Division of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, Montreal, Quebec, Canada.
J Card Fail. 2010 Aug;16(8):649-58. doi: 10.1016/j.cardfail.2010.03.013. Epub 2010 May 14.
Randomized controlled trials (RCTs) evaluating the efficacy and safety of erythropoiesis-stimulating agents (ESAs), including erythropoietin and darbepoetin, among patients with chronic heart failure (CHF) and anemia have yielded heterogeneous results, and important safety questions remain unanswered. We therefore undertook a meta-analysis to examine the effects of ESAs in this population.
We systematically searched EMBASE, Medline, the Cochrane Library, ClinicalTrials.gov, and relevant bibliographies to identify all relevant RCTs. Data were aggregated using random-effects models. We identified 9 RCTs (n = 747 patients). Compared with control, ESAs were associated with a significant reduction in CHF-related hospitalizations (odds ratio [OR] = 0.41; 95% confidence interval [CI] = 0.24-0.69). The effect of ESAs on mortality was inconclusive (OR = 0.60; 95% CI = 0.32-1.11). ESAs were associated with improved quality of life and left ventricular ejection fraction, lower brain-natriuretic peptide levels, and improved exercise tolerance test performance. There was no evidence of an increase in the incidence of adverse events among patients randomized to ESAs (OR = 0.86; 95% CI = 0.51-1.42).
In patients with CHF and anemia, ESAs are associated with a decrease in CHF-related hospitalizations and improved quality of life and exercise tolerance. However, RCTs completed to date have involved a small number of patients, and available mortality data are inconclusive.
评估红细胞生成刺激剂（ESAs），包括促红细胞生成素和达贝泊汀，在慢性心力衰竭（CHF）和贫血患者中的疗效和安全性的随机对照试验（RCTs）产生了不一致的结果，并且重要的安全性问题仍未得到解答。因此，我们进行了荟萃分析来研究 ESAs 在该人群中的作用。
我们系统地搜索了 EMBASE、Medline、Cochrane 图书馆、ClinicalTrials.gov 和相关的参考文献，以确定所有相关的 RCTs。使用随机效应模型汇总数据。我们确定了 9 项 RCT（n = 747 名患者）。与对照组相比，ESA 与 CHF 相关住院的显著减少相关（优势比[OR] = 0.41；95%置信区间[CI] = 0.24-0.69）。ESA 对死亡率的影响尚无定论（OR = 0.60；95%CI = 0.32-1.11）。ESA 与生活质量和左心室射血分数的提高、脑钠肽水平的降低以及运动耐量试验表现的改善相关。随机分配给 ESA 的患者不良事件的发生率没有增加的证据（OR = 0.86；95%CI = 0.51-1.42）。
在 CHF 和贫血患者中，ESA 与 CHF 相关住院的减少以及生活质量和运动耐量的改善相关。然而，迄今为止完成的 RCT 涉及的患者数量较少，并且可用的死亡率数据尚无定论。
