β受体阻滞剂预防蒽环类药物所致心脏毒性：一项网状Meta分析。

Preventive use of beta-blockers for anthracycline-induced cardiotoxicity: A network meta-analysis.

作者信息

He Dongsheng, Hu Jun, Li Ying, Zeng Xiaofei

机构信息

Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China.

Department of Cardiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China.

出版信息

Front Cardiovasc Med. 2022 Aug 11;9:968534. doi: 10.3389/fcvm.2022.968534. eCollection 2022.

BACKGROUND

Anthracyclines are commonly used chemotherapeutic agents to treat malignant tumors. However, cardiotoxicity is a potentially serious adverse effect of anthracyclines. Beta-blockers may be effective in preventing anthracycline-induced cardiotoxicity (AIC). However, the lack of direct comparisons of various beta-blockers interferes with clinical decision-making. Network meta-analysis (NMA) was performed to assess the effectiveness of beta-blockers for AIC.

METHODS

We searched PubMed, Embase, Web of Science, and the Cochrane Central Register of Clinical Trials. The last update was in May 2022. Randomized controlled trials (RCT) of beta-blockers for AIC were included. Four beta-blockers were selected for comparison based on the number of studies. NMA was conducted with STATA 14.0 software.

RESULTS

A total of 10 RCTs (875 patients) met the selection criteria. NMA results showed that carvedilol was superior to bisoprolol [ = -0.50, 95% (-0.91, -0.10)] and nebivolol [ = -1.46, 95% (-2.82, -0.11)] in a delay of LVEF. The results of the cumulative probability ordering are as follows: carvedilol (83.8%) > metoprolol (71.8%) > bisoprolol (43.9%) > placebo (40.9%) > nebivolol (9.5%).

CONCLUSION

Based on the available evidence, carvedilol is the best beta-blocker for AIC, followed by metoprolol. However, additional studies with large samples should be conducted to confirm our findings.

背景

蒽环类药物是治疗恶性肿瘤常用的化疗药物。然而，心脏毒性是蒽环类药物潜在的严重不良反应。β受体阻滞剂可能对预防蒽环类药物所致心脏毒性（AIC）有效。然而，缺乏对各种β受体阻滞剂的直接比较妨碍了临床决策。进行网状Meta分析（NMA）以评估β受体阻滞剂对AIC的有效性。

方法

我们检索了PubMed、Embase、Web of Science和Cochrane临床试验中心注册库。最后一次更新时间为2022年5月。纳入了β受体阻滞剂治疗AIC的随机对照试验（RCT）。根据研究数量选择了四种β受体阻滞剂进行比较。使用STATA 14.0软件进行NMA。

结果

共有10项RCT（875例患者）符合入选标准。NMA结果显示，在延缓左心室射血分数（LVEF）方面，卡维地洛优于比索洛尔[= -0.50，95%可信区间（-0.91，-0.10）]和奈必洛尔[= -1.46，95%可信区间（-2.82，-0.11）]。累积概率排序结果如下：卡维地洛（83.8%）>美托洛尔（71.8%）>比索洛尔（43.9%）>安慰剂（40.9%）>奈必洛尔（9.5%）。