目的:心血管不良事件(CVAEs)是第一代Bruton酪氨酸激酶抑制剂(BTKis)的常见不良反应,严重限制了其使用。这导致了第二代BTKis-acalabrutinib和zanubrutinib的开发,它们更具选择性,强力,并推测其安全性优于前一组药物。然而,在临床实践中,有与第二代BTKis相关的CVAE的零星报道.为了解决这个问题,进行了综合荟萃分析,以汇集记录的CVAE,包括大出血,任何出血,房室传导阻滞,心房颤动/扑动,心包积液,心包炎,心力衰竭,心脏骤停,心肌梗塞,高血压,低血压,和中风。这项荟萃分析纳入了8项研究。其中,6个是III期试验,2个是II期试验。这些研究总共招募了2938名患者。
方法:多个数据库,包括PubMed,MEDLINE,科克伦图书馆,Scopus,和EMBASE,从开始到2023年1月14日,系统搜索相关临床试验。使用的效果指标是比值比(OR)和95%CI。
结果:在初始数据库搜索期间确定的总共1774项研究中,8例纳入荟萃分析。两组的总死亡率和心血管死亡率具有可比性。心血管死亡率无显著差异(OR=0.36;95%CI,0.08-1.65;n=2588;I2=45%;P=0.19)。全因死亡率也有类似的结果(OR=0.85;95%CI,0.67-1.07),任何出血(OR=1.90;95%CI,0.88-4.09),大出血(OR=1.07;95%CI,0.65-1.76),房室传导阻滞(OR=0.74;95%CI,0.15-3.68),心房颤动/扑动(OR=0.74;95%CI,0.37-1.50),以及与第二代BTKis相关的其他CVAE。
结论:根据现有证据,在安全性方面,与标准治疗相比,第二代BTKis并无更差的心血管结局或优越性的迹象.然而,需要更多的大规模对照试验来为新一代BTKis的优异耐受性提供有力支持.
Cardiovascular adverse events (CVAEs) are common adverse effects of first-generation Bruton tyrosine kinase inhibitors (BTKis) and limit their use considerably. This led to the development of second-generation BTKis-acalabrutinib and
zanubrutinib-which are more selective, potent, and presumed to have better safety profiles than the previous group of medications. However, there have been sporadic reports of CVAEs associated with second-generation BTKis in clinical practice. To address this issue, a comprehensive meta-analysis to pool the documented CVAEs was performed, including major hemorrhage, any bleeding, atrioventricular block, atrial fibrillation/flutter, pericardial effusion, pericarditis, heart failure, cardiac arrest, myocardial infarction, hypertension, hypotension, and stroke. This meta-analysis incorporated 8 studies. Among these, 6 were Phase III trials and 2 were Phase II trials. These studies collectively enrolled a total of 2938 patients.
Multiple databases, including PubMed, MEDLINE, Cochrane Library, Scopus, and EMBASE, were systematically searched for relevant clinical trials from inception through January 14, 2023. The effect measure used was odds ratio (OR) and 95% CI.
Of a total of 1774 studies identified during the initial database search, 8 were included in the meta-analysis. The incidence of overall and cardiovascular mortality was comparable between the 2 groups. There were no significant differences observed for cardiovascular mortality (OR = 0.36; 95% CI, 0.08-1.65; n = 2588; I2 = 45%; P = 0.19). Similar results were found for all-cause mortality (OR = 0.85; 95% CI, 0.67-1.07), any bleeding (OR = 1.90; 95% CI, 0.88-4.09), major bleeding (OR = 1.07; 95% CI, 0.65-1.76), atrioventricular block (OR = 0.74; 95% CI, 0.15-3.68), atrial fibrillation/flutter (OR = 0.74; 95% CI, 0.37-1.50), and other CVAEs associated with second-generation BTKis.
Based on the available evidence, there is no indication of worse cardiovascular outcomes or superiority of second-generation BTKis compared with standard treatments in terms of safety profile. However, additional large-scale controlled trials are needed to provide robust support for the superior tolerability of new-generation BTKis.