the study. On average patients spent 13% of their remaining life span in hospital care (median 8%, range: 1–34%).

Conclusion

This Austrian prescription database allows some insights into the outcome of CRPC patients treated with AA and ENZ and their sequence in a real-life setting. Drug adherence was satisfactory, OS was shorter for AA and ENZ as compared to the pivotal phase III trials.

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Authors and Affiliations

  1. Department of Urology, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria

    Badereddin Mohamad Al-Ali, Klaus Eredics, Stephan Madersbacher & Ingrid Schauer MD

  2. Sigmund Freud Private University, Vienna, Austria

    Stephan Madersbacher

Authors
  1. Badereddin Mohamad Al-Ali
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  2. Klaus Eredics
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  3. Stephan Madersbacher
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  4. Ingrid Schauer MD
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Correspondence to Ingrid Schauer MD.

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B.M. Al-Ali, K. Eredics, S. Madersbacher, and I. Schauer declare that they have no competing interests.

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Al-Ali, B.M., Eredics, K., Madersbacher, S. et al. Abiraterone acetate, enzalutamide and their sequence for castration-resistant prostate cancer. Wien Klin Wochenschr 130, 659–664 (2018). https://doi.org/10.1007/s00508-018-1394-0

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  • DOI: https://doi.org/10.1007/s00508-018-1394-0

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