SYSTEMATIC REVIEW article
Front. Cardiovasc. Med.
Sec. Cardio-Oncology
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1612060
Pharmacological interventions to prevent cardiotoxicity in patients undergoing anthracycline-based chemotherapy: a network meta-analysis
Provisionally accepted
- School of Nursing, Shandong First Medical University, Tai'an, China
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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 2858 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.
Keywords: Anthracyclines, Pharmacological intervention, cardiotoxicity, chemotherapy, PROSPERO registration number： CRD42024567684
Received: 17 Apr 2025; Accepted: 18 Aug 2025.
Copyright: © 2025 Liu, Ding and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Aihua Zhang, School of Nursing, Shandong First Medical University, Tai'an, China
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