Buchrits Shira, Itzhaki Oranit, Avni Tomer, Raanani Pia, Gafter-Gvili Anat
Internal Medicine Department A, Rabin Medical Center, Beilinson Hospital, Petah-Tikva 4941492, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
J Clin Med. 2022 Jul 18;11(14):4156. doi: 10.3390/jcm11144156.
Background: The pathophysiology of cancer-related anemia is multifactorial, including that of chemotherapy-induced anemia (CIA). The guidelines are not consistent in their approach to the use of intravenous (IV) iron in patients with cancer as part of the clinical practice. Materials and methods: All randomized controlled trials that compared IV iron with either no iron or iron taken orally for the treatment of CIA were included. We excluded trials if erythropoiesis-stimulating agents (ESAs) were used. The primary outcome was the percentage of patients requiring a red blood cell (RBC) transfusion during the study period. The secondary outcomes included the hematopoietic response (an increase in the Hb level by more than 1 g/dL or an increase above 11 g/dL), the iron parameters and adverse events. For the dichotomous data, risk ratios (RRs) with 95% confidence intervals (Cis) were estimated and pooled. For the continuous data, the mean differences were calculated. A fixed effect model was used, except in the event of significant heterogeneity between the trials (p < 0.10; I2 > 40%), in which we used a random effects model. Results: A total of 8 trials published between January 1990 and July 2021 that randomized 1015 patients fulfilled the inclusion criteria. Of these, 553 patients were randomized to IV iron and were compared with 271 patients randomized to oral iron and 191 to no iron. IV iron decreased the percentage of patients requiring a blood transfusion compared with oral iron (RR 0.72; 95% CI 0.55−0.95) with a number needed to treat of 20 (95% CI 11−100). IV iron increased the hematopoietic response (RR 1.23; 95% CI 1.01−1.5). There was no difference with respect to the risk of adverse events (RR 0.97; 95% CI 0.88−1.07; 8 trials) or severe adverse events (RR 1.09; 95% CI 0.76−1.57; 8 trials). Conclusions: IV iron resulted in a decrease in the need for RBC transfusions, with no difference in adverse events in patients with CIA. IV iron for the treatment of CIA should be considered in clinical practice.
背景:癌症相关性贫血的病理生理学是多因素的,包括化疗所致贫血(CIA)。在临床实践中,对于癌症患者使用静脉铁剂的方法,指南并不一致。材料与方法:纳入所有比较静脉铁剂与不使用铁剂或口服铁剂治疗CIA的随机对照试验。如果使用了促红细胞生成素(ESA),则排除该试验。主要结局是研究期间需要输注红细胞(RBC)的患者百分比。次要结局包括造血反应(血红蛋白水平升高超过1 g/dL或升高至11 g/dL以上)、铁参数和不良事件。对于二分数据,估计并汇总具有95%置信区间(CI)的风险比(RR)。对于连续数据,计算平均差异。采用固定效应模型,除非试验间存在显著异质性(p < 0.10;I2>40%),此时采用随机效应模型。结果:1990年1月至2021年7月发表的8项随机对照试验共纳入1015例患者,符合纳入标准。其中,553例患者被随机分配至静脉铁剂组,与271例随机分配至口服铁剂组和191例不使用铁剂组进行比较。与口服铁剂相比,静脉铁剂降低了需要输血的患者百分比(RR 0.72;95%CI 0.55−0.95),治疗所需人数为20(95%CI 11−100)。静脉铁剂增加了造血反应(RR 1.23;95%CI 1.01−1.5)。不良事件风险(RR 0.97;95%CI 0.88−1.07;8项试验)或严重不良事件风险(RR 1.09;95%CI 0.76−1.57;8项试验)无差异。结论:静脉铁剂可减少CIA患者对RBC输血的需求,且不良事件无差异。临床实践中应考虑使用静脉铁剂治疗CIA。
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