Comparing Renin-Angiotensin-Aldosterone Blockade Regimens for Long-Term Chemotherapy-Related Cardiac Dysfunction: A Network Meta-Analysis.

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Drugs and Therapy Pub Date : 2025-02-01 Epub Date: 2023-06-14 DOI:10.1007/s10557-023-07457-w

Jiaqi Li, Ainsley Ryan Yan Bin Lee, Areeba Tariq, Grace Lau, Chun En Yau, Li Ling Tan, Sara Moiz Tyebally, Matilda Xinwei Lee, Chieh Yang Koo, Ching-Hui Sia

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引用次数: 0

Abstract

Purpose: Cancer therapies including trastuzumab and anthracyclines are cardiotoxic and cause cardiac dysfunction. To prevent cardiotoxicity, pharmacological agents used in heart failure have been administered concomitantly with cardiotoxic cancer therapy, but few studies to date have performed a head-to-head comparison of these different agents. This systematic review and network meta-analysis of randomized-controlled trials aims to evaluate the efficacy of renin-angiotensin-aldosterone system (RAAS) blockers, namely angiotensin-converting enzyme inhibitors (ACE-Is), aldosterone receptor blockers (ARBs), and mineralocorticoid receptor antagonists (MRAs), in primary prevention against chemotherapy-related cardiac dysfunction in patients receiving anthracyclines and/or trastuzumab.

Methods: A systematic search was performed in major web databases for studies from inception to 15 September 2022. A Bayesian network meta-analysis model was used to assess the relative effects of competing treatments on the primary outcomes of risk of significant decline in left ventricular ejection fraction (LVEF) and mean LVEF decline. Secondary outcomes included left ventricular diastolic function, global longitudinal strain, and cardiac biomarkers. This study is registered with PROSPERO, CRD42022357980.

Results and conclusion: Nineteen studies reported the effects of 13 interventions (N = 1905 patients). Only enalapril (RR 0.05, 95% CI 0.00-0.20) was associated with reduced risk of patients developing significant decline in LVEF relative to placebo. Subgroup analysis showed that the beneficial effect of enalapril was driven by protection against anthracycline-associated toxicity. In addition, no RAAS-inhibiting agents showed efficacy in protection against treatment with both anthracycline and trastuzumab. The use of RAAS inhibition therapy did not conclusively impact on other markers of cardiac function, including left ventricular diastolic function and cardiac biomarkers.

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比较肾素-血管紧张素-醛固酮阻断方案治疗长期化疗相关心功能障碍:网络荟萃分析。

目的:包括曲妥珠单抗和蒽环类药物在内的癌症治疗具有心脏毒性并导致心功能障碍。为了防止心脏毒性，用于心力衰竭的药物与心脏毒性癌症治疗同时使用，但迄今为止很少有研究对这些不同药物进行正面比较。这项随机对照试验的系统回顾和网络meta分析旨在评估肾素-血管紧张素-醛固酮系统(RAAS)阻滞剂，即血管紧张素转换酶抑制剂(ACE-Is)、醛固酮受体阻滞剂(ARBs)和矿皮质激素受体拮抗剂(MRAs)在接受蒽环类药物和/或曲妥珠单抗的患者化疗相关性心功能障碍的一级预防中的疗效。方法:系统检索自研究开始至2022年9月15日的主要网络数据库。采用贝叶斯网络元分析模型来评估竞争治疗对左室射血分数(LVEF)显著下降风险和平均LVEF下降的主要结局的相对影响。次要结局包括左室舒张功能、整体纵向应变和心脏生物标志物。本研究已注册为PROSPERO, CRD42022357980。结果与结论:19项研究报告了13种干预措施的效果(N = 1905例患者)。与安慰剂相比，只有依那普利(RR 0.05, 95% CI 0.00-0.20)与患者LVEF显著下降的风险降低相关。亚组分析显示，依那普利的有益作用是由对蒽环类药物相关毒性的保护所驱动的。此外，没有任何raas抑制剂显示出对蒽环类药物和曲妥珠单抗联合治疗的保护作用。RAAS抑制治疗对其他心功能指标没有决定性影响，包括左室舒张功能和心脏生物标志物。

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来源期刊

Cardiovascular Drugs and Therapy 医学-心血管系统

CiteScore

8.30

自引率

0.00%

发文量

110

审稿时长

4.5 months

期刊介绍： Designed to objectively cover the process of bench to bedside development of cardiovascular drug, device and cell therapy, and to bring you the information you need most in a timely and useful format, Cardiovascular Drugs and Therapy takes a fresh and energetic look at advances in this dynamic field. Homing in on the most exciting work being done on new therapeutic agents, Cardiovascular Drugs and Therapy focusses on developments in atherosclerosis, hyperlipidemia, diabetes, ischemic syndromes and arrhythmias. The Journal is an authoritative source of current and relevant information that is indispensable for basic and clinical investigators aiming for novel, breakthrough research as well as for cardiologists seeking to best serve their patients. Providing you with a single, concise reference tool acknowledged to be among the finest in the world, Cardiovascular Drugs and Therapy is listed in Web of Science and PubMed/Medline among other abstracting and indexing services. The regular articles and frequent special topical issues equip you with an up-to-date source defined by the need for accurate information on an ever-evolving field. Cardiovascular Drugs and Therapy is a careful and accurate guide through the maze of new products and therapies which furnishes you with the details on cardiovascular pharmacology that you will refer to time and time again.