Advertisement

Efficacy of Carvedilol in Preventing Anthracycline-induced Cardiotoxicity: A Meta-analysis of Randomized Controlled Trials

      This paper is only available as a PDF. To read, Please Download here.

      Background

      Cancer Therapeutics Related Cardiac Dysfunction (CTRCD) is a common sequelae following treatment with anthracyclines. The non-selective beta-blocker, carvedilol, has shown potential benefit as primary prophylaxis in the prevention of CTRCD through its chronotropic and antioxidant properties. In this study, we aimed to assess the efficacy of carvedilol versus placebo in preventing CTRCD.

      Methods

      Electronic databases were searched for randomized controlled trials which used carvedilol for patients who will undergo anthracycline-based chemotherapeutic regimen. Three independent reviewers assessed the quality of the eight studies based on the Cochrane Handbook for Systematic Reviews of Interventions prior to inclusion in the study. Data extracted were analyzed using Revman Version 5.3. Tests for heterogeneity was performed using the chi-square test.

      Results

      Eight randomized controlled trials with a total of 785 patients comparing carvedilol to placebo were assessed to be of good quality with low to moderate risk of bias. Results showed that patients on carvedilol had significantly higher post-treatment Left Ventricular Ejection Fraction (LVEF) (mean difference: 1.67, 95% CI: 0.89 to 2.44; p<0.01), with no dose response trend noted for the 12.5 mg dose (RR: 0.87, 95% CI: 0.43-1.73, p: 0.69) and 25 mg dose (RR: 0.85, 95% CI: 0.27-2.64, p: 0.77) compared to placebo. Patients on carvedilol had lower post-treatment end-systolic LV diameter (mean difference: -1.32, 95% CI: -2.36 to -0.28; p: 0.01), and lower end-diastolic LV diameter amongst those on higher doses (mean difference: -2.62, 95% CI: -4.66 to -0.58; p: 0.01). However, there was no statistically significant mortality difference between carvedilol and placebo (RR: 0.77, 95% CI: 0.40-1.50, p: 0.45).

      Conclusion

      Our results demonstrated that carvedilol was able to prevent post-treatment reduction of LVEF and the attenuation of chamber enlargement amongst patients who underwent anthracycline-based chemotherapy. However, it had no effect on long-term mortality.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Cardiac Failure
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect