Efficacy and safety of demethylation drugs in treatment of myelodysplastic syndrome: a Meta-analysis / 白血病·淋巴瘤

ABSTRACT

Objective:To systematically evaluate the efficacy and safety of demethylation drugs intreatment of myelodysplastic syndrome (MDS), and to provide reliable basis and guidance for clinical application of these drugs.Methods:The randomized controlled trials (RCT) of demethylation drugs for treatment of MDS published in the PubMed, Web of Science, Embase, Cochrane Library, Chinese Journal Full-text Database (CNKI), Chinese Biomedical Literature Database (CBM) and VIP database from January 2000 to December 2019 were searched by computer. RevMan 5.3 software was used for Meta-analysis of the efficacy and safety.Results:Seven RCT studies involving 1 172 patients were obtained. Meta-analysis showed that the complete remission rate ( OR = 6.26, 95% CI 1.74-22.49, P = 0.005), partial remission rate ( OR = 4.65, 95% CI 1.51-14.29, P = 0.007), overall response rate ( OR = 14.14, 95% CI 7.27-27.51, P < 0.01), hematology improves ( OR = 3.47, 95% CI 1.44-8.32, P = 0.005) in the demethylation drug treatment group were better than those in the best supportive treatment group. Meanwhile, the overall survival of patients in azacytidine group was improved ( HR = 0.62, 95% CI 0.50-0.77, P < 0.01). In terms of adverse reactions, demethylation drugs increased the incidence of neutropenic fever ( OR = 4.19, 95% CI 2.26-7.76, P < 0.01). However, there was no significant difference in the incidence of neutropenia, thrombocytopenia, anemia, infection, nausea, liver damage and fatigue between the two groups (all P > 0.05). Conclusions:The effect of demethylation drugs in treatment of MDS is obvious, the remission rate can be improved, and azacytidine can prolong the patients' survival, but demethylation drugs increase the incidence of neutropenia fever. In the clinical application of demethylation drugs, it is necessary to further carefully evaluate their clinical safety.