What is Relugolix?
Relugolix is an oral medication used to treat advanced prostate cancer. It belongs to a class of drugs known as gonadotropin-releasing hormone (GnRH) receptor antagonists. These drugs lower the levels of testosterone in the body. Lowering testosterone is crucial in treating prostate cancer because testosterone can stimulate the growth of prostate cancer cells.
How does Relugolix work?
Relugolix works by directly inhibiting the GnRH receptors inthe pituitary gland. This inhibition prevents the release of luteinising hormone (LH) and follicle-stimulating hormone (FSH), which are necessary for the production of testosterone in the testes. By reducing the levels of thesehormones, Relugolix effectively lowers testosterone levels, thereby slowing the growth of prostate cancer cells.
Has this oral treatment for advacned prostate cancer been approved?
The National Institute for Health and Care Excellence (NICE) has recommended Relugolix for the treatment of advancedhormone-sensitive prostate cancer.
How is Relugolix taken?
As per the British National Formularly (BNF) one needs totake an initial loading dose 360 mg for 1 dose, then maintenance120 mg once daily.
I missed my dose what should I do?
If a dose is missed by more than 12 hours, skip the misseddose and take the next dose at the regular scheduled time. If the treatment is paused for more than 7 days, restart with the loading dose
What are the benefits of Relugolix over traditional treatments?
Oral Administration: Unlike traditional GnRH agonists that require injections, Relugolix is taken orally, making it more convenient for patients.
Rapid Action: Relugolix quickly reduces testosterone levels, often within a few days, where as GnRH agonists can take several weeks.
Fewer Cardiovascular Risks: Studies have shown that Relugolix may have a lower risk of cardiovascular events compared totraditional GnRH agonists. For example, in a pivotal clinical trial, the HEROstudy, the incidence of major cardiovascular events was 2.9% with Relugolix versus 6.2% with leuprolide, a common GnRH agonist.
Reversible Effects: The effects of Relugolixare more rapidly reversible upon discontinuation compared to GnRH agonists,which is beneficial if hormone therapy needs to be paused or stopped.
Who should consider taking Relugolix?
Relugolix is primarily prescribed for men with advancedprostate cancer. It may be particularly beneficial for patients who:
· Prefer an oral medication over injections.
· Have a history of cardiovascular disease or areat high risk of cardiovascular events.
· Need a rapid reduction in testosterone levels.
What are the potential side effects of Relugolix?
Like all medications, Relugolix can cause side effects.Common side effects include:
· Hot flushes
· Fatigue
· Diarrhoea
· Constipation
· Decreased sexual desire and erectile dysfunction
Less common but more serious side effects can include:
· Cardiovascular events, though at a lower rate compared to some other hormone therapies.
· Increased risk of bone thinning or osteoporosis due to prolonged low testosterone levels.
How is Relugolix administered?
Relugolix is taken orally, once a day. It is crucial to follow the prescribed dosage instructions carefully to maintain effective testosterone suppression.
Are there any contraindications or interactions with other medications?
Patients should inform their healthcare provider of allmedications they are currently taking, as Relugolix can interact with otherdrugs. Some contraindications include:
- Severe liver impairment
- History of hypersensitivity to Relugolix or any of itscomponents
Certain medications, such as those that influence liver enzymes, can alter the effectiveness of Relugolix. Always consult with ahealthcare provider for a complete list of potential interactions.
What should patients discuss with their doctor before starting Relugolix?
Before starting Relugolix, patients should discuss thefollowing with their doctor:
- Their complete medical history, including anycardiovascular issues, liver problems, or osteoporosis.
- All current medications, including over-the-counter drugs,supplements, and herbal products.
- The potential benefits and risks of Relugolix compared toother prostate cancer treatments.
- The importance of adhering to the treatment plan and attending regular follow-up appointments to monitor hormone levels and overallhealth.
How effective is Relugolix in clinical trials?
In clinical trials, particularly the HERO study, Relugolix has demonstrated significant effectiveness. The study showed that 96.7% of mentreated with Relugolix achieved and maintained castrate levels of testosterone(≤50 ng/dL) through 48 weeks, compared to 88.8% of men treated with leuprolide.Additionally, the onset of testosterone suppression was faster with Relugolix,and it also offered a better cardiovascular safety profile.
Reflection from a prostate cancer specialist
Relugolix is a promising oral medication for the treatment of advanced prostate cancer, offering several benefits over traditional GnRH agonists, including rapid action, convenient administration, and a lower risk of cardiovascular events.
