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Prevention and treatment of anthracycline-induced cardiotoxicity: a systematic review and network meta-analysis of randomized controlled trials.

  • 2025-07-10
  • Cardio-oncology (London, England) 11(1)
    • Siyu Li
    • Wenrui Li
    • Mengfei Cheng
    • Xiaoxiao Wang
    • Wanyi Chen

Study Design

Type
Review
Sample size
n = 128
Population
10,431 cancer patients treated with anthracyclines and 78 drug regimens
Methods
Bayesian Model-based network meta-analysis of 128 RCTs identified from seven databases

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.

Research Insights

  • Glutathione→Reduced Left Ventricular Ejection Fraction Decline

    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.

    Effect
    Neutral
    Effect size
    Small
  • L-Carnitine→Reduced Left Ventricular Ejection Fraction Decline

    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.

    Effect
    Neutral
    Effect size
    Small
  • N-Acetyl Cysteine→Reduced Left Ventricular Ejection Fraction Decline

    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.

    Effect
    Neutral
    Effect size
    Small
  • Vitamin C→Reduced Left Ventricular Ejection Fraction Decline

    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.

    Effect
    Neutral
    Effect size
    Small
  • Vitamin E→Reduced Left Ventricular Ejection Fraction Decline

    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.

    Effect
    Neutral
    Effect size
    Small
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