Chen Jie, Shan Haili, Yang Wenjun, Zhang Jiali, Dai Haibin, Ye Ziqi
Department of Pharmacy, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Front Pharmacol. 2021 May 13;12:684550. doi: 10.3389/fphar.2021.684550. eCollection 2021.
Vitamin E has been increasingly used to prevent chemotherapy-induced peripheral neuropathy (CIPN) in recent years. However, it is still unclear whether vitamin E can effectively prevent CIPN. We searched all clinical studies in the Embase, Cochrane Library, Clinicaltrials.gov, and PubMed databases from inception to December 2020. We performed a meta-analysis of 9 randomized controlled trials (RCTs) with 486 patients that compared the vitamin E group with the control group. Outcomes of the study were incidence of all-grade CIPN, incidence of severe CIPN, and the total neuropathy scores (TNS). Random effect models were used to make the meta-analysis results more cautious. Notably, vitamin E significantly reduced the incidence of all-grade CIPN (overall risk ratio (RR) = 0.55, 95% CI: 0.36, 0.85, I = 77.3%, = 0.007), and TNS (overall standard mean difference (SMD) = -0.64, 95% CI: 1.03, -0.25, I = 42.7%, = 0.001). However, the results of the subgroup analysis, which included only double-blind RCTs, suggested that vitamin E did not significantly reduce the incidence of all-grade CIPN (overall RR = 0.52, 95% CI: 0.07, 4.06, I = 77.5%, = 0.531). Moreover, there was no significant difference in the incidence of severe CIPN between these two arms ( = 0.440). The results of our meta-analysis suggests that vitamin E has a beneficial effect on the incidence and symptoms of CIPN. However, routine prophylactic use of vitamin E is still not recommended. Moreover, more high-quality double-blind RCTs are needed to further validate the effects of vitamin E in prevention of CIPN.
近年来，维生素E越来越多地被用于预防化疗引起的周围神经病变（CIPN）。然而，维生素E是否能有效预防CIPN仍不清楚。我们检索了Embase、Cochrane图书馆、Clinicaltrials.gov和PubMed数据库中从创建到2020年12月的所有临床研究。我们对9项随机对照试验（RCT）进行了荟萃分析，涉及486名患者，比较了维生素E组和对照组。研究结果包括所有级别的CIPN发病率、严重CIPN发病率和总神经病变评分（TNS）。采用随机效应模型使荟萃分析结果更加谨慎。值得注意的是，维生素E显著降低了所有级别的CIPN发病率（总体风险比（RR）=0.55，95%置信区间：0.36，0.85，I²=77.3%，P=0.007），以及TNS（总体标准平均差（SMD）=-0.64，95%置信区间：-1.03，-0.25，I²=42.7%，P=0.001）。然而，仅包括双盲RCT的亚组分析结果表明，维生素E并没有显著降低所有级别的CIPN发病率（总体RR=0.52，95%置信区间：0.07，4.06，I²=77.5%，P=0.531）。此外，两组之间严重CIPN的发病率没有显著差异（P=0.440）。我们的荟萃分析结果表明，维生素E对CIPN的发病率和症状有有益影响。然而，仍不建议常规预防性使用维生素E。此外，需要更多高质量的双盲RCT来进一步验证维生素E在预防CIPN方面的效果。
