Risk of Alzheimer's Disease Among Senior Medicare Beneficiaries Treated With Androgen Deprivation Therapy for Prostate Cancer

• Published in: Journal of clinical oncology Vol. 35; no. 30; pp. 3401 - 3409
• Main Authors: Baik, Seo Hyon, Kury, Fabricio Sampaio Peres, McDonald, Clement Joseph
• Format: Journal Article
• Language: English
• Published: United States American Society of Clinical Oncology 20-10-2017
• Subjects: Aged; Aged, 80 and over; Alzheimer Disease - chemically induced; Alzheimer Disease - diagnosis; Androgen Antagonists - adverse effects; Androgen Antagonists - therapeutic use; Cause of Death; Cohort Studies; Dementia - chemically induced; Dementia - diagnosis; Humans; Male; Medicare - statistics & numerical data; ORIGINAL REPORTS; Propensity Score; Proportional Hazards Models; Prostatic Neoplasms - drug therapy; Risk Assessment - methods; Risk Assessment - statistics & numerical data; Risk Factors; Survival Analysis; United States
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2017.72.6109

Purpose To assess the relative risk of Alzheimer's disease (AD) among patients with prostate cancer who received androgen deprivation therapy (ADT), after adjustment for other cancer therapies. Methods Data from demographics, survival, diagnoses codes, procedure codes, and other information about beneficiaries age 67 years or older in the Medicare claims database was assessed to determine the unadjusted and adjusted risks of AD and of dementia from ADT. The prespecified survival analysis method was competing risk regression. Results Of the 1.2 million fee-for-service Medicare beneficiaries who developed prostate cancer in 2001 to 2014, 35% received ADT. Of these, 109,815 (8.9%) and 223,765 (18.8%) developed AD and dementia, respectively, and 26% to 33% died without either outcome. Unadjusted rates of AD and all-cause mortality per 1,000 patient-years were higher among ADT recipients; the unadjusted rates of AD were 17.0 and 15.5 per 1,000 person-years in recipients and nonrecipients, respectively, and the unadjusted rates of all-cause mortality were 73.0 and 51.6 per 1,000 person-years, respectively. The unadjusted rates for dementia in ADT recipients versus nonrecipients were 38.5 and 32.9, respectively, and the unadjusted rates of mortality were 60.2 versus 40.4, respectively. However, after analysis was adjusted for other cancer therapies and other covariates, patients with ADT treatment had no increased risk of AD (subdistribution hazard ratio [SHR], 0.98; 95% CI, 0.97 to 0.99) and had only a miniscule (1%) risk of dementia (SHR, 1.01; 95% CI, 1.01 to 1.02); patients treated with ADT were more likely to die before progression to AD (SHR, 1.24; 95% CI, 1.23 to 1.24) or dementia (SHR, 1.26; 95% CI, 1.25 to 1.26). The risks of AD and dementia were not associated with duration of ADT (ie, no dose effect). Other secondary analyses confirmed these results. Conclusion These data suggest that ADT treatment has no hazard for AD and no meaningful hazard for dementia among men age 67 years or older who are enrolled in Medicare.