ACE Inhibitors, ARBs May Improve NMIBC Outcomes

Use of the medications was associated with a significant 39% decreased risk of tumor recurrence after surgery.
Use of the medications was associated with a significant 39% decreased risk of tumor recurrence after surgery.

NEW ORLEANS—Pharmacologic inhibition of the renin-angiotensin system (RAS) is associated with improved patient outcomes following surgery for non-muscle invasive bladder cancer (NMIBC), new study findings presented at the American Urological Association annual meeting suggest.

First author Michael L. Blute, Jr., MD, a fellow in urologic oncology, senior author Tracy M. Downs, MD, both of the University of Wisconsin in Madison, and colleagues studied 340 NMIBC patients (median age 69.6 years) with underwent transurethral resection of bladder tumor (TURBT). They evaluated whether treatment with ACE inhibitors or angiotensin receptor blockers (ARBs) at initial surgery was associated with decreased risk of recurrence or progression.

After a median follow-up of 3 years, 200 patients (59%) experienced recurrence and 14 (4.1%) had stage progression. Of these 214 patients, 143 were taking an ACE inhibitor or ARB at the time of their first TURBT. In multivariate analysis, patients treated with an ACE inhibitor or ARB had a significant 39% decreased risk of tumor recurrence compared with patients not treated with either medication type. The 5-year recurrence-free survival rate was 45.6% for patients treated with an ACE inhibitor or ARB compared with 28.1% for patients not treated with these medications.

Dr. Downs' group performed a subgroup analysis looking at patients on bacillus Calmette-Guérin (BCG) therapy alone (85 patients) and those who received BCG in addition to an ACE inhibitor or ARB.  The BCG-only patients had a 2-fold increased risk of recurrence compared with those treated with BCG and RAS inhibition.

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