Real-World Early Prostate-Specific Antigen Response Comparison Among Patients with Metastatic Castration Sensitive Prostate Cancer Treated with Apalutamide or Abiraterone Acetate in the United States.
Abstract
Background
Despite the availability of several androgen receptor pathway inhibitors for the treatment of patients with metastatic castration-sensitive prostate cancer (mCSPC), there has been a lack of head-to-head randomized clinical trials to evaluate their comparative efficacy in this population.Objective
This real-world study provides a comprehensive and robust comparison of the decline in prostate-specific antigen ≥90% (PSA90) among patients with mCSPC who initiated apalutamide or abiraterone acetate in the United States.Methods
Clinical data were collected from US community urology practices by Precision Point Specialty Analytics and linked with administrative claims from the Komodo Health Solutions Research Database. Patients with mCSPC were included in apalutamide or abiraterone acetate cohorts based on their first dispensation/paid claim on or after September 17, 2019 (index date), and followed to the earliest of treatment discontinuation or switch, end of insurance/clinical activity, or end of data availability (Dec. 31, 2023). Inverse probability of treatment weighting balanced potentially confounding patient characteristics. PSA90 response by 6 months post index was compared between the cohorts using weighted Kaplan-Meier analysis and time to PSA90 response was compared using a weighted Cox model with a time-varying treatment effect.Results
The study included 1351 patients in the apalutamide cohort and 1003 patients in the abiraterone acetate cohort. By 6 months, 61.4% of the weighted apalutamide cohort and 45.9% of the weighted abiraterone acetate cohort achieved a PSA90 response. Compared with abiraterone acetate, patients treated with apalutamide were 73% more likely to achieve a PSA90 response at 6 months (weighted hazard ratio, 1.73; 95% confidence interval, 1.44-2.08; P < .001). The median time to PSA90 response was 3.8 and 8.7 months in the apalutamide and abiraterone acetate cohorts, respectively.Conclusions
The results of this study confirm that patients with mCSPC treated with apalutamide have significantly higher rates of PSA90 response compared with abiraterone acetate after 6 months of treatment. Real-world evidence highlights apalutamide as an important treatment option to improve the prognosis of patients with mCSPC.
Related
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- Cost-Utility Analysis of First-Line Olaparib plus Abiraterone for Metastatic Castration-Resistant Prostate Cancer in China after Volume-Based Procurement
- Cost-effectiveness of capivasertib plus abiraterone for PTEN-deficient metastatic hormone-sensitive prostate cancer in the United States
- Prostate-directed Radiotherapy in Selected Patients With Metastatic Castration-sensitive Prostate Cancer: A Real-world Case Series
- Predictors of guideline-concordant treatment intensification in metastatic castration-sensitive prostate cancer: an explainable machine learning study
BibTeX
@article{lowentritt2026realworld,
title = {{Real-World Early Prostate-Specific Antigen Response Comparison Among Patients with Metastatic Castration Sensitive Prostate Cancer Treated with Apalutamide or Abiraterone Acetate in the United States.}},
author = {Benjamin Lowentritt and Mehmet A Bilen and Sabree Burbage and Charmi Patel and Frederic Kinkead and Carmine Rossi and Gordon Wong and Dominic Pilon and Neal Shore},
journal = {Journal of health economics and outcomes research},
year = {2026},
month = oct,
doi = {10.36469/001c.170641},
url = {https://europepmc.org/article/MED/42968988},
note = {CC BY},
}
RIS
TY - JOUR
TI - Real-World Early Prostate-Specific Antigen Response Comparison Among Patients with Metastatic Castration Sensitive Prostate Cancer Treated with Apalutamide or Abiraterone Acetate in the United States.
AU - Benjamin Lowentritt
AU - Mehmet A Bilen
AU - Sabree Burbage
AU - Charmi Patel
AU - Frederic Kinkead
AU - Carmine Rossi
AU - Gordon Wong
AU - Dominic Pilon
AU - Neal Shore
PY - 2026
DA - 2026/10/30
JO - Journal of health economics and outcomes research
DO - 10.36469/001c.170641
UR - https://europepmc.org/article/MED/42968988
AB - Background Despite the availability of several androgen receptor pathway inhibitors for the treatment of patients with metastatic castration-sensitive prostate cancer (mCSPC), there has been a lack of head-to-head randomized clinical trials to evaluate their comparative efficacy in this population.Objective This real-world study provides a comprehensive and robust comparison of the decline in prostate-specific antigen ≥90% (PSA90) among patients with mCSPC who initiated apalutamide or abiraterone acetate in the United States.Methods Clinical data were collected from US community urology practices by Precision Point Specialty Analytics and linked with administrative claims from the Komodo Health Solutions Research Database. Patients with mCSPC were included in apalutamide or abiraterone acetate cohorts based on their first dispensation/paid claim on or after September 17, 2019 (index date), and followed to the earliest of treatment discontinuation or switch, end of insurance/clinical activity, or end of data availability (Dec. 31, 2023). Inverse probability of treatment weighting balanced potentially confounding patient characteristics. PSA90 response by 6 months post index was compared between the cohorts using weighted Kaplan-Meier analysis and time to PSA90 response was compared using a weighted Cox model with a time-varying treatment effect.Results The study included 1351 patients in the apalutamide cohort and 1003 patients in the abiraterone acetate cohort. By 6 months, 61.4% of the weighted apalutamide cohort and 45.9% of the weighted abiraterone acetate cohort achieved a PSA90 response. Compared with abiraterone acetate, patients treated with apalutamide were 73% more likely to achieve a PSA90 response at 6 months (weighted hazard ratio, 1.73; 95% confidence interval, 1.44-2.08; P < .001). The median time to PSA90 response was 3.8 and 8.7 months in the apalutamide and abiraterone acetate cohorts, respectively.Conclusions The results of this study confirm that patients with mCSPC treated with apalutamide have significantly higher rates of PSA90 response compared with abiraterone acetate after 6 months of treatment. Real-world evidence highlights apalutamide as an important treatment option to improve the prognosis of patients with mCSPC.
SN - 2326-697X
SN - 2327-2236
ER -