Long-term effectiveness of empiric cardio-protection in patients receiving cardiotoxic chemotherapies: A systematic review & bayesian network meta-analysis.
Long-term effectiveness of empiric cardio-protection in patients receiving cardiotoxic chemotherapies: A systematic review & bayesian network meta-analysis.
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接受心脏毒性化疗的患者经验性心脏保护的长期有效性：系统评价
DOI：
10.1016/j.ejca.2022.03.024
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Addison,Daniel
中科院分区：
文献类型：
--
作者：
Sayed,Ahmed;Abdelfattah,OmarM;Munir,Malak;Shazly,Omar;Awad,AhmedK;Ghaith,HazemS;Moustafa,Khaled;Gerew,Maria;Guha,Avirup;Barac,Ana;Fradley,MichaelG;Abela,GeorgeS;Addison,Daniel
背景心脏保护疗法是减少接受化疗的患者治疗限制性心脏毒性的重要途径。然而，经验性心脏保护的最佳持续时间、策略和长期疗效仍然未知。方法利用 MEDLINE/Pubmed、CENTRAL 和 ClinicalTrials.gov 数据库，我们确定了从开始到 2021 年 11 月研究心脏保护疗法的所有随机对照试验 (PROSPERO-ID:CRD42021265006)。心脏保护类别包括 ACEI、ARB、β 受体阻滞剂、右雷佐生 (DEX)、他汀类药物和盐皮质激素受体拮抗剂。主要终点是新发心力衰竭（HF）。次要结果是左心室射血分数（LVEF）变化、低血压和全因死亡率的平均差异。使用网络荟萃分析来评估每种疗法的心脏保护作用，以推断出最有效的疗法。两项分析均使用贝叶斯随机效应模型来估计风险比 (RR) 和 95% 可信区间 (95% CrI)。结果总体而言，从 726 篇文章中，确定了 39 项试验，评估了 5931 名参与者（38.0 ± 19.1 岁，72.0% 女性）。使用任何心脏保护策略可减少新发心力衰竭（RR：0.32；95% CrI：0.19–0.55）、改善 LVEF（平均差：3.92%；95% CrI：2.81–5.07）、增加低血压（RR：3.27；95% CrI：1.38–9.87），并且死亡率没有差异。根据对照组，为预防一次心力衰竭事件而需要进行“任何”心脏保护治疗的人数为 45 人，其中治疗时间≥1 年的人数为 21 人。右雷佐生在预防心力衰竭方面最有效（累积排名曲线下的表面：81.47%），而盐皮质激素受体拮抗剂在保留 LVEF 方面最有效（累积排名曲线下的表面：99.22%）。结论对于需要抗癌治疗的患者来说，心脏毒性仍然是一个挑战。开始延长心脏保护时间可以减少心力衰竭的发生。需要进行额外的头对头试验。
BackgroundCardioprotective therapies represent an important avenue to reduce treatment-limiting cardiotoxicities in patients receiving chemotherapy. However, the optimal duration, strategy and long-term efficacy of empiric cardio-protection remains unknown.MethodsLeveraging the MEDLINE/Pubmed, CENTRAL and clinicaltrials.gov databases, we identified all randomised controlled trials investigating cardioprotective therapies from inception to November 2021 (PROSPERO-ID:CRD42021265006). Cardioprotective classes included ACEIs, ARBs, Beta-blockers, dexrazoxane (DEX), statins and mineralocorticoid receptor antagonists. The primary end-point was new-onset heart failure (HF). Secondary outcomes were the mean difference in left ventricular ejection fraction (LVEF) change, hypotension and all-cause mortality. Network meta-analyses were used to assess the cardioprotective effects of each therapy to deduce the most effective therapies. Both analyses were performed using a Bayesian random effects model to estimate risk ratios (RR) and 95% credible intervals (95% CrI).ResultsOverall, from 726 articles, 39 trials evaluating 5931 participants (38.0 ± 19.1 years, 72.0% females) were identified. The use of any cardioprotective strategy associated with reduction in new-onset HF (RR:0.32; 95% CrI:0.19–0.55), improved LVEF (mean difference: 3.92%; 95% CrI:2.81–5.07), increased hypotension (RR:3.27; 95% CrI:1.38–9.87) and no difference in mortality. Based on control arms, the number-needed-to-treat for ‘any’ cardioprotective therapy to prevent one incident HF event was 45, including a number-needed-to-treat of 21 with ≥1 year of therapy. Dexrazoxane was most effective at HF prevention (Surface Under the Cumulative Ranking curve: 81.47%), and mineralocorticoid receptor antagonists were most effective at preserving LVEF (Surface Under the Cumulative Ranking curve: 99.22%).ConclusionCardiotoxicity remains a challenge for patients requiring anticancer therapies. The initiation of extended duration cardioprotection reduces incident HF. Additional head-to-head trials are needed.
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影响因子：
28.4
作者：
Boekhout, Annelies H.;Gietema, Jourik A.;Schellens, Jan H. M.
通讯作者：
Schellens, Jan H. M.
影响因子：
9
作者：
Henninger C;Fritz G
通讯作者：
Fritz G
影响因子：
51.1
作者：
Lipshultz, Steven E.;Scully, Rebecca E.;Lipsitz, Stuart R.;Sallan, Stephen E.;Silverman, Lewis B.;Miller, Tracie L.;Borry, Elly V.;Asselin, Barbara L.;Athale, Uma;Clavell, Luis A.;Larsen, Eric;Moghrabi, Albert;Samson, Yvan;Michon, Bruno;Schorin, Marshall A.;Cohen, Harvey J.;Neuberg, Donna S.;Orav, E. John;Colan, Steven D.
通讯作者：
Colan, Steven D.
乳腺癌辅助治疗期间预防心脏功能障碍 (PRADA)
影响因子：
37.8
作者：
S. Heck;A. Mecinaj;A. H. Ree;P. Hoffmann;J. Schulz;MortenW. Fagerland;B. Gravdehaug;H. Røsjø;K. Steine;J. Geisler;G. Gulati;T. Omland
通讯作者：
T. Omland
影响因子：
3.8
作者：
Totzeck, Matthias;Mincu, Raluca, I;Rassaf, Tienush
通讯作者：
Rassaf, Tienush