Key Differences Between Enzalutamide and Darolutamide

Summary for Physicians: Key Differences Between Enzalutamide and Darolutamide

Although both enzalutamide and darolutamide are androgen receptor inhibitors, they have several important distinguishing characteristics:

• Blood-brain barrier penetration: Darolutamide has negligible blood-brain barrier penetration, potentially resulting in fewer central nervous system adverse effects compared with enzalutamide.
• Chemical structure: Darolutamide has a distinct chemical structure with lower binding affinity to GABA-A receptors.
• Drug interactions: Darolutamide has a different drug interaction profile and may be preferable in patients on multiple medications.
• Adverse effect profile: Darolutamide may be associated with lower incidence of fatigue, falls, and cognitive effects compared with enzalutamide.
• Specific indications: Although both are approved for nonmetastatic castration-resistant prostate cancer, they may have different additional approved indications depending on region.

These differences may influence clinical decision-making when selecting between these agents for individual patients.