What type of study is this?

This is a Network Meta-analysis study (also classified as: RCT).

September 10, 2025Open Access

Pharmacological interventions to prevent cardiotoxicity in patients undergoing anthracycline-based chemotherapy: a network meta-analysis

XLXiaoyu LiuShanghai Ninth People's Hospital RDRan DingNorth China University of Science and Technology AZAihua ZhangQingdao University

Key Points

Spironolactone significantly improved left ventricular ejection fraction, enhancing cardiac function during chemotherapy.
Of the 28 randomized controlled trials analyzed, Dexrazoxane reduced the occurrence of cardiac events by 72%.
A comprehensive network meta-analysis was performed, evaluating several therapies aimed at reducing chemotherapy-induced cardiotoxicity.
These findings support the inclusion of cardioprotective agents in treatment regimens to minimize heart-related side effects.

Abstract

Background This study evaluates the efficacy of various pharmacological therapies in mitigating the cardiotoxicity associated with anthracycline chemotherapy and furnishes contemporary, evidence-based guidelines and recommendations for clinical practice. Methods We searched the EMBASE, Cochrane Library, PubMed, Web of Science, and Scopus databases from the beginning of each database to April 2024 and were limited to English-language documents. The primary objective of this study is to assess the efficacy of cardioprotective drugs in preventing the reduction of left ventricular ejection fraction (LVEF) and the incidence of cardiac events. The secondary objective is to evaluate the impact of these drugs on reducing left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic diameter (LVEDD), as well as on maintaining the ratio of peak mitral annular diastolic velocity to atrial contraction velocity (E/A ratio). Results 54,852 studies were retrieved from five databases, and 28 randomized controlled trials involving 2,858 patients were finally included. Network Meta-analysis results showed that, compared to the control group, Spironolactone demonstrated the most significant improvement in (LVEF MD = 12.10, 95% CI (7.50, 16.70) and LVESD MD = −5.00, 95% CI (−7.68, −2.32). For reducing cardiac events, Dexrazoxane OR = 0.28, 95% CI (0.16, 0.50) and Vitamin E combined with Levocarnitine OR = 0.27, 95% CI (0.08, 0.90) were the most effective interventions. In terms of diastolic function (E/A ratio), Nebivolol outperformed other β-blockers MD = 0.23, 95% CI (0.09, 0.37). However, no intervention demonstrated a statistically significant effect on LVEDD. Conclusion According to the research findings, Spironolactone and Dexrazoxane significantly prevent the decline in LVEF and the occurrence of cardiac events compared to placebo or conventional chemotherapy, with statistical significance. This discovery provides valuable reference for the clinical prevention of anthracycline chemotherapy-induced cardiotoxicity, contributing to the optimization of treatment regimens, reduction of cardiac toxicity risks in patients, and improvement of prognosis. Systematic Review Registration PROSPERO (CRD42024567684).

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