Diabetes and Acute Care Use Among Patients With Metastatic Prostate Cancer Treated With Androgen Receptor Signaling Inhibitors.

Abstract

Androgen receptor signaling inhibitors (ARSIs) are mainstay treatments for metastatic prostate cancer. Hyperglycemia is a common side effect, but limited data exist on outcomes such as acute care use among patients on these medications. This study aimed to assess the impact of diabetes on acute care use in older patients with metastatic prostate cancer on ARSIs. We used SEER-Medicare data for patients 66 years and older with de novo metastatic prostate cancer who were prescribed abiraterone, enzalutamide, or apalutamide from 2010 to 2017. Negative binomial regression calculated incidence rate ratios of acute care use (total hospital or emergency admissions divided by total time at risk) for each model covariate among diabetic and nondiabetic patients after initiation of ARSI. A total of 2,697 patients were included, of which 17.4% had diabetes. The average age was 75.0 years, and most were White (80.3%). Most (85.3%) patients received androgen deprivation therapy before ARSI. Acute care use within 6 months occurred in 29.5% of patients, with 39.9% in the diabetes group and 27.4% in the nondiabetes group (<i>P</i> < .0001). Adjusted for covariates, patients with diabetes had an increased rate of acute care use (Incidence rate ratio [IRR] = 1.38 [95% CI, 1.11 to 1.70]; <i>P</i> = .003) compared with those without diabetes. In addition, compared with those who were prescribed only enzalutamide or apalutamide, patients who were prescribed abiraterone had an increased rate of acute care use (IRR, 1.43 [95% CI, 1.12 to 1.82]; <i>P</i> = .005). Acute care use was common among patients with metastatic prostate cancer on ARSIs. Patients with diabetes experienced higher rates of acute care use compared with those without diabetes among all ARSI types. Future studies should assess potential interventions in older patients with diabetes on ARSIs.