Cardio-Oncology Department and Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran.
Health Technology Assessment, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Int J Clin Pharm. 2021 Feb;43(1):25-34. doi: 10.1007/s11096-020-01146-6. Epub 2020 Sep 10.
Background Anthracycline based chemotherapy is commonly used in many malignancies. While life expectancy increases with the use of this medication, cardiac toxicity causes a risk for patients' health due to anthracyclines. Objective This systematic review and meta-analysis emphasizes on prevention of anthracycline-associated cardiotoxicity in breast cancer and lymphoma patients. Methods We conducted a systematic review of electronic databases including PubMed, Medline, EMBASE, ClinicalTrials.gov, Web of Science, and the Cochrane Library from inception to June 2019 collecting published articles on primary prevention of anthracycline-associated cardiotoxicity in breast cancer and lymphoma patients. We conducted a network meta-analysis and a pairwise meta-analysis in order to compare direct and indirect cardiac agents group with control group calculate left ventricular ejection fraction change. Primary studies results were pooled using random effects model, frequent network meta-analyses, and performed pairwise meta-analysis using netmeta and meta packages respectively in R software version 3.5.1. Results Twelve studies reported left ventricular ejection fraction outcome among 526 patients in the cardiac agent group and 508 in the control group. Based on Surface Under the Cumulative Ranking cure result, spironolactone was the best in left ventricular ejection fraction change and based on meta-analysis, cardiac group had 1.98 unit left ventricular ejection fraction more than the control group (MD = 1.98, 95% CI 0.15-3.81, p value = 0.03). Conclusions The amount of left ventricular ejection fraction used by cardiac agents in anthracycline-based chemotherapy was reduced to a lesser extent. The effective and ineffective drugs were spironolactone and metoprolol, respectively.
背景 蒽环类化疗药物在许多恶性肿瘤中广泛应用。虽然使用这种药物可以提高患者的预期寿命，但蒽环类药物的心脏毒性会给患者的健康带来风险。目的 本系统评价和荟萃分析强调预防乳腺癌和淋巴瘤患者蒽环类相关心脏毒性。方法 我们对电子数据库进行了系统检索，包括 PubMed、Medline、EMBASE、ClinicalTrials.gov、Web of Science 和 Cochrane Library，从建库到 2019 年 6 月，收集关于乳腺癌和淋巴瘤患者蒽环类相关心脏毒性的一级预防的已发表文章。我们进行了网络荟萃分析和成对荟萃分析，以比较直接和间接心脏药物组与对照组计算左心室射血分数的变化。使用随机效应模型对主要研究结果进行汇总，使用 frequent network meta-analyses 进行频繁网络荟萃分析，并在 R 软件版本 3.5.1 中分别使用 netmeta 和 meta 包进行成对荟萃分析。结果 12 项研究报告了 526 例心脏药物组和 508 例对照组患者的左心室射血分数结果。基于累积排序曲线下面积结果，螺内酯在左心室射血分数变化方面效果最佳，基于荟萃分析，心脏药物组的左心室射血分数比对照组多 1.98 单位（MD=1.98，95%CI 0.15-3.81，p 值=0.03）。结论 心脏药物在蒽环类化疗中使用的左心室射血分数减少程度较小。有效的和无效的药物分别是螺内酯和美托洛尔。
