Department of Clinical Pharmacy, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-cho, Matsuyama, Ehime, Japan.
Division of Pharmacy, Ehime University Hospital, Shitsukawa, Toon, Ehime, Japan; Division of Pharmaceutical Care Sciences, Keio University Graduate School of Pharmaceutical Sciences, 1-5-30 Shibakoen, Minato-ku, Tokyo, Japan.
Clin Ther. 2018 Jul;40(7):1214-1222.e1. doi: 10.1016/j.clinthera.2018.05.011. Epub 2018 Jul 23.
Oxaliplatin-induced peripheral neuropathy has remained an unresolved issue in clinical practice. Our previous study hypothesized that inhibition of the renin-angiotensin system (RAS) may produce a preventive effect on oxaliplatin-induced neuropathy. The aim of this study was to clarify whether RAS inhibitors prevent oxaliplatin-induced peripheral neuropathy.
This study retrospectively analyzed data from cancer patients who had received chemotherapy including oxaliplatin and were treated with or without RAS inhibitors. This retrospective observational study was conducted at Ehime University Hospital using electronic medical records from May 2009 to December 2016. The primary end point was the incidence of severe peripheral neuropathy during or after oxaliplatin treatment, according to the Common Terminology Criteria for Adverse Events, version 4.0. A multivariate Cox proportional hazards model analysis was used to identify risk factors.
A total of 150 patients were included in the study. The estimated incidence of peripheral neuropathy was 36.9% and 91.7% in the RAS inhibitor group and the non-RAS inhibitor group, respectively. The multivariate analysis using a Cox proportional hazards model showed that the RAS inhibitor group was slightly associated with a decreased risk of neurotoxicity (adjusted hazard ratio, 0.42 [95% CI, 0.18-0.99]; P = 0.048).
The present findings suggest that RAS inhibitors have the ability to prevent oxaliplatin-induced peripheral neuropathy.
奥沙利铂引起的周围神经病变在临床实践中仍然是一个未解决的问题。我们之前的研究假设，肾素-血管紧张素系统（RAS）的抑制可能对奥沙利铂引起的神经病变产生预防作用。本研究的目的是阐明 RAS 抑制剂是否可预防奥沙利铂引起的周围神经病变。
本研究回顾性分析了接受包括奥沙利铂在内的化疗且接受或未接受 RAS 抑制剂治疗的癌症患者的数据。这项在爱媛大学医院进行的回顾性观察性研究使用了 2009 年 5 月至 2016 年 12 月的电子病历。主要终点是根据不良事件通用术语标准，版本 4.0，奥沙利铂治疗期间或之后发生严重周围神经病变的发生率。采用多变量 Cox 比例风险模型分析来确定危险因素。
本研究共纳入 150 例患者。RAS 抑制剂组和非 RAS 抑制剂组的周围神经病变发生率分别估计为 36.9%和 91.7%。使用 Cox 比例风险模型的多变量分析显示，RAS 抑制剂组的神经毒性风险略有降低（调整后的危险比，0.42[95%CI，0.18-0.99]；P=0.048）。
本研究结果表明，RAS 抑制剂具有预防奥沙利铂引起的周围神经病变的能力。
