Bohlius Julia, Wilson Jayne, Seidenfeld Jerome, Piper Margaret, Schwarzer Guido, Sandercock Josie, Trelle Sven, Weingart Olaf, Bayliss Sue, Djulbegovic Benjamin, Bennett Charles L, Langensiepen Simon, Hyde Chris, Engert Andreas
Department of Internal Medicine I, University of Cologne, Germany.
J Natl Cancer Inst. 2006 May 17;98(10):708-14. doi: 10.1093/jnci/djj189.
This is an updated systematic review of 57 trials and 9353 cancer patients from articles, abstracts, and reports published between January 1, 1985, and April 30, 2005, on the effects of epoetin alfa and beta (i.e., epoetin) and darbepoetin alfa (i.e., darbepoetin). We included randomized controlled trials comparing epoetin or darbepoetin plus red blood cell transfusion with red blood cell transfusion alone for prophylaxis or treatment of anemia in cancer patients with or without concurrent antineoplastic therapy. The Cochrane Library, MEDLINE, EMBASE, and conference proceedings were searched. Effect estimates and 95% confidence intervals (CIs) were calculated with fixed-effects models. Treatment with epoetin or darbepoetin statistically significantly reduced the risk for red blood cell transfusions (relative risk [RR] = 0.64, 95% CI = 0.60 to 0.68; 42 trials and 6510 patients) and improved hematologic response (RR = 3.43, 95% CI = 3.07 to 3.84; 22 trials and 4307 patients). Treatment with epoetin or darbepoetin increased the risk of thrombo-embolic events (RR = 1.67, 95% CI = 1.35 to 2.06; 35 trials and 6769 patients). Uncertainties remain as to whether and how epoetin or darbepoetin affects overall survival (hazard ratio = 1.08, 95% CI = 0.99 to 1.18; 42 trials and 8167 patients). Caution is advised when using epoetin or darbepoetin in combination with thrombogenic chemotherapeutic agents or for cancer patients who are at high risk for thrombo-embolic events.
这是一项更新的系统评价，纳入了1985年1月1日至2005年4月30日期间发表的文章、摘要和报告中的57项试验及9353例癌症患者，内容涉及阿法依泊汀和贝他依泊汀（即依泊汀）以及达贝泊汀阿尔法（即达贝泊汀）的疗效。我们纳入了随机对照试验，这些试验比较了依泊汀或达贝泊汀加红细胞输血与单纯红细胞输血，用于预防或治疗接受或未接受同步抗肿瘤治疗的癌症患者的贫血。检索了Cochrane图书馆、MEDLINE、EMBASE和会议论文集。使用固定效应模型计算效应估计值和95%置信区间（CI）。使用依泊汀或达贝泊汀治疗在统计学上显著降低了红细胞输血风险（相对风险[RR]=0.64，95%CI=0.60至0.68；42项试验，6510例患者），并改善了血液学反应（RR=3.43，95%CI=3.07至3.84；22项试验，4307例患者）。使用依泊汀或达贝泊汀治疗增加了血栓栓塞事件的风险（RR=1.67，95%CI=1.35至2.06；35项试验，6769例患者）。依泊汀或达贝泊汀是否以及如何影响总生存期仍存在不确定性（风险比=1.08，95%CI=0.99至1.18；42项试验，8167例患者）。在将依泊汀或达贝泊汀与致血栓性化疗药物联合使用时，或用于血栓栓塞事件高风险的癌症患者时，建议谨慎使用。
