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Review
. 2018 Jun 19:9:238.
doi: 10.3389/fphar.2018.00238. eCollection 2018.

Efficacy and Safety of Cyclosporine in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis

Firdaus A Rahman  1 , Siti S Abdullah  1 , Wan Zanariah W A Manan  1 , Loh Teng-Hern Tan  2 , Chin-Fen Neoh  1 , Long Chiau Ming  3 , Kok-Gan Chan  4   5 , Learn-Han Lee  2   6   7   8   9 , Bey-Hing Goh  2   6   7   8   9 , Shahrzad Salmasi  10 , David Bin-Chia Wu  7 , Tahir M Khan  7   9   11
Affiliations
Review

Efficacy and Safety of Cyclosporine in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis

Firdaus A Rahman et al. Front Pharmacol. .

Abstract

There are various studies that have addressed the use of Cyclosporine among patients with acute myocardial infarction (AMI). However, to date there is hardly any concise and systematically structured evidence that debate on the efficacy and safety of Cyclosporine in AMI patients. The aim of this review is to systematically summarize the overall evidence from published trials, and to conduct a meta-analysis in order to determine the efficacy and safety of Cyclosporine vs. placebo or control among patients with AMI. All randomized control trial (RCT) published in English language from January 2000 to August 2017 were included for the systematic review and meta-analysis. A total of six RCTs met the inclusion and were hence included in the systematic review and meta-analysis. Based on the performed meta-analysis, no significant difference was found between Cyclosporine and placebo in terms of left ventricular ejection fraction (LVEF) improvement (mean difference 1.88; 95% CI -0.99 to 4.74; P = 0.2), mortality rate (OR 1.01; 95% Cl 0.60 to 1.67, P = 0.98) and recurrent MI occurrence (OR 0.65; 95% Cl 0.29 to 1.45, P = 0.29), with no evidence of heterogeneity, when given to patients with AMI. Cyclosporine also did not significantly lessen the rate of rehospitalisation in AMI patients when compared to placebo (OR 0.91; 95% Cl 0.58 to 1.42, P = 0.68), with moderate heterogeneity (I2 = 46%). There was also no significant improvement in heart failure events between Cyclosporine and placebo in AMI patients (OR 0.63; 95% Cl 0.31 to 1.29, P = 0.21; I2 = 80%). No serious adverse events were reported in Cyclosporine group across all studies suggesting that Cyclosporine is well tolerated when given to patients with AMI. The use of Cyclosporine in this group of patients, however, did not result in better clinical outcomes vs. placebo at improving LVEF, mortality rate, recurrent MI, rehospitalisation and heart failure event.

Keywords: acute myocardial infraction; cyclosporine; efficacy; meta-analysis; safety.

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Figures

Figure 1
Figure 1
PRISMA chart.
Figure 2
Figure 2
Risk of bias of included studies.
Figure 3
Figure 3
Summary risk of bias of included studies.
Figure 4
Figure 4
Forest plot of cyclosporine vs. placebo at improving LVEF.
Figure 5
Figure 5
Funnel plot for the risk of publication bias of outcome LVEF.
Figure 6
Figure 6
Forest plot of cyclosporine vs. placebo in preventing death.
Figure 7
Figure 7
Forest plot of cyclosporine vs. placebo in preventing rehospitalisation.
Figure 8
Figure 8
Forest plot of cyclosporine vs. placebo in preventing recurrent MI.
Figure 9
Figure 9
Forest plot of cyclosporine vs. placebo in preventing heart failure.
See this image and copyright information in PMC

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