Efficacy and Safety of Traditional Chinese Medicine Combined with Dexrazoxane on Cardiotoxicity-induced Anthracyclines-based Chemotherapy: A Meta-Analysis

Abstract

Background: Traditional Chinese Medicine (TCM) has been used in the treatment of anthracycline (ANTs)-induced cardiotoxicity. This meta-analysis aims to evaluate systematically the efficacy and safety of TCM combined with dexrazoxane (DRZ) on cardiotoxicity caused by ANTs.Materials and Methods: Retrieval of the China National Knowledge Infrastructure (CNKI), WAN FANG DATA, Chinese Biomedical Database (CBM), Cochrane Library, and PubMed was conducted through various methods. The meta-analysis was registered on PROSPERO (Registration ID: CRD42023435324). A randomized controlled trial (RCT) of TCM in combination with DRZ to avert cardiotoxicity caused by ANTs was compiled. The efficacy and safety of TCM Combined with DRZ, the cardiotoxicity induced by ANTs was synthesized and discussed, along with the outcomes of cardiac troponin T (cTnT), cardiac troponin I (cTnI), brain natriuretic peptide (BNP), creatine kinase isoenzymes (CK-MB), creatine kinase (CK), left ventricular ejection fraction (LVEF), electrocardiogram (ECG) abnormalities, and the incidence of adverse reactions. RevMan 5.3 was used for meta-analysis.Results: A total of 10 RCTs with 746 patients were included. The pooled results showed that TCM combined with DRZ treatment decreased significantly the incidence of ECG abnormalities (RR = 0.47, 95% CI [0.32,0.70], p = 0.0001), the level of cTnT (MD = −7.16, 95% CI [−8.31, −6.02], p<0.001), CK (MD = −14.94, 95% CI [−22.91, −6.97], p<0.001), cTnI (MD = −0.10, 95% CI [−0.14, −0.06], p<0.001), BNP (MD = −33.66, 95% CI [−36.95, −30.37], p<0.001), CK-MB (MD = −5.93, 95% CI [−8.16, −3.70], p<0.001). However, there was no significant change in LVEF in the experimental group compared with the control group (MD = 4.81, 95% CI [−02.99, 12.21], p = 0.23). Moreover, adverse events have no significant difference between the two groups as well (RR = 0.60, 95% CI [0.31, 1.15], p = 0.13).Conclusion: This meta-analysis revealed TCM combined with DRZ appears to be able to improve the efficacy of cardiotoxicity caused by ANTs, but the included studies were of poor quality, and high-quality RCTs would be preferred for future studies.

Keywords: Traditional Chinese Medicine (TCM); dexrazoxane (DRZ); anthracycline (ANTs); cardiotoxicity; meta-analysis