Degarelix

This is the trial that led to regulatory approval of relgolix, which is an oral-generated antagonist for patients who are in need of ADT, and it was compared with luprolide.

Because of the question of whether GnRH antagonists may have lower cardiovascular risk, and this was raised through multiple phase two trials, it was actually a pre-specified adverse event of interest noted that the team who was doing this trial wanted to look into this.

They collected these MACE or major adverse cardiovascular events just through standard adverse event collection.

These were not adjudicated, just to be clear, as specific cardiac events.

So I think as we consider this, we have to understand what do the guidelines say? What do we as clinicians do when we're seeing a patient related to cardiac risk?

So these guidelines are a little dated, and I think there's always time to update this, and I think it's probably a good time now.

But what they said before even the REVOLUTION trial happened was in patients with pre-existing symptomatic coronary artery disease, so a very specific patient population who is going to go through androgen deprivation therapy is to consider GnRH antagonists.

They almost imagined the REVOLUTION data even before it came out, because these guidelines came out four years before the REVOLUTION data came out.