Meta-Analysis: Benefits and Risks of Erythropoiesis-Stimulating Agents
Tonelli M, Hemmelgarn B, Reiman T, et al. Benefits and harms of erythropoiesis-stimulating agents for anemia related to cancer: a meta-analysis. CMAJ. 2009 May 26;180(11):E62-71. PMCID: PMC2683210.
Noting "a striking lack of data to support Health Canada’s labels and the American Society of Clinical Oncology’s guidelines for the use of erythropoiesis-stimulating agents in people with cancer-related anemia," researchers from the University of Alberta and other Canadian centers undertook a systematic review of the benefits and risks of these controversial agents in adult patients with anemia related to cancer or chemotherapy.
The researchers analyzed 52 clinical trials including more than 12,000 patients receiving treatment for various solid tumors and hematologic malignancies. Measures of benefit included health-related quality of life and use of blood transfusions; measures of risk included all-cause mortality, cardiovascular events and hypertension, and other adverse events.
Their conclusion:
"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."
The authors found no evidence that use of erythropoiesis-stimulating agents affected the risk of cardiovascular events, but did find a borderline increase in the risk of hypertension.
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