A systematic review and meta-analysis of beta-blockers and renin-angiotensin system inhibitors for preventing left ventricular dysfunction due to anthracyclines or trastuzumab in patients with breast cancer
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissionsoup.com..
AIMS: Trastuzumab and anthracyclines, often used in the treatment of breast cancer, may impair myocardial function, and reduce left ventricular ejection fraction (LVEF), potentially causing heart failure. Randomized controlled trials (RCTs) have evaluated the effects of beta-blockers (BBs), angiotensin receptor blockers (ARBs), and angiotensin-converting enzyme inhibitors (ACEI) on trastuzumab- and anthracycline-associated cardiotoxicity. We report a meta-analysis of these RCTs in patients with breast cancer.
METHODS AND RESULTS: The primary analysis was on the effect of BBs and ACEI/ARBs on LVEF in patients treated with either trastuzumab or anthracyclines. A secondary analysis was done investigating the effect of BBs or ACEI/ARBs on LVEF in trastuzumab and anthracycline treatments. Only RCTs were included using the search term 'ARBs, ACEIs, BBs, anthracyclines, trastuzumab, and breast cancer' in PubMed, Embase, and CENTRAL up to 31 March 2021. A meta-analysis was conducted to estimate the mean difference (MD) in LVEF between intervention and placebo groups at follow-up. A total of nine RCTs (n = 1362) were included in the analysis. All patients were women. BBs and ACEI/ARBs were shown to attenuate the decline in LVEF during trastuzumab and anthracycline treatments [MD: 2.4; 95% confidence interval (CI): 0.3-4.2 and MD: 1.5; 95% CI: -0.6 to 3.7]. Compared with placebo, LVEF was significantly higher in patients assigned to BB or ACEI/ARB on trastuzumab (MD: 2.3; 95% CI: 0.0-4.6) but not on anthracyclines (MD: 1.9; 95% CI: -0.5 to 4.2).
CONCLUSION: Both BB and ACEI/ARB therapies were associated with the preservation of LVEF during trastuzumab and anthracycline-containing regimens as compared with placebo, suggesting both to be beneficial.
| Errataetall: |
CommentIn: Eur Heart J. 2022 Jul 14;43(27):2570-2572. - PMID 34951626 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:43 |
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| Enthalten in: |
European heart journal - 43(2022), 27 vom: 14. Juli, Seite 2562-2569 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Lewinter, Christian [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 15.07.2022 Date Revised 16.08.2022 published: Print CommentIn: Eur Heart J. 2022 Jul 14;43(27):2570-2572. - PMID 34951626 Citation Status MEDLINE |
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| doi: |
10.1093/eurheartj/ehab843 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM334875293 |
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| 100 | 1 | |a Lewinter, Christian |e verfasserin |4 aut | |
| 245 | 1 | 2 | |a A systematic review and meta-analysis of beta-blockers and renin-angiotensin system inhibitors for preventing left ventricular dysfunction due to anthracyclines or trastuzumab in patients with breast cancer |
| 264 | 1 | |c 2022 | |
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| 500 | |a Date Completed 15.07.2022 | ||
| 500 | |a Date Revised 16.08.2022 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentIn: Eur Heart J. 2022 Jul 14;43(27):2570-2572. - PMID 34951626 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissionsoup.com. | ||
| 520 | |a AIMS: Trastuzumab and anthracyclines, often used in the treatment of breast cancer, may impair myocardial function, and reduce left ventricular ejection fraction (LVEF), potentially causing heart failure. Randomized controlled trials (RCTs) have evaluated the effects of beta-blockers (BBs), angiotensin receptor blockers (ARBs), and angiotensin-converting enzyme inhibitors (ACEI) on trastuzumab- and anthracycline-associated cardiotoxicity. We report a meta-analysis of these RCTs in patients with breast cancer | ||
| 520 | |a METHODS AND RESULTS: The primary analysis was on the effect of BBs and ACEI/ARBs on LVEF in patients treated with either trastuzumab or anthracyclines. A secondary analysis was done investigating the effect of BBs or ACEI/ARBs on LVEF in trastuzumab and anthracycline treatments. Only RCTs were included using the search term 'ARBs, ACEIs, BBs, anthracyclines, trastuzumab, and breast cancer' in PubMed, Embase, and CENTRAL up to 31 March 2021. A meta-analysis was conducted to estimate the mean difference (MD) in LVEF between intervention and placebo groups at follow-up. A total of nine RCTs (n = 1362) were included in the analysis. All patients were women. BBs and ACEI/ARBs were shown to attenuate the decline in LVEF during trastuzumab and anthracycline treatments [MD: 2.4; 95% confidence interval (CI): 0.3-4.2 and MD: 1.5; 95% CI: -0.6 to 3.7]. Compared with placebo, LVEF was significantly higher in patients assigned to BB or ACEI/ARB on trastuzumab (MD: 2.3; 95% CI: 0.0-4.6) but not on anthracyclines (MD: 1.9; 95% CI: -0.5 to 4.2) | ||
| 520 | |a CONCLUSION: Both BB and ACEI/ARB therapies were associated with the preservation of LVEF during trastuzumab and anthracycline-containing regimens as compared with placebo, suggesting both to be beneficial | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Meta-Analysis | |
| 650 | 4 | |a Systematic Review | |
| 650 | 4 | |a Angiotensin receptor blockers | |
| 650 | 4 | |a Angiotensin-converting enzyme inhibitors | |
| 650 | 4 | |a Anthracyclines | |
| 650 | 4 | |a Beta-blockers | |
| 650 | 4 | |a Breast cancer | |
| 650 | 4 | |a Cardiotoxicity | |
| 650 | 4 | |a Left ventricular ejection fraction | |
| 650 | 4 | |a Prevention | |
| 650 | 4 | |a Trastuzumab | |
| 650 | 7 | |a Adrenergic beta-Antagonists |2 NLM | |
| 650 | 7 | |a Angiotensin Receptor Antagonists |2 NLM | |
| 650 | 7 | |a Angiotensin-Converting Enzyme Inhibitors |2 NLM | |
| 650 | 7 | |a Anthracyclines |2 NLM | |
| 650 | 7 | |a Antibiotics, Antineoplastic |2 NLM | |
| 650 | 7 | |a Antihypertensive Agents |2 NLM | |
| 650 | 7 | |a Trastuzumab |2 NLM | |
| 650 | 7 | |a P188ANX8CK |2 NLM | |
| 700 | 1 | |a Nielsen, Torsten Holm |e verfasserin |4 aut | |
| 700 | 1 | |a Edfors, Lars Robert |e verfasserin |4 aut | |
| 700 | 1 | |a Linde, Cecilia |e verfasserin |4 aut | |
| 700 | 1 | |a Bland, John Martin |e verfasserin |4 aut | |
| 700 | 1 | |a LeWinter, M |e verfasserin |4 aut | |
| 700 | 1 | |a Cleland, John G F |e verfasserin |4 aut | |
| 700 | 1 | |a Køber, Lars |e verfasserin |4 aut | |
| 700 | 1 | |a Braunschweig, Frieder |e verfasserin |4 aut | |
| 700 | 1 | |a Mansson-Broberg, Agneta |e verfasserin |4 aut | |
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