Key result
Nicorandil, dexrazoxane, and carvedilol prevent anthracycline-induced LVEF decline, with nicorandil preserving ~14% LVEF versus control.
Why the study?
Anthracyclines are cornerstone chemotherapeutics, but their use is limited by cardiotoxicity.
Do cardioprotective drugs prevent LVEF decline and anthracycline-induced cardiotoxicity in cancer patients receiving anthracyclines?
Meta-Analysis (n=10,431)
Do cardioprotective drugs prevent LVEF decline and anthracycline-induced cardiotoxicity in cancer patients receiving anthracyclines?
Effect estimate: MD 14.24 (95% CI 5.122, 23.31)
Carvedilol and dexrazoxane, along with certain Chinese patent medicines and nicorandil, show significant potential in preventing anthracycline-induced LVEF decline, whereas evidence for statins and vitamins remains insufficient.
Supports use of nicorandil, dexrazoxane, or carvedilol to preserve LVEF with anthracyclines; extends trial evidence via network meta-analysis.
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.
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Li et al. (2025) conducted a meta-analysis in Anthracycline-induced cardiotoxicity (n=10,431). Cardioprotective drugs (e.g., Nicorandil, Dexrazoxane, Carvedilol) vs. Placebo or no treatment was evaluated on Decrease in left ventricular ejection fraction (LVEF) after chemotherapy (MD 14.24, 95% CI 5.122, 23.31). Nicorandil (MD 14.24), Dexrazoxane (MD 5.066), and Carvedilol (MD 4.024) significantly prevented the decline of left ventricular ejection fraction compared to no cardioprotective treatment in patients receiving anthracyclines.
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