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. 2021 Feb;43(1):25-34.
doi: 10.1007/s11096-020-01146-6. Epub 2020 Sep 10.

Prevention of anthracycline-induced cardiotoxicity: a systematic review and network meta-analysis

Azin Alizadehasl  1 , Nashmil Ghadimi  2 , Sara Kaveh  2 , Majid Maleki  3 , Ardeshir Ghavamzadeh  4 , Feridoun Noohi  3 , Hossein Hosseinifard  5
Affiliations

Prevention of anthracycline-induced cardiotoxicity: a systematic review and network meta-analysis

Azin Alizadehasl et al. Int J Clin Pharm. 2021 Feb.

Abstract

Background Anthracycline based chemotherapy is commonly used in many malignancies. While life expectancy increases with the use of this medication, cardiac toxicity causes a risk for patients' health due to anthracyclines. Objective This systematic review and meta-analysis emphasizes on prevention of anthracycline-associated cardiotoxicity in breast cancer and lymphoma patients. Methods We conducted a systematic review of electronic databases including PubMed, Medline, EMBASE, ClinicalTrials.gov, Web of Science, and the Cochrane Library from inception to June 2019 collecting published articles on primary prevention of anthracycline-associated cardiotoxicity in breast cancer and lymphoma patients. We conducted a network meta-analysis and a pairwise meta-analysis in order to compare direct and indirect cardiac agents group with control group calculate left ventricular ejection fraction change. Primary studies results were pooled using random effects model, frequent network meta-analyses, and performed pairwise meta-analysis using netmeta and meta packages respectively in R software version 3.5.1. Results Twelve studies reported left ventricular ejection fraction outcome among 526 patients in the cardiac agent group and 508 in the control group. Based on Surface Under the Cumulative Ranking cure result, spironolactone was the best in left ventricular ejection fraction change and based on meta-analysis, cardiac group had 1.98 unit left ventricular ejection fraction more than the control group (MD = 1.98, 95% CI 0.15-3.81, p value = 0.03). Conclusions The amount of left ventricular ejection fraction used by cardiac agents in anthracycline-based chemotherapy was reduced to a lesser extent. The effective and ineffective drugs were spironolactone and metoprolol, respectively.

Keywords: Anthracycline; Breast cancer; Cardiac agents; Cardiotoxicity; LVEF; Lymphoma; Network meta-analysis; Prevention; Systematic review.

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References

    1. Chotenimitkhun R, D’Agostino R Jr, Lawrence JA, Hamilton CA, Jordan JH, Vasu S, et al. Chronic statin administration may attenuate early anthracycline-associated declines in left ventricular ejection function. Can J Cardiol. 2015;31(3):302–7. - DOI
    1. Jhorawat R, Kumari S, Varma SC, Rohit MK, Narula N, Suri V, et al. Preventive role of carvedilol in adriamycin-induced cardiomyopathy. Indian J Med Res. 2016;144(5):725–9. - DOI
    1. Marty M, Espie M, Llombart A, Monnier A, Rapoport BL, Stahalova V. Multicenter randomized phase III study of the cardioprotective effect of dexrazoxane (Cardioxane) in advanced/metastatic breast cancer patients treated with anthracycline-based chemotherapy. Ann Oncol. 2006;17(4):614–22. - DOI
    1. Elitok A, Oz F, Cizgici AY, Kilic L, Ciftci R, Sen F, et al. Effect of carvedilol on silent anthracycline-induced cardiotoxicity assessed by strain imaging: a prospective randomized controlled study with six-month follow-up. Cardiol J. 2014;21(5):509–15. - DOI
    1. Gulati G, Heck SL, Ree AH, Hoffmann P, Schulz-Menger J, Fagerland MW, et al. Prevention of cardiac dysfunction during adjuvant breast cancer therapy (PRADA): a 2 x 2 factorial, randomized, placebo-controlled, double-blind clinical trial of candesartan and metoprolol. Eur Heart J. 2016;37(21):1671–80. - DOI

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