Renin-angiotensin System Antagonists and Beta-blockers in Prevention of Anthracycline Cardiotoxicity: a Systematic Review and Meta-analysis

dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorAVILA, Monica Samuel
dc.contributor.authorSIQUEIRA, Suellen Rodrigues Rangel
dc.contributor.authorWALDECK, Lucas
dc.contributor.authorAYUB-FERREIRA, Silvia Moreira
dc.contributor.authorTAKX, Richard
dc.contributor.authorBITTENCOURT, Marcio Sommer
dc.contributor.authorBOCCHI, Edimar Alcides
dc.date.accessioned2023-08-16T17:46:07Z
dc.date.available2023-08-16T17:46:07Z
dc.date.issued2023
dc.description.abstractBackground: The evidence supporting the use of renin-angiotensin-aldosterone system (RAAS) inhibitors and beta-blockers for the prevention of anthracycline-induced cardiomyopathy is controversial. Objective: We performed a meta-analysis to assess the effectiveness of these drugs in preventing cardiotoxicity. Methods: The meta-analysis included prospective, randomized studies in adults receiving anthracycline chemotherapy and compared the use of RAAS inhibitors or beta-blockers versus placebo with a follow-up of 6 to 18 months. The primary outcome was change in left ventricular ejection fraction (LVEF) during chemotherapy. Secondary outcomes were the incidence of heart failure, all-cause mortality, and changes in end-diastolic measurement. Heterogeneity was assessed by stratification and meta-regression. A significance level of p < 0.05 was adopted. Results: The search resulted in 17 studies, totaling 1,530 patients. The variation (delta) in LVEF was evaluated in 14 studies. Neurohormonal therapy was associated with a lower delta in pre- versus post-therapy LVEF (weighted mean difference 4.42 [95% confidence interval2.3 to 6.6]) and higher final LVEF (p < 0.001). Treatment resulted in a lower incidence of heart failure (risk ratio 0.45 [95% confidence interval0.3 to 0.7]). There was no effect on mortality (p = 0.3). For analysis of LVEF, substantial heterogeneity was documented, which was not explained by the variables explored in the study. Conclusion: The use of RAAS inhibitors and beta-blockers to prevent anthracycline-induced cardiotoxicity was associated with less pronounced reduction in LVEF, higher final LVEF, and lower incidence of heart failure. No changes in mortalitywere observed. (CRD PROSPERO 42019133615)eng
dc.description.abstractResumo Fundamento: As evidências que embasam o uso de inibidores do sistema-renina-angiotensina aldosterona (SRAA) e betabloqueadores para prevenção de cardiomiopatia induzida por antraciclinas são controversas. Objetivo: Realizamos uma metanálise para avaliar a eficácia desses medicamentos na prevenção da cardiotoxicidade. Métodos: A metanálise incluiu estudos prospectivos e randomizados com adultos submetidos à quimioterapia com antraciclina e comparou o uso de terapias SRAA ou betabloqueadores versus placebo com seguimento de 6 a 18 meses. O desfecho primário foi alteração da fração de ejeção do ventrículo esquerdo (FEVE) durante a quimioterapia. Os desfechos secundários foram: a incidência de insuficiência cardíaca, mortalidade por todas as causas e alterações na medida do diâmetro diastólico final. A avaliação da heterogeneidade foi realizada por estratificação e meta-regressão. O nível de significância adotado foi p < 0,05. Resultados: A busca resultou em 17 estudos, totalizando 1.530 pacientes. A variação (delta) da FEVE foi avaliada em 14 estudos. A terapia neuro-hormonal foi associada a um menor delta na FEVE pré-terapia versus pós-terapia (diferença média ponderada 4,42 [intervalo de confiança de 95% 2,3 a 6,6]) e maior FEVE final (p < 0,001). O tratamento resultou em menor incidência de insuficiência cardíaca (risk ratio 0,45 [intervalo de confiança de 95% 0,3 a 0,7]). Não houve efeito na mortalidade (p = 0,3). Para a análise da FEVE, foi documentada heterogeneidade substancial, não explicada pelas variáveis exploradas no estudo. Conclusão: O uso de inibidores do SRAA e betabloqueadores para prevenção da cardiotoxicidade induzida por antraciclinas foi associado a redução menos pronunciada da FEVE, maior FEVE final e menor incidência de insuficiência cardíaca. Não foram observadas alterações na mortalidade. (CRD PROSPERO 42019133615)
dc.description.indexMEDLINE
dc.description.indexPubMed
dc.description.indexWoS
dc.description.indexScopus
dc.description.indexScielo
dc.identifier.citationARQUIVOS BRASILEIROS DE CARDIOLOGIA, v.120, n.5, article ID e20220298, 10p, 2023
dc.identifier.doi10.36660/abc.20220298
dc.identifier.eissn1678-4170
dc.identifier.issn0066-782X
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/54619
dc.language.isoeng
dc.language.isopor
dc.publisherARQUIVOS BRASILEIROS CARDIOLOGIAeng
dc.relation.ispartofArquivos Brasileiros de Cardiologia
dc.rightsopenAccesseng
dc.rights.holderCopyright ARQUIVOS BRASILEIROS CARDIOLOGIAeng
dc.subjectDrug Therapyeng
dc.subjectHeart Failureeng
dc.subjectAngiotensin-Converting Enzyme Inhibitorseng
dc.subjectMineralocorticoideng
dc.subjectReceptor Antagonists Anthracyclineseng
dc.subjectAntagonistas de Receptores de Mineralocorticoides
dc.subjectAntraciclinas
dc.subjectInibidores da Enzima Conversora de Angiotensina
dc.subjectInsuficiência Cardíaca
dc.subjectTratamento Farmacológico
dc.subject.otherdoxorubicin-induced cardiotoxicityeng
dc.subject.othercarvediloleng
dc.subject.otherchemotherapyeng
dc.subject.othercancereng
dc.subject.otherenalaprileng
dc.subject.othertherapyeng
dc.subject.otherdysfunctioneng
dc.subject.othernebivololeng
dc.subject.otherriskeng
dc.subject.wosCardiac & Cardiovascular Systemseng
dc.titleRenin-angiotensin System Antagonists and Beta-blockers in Prevention of Anthracycline Cardiotoxicity: a Systematic Review and Meta-analysiseng
dc.title.alternativeAntagonistas do Sistema Renina-Angiotensina e Betabloqueadores na Prevenção da Cardiotoxicidade por Antraciclinas: Revisão Sistemática e Metanálise
dc.typearticleeng
dc.type.categoryrevieweng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.affiliation.countryHolanda
hcfmusp.affiliation.countryisonl
hcfmusp.author.externalSIQUEIRA, Suellen Rodrigues Rangel:Univ Sao Paulo, Dept Insuficiencia Cardiaca, Fac Med, Inst Coracao InCor Hosp Clin, Sao Paulo, SP, Brazil
hcfmusp.author.externalWALDECK, Lucas:Univ Sao Paulo, Dept Insuficiencia Cardiaca, Fac Med, Inst Coracao InCor Hosp Clin, Sao Paulo, SP, Brazil
hcfmusp.author.externalTAKX, Richard:Univ Med Ctr Utrecht, Departmento Radiol, Utrecht, Netherlands
hcfmusp.citation.scopus1
hcfmusp.contributor.author-fmusphcMONICA SAMUEL AVILA GRINBERG
hcfmusp.contributor.author-fmusphcSILVIA MOREIRA AYUB FERREIRA
hcfmusp.contributor.author-fmusphcMARCIO SOMMER BITTENCOURT
hcfmusp.contributor.author-fmusphcEDIMAR ALCIDES BOCCHI
hcfmusp.description.articlenumbere20220298
hcfmusp.description.issue5
hcfmusp.description.volume120
hcfmusp.origemWOS
hcfmusp.origem.pubmed37255127
hcfmusp.origem.scieloSCIELO:S0066-782X2023000500309
hcfmusp.origem.scopus2-s2.0-85160631032
hcfmusp.origem.wosWOS:001006804800001
hcfmusp.publisher.cityRIO DE JANEIROeng
hcfmusp.publisher.countryBRAZILeng
hcfmusp.relation.referenceAbdel-Qadir H, 2017, ANN ONCOL, V28, P628, DOI 10.1093/annonc/mdw671eng
hcfmusp.relation.referenceAbuosa AM, 2018, INDIAN HEART J, V70, pS96, DOI 10.1016/j.ihj.2018.06.011eng
hcfmusp.relation.referenceAkpek M, 2015, EUR J HEART FAIL, V17, P81, DOI 10.1002/ejhf.196eng
hcfmusp.relation.referenceAlizadehasl A, 2021, INT J CLIN PHARM-NET, V43, P25, DOI 10.1007/s11096-020-01146-6eng
hcfmusp.relation.referenceAvila MS, 2018, J AM COLL CARDIOL, V71, P2281, DOI 10.1016/j.jacc.2018.02.049eng
hcfmusp.relation.referenceBeheshti AT, 2016, CARDIOLOGY, V134, P47, DOI 10.1159/000442722eng
hcfmusp.relation.referenceBloom MW, 2016, CIRC-HEART FAIL, V9, DOI 10.1161/CIRCHEARTFAILURE.115.002661eng
hcfmusp.relation.referenceBosch X, 2013, J AM COLL CARDIOL, V61, P2355, DOI 10.1016/j.jacc.2013.02.072eng
hcfmusp.relation.referenceCardinale D, 2006, CIRCULATION, V114, P2474, DOI 10.1161/CIRCULATIONAHA.106.635144eng
hcfmusp.relation.referenceCaspani F, 2021, INTERN EMERG MED, V16, P477, DOI 10.1007/s11739-020-02508-8eng
hcfmusp.relation.referenceCochera F, 2018, CANCER MANAG RES, V10, P2071, DOI 10.2147/CMAR.S166481eng
hcfmusp.relation.referenceDessi M, 2011, EXP THER MED, V2, P1003, DOI 10.3892/etm.2011.305eng
hcfmusp.relation.referenceElitok A, 2014, CARDIOL J, V21, P509, DOI 10.5603/CJ.a2013.0150eng
hcfmusp.relation.referenceFang KF, 2021, HEART FAIL REV, V26, P101, DOI 10.1007/s10741-019-09906-xeng
hcfmusp.relation.referenceGeorgakopoulos P, 2010, AM J HEMATOL, V85, P894, DOI 10.1002/ajh.21840eng
hcfmusp.relation.referenceGhasemi K, 2021, J ONCOL PHARM PRACT, V27, P414, DOI 10.1177/1078155220965674eng
hcfmusp.relation.referenceGulati G, 2016, EUR HEART J, V37, P1671, DOI 10.1093/eurheartj/ehw022eng
hcfmusp.relation.referenceHiggins JPT, 2011, BMJ-BRIT MED J, V343, DOI 10.1136/bmj.d5928eng
hcfmusp.relation.referenceHuang S, 2019, HEART FAIL REV, V24, P325, DOI 10.1007/s10741-018-9755-3eng
hcfmusp.relation.referenceJanbabai G, 2017, CARDIOVASC TOXICOL, V17, P130, DOI 10.1007/s12012-016-9365-zeng
hcfmusp.relation.referenceJhorawat R, 2016, INDIAN J MED RES, V144, P724, DOI 10.4103/ijmr.IJMR_1323_14eng
hcfmusp.relation.referenceKalam K, 2013, EUR J CANCER, V49, P2900, DOI 10.1016/j.ejca.2013.04.030eng
hcfmusp.relation.referenceKalay N, 2006, J AM COLL CARDIOL, V48, P2258, DOI 10.1016/j.jacc.2006.07.052eng
hcfmusp.relation.referenceKaya MG, 2013, INT J CARDIOL, V167, P2306, DOI 10.1016/j.ijcard.2012.06.023eng
hcfmusp.relation.referenceKheiri B, 2018, AM J CARDIOL, V122, P1960, DOI 10.1016/j.amjcard.2018.08.039eng
hcfmusp.relation.referenceLi XY, 2020, PHARMACOL RES, V151, DOI 10.1016/j.phrs.2019.104577eng
hcfmusp.relation.referenceLin H, 2021, CARDIOLOGY, V146, P469, DOI 10.1159/000512848eng
hcfmusp.relation.referenceZamorano JL, 2016, KARDIOL POL, V74, P1193, DOI 10.5603/KP.2016.0156eng
hcfmusp.relation.referenceMa YX, 2019, BMC PHARMACOL TOXICO, V20, DOI 10.1186/s40360-019-0298-6eng
hcfmusp.relation.referenceMiller KD, 2019, CA-CANCER J CLIN, V69, P363, DOI 10.3322/caac.21565eng
hcfmusp.relation.referenceNabati M, 2017, J CARDIOVASC PHARM, V69, P279, DOI 10.1097/FJC.0000000000000470eng
hcfmusp.relation.referencePage MJ, 2022, REV PANAM SALUD PUBL, V46, DOI [10.1136/bmj.n160, 10.26633/RPSP.2022.112]eng
hcfmusp.relation.referenceSalehi Rezvanie, 2011, Am Heart Hosp J, V9, P95eng
hcfmusp.relation.referenceSung H, 2021, CA-CANCER J CLIN, V71, P209, DOI 10.3322/caac.21660eng
hcfmusp.relation.referenceVaduganathan M, 2019, JACC-CARDIOONCOL, V1, P54, DOI 10.1016/j.jaccao.2019.08.006eng
hcfmusp.relation.referencevan Dalen EC, 2008, COCHRANE DB SYST REV, DOI 10.1002/14651858.CD003917.pub3eng
hcfmusp.relation.referenceXu LY, 2020, CARDIOVASC TOXICOL, V20, P11, DOI 10.1007/s12012-019-09558-1eng
hcfmusp.relation.referenceZhan T, 2020, HERZ, V45, P1, DOI 10.1007/s00059-018-4779-yeng
hcfmusp.scopus.lastupdate2024-06-16
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