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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Recombinant human erythropoiesis-stimulating agents and mortality in patients with cancer: a meta-analysis of randomised trials
The Lancet, Volume 373, No. 9674, Year 2009
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Description
Background: Erythropoiesis-stimulating agents reduce anaemia in patients with cancer and could improve their quality of life, but these drugs might increase mortality. We therefore did a meta-analysis of randomised controlled trials in which these drugs plus red blood cell transfusions were compared with transfusion alone for prophylaxis or treatment of anaemia in patients with cancer. Methods: Data for patients treated with epoetin alfa, epoetin beta, or darbepoetin alfa were obtained and analysed by independent statisticians using fixed-effects and random-effects meta-analysis. Analyses were by intention to treat. Primary endpoints were mortality during the active study period and overall survival during the longest available follow-up, irrespective of anticancer treatment, and in patients given chemotherapy. Tests for interactions were used to identify differences in effects of erythropoiesis-stimulating agents on mortality across prespecified subgroups. Findings: Data from a total of 13 933 patients with cancer in 53 trials were analysed. 1530 patients died during the active study period and 4993 overall. Erythropoiesis-stimulating agents increased mortality during the active study period (combined hazard ratio [cHR] 1·17, 95% CI 1·06-1·30) and worsened overall survival (1·06, 1·00-1·12), with little heterogeneity between trials (I2 0%, p=0·87 for mortality during the active study period, and I2 7·1%, p=0·33 for overall survival). 10 441 patients on chemotherapy were enrolled in 38 trials. The cHR for mortality during the active study period was 1·10 (0·98-1·24), and 1·04 (0·97-1·11) for overall survival. There was little evidence for a difference between trials of patients given different anticancer treatments (p for interaction=0·42). Interpretation: Treatment with erythropoiesis-stimulating agents in patients with cancer increased mortality during active study periods and worsened overall survival. The increased risk of death associated with treatment with these drugs should be balanced against their benefits. Funding: German Federal Ministry of Education and Research, Medical Faculty of University of Cologne, and Oncosuisse (Switzerland). © 2009 Elsevier Ltd. All rights reserved.
Authors & Co-Authors
Bohlius, Julia
Switzerland, Bern
University of Bern
Schmidlin, Kurt
Switzerland, Bern
University of Bern
Trelle, Sven
Switzerland, Bern
University of Bern
Switzerland, Bern
University Hospital Bern
Zwahlen, Marcel
Switzerland, Bern
University of Bern
Switzerland, Bern
University Hospital Bern
Clarke, Michael J.
United Kingdom, Royston
National Institute for Health and Care Research
Ireland, Dublin
Trinity College Dublin
Piper, Margaret A.
Unknown Affiliation
Rades, Dirk
Germany, Lubeck
Universitätsklinikum Schleswig-holstein Campus Lübeck
Djulbegović, Benjamin J.
United States, Tampa
University of South Florida, Tampa
United States, Tampa
Moffitt Cancer Center
Fey, Martin F.
Switzerland, Bern
University Hospital Bern
Ray-Coquard, Isabelle Laure
France, Lyon
Le Centre Régional de Lutte Contre le Cancer Léon Bérard
MacHtay, Mitchell X.
Unknown Affiliation
Möbus, Volker J.
Unknown Affiliation
Thomas, Gillian Monica
Unknown Affiliation
Untch, Michael M.
Unknown Affiliation
Schumacher, Martin C.
Germany, Freiburg Im Breisgau
Universitätsklinikum Freiburg
Egger, Matthias
Switzerland, Bern
University of Bern
Engert, Andreas
Germany, Koln
Uniklinik Köln
Statistics
Citations: 511
Authors: 17
Affiliations: 12
Identifiers
Doi:
10.1016/S0140-6736(09)60502-X
ISSN:
01406736
Research Areas
Cancer
Disability
Environmental
Genetics And Genomics
Study Design
Randomised Control Trial
Cohort Study
Study Approach
Systematic review