Lindquist Desirae E, Cruz Jennifer L, Brown Jamie N
Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA.
Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, NC, USA
J Cardiovasc Pharmacol Ther. 2015 Jan;20(1):59-65. doi: 10.1177/1074248414541841. Epub 2014 Jul 3.
To determine the efficacy and safety of erythropoiesis-stimulating agents (ESAs) for the treatment of anemia in patients with systolic heart failure.
A search of MEDLINE (1946-January 2014) and EMBASE (1947-January 2014) was conducted using the search terms erythropoietin and systolic heart failure. In addition, bibliographies of relevant articles were reviewed for additional citations.
All English language randomized controlled trials evaluating clinical outcomes or adverse events when using ESAs in the setting of systolic heart failure were included.
A total of 9 studies were reviewed. All studies examining hematological parameters found a statistically significant increase in hemoglobin levels with active treatment versus placebo. Of the 7 trials evaluating exercise tolerance or capacity, only 4 demonstrated statistically significant improvement in these measures in patients receiving ESAs, whereas the remainder showed no clinical benefit. Four studies examined quality-of-life measures. Although numerical improvements were observed in most trials, statistical significance was reached in only 2 trials. A nonsignificant trend for decreased mortality in patients treated with darbepoetin with a similar adverse event profile compared to placebo was shown in one study; however, the largest trial to date showed no benefit in all-cause mortality or heart failure-related hospitalizations with the use of ESAs. Additionally, a statistically significant increase in the number of cerebrovascular events and thrombotic events was found.
There is inconclusive evidence to suggest that the use of ESAs in treating anemia in patients with heart failure is beneficial. Although ESAs demonstrated a clear ability for increasing hemoglobin levels, the data regarding clinical outcomes such as exercise parameters, quality of life, and hospitalizations are conflicting. In addition, a mortality benefit has not been shown; therefore, the potential for improved symptomatology must be weighed against the potential for adverse events.
确定促红细胞生成素（ESAs）治疗收缩性心力衰竭患者贫血的疗效和安全性。
使用检索词“促红细胞生成素”和“收缩性心力衰竭”对MEDLINE（1946年 - 2014年1月）和EMBASE（1947年 - 2014年1月）进行检索。此外，还查阅了相关文章的参考文献以获取更多引用文献。
纳入所有评估在收缩性心力衰竭情况下使用ESAs时临床结局或不良事件的英文随机对照试验。
共审查了9项研究。所有检查血液学参数的研究均发现，与安慰剂相比，积极治疗组血红蛋白水平有统计学显著升高。在7项评估运动耐量或能力的试验中，只有4项显示接受ESAs治疗的患者在这些指标上有统计学显著改善，其余试验未显示临床获益。4项研究检查了生活质量指标。虽然大多数试验观察到数值上的改善，但只有2项试验达到统计学显著水平。一项研究显示，与安慰剂相比，接受达贝泊汀治疗的患者死亡率有下降趋势，但无统计学意义；然而，迄今为止最大规模的试验表明，使用ESAs对全因死亡率或心力衰竭相关住院治疗并无益处。此外，还发现脑血管事件和血栓事件的数量有统计学显著增加。
尚无确凿证据表明使用ESAs治疗心力衰竭患者的贫血有益。虽然ESAs显示出明显提高血红蛋白水平的能力，但关于运动参数、生活质量和住院等临床结局的数据相互矛盾。此外，尚未显示出死亡率获益；因此，必须权衡症状改善的可能性与不良事件的可能性。
