Data Science, Evidence-Based and Clinical Research Laboratory, Department of Health, Social and Clinical Pharmacy, College of Pharmacy, Chung-Ang University, Seoul, 06974, Republic of Korea.
Clin Exp Med. 2023 Oct;23(6):2705-2714. doi: 10.1007/s10238-023-01041-0. Epub 2023 Mar 25.
Myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) are hematologic malignancies that mostly affect the elderly and have poor prognoses. Mutations in epigenetic regulatory genes cause AML/MDS through changes in DNA methylation and histone modifications. Some epigenetic agents are used in patients with AML and MDS. However, most studies have focused on azacitidine (AZA) or decitabine (DEC), and few studies have been conducted on combination therapies or other epigenetic therapies. This network meta-analysis (NMA) aimed to compare the efficacy of epigenetic agents overall in patients with AML and MDS. A systematic review and NMA of all available II-III phase randomized controlled trials (RCTs) comparing epigenetic agents were performed. The Embase and PubMed databases were searched for relevant studies. The Bayesian model was used in the NMA, and the surface under the cumulative ranking curve (SUCRA) was used to rank comparisons. The primary endpoint was overall survival (OS), and the secondary endpoints were complete response (CR) and partial response (PR). OS was extended by AZA + venetoclax (SUCRA 0.94) in patients with AML and MDS. DEC (SUCRA 0.78) relatively improved CR and PR. In this study, AZA-related treatment was relatively effective in improving the OS of patients with AML and MDS, and DEC-related treatment showed a relatively high effect on CR and PR. The protocol for this systematic review was registered with the International Prospective Register of Systematic Reviews (CRD42022303601).
骨髓增生异常综合征（MDS）和急性髓系白血病（AML）是主要影响老年人且预后不良的血液系统恶性肿瘤。表观遗传调控基因的突变通过 DNA 甲基化和组蛋白修饰的改变导致 AML/MDS。一些表观遗传药物用于 AML 和 MDS 患者。然而，大多数研究都集中在阿扎胞苷（AZA）或地西他滨（DEC）上，很少有研究涉及联合治疗或其他表观遗传治疗。本网络荟萃分析（NMA）旨在比较 AML 和 MDS 患者总体上的表观遗传药物疗效。对所有可用的 II-III 期随机对照试验（RCT）进行了系统评价和 NMA，这些 RCT 比较了表观遗传药物。在 Embase 和 PubMed 数据库中搜索了相关研究。NMA 采用贝叶斯模型，累积排序曲线下面积（SUCRA）用于比较排名。主要终点是总生存期（OS），次要终点是完全缓解（CR）和部分缓解（PR）。AZA+venetoclax 延长了 AML 和 MDS 患者的 OS（SUCRA 0.94）。DEC（SUCRA 0.78）相对提高了 CR 和 PR。在这项研究中，AZA 相关治疗在改善 AML 和 MDS 患者的 OS 方面相对有效，而 DEC 相关治疗在 CR 和 PR 方面显示出相对较高的效果。该系统评价的方案已在国际前瞻性注册系统评价数据库（CRD42022303601）中注册。
