Protective effects of sacubitril/valsartan in anthracyclines-induced cardiotoxicity: A Systematic Review and Meta-Analysis

Background One of the adverse effects of anthracycline use is cardiotoxicity manifested as heart failure. The benefit of sacubitril/valsartan in patients with heart failure of ischemic origin has been demonstrated, but not due to toxicity. Our objective was to determine if there are protective effects of the use of sacubitril/valsartan in cardiotoxicity induced by anthracyclines. Methods A bibliographic search was carried out in PubMed, Cochrane Library, LILACS, Scopus, EBSCO and Google Scholar. A systematic review and meta-analysis was performed to assess mean differences (MD) with 95% confidence intervals following the PRISMA Statement. Results 558 published articles were found, of which three were submitted to analysis, with a total sample of 69 patients. With the use of sacubitril/valsartan there was an increase in the percentage of left ventricular ejection fraction (LVEF) [MD 6.78% (p < 0.001)], an increase in the percentage of global longitudinal strain of the left ventricle (LV-GLS) [MD 3.37 % (p < 0.001)], and decreased serum levels of NT-proBNP [MD −1003.64 pg/mL (p < 0.001)]; in addition, there was an increase in the distance traveled with the use of sacubitril/valsartan [MD 95.23 meters (p < 0.001)] compared to their baseline values, respectively. Conclusions This meta-analysis suggests that there is a benefit from the use of sacubitril/valsartan in patients with heart failure related to the use of anthracyclines on ventricular remodeling and functional capacity. This is the first meta-analysis to our knowledge evaluating this effect. Randomized double-blind placebo-controlled clinical trials are required to confirm these findings.