Preventive role of carvedilol in adriamycin-induced cardiomyopathy

Jhorawat, Rajesh; Kumari, Savita; Varma, Subhash; Rohit, Manoj Kumar; Narula, Nidhi; Suri, Vikas; Malhotra, Pankaj; Jain, Sanjay

doi:10.4103/ijmr.ijmr_1323_14

Cited by 42 publications

(38 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…J. (2014) [25]12.5NHL, HD, ALL27 (14.8%)27 (33.3%)43.89 ± 15.6638.74 ± 18.36267.36252.6563.19 ± 7.2267.56 ± 5.986A. E. (2014) [26]12.5BC40 (100%)40 (100%)54.3 ± 9.352.9 ± 11.2535.6523.366.0 ± 6.165.0 ± 4.56M.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Protective role of beta-blockers in chemotherapy-induced cardiotoxicity—a systematic review and meta-analysis of carvedilol

et al. 2018

View full text Add to dashboard Cite

Some randomized controlled trials (RCTs) have tested the efficacy of beta-blockers as prophylactic agents on cancer therapy-induced cardiotoxicity; however, the quality of this evidence remains undetermined. This systematic review and meta-analysis study aims to evaluate the prophylactic effects of beta-blockers, especially carvedilol, on chemotherapy-induced cardiotoxicity. RCTs were identified by searching the MEDLINE (PubMed), Embase (OvidSP), Cochrane CENTRAL (OvidSP), etc., until December 2017. Inclusion criteria were randomized clinical trial and adult cancer patients started beta-blockers before chemotherapy. We evaluated the mean differences (MD) by fixed- or random-effects model and the odds ratio by Peto’s method. Primary outcome was the left ventricular ejection fraction (LVEF) of patients after chemotherapy, and secondary outcomes were all-cause mortality, clinically overt cardiotoxicity, and other echocardiographic measurements. In total, we included six RCTs that used carvedilol as a prophylactic agent in patients receiving chemotherapy. The LVEF was not significantly distinct between those using carvedilol and placebo after chemotherapy (MD, 1.74; 95% confidence interval (CI), − 0.18 to 3.66; P = 0.08). The incidence of clinically overt cardiotoxicity was lower in the carvedilol group compared with the control group (Peto OR, 0.42; 95% CI, 0.20–0.89; P = 0.02). Furthermore, after chemotherapy, the LV end-diastolic diameter did not increase in the carvedilol group compared with the placebo group (MD, − 1.41; 95% CI, − 2.32 to − 0.50; P = 0.002). The prophylactic use of carvedilol exerted no impact on the early asymptomatic LVEF decrease but seemed to attenuate the frequency of clinically overt cardiotoxicity and prevent ventricular remodeling. Electronic supplementary material The online version of this article (10.1007/s10741-018-9755-3) contains supplementary material, which is available to authorized users.

show abstract

Section: Resultsmentioning

confidence: 99%

“…K. [24]1 (4%)4 (16%)LVEF < 50%1 (4%)5 (20%)R.J. [25]6 (22%)5 (18%)LVEF < 50%1 (4%)3 (12%)A. E. [26]00Interrupted chemotherapy due to cardiotoxicity00M.…”

Section: Resultsmentioning

confidence: 99%

Protective role of beta-blockers in chemotherapy-induced cardiotoxicity—a systematic review and meta-analysis of carvedilol

et al. 2018

View full text Add to dashboard Cite

show abstract

“…The analysis included 10 studies [13][14][15][16][17][18][19][20]25,26 with 385 patients in the beta-blocker group and 384 control patients. The mean LVEF difference between the beta-blocker group and the control group was 2.57%, 95% CI (0.63-4.51), P = 0.009.…”

Section: Resultsmentioning

confidence: 99%

“…The most frequent tumour disease was breast cancer followed by haematological malignancies. Eight eligible trials assessing beta-blockers (carvedilol, nebivolol, bisoprolol, and metoprolol), [13][14][15][16][17][18][19][20] four studies assessing ACE inhibitors/ARBs (enalapril, telmisartan, candesartan, and perindopril), [21][22][23][24] and two studies assessing beta-blockers and ACE inhibitors/ARBs in parallel arms 25,26 were identified ( Table 1). The sample sizes in groups were rather low, ranging from n = 18 to n = 103.…”

Section: Resultsmentioning

confidence: 99%

“…The mean LVEF difference between the beta-blocker group and the control group was 2.57%, 95% CI (0.63-4.51), P = 0.009. The analysis included 10 studies [13][14][15][16][17][18][19][20]25,26 with 385 patients in the beta-blocker group and 384 control patients. The heterogeneity was considerable between the selected studies, as shown by an I 2 value of 86%, with P < 0.001 ( Figure 1).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Heart failure from cancer therapy: can we prevent it?

et al. 2019

View full text Add to dashboard Cite

Aims Conventional cytotoxic chemotherapy is still among the most effective treatment options for many types of cancer. However, cardiotoxicity, notably the decrease in left ventricular function under these regimens, can impair prognosis. Thus, prevention and treatment of cardiotoxicity are crucial. The present meta‐analysis aims to assess the efficacy of beta‐blockers or angiotensin‐converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs) for prevention of cardiotoxicity. Methods and results We systematically searched Pubmed, Cochrane, EMBASE, and Web of Science databases for randomized controlled trials published until February 2019. The analysis included randomized studies that reported on left ventricular ejection fraction (LVEF) after 6 months of chemotherapy in cancer patients who received beta‐blockers or ACE inhibitors/ARBs for prevention of cardiotoxicity compared with controls. Studies on combination cardioprotective therapies were excluded from the analysis. The primary endpoint was prevention of a decrease in LVEF as defined by the individual study and as assessed by either transthoracic echocardiography or magnetic resonance imaging. We here show that patients under anthracycline‐based chemotherapy have a moderate yet significant benefit in LVEF from beta‐blockers or ACEs/ARBs. The beta‐blocker analysis included 769 cancer patients, and the ACE inhibitors/ARBs analysis included a total of 581 cancer patients. The mean LVEF difference between the beta‐blocker group and the control group was 2.57% (95% confidence interval 0.63–4.51, P = 0.009). The mean difference for ACE inhibitors/ARBs was 4.71% (95% confidence interval 0.38–9.03, P = 0.03). However, the beneficial effects throughout the studies were variable as documented by significant heterogeneity between the studies. Conclusions Systematic evidence is needed to solidly found recommendations for cardioprotective prevention during chemotherapy. Likewise, trials on other neurohumoral drugs (spironolactone) and lipid‐lowering approaches are required to improve protection for cardio‐oncology patients.

show abstract

Antioxidant, antiapoptotic, and antifibrotic effects of the combination of liposomal resveratrol and carvedilol against doxorubicin‐induced cardiomyopathy in rats

Alanazi

Fadda

Alhusaini

et al. 2020

J Biochem & Molecular Tox

View full text Add to dashboard Cite

The use of the cytotoxic antibiotic doxorubicin (DOXR) is limited by its dose‐dependent cardiotoxicity. The aim of this study was to evaluate the cardioprotective effect of the combination of carvedilol (CARD) and liposomal resveratrol (LIPO RESV) against DOXR‐induced cardiomyopathy in rats. The results of the present study showed that DOXR administration significantly increased heart weight/body weight ratio by 35.6%, creatine kinase‐MB (CK‐MB) by 40.6%, troponin‐I levels by 85%, and decreased reduced glutathione level and superoxide dismutase activity by 47% and 52%, respectively compared to the control group. Moreover, cardiac caspase‐3 protein expression was upregulated by 51.6% vs the control group. In contrast, treatment of DOXR‐administered rats with CARD, RESV, or LIPO RESV and their combination for 6 weeks improved all the above‐mentioned measured parameters. In conclusion, concomitant administration of CARD and LIPO RESV exerted additive pharmacological effects in some measured parameters against DOXR‐induced cardiomyopathy and this may be a useful cardioprotective strategy.

show abstract

Preventive role of carvedilol in adriamycin-induced cardiomyopathy

Cited by 42 publications

References 19 publications

Protective role of beta-blockers in chemotherapy-induced cardiotoxicity—a systematic review and meta-analysis of carvedilol

Protective role of beta-blockers in chemotherapy-induced cardiotoxicity—a systematic review and meta-analysis of carvedilol

Heart failure from cancer therapy: can we prevent it?

Antioxidant, antiapoptotic, and antifibrotic effects of the combination of liposomal resveratrol and carvedilol against doxorubicin‐induced cardiomyopathy in rats

Contact Info

Product

Resources

About