Neurotoxicities of novel non-steroidal anti-androgens for prostate cancer: A systematic review and meta-analysis.

INTRODUCTION: Novel non-steroidal anti-androgens (NSAA) are increasingly part of the management of prostate cancer. We aimed to quantify and compare the neurologic side effects of NSAA agents. MATERIALS AND METHODS: Phase III randomized controlled trials evaluating NSAAs in the treatment of prostate cancer were selected by two reviewers independently in MEDLINE. A random-effects model and the Mantel-Haenszel method were used. The Odds Ratio (OR) and its 95 % confidence interval were computed. The primary endpoints were the rates of neurologic adverse events. RESULTS: Eight phase III trials evaluating novel NSAAs (vs. non-NSAAs) were included. Fatigue (OR:1.66 [1.32-2.08]), falls (OR:1.76 [1.25-2.49]), headache (OR:1.74 [1.42-2.14]), and dizziness (OR:1.70 [1.33-2.19]) were found to be significantly associated with NSAA use. CONCLUSIONS: NSAAs are associated with an increase in various neurologic adverse events. When NSAAs are prescribed, neurologic adverse event prevention and management strategies should be discussed and implemented.