This network meta-analysis compared the efficacy and adverse events of conventional (bicalutamide) and second-generation androgen receptor inhibitors (ARIs; enzalutamide, apalutamide, and darolutamide) in treating castration-resistant prostate cancer (CRPC). Seven randomized clinical trials (RCTs) involving 6,993 patients were analyzed. Second-generation ARIs were superior to bicalutamide in terms of progression-free survival (PFS), prostate-specific antigen (PSA) progression-free survival (PSA-PFS), and overall survival (OS). However, there were subtle differences among the second-generation ARIs; apalutamide showed a higher rate of Grade 3+ adverse events (AEs). All ARIs were generally well-tolerated.
