Real-Life Use Patterns of Androgen Receptor Pathway Inhibitors (ARPIs): A Nationwide Register-Based Study in Finland...

Area of Science:

• Oncology
• Pharmacology
• Health Economics

Background:

• Prostate cancer (PC) is a prevalent malignancy in Western countries, with androgens driving tumor growth.
• Androgen pathway inhibitors (ARPIs) are crucial in PC treatment, yet their sequential use lacks robust evidence.
• Clinical practice has adopted sequential ARPI use despite limited supporting data.

Purpose of the Study:

• To analyze real-world patterns of ARPI use, focusing on sequential administration in Finland.
• To evaluate the associated treatment costs of sequential ARPI therapy.
• To identify trends in ARPI utilization over time.

Main Methods:

• Utilized nationwide register data of ARPI purchases (enzalutamide, apalutamide, darolutamide, abiraterone) from Finland's National Health Insurance scheme (2012-2023).
• Included patient demographics and medicine purchase details for descriptive analysis.
• Covered all reimbursed ARPI purchases nationwide.

Main Results:

• 8,369 patients initiated ARPIs, with a median age of 75.1 years.
• 32.1% of patients (n=2685) received at least two ARPIs sequentially.
• Sequential ARPI use peaked in 2017 (56% of initiations) and declined to 14% by 2022, with total sequential use costs reaching €43.8 million.

Conclusions:

• Sequential ARPI use was initially prevalent in Finland but decreased after guideline updates.
• Evidence from randomized trials is necessary to guide optimal sequential ARPI treatment strategies.
• Further research is required to validate the efficacy and cost-effectiveness of sequential ARPI therapy.