Pharmacologic prevention of cardiotoxicity in breast cancer: a Bayesian network meta-analysis and meta-regression.
15 affiliations
- 1Department of Internal Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq.
- 2Department of Internal Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
- 3Department of Internal Medicine, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh.
- 4Department of Internal Medicine, Peoples University of Medical and Health Sciences for Women, Nawabshah, Pakistan.
- 5Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan.
- 6Department of Internal Medicine, University of Tripoli Faculty of Medicine, Tripoli, Libya.
- 7Department of Internal Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
- 8Department of Internal Medicine, Maritime Hospital, Byblos, Lebanon.
- 9Department of Internal Medicine, Mamata Medical College, Khammam, India.
- 10Department of Cardiology, Camden Clark Medical Center, West Virginia University, Parkersburg, WV, USA.
- 11Department of Internal Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt.
- 12Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA.
- 13Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- 14Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA. [email protected].
- 15Division of Cardiology, University of Texas Medical Branch, 301 University Blvd. 5.106 John Sealy Annex, Galveston, TX, 77555-0553, USA. [email protected].
Abstract
Background
Cancer therapy related cardiac dysfunction (CTRCD) is a major concern in breast cancer patients, often reducing left ventricular ejection fraction (LVEF) and causing symptomatic heart failure. This study assessed the comparative effectiveness and safety of cardioprotective drugs in preserving LVEF during chemotherapy.Methods
Our database search, included Cochrane, PubMed, WOS, and SCOPUS, from inception to May 1st, 2024, to find randomized controlled trials (RCTs) that assessed the effectiveness and safety of cardioprotective drugs in breast cancer patients undergoing chemotherapy. Bayesian network meta-analysis and meta-regression were performed using the BUGSnet package in R studio version 4.4.2, applying a random-effects model, and mean differences (MD) with 95% credible intervals (CrI) were calculated.Results
Eighteen RCTs involving 2,223 patients, met the inclusion criteria. Participants had a mean age was 48.78 (SD: 9.7). Spironolactone provided the greatest improvement in LVEF compared to placebo MD: 12.80; 95% CrI: 5.99 to 19.60, with the highest SUCRA value (97.84). Nebivolol ranked second (MD: 7.30; 95% CrI: 0.34 to 14.25; SUCRA: 81.67), while lisinopril + bisoprolol showed modest benefit (MD: 5.25; 95% CrI: -1.57 to 12.06; SUCRA: 69.43). Other agents, including rosuvastatin, bisoprolol, and candesartan, had variable effects with wide CrIs, and carvedilol and metoprolol showed limited efficacy. Model diagnostics confirmed stable convergence, good model fit, and no significant inconsistency across comparisons. Covariate-adjusted effect size from Bayesian network meta-regression identified hypertension prevalence and sample size as significant positive modifiers of treatment effect. Sensitivity analyses using a leave-one-out approach confirmed the robustness of the findings.Conclusion
Spironolactone and nebivolol are promising candidates for preserving LVEF in breast cancer patients undergoing cardiotoxic chemotherapy, while metoprolol showed minimal benefit. However, further studies with larger sample sizes and longer follow-up are essential to validate these results and assess long-term clinical outcomes.
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BibTeX
@article{alshammari2026pharmacologic,
title = {{Pharmacologic prevention of cardiotoxicity in breast cancer: a Bayesian network meta-analysis and meta-regression.}},
author = {Ali Saad Al-Shammari and Ahmed Ibrahim and M Rafiqul Islam and Ahmed Sermed Al Sakini and Pakeezah Tabasum and Rubab Zahra and Naiela E Almansouri and Hadeel Aboueisha and Hiba Hamdar and Uzair Iqbal and Shanmukh Lingamsetty and Yasar Sattar and Mohamed Abuelazm and Mohanad Albayyaa and Abdelrahman Ali and Cezar Iliescu and Haider Al-Taii and Wissam Khalife},
journal = {Cardio-oncology (London, England)},
year = {2026},
month = aug,
doi = {10.1186/s40959-026-00515-w},
url = {https://europepmc.org/article/MED/42958440},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Pharmacologic prevention of cardiotoxicity in breast cancer: a Bayesian network meta-analysis and meta-regression.
AU - Ali Saad Al-Shammari
AU - Ahmed Ibrahim
AU - M Rafiqul Islam
AU - Ahmed Sermed Al Sakini
AU - Pakeezah Tabasum
AU - Rubab Zahra
AU - Naiela E Almansouri
AU - Hadeel Aboueisha
AU - Hiba Hamdar
AU - Uzair Iqbal
AU - Shanmukh Lingamsetty
AU - Yasar Sattar
AU - Mohamed Abuelazm
AU - Mohanad Albayyaa
AU - Abdelrahman Ali
AU - Cezar Iliescu
AU - Haider Al-Taii
AU - Wissam Khalife
PY - 2026
DA - 2026/08/03
JO - Cardio-oncology (London, England)
DO - 10.1186/s40959-026-00515-w
UR - https://europepmc.org/article/MED/42958440
AB - Background Cancer therapy related cardiac dysfunction (CTRCD) is a major concern in breast cancer patients, often reducing left ventricular ejection fraction (LVEF) and causing symptomatic heart failure. This study assessed the comparative effectiveness and safety of cardioprotective drugs in preserving LVEF during chemotherapy.Methods Our database search, included Cochrane, PubMed, WOS, and SCOPUS, from inception to May 1st, 2024, to find randomized controlled trials (RCTs) that assessed the effectiveness and safety of cardioprotective drugs in breast cancer patients undergoing chemotherapy. Bayesian network meta-analysis and meta-regression were performed using the BUGSnet package in R studio version 4.4.2, applying a random-effects model, and mean differences (MD) with 95% credible intervals (CrI) were calculated.Results Eighteen RCTs involving 2,223 patients, met the inclusion criteria. Participants had a mean age was 48.78 (SD: 9.7). Spironolactone provided the greatest improvement in LVEF compared to placebo MD: 12.80; 95% CrI: 5.99 to 19.60, with the highest SUCRA value (97.84). Nebivolol ranked second (MD: 7.30; 95% CrI: 0.34 to 14.25; SUCRA: 81.67), while lisinopril + bisoprolol showed modest benefit (MD: 5.25; 95% CrI: -1.57 to 12.06; SUCRA: 69.43). Other agents, including rosuvastatin, bisoprolol, and candesartan, had variable effects with wide CrIs, and carvedilol and metoprolol showed limited efficacy. Model diagnostics confirmed stable convergence, good model fit, and no significant inconsistency across comparisons. Covariate-adjusted effect size from Bayesian network meta-regression identified hypertension prevalence and sample size as significant positive modifiers of treatment effect. Sensitivity analyses using a leave-one-out approach confirmed the robustness of the findings.Conclusion Spironolactone and nebivolol are promising candidates for preserving LVEF in breast cancer patients undergoing cardiotoxic chemotherapy, while metoprolol showed minimal benefit. However, further studies with larger sample sizes and longer follow-up are essential to validate these results and assess long-term clinical outcomes.
SN - 2057-3804
ER -