Prevention of anthracycline-induced cardiotoxicity: a systematic review and network meta-analysis
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REVIEW ARTICLE
Prevention of anthracycline‑induced cardiotoxicity: a systematic review and network meta‑analysis Azin Alizadehasl1 · Nashmil Ghadimi2 · Sara Kaveh2 · Majid Maleki3 · Ardeshir Ghavamzadeh4 · Feridoun Noohi3 · Hossein Hosseinifard5 Received: 3 January 2020 / Accepted: 3 September 2020 © Springer Nature Switzerland AG 2020
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 Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11096-020-01146-6) contains supplementary material, which is available to authorized users.
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* Hossein Hosseinifard [email protected]
• Concomitant use of cardiac agents with Anthracycline-
1
Cardio‑Oncology Department and Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
2
Health Technology Assessment, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
3
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
4
Hematology‑Oncology and Stem Cell Transplantation Research Center, School of Medicine,
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