Abstract：
BACKGROUND: The benefits in survivorship gained with anthracycline (ANT)-based chemotherapies for breast cancer are unfortunately mitigated for some patients by irreversible cardiotoxicity. Randomised controlled trials (RCTs) have explored multiple cardioprotection options, however, it remains unclear which drug is most effective in preserving left ventricular ejection fraction (LVEF). This study aimed to perform a systematic review and network meta-analysis, using Bayesian and frequentist approaches, of RCTs evaluating cardioprotective agents.
METHODS: Two authors searched four databases (CENTRAL, Cochrane Reviews, MEDLINE, SCOPUS), to find RCTs evaluating cardioprotective agents. Trial populations were limited to patients with breast cancer without prior ANT exposure. The primary outcome was mean LVEF change pre and post ANT dosing. Our primary analysis utilised a Bayesian approach, while our sensitivity analysis used frequentist methodology (Prospero registration number CRD42020199580).
RESULTS: From 4,007 search results, we identified 12 RCTs, with their various trial arms considered separately-nine beta-blocker (BB), two angiotensin-converting enzyme inhibitor /angiotensin receptor blockers [(AA)+BB=AABB], one AA, one spironolactone, one statin-evaluating 1,126 patients (age 50.5 years). Bayesian network meta-analysis showed no difference in LVEF preservation between AA (1.3%, 95% credible interval [-0.20, 2.9]), BB (0.77, [-0.21, 1.8]), AABB (0.84 [-1.1, 2.8]), spironolactone (0.72, [-2.3, 3.7]) or statin (0.60, [-2.4, 3.6]) when compared against placebo. However, the frequentist analysis showed benefits from using AA (mean difference, 1.32% [0.32, 2.33]) and BB (mean difference, 0.76% [0.12, 1.4]).
CONCLUSIONS: There is insufficient evidence to support prophylactic cardioprotection to prevent EF reduction. However, frequentist analysis suggested that AA or BBs provide cardioprotection. Thus, for those already on other anti-hypertensives, switching to AA or BBs could be considered.
METHODS: Two authors searched four databases (CENTRAL, Cochrane Reviews, MEDLINE, SCOPUS), to find RCTs evaluating cardioprotective agents. Trial populations were limited to patients with breast cancer without prior ANT exposure. The primary outcome was mean LVEF change pre and post ANT dosing. Our primary analysis utilised a Bayesian approach, while our sensitivity analysis used frequentist methodology (Prospero registration number CRD42020199580).
RESULTS: From 4,007 search results, we identified 12 RCTs, with their various trial arms considered separately-nine beta-blocker (BB), two angiotensin-converting enzyme inhibitor /angiotensin receptor blockers [(AA)+BB=AABB], one AA, one spironolactone, one statin-evaluating 1,126 patients (age 50.5 years). Bayesian network meta-analysis showed no difference in LVEF preservation between AA (1.3%, 95% credible interval [-0.20, 2.9]), BB (0.77, [-0.21, 1.8]), AABB (0.84 [-1.1, 2.8]), spironolactone (0.72, [-2.3, 3.7]) or statin (0.60, [-2.4, 3.6]) when compared against placebo. However, the frequentist analysis showed benefits from using AA (mean difference, 1.32% [0.32, 2.33]) and BB (mean difference, 0.76% [0.12, 1.4]).
CONCLUSIONS: There is insufficient evidence to support prophylactic cardioprotection to prevent EF reduction. However, frequentist analysis suggested that AA or BBs provide cardioprotection. Thus, for those already on other anti-hypertensives, switching to AA or BBs could be considered.
摘要：
背景：不幸的是，一些患者通过不可逆的心脏毒性减轻了蒽环类（ANT）化疗治疗乳腺癌的获益。随机对照试验（RCT）探索了多种心脏保护选择，然而,目前尚不清楚哪种药物对保留左心室射血分数(LVEF)最有效.本研究旨在进行系统综述和网络荟萃分析，使用贝叶斯和频率论方法，评估心脏保护剂的随机对照试验。
方法：两位作者搜索了四个数据库(CENTRAL，Cochrane评论,MEDLINE,SCOPUS),寻找评估心脏保护剂的随机对照试验。试验人群仅限于先前没有ANT暴露的乳腺癌患者。主要结果是ANT给药前后的平均LVEF变化。我们的主要分析使用了贝叶斯方法，而我们的敏感性分析使用了频率方法(Prospero登记号CRD42020199580)。
结果：来自4,007个搜索结果，我们确定了12个随机对照试验,他们的不同试验组分别考虑-九种β受体阻滞剂（BB），两种血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂[（AA）BB=AABB]，一个AA,一个螺内酯,1,126例患者（年龄50.5岁）。贝叶斯网络荟萃分析显示，AA之间的LVEF保存没有差异(1.3%，95%可信区间[-0.20，2.9])，BB(0.77,[-0.21,1.8]),AABB（0.84[-1.1,2.8]），与安慰剂相比，螺内酯（0.72，[-2.3，3.7]）或他汀类药物（0.60，[-2.4，3.6]）。然而,频率分析显示使用AA的好处(平均差，1.32%[0.32，2.33])和BB(平均差，0.76%[0.12，1.4]）。
结论：没有足够的证据支持预防性心脏保护以防止EF降低。然而,频率分析显示AA或BB提供心脏保护。因此，对于那些已经服用过其他抗高血压药的人来说，可以考虑切换到AA或BB。
方法：两位作者搜索了四个数据库(CENTRAL，Cochrane评论,MEDLINE,SCOPUS),寻找评估心脏保护剂的随机对照试验。试验人群仅限于先前没有ANT暴露的乳腺癌患者。主要结果是ANT给药前后的平均LVEF变化。我们的主要分析使用了贝叶斯方法，而我们的敏感性分析使用了频率方法(Prospero登记号CRD42020199580)。
结果：来自4,007个搜索结果，我们确定了12个随机对照试验,他们的不同试验组分别考虑-九种β受体阻滞剂（BB），两种血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂[（AA）BB=AABB]，一个AA,一个螺内酯,1,126例患者（年龄50.5岁）。贝叶斯网络荟萃分析显示，AA之间的LVEF保存没有差异(1.3%，95%可信区间[-0.20，2.9])，BB(0.77,[-0.21,1.8]),AABB（0.84[-1.1,2.8]），与安慰剂相比，螺内酯（0.72，[-2.3，3.7]）或他汀类药物（0.60，[-2.4，3.6]）。然而,频率分析显示使用AA的好处(平均差，1.32%[0.32，2.33])和BB(平均差，0.76%[0.12，1.4]）。
结论：没有足够的证据支持预防性心脏保护以防止EF降低。然而,频率分析显示AA或BB提供心脏保护。因此，对于那些已经服用过其他抗高血压药的人来说，可以考虑切换到AA或BB。
