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Nubeqa Monotherapy vs Dual Therapy with ADT
Prostate Cancer | Last Active: 2 days ago | Replies (18)Comment receiving replies
@jeffmarc As far as actual cognitive impairment goes, fewer than 10% of patients experienced it on any ADT+a lutamide combination according to one study:
https://dailynews.ascopubs.org/do/mental-health-and-cognitive-toxicities-androgen-receptor-signaling-inhibitors
It does support your general point, that Darolutamide appeared not to increase the risk of cognitive impairment:
ADT alone: 3% risk
ADT + Darolutamide: 3% risk (small increase, but within margin of error)
ADT + Abiraterone: 4% risk
ADT + Apalutamide: 5% risk
ADT + Enzalutamide: 9% risk
Note that they had a paucity of studies to review for Darolutamide (that was a caveat in the findings).
These numbers are very low compared to the impression you might have, but that's what I meant by selection bias: people who have no cognitive issues with ADT + ARSI are much less likely to show up in an online forum or support group looking for help.
And for the small minority who did have cognitive impairment on another ARSI which cleared up when they switched to Darolutamide, they probably felt a general sense of well-being overall once the fog cleared.
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@northoftheborder
Not sure those percentages really hold up, Though Apalutamide was much better than Enzalutamide.
The study showed Enzalutamide users had a 3.66 times higher chance of Cognitive impairment than somebody without the drug.
In the case of Apalutamide it was 1.76 times more likely to be a problem, though the range varied from 1.08 times (not really significant) to 2.87 times (significant).
As for cognitive impairment, a network meta-analysis of 15 prospective trials showed that compared with ADT alone, enzalutamide had the highest risk of cognitive impairment (odds ratio [OR] 3.66, 95% CI [2.84, 4.73]), followed by apalutamide (OR 1.76, 95% CI [1.08, 2.87]) and abiraterone (OR 1.64, 95% CI [1.01, 2.45]).14 Darolutamide was not associated with an increased risk of cognitive impairment compared with ADT alone (HR 1.11, 95% CI [0.51, 2.39]); however, only 1 of these 15 trials included darolutamide.
I was out to dinner with a guy Sunday night who had just started Orgovyx Two months ago, He already noticed some brain fog issues with remembering names. ADT seems to make it worse.