Prevention and treatment of anthracycline-induced cardiotoxicity: a systematic review and network meta-analysis of randomized controlled trials
Abstract Background Anthracyclines are cornerstone chemotherapeutics, but cardiotoxicity limits their use. Objective This study aims to evaluate the efficacy of various drugs in preventing and treating anthracycline-induced cardiotoxicity (AIC). Methods We conducted an extensive search across seven...
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BMC
2025-07-01
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| Series: | Cardio-Oncology |
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| Online Access: | https://doi.org/10.1186/s40959-025-00360-3 |
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| author | Siyu Li Wenrui Li Mengfei Cheng Xiaoxiao Wang Wanyi Chen |
| author_facet | Siyu Li Wenrui Li Mengfei Cheng Xiaoxiao Wang Wanyi Chen |
| author_sort | Siyu Li |
| collection | DOAJ |
| description | Abstract Background Anthracyclines are cornerstone chemotherapeutics, but cardiotoxicity limits their use. Objective This study aims to evaluate the efficacy of various drugs in preventing and treating anthracycline-induced cardiotoxicity (AIC). Methods We conducted an extensive search across seven databases to identify randomized controlled trials (RCTs) pertinent to the prevention and treatment of AIC with medications. Subsequently, a Bayesian Model-based network meta-analysis was performed in the R 4.4.0. Results A total of 128 RCTs involving 10,431 cancer patients treated with anthracyclines and 78 drug regimens were included in this study. The network meta-analysis results showed that, compared with patients who did not receive cardioprotective drugs, those treated with Calcium Dibutyryladenosine Cyclophosphate (Mean Difference [95% Credible Interval], 8.760 [0.5917, 16.92]), Carvedilol (4.024 [0.5372, 7.656]), Carvedilol + Candesartan (7.934 [3.159, 12.91]), Compound Salvia Miltiorrhiza + Levocarnitine (9.087 [0.9160, 17.25]), Dexrazoxane (5.066 [2.589, 7.540]), Dexrazoxane + Cinobufacini (11.61 [4.590, 18.70]), Dexrazoxane + Shenqi Fuzheng (13.05 [4.640, 21.40]), Nicorandil (14.24 [5.122, 23.31]), Qiliqiangxin (11.38 [2.826, 19.91]), and Xinmai Long (6.371 [1.735, 11.02]) experienced less decrease in LVEF after chemotherapy. The SUCRA ranking results indicated that the most effective treatment option for preserving LVEF was Nicorandil (SUCRA 91.76%). Conclusion Apart from Dexrazoxane, Carvedilol, a β-blocker, also appears to show significant potential in preventing AIC. Furthermore, our results indicate that there is insufficient evidence to support the beneficial effects of statins, Sildenafil, Ivabradine, Levocarnitine, N-acetylcysteine, Glutathione, Coenzyme Q10, Vitamin E, and Vitamin C in preventing LVEF decline and exerting a positive effect on the prevention of AIC. |
| format | Article |
| id | doaj-art-84df1145bb074e1c8c26de201fc7a5ab |
| institution | Kabale University |
| issn | 2057-3804 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardio-Oncology |
| spelling | doaj-art-84df1145bb074e1c8c26de201fc7a5ab2025-08-20T03:43:37ZengBMCCardio-Oncology2057-38042025-07-0111111910.1186/s40959-025-00360-3Prevention and treatment of anthracycline-induced cardiotoxicity: a systematic review and network meta-analysis of randomized controlled trialsSiyu Li0Wenrui Li1Mengfei Cheng2Xiaoxiao Wang3Wanyi Chen4Department of Pharmacy, Chongqing University Cancer HospitalDepartment of Pharmacy, Chongqing University Cancer HospitalDepartment of Pharmacy, Chongqing University Cancer HospitalDepartment of Pharmacy, Chongqing University Cancer HospitalDepartment of Pharmacy, Chongqing University Cancer HospitalAbstract Background Anthracyclines are cornerstone chemotherapeutics, but cardiotoxicity limits their use. Objective This study aims to evaluate the efficacy of various drugs in preventing and treating anthracycline-induced cardiotoxicity (AIC). Methods We conducted an extensive search across seven databases to identify randomized controlled trials (RCTs) pertinent to the prevention and treatment of AIC with medications. Subsequently, a Bayesian Model-based network meta-analysis was performed in the R 4.4.0. Results A total of 128 RCTs involving 10,431 cancer patients treated with anthracyclines and 78 drug regimens were included in this study. The network meta-analysis results showed that, compared with patients who did not receive cardioprotective drugs, those treated with Calcium Dibutyryladenosine Cyclophosphate (Mean Difference [95% Credible Interval], 8.760 [0.5917, 16.92]), Carvedilol (4.024 [0.5372, 7.656]), Carvedilol + Candesartan (7.934 [3.159, 12.91]), Compound Salvia Miltiorrhiza + Levocarnitine (9.087 [0.9160, 17.25]), Dexrazoxane (5.066 [2.589, 7.540]), Dexrazoxane + Cinobufacini (11.61 [4.590, 18.70]), Dexrazoxane + Shenqi Fuzheng (13.05 [4.640, 21.40]), Nicorandil (14.24 [5.122, 23.31]), Qiliqiangxin (11.38 [2.826, 19.91]), and Xinmai Long (6.371 [1.735, 11.02]) experienced less decrease in LVEF after chemotherapy. The SUCRA ranking results indicated that the most effective treatment option for preserving LVEF was Nicorandil (SUCRA 91.76%). Conclusion Apart from Dexrazoxane, Carvedilol, a β-blocker, also appears to show significant potential in preventing AIC. Furthermore, our results indicate that there is insufficient evidence to support the beneficial effects of statins, Sildenafil, Ivabradine, Levocarnitine, N-acetylcysteine, Glutathione, Coenzyme Q10, Vitamin E, and Vitamin C in preventing LVEF decline and exerting a positive effect on the prevention of AIC.https://doi.org/10.1186/s40959-025-00360-3AnthracyclinesCardiotoxicityRandomized controlled trialsNetwork meta-analysisSystematic review |
| spellingShingle | Siyu Li Wenrui Li Mengfei Cheng Xiaoxiao Wang Wanyi Chen Prevention and treatment of anthracycline-induced cardiotoxicity: a systematic review and network meta-analysis of randomized controlled trials Cardio-Oncology Anthracyclines Cardiotoxicity Randomized controlled trials Network meta-analysis Systematic review |
| title | Prevention and treatment of anthracycline-induced cardiotoxicity: a systematic review and network meta-analysis of randomized controlled trials |
| title_full | Prevention and treatment of anthracycline-induced cardiotoxicity: a systematic review and network meta-analysis of randomized controlled trials |
| title_fullStr | Prevention and treatment of anthracycline-induced cardiotoxicity: a systematic review and network meta-analysis of randomized controlled trials |
| title_full_unstemmed | Prevention and treatment of anthracycline-induced cardiotoxicity: a systematic review and network meta-analysis of randomized controlled trials |
| title_short | Prevention and treatment of anthracycline-induced cardiotoxicity: a systematic review and network meta-analysis of randomized controlled trials |
| title_sort | prevention and treatment of anthracycline induced cardiotoxicity a systematic review and network meta analysis of randomized controlled trials |
| topic | Anthracyclines Cardiotoxicity Randomized controlled trials Network meta-analysis Systematic review |
| url | https://doi.org/10.1186/s40959-025-00360-3 |
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