title: Benefits and harms of erythropoiesis-stimulating agents for anemia related to cancer: a meta-analysis.
abstract: BACKGROUND
  Erythropoiesis-stimulating agents are used to treat anemia in patients with cancer. However, their safety and effectiveness is controversial. We did a systematic review of the clinical efficacy and harms of these agents in adults with anemia related to cancer or chemotherapy.
  
  
  METHODS
  We conducted a systematic review of published and unpublished randomized controlled trials (RCTs) using accepted methods for literature searches, article selection, data extraction and quality assessment. We included RCTs involving anemic adults with cancer. We compared the use of erythropoiesis-stimulating agents with nonuse and assessed clinical outcomes (all-cause mortality, cardiovascular events and hypertension, health-related quality of life, blood transfusions and tumour response) and harms (serious adverse events) between groups.
  
  
  RESULTS
  We identified 52 trials (n = 12 006) that met our selection criteria. The pooled all-cause mortality during treatment was significantly higher in the group receiving erythropoiesis-stimulating therapy than in the control group (relative risk [RR] 1.15, 95% confidence interval [CI] 1.03 to 1.29). Compared with no treatment, use of erythropoiesis-stimulating agents led to clinically detectable improvements in disease-specific measures of quality of life. It also reduced the use of blood transfusions (RR 0.64, 95% CI 0.56 to 0.73). However, it led to an increased risk of thrombotic events (RR 1.69, 95% CI 1.27 to 2.24) and serious adverse events (RR 1.16, 95% CI 1.08 to 1.25).
  
  
  CONCLUSIONS
  Use of erythropoiesis-stimulating agents in patients with cancer-related anemia improved some disease-specific measures of quality of life and decreased the use of blood transfusions. However, it increased the risk of death and serious adverse events. Our findings suggest that such therapy not be used routinely as an alternative to blood transfusion in patients with anemia related to cancer.
authors.affiliation: Department of Medicine, University of Alberta, Edmonton. mtonelli-admin@med.ualberta.ca
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.forename: Brenda
authors.initials: B
authors.lastname: Hemmelgarn
authors.forename: Tony
authors.initials: T
authors.lastname: Reiman
authors.forename: Braden
authors.initials: B
authors.lastname: Manns
authors.forename: M Neil
authors.initials: MN
authors.lastname: Reaume
authors.forename: Anita
authors.initials: A
authors.lastname: Lloyd
authors.forename: Natasha
authors.initials: N
authors.lastname: Wiebe
authors.forename: Scott
authors.initials: S
authors.lastname: Klarenbach
mesh_terms: D000740:Anemia / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001803:Blood Transfusion / Q000706:statistics & numerical data; D006397:Hematinics / Q000494:pharmacology*; D006801:Humans; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D011788:Quality of Life; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
chemical_list: D000970:Antineoplastic Agents; D006397:Hematinics