Objective:

To quantitatively synthesize evidence from randomized controlled trials to evaluate and compare the risk of hypokalemia associated with abiraterone, enzalutamide, and their combination in prostate cancer patients.

Approach:

• Search strategy and study selection: A systematic literature search was performed in accordance with PRISMA guidelines across multiple databases, focusing on RCTs involving prostate cancer patients treated with ARATs.
• Eligibility criteria: Included studies were phase II or III RCTs comparing ARATs against placebo/control, reporting hypokalemia incidence.
• Data extraction and quality assessment: Data were extracted independently by two investigators, and the methodological quality was assessed using the Cochrane Risk of Bias tool.
• Statistical analysis: Pooled risk ratios for hypokalemia were calculated using a random-effects model, with sensitivity analyses conducted for robustness.

Key Findings:

• Nine reports were included in the meta-analysis.
• The incidence of hypokalemia varied across different ARAT regimens.
• Abiraterone was associated with a higher risk of hypokalemia compared to enzalutamide.

Interpretation:

Limitations:

• Limited number of eligible reports (n = 9) restricted the ability to perform meta-regression.
• Potential publication bias was assessed but not definitively established.

Conclusion:

The systematic review highlights the need for careful monitoring of hypokalemia in patients treated with abiraterone and enzalutamide.