The effect of concurrent use of antihypertensive, proton pump inhibitor, statin, and opioid medications on clinical outcomes during enzalutamide or abiraterone acetate therapy in patients with metastatic prostate cancer

Objective: This study aimed to evaluate the impact of concomitant use of antihypertensive agents, statins, proton pump inhibitors (PPIs), and opioids on clinical outcomes in patients with metastatic prostate cancer undergoing treatment with enzalutamide or abiraterone acetate, and to investigate the potential influence of drug–drug interactions on survival outcomes. Materials and Methods: Patients diagnosed with metastatic prostate cancer and receiving enzalutamide or abiraterone acetate at Gaziantep University Şahinbey Research and Training Hospital, Department of Medical Oncology, were retrospectively analyzed. Patient data including age, family history, comorbidities, date of diagnosis, disease stage, baseline prostate-specific antigen (PSA) level, Gleason score, sites of metastasis, ECOG performance status, progression history, type and duration of treatment (chemotherapy, radiotherapy, or surgery), genetic alterations (BRCA, MSI, etc.), and concomitant use of antihypertensive drugs, PPIs, statins, and opioids were recorded. Statistical analyses were performed using SPSS version 22.0, and a p-value < 0.05 was considered statistically significant. Results: A total of 184 patients were included in the study, of whom 105 received enzalutamide and 79 received abiraterone acetate. The median age at diagnosis was 68 years. The mean progression-free survival (PFS) was 16.4 ± 14.9 months, and the mean overall survival (OS) was 21.3 ± 16.7 months. The concurrent use of antihypertensives, PPIs, and statins showed no significant difference in PFS or OS compared to non-users (p>0.05). However, patients receiving opioids demonstrated significantly shorter survival durations in both treatment groups. Conclusion: In patients with metastatic prostate cancer treated with enzalutamide or abiraterone acetate, concurrent opioid use was associated with significantly reduced progression-free and overall survival. In contrast, the use of antihypertensives, statins, and proton pump inhibitors did not significantly affect survival outcomes. Keywords: Enzalutamide, Abiraterone acetate, Drug interaction,