title: Comparison between decitabine and azacitidine for the treatment of myelodysplastic syndrome: a meta-analysis with 1,392 participants.
abstract: The hypomethylating agents decitabine and azacitidine have been found to improve the outcome of patients with myelodysplastic syndrome (MDS); however, the clinical choice between them is controversial. Therefore, this meta-analysis was performed to compare the efficacy, toxicity, and survival advantage of decitabine and azacitidine in patients with MDS. Eleven trials with a total of 1392 patients with MDS (decitabine, n = 768; azacitidine, n = 624) were included for analysis. The pooled estimates of partial response, hematologic improvement, and overall response rates for azacitidine were significantly higher than for decitabine. There were no differences between these 2 drugs regarding complete response, red blood cell transfusion-independent rates, and grade 3 or 4 hematologic toxicity. When compared with best supportive care, azacitidine significantly improved overall survival (hazard ratio [HR], 0.69; 95% CI, 0.54-0.87) and time to acute myeloid leukemia transformation (HR, 0.51; 95% CI, 0.35-0.74). But these benefits were not found with decitabine. Among patients with higher risk (International Prognostic Scoring System value of 3) or older than 75 years, treatment with azacitidine was a favorable factor, whereas decitabine showed no advantage. Therefore, with higher overall response rates and better survival benefits, azacitidine is recommended as the first-line hypomethylating agent for MDS, especially in elderly patients or those with high risk.
authors.affiliation: Department of Hematology, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
authors.forename: Mixue
authors.initials: M
authors.lastname: Xie
authors.affiliation: Department of Cancer Biotherapy, Third Affiliated Hospital of the People's Liberation Army Second Military Medical University, Shanghai, China; Gene-Viral Therapy Laboratory, Third Affiliated Hospital of the People's Liberation Army Second Military Medical University, Shanghai, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Jiang
authors.affiliation: Department of Hematology, Huadong Hospital Affiliated to Fudan University, Shanghai, China. Electronic address: xyh@medmail.com.cn.
authors.forename: Yanhui
authors.initials: Y
authors.lastname: Xie
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001374:Azacitidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D057186:Comparative Effectiveness Research; D000077209:Decitabine; D006801:Humans; D009190:Myelodysplastic Syndromes / Q000188:drug therapy* / Q000401:mortality; D017594:Publication Bias; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D000077209:Decitabine; D001374:Azacitidine
keywords: Azacitidine; Decitabine; Hypomethylating agents; Meta-analysis; Myelodysplastic Syndrome