title: Recombinant human erythropoietins and cancer patients: updated meta-analysis of 57 studies including 9353 patients.
abstract: This is an updated systematic review of 57 trials and 9353 cancer patients from articles, abstracts, and reports published between January 1, 1985, and April 30, 2005, on the effects of epoetin alfa and beta (i.e., epoetin) and darbepoetin alfa (i.e., darbepoetin). We included randomized controlled trials comparing epoetin or darbepoetin plus red blood cell transfusion with red blood cell transfusion alone for prophylaxis or treatment of anemia in cancer patients with or without concurrent antineoplastic therapy. The Cochrane Library, MEDLINE, EMBASE, and conference proceedings were searched. Effect estimates and 95% confidence intervals (CIs) were calculated with fixed-effects models. Treatment with epoetin or darbepoetin statistically significantly reduced the risk for red blood cell transfusions (relative risk [RR] = 0.64, 95% CI = 0.60 to 0.68; 42 trials and 6510 patients) and improved hematologic response (RR = 3.43, 95% CI = 3.07 to 3.84; 22 trials and 4307 patients). Treatment with epoetin or darbepoetin increased the risk of thrombo-embolic events (RR = 1.67, 95% CI = 1.35 to 2.06; 35 trials and 6769 patients). Uncertainties remain as to whether and how epoetin or darbepoetin affects overall survival (hazard ratio = 1.08, 95% CI = 0.99 to 1.18; 42 trials and 8167 patients). Caution is advised when using epoetin or darbepoetin in combination with thrombogenic chemotherapeutic agents or for cancer patients who are at high risk for thrombo-embolic events.
authors.affiliation: Department of Internal Medicine I, University of Cologne, Germany. julia.bohlius@uk-koeln.de
authors.forename: Julia
authors.initials: J
authors.lastname: Bohlius
authors.forename: Jayne
authors.initials: J
authors.lastname: Wilson
authors.forename: Jerome
authors.initials: J
authors.lastname: Seidenfeld
authors.forename: Margaret
authors.initials: M
authors.lastname: Piper
authors.forename: Guido
authors.initials: G
authors.lastname: Schwarzer
authors.forename: Josie
authors.initials: J
authors.lastname: Sandercock
authors.forename: Sven
authors.initials: S
authors.lastname: Trelle
authors.forename: Olaf
authors.initials: O
authors.lastname: Weingart
authors.forename: Sue
authors.initials: S
authors.lastname: Bayliss
authors.forename: Benjamin
authors.initials: B
authors.lastname: Djulbegovic
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
authors.forename: Simon
authors.initials: S
authors.lastname: Langensiepen
authors.forename: Chris
authors.initials: C
authors.lastname: Hyde
authors.forename: Andreas
authors.initials: A
authors.lastname: Engert
mesh_terms: D000747:Anemia, Hypochromic / Q000139:chemically induced / Q000188:drug therapy* / Q000517:prevention & control* / Q000628:therapy; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000068256:Darbepoetin alfa; D000068817:Epoetin Alfa; D017707:Erythrocyte Transfusion; D004921:Erythropoietin / Q000031:analogs & derivatives / Q000627:therapeutic use*; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D009369:Neoplasms / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins; D012107:Research Design; D018570:Risk Assessment; D013923:Thromboembolism / Q000139:chemically induced* / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D000068817:Epoetin Alfa