ABSTRACT
Anthracyclines are effective chemotherapeutic agents widely used to treat various cancers, but their use is limited by the risk of cardiotoxicity and heart failure. While strategies like dose reduction have been explored, there are no well-established therapies to mitigate this risk. Emerging evidence suggests sodium-glucose cotransporter 2 inhibitors (SGLT2i) may have cardioprotective effects, providing a rationale for investigating their potential utility in anthracycline-treated patients. We conducted a systematic review and meta-analysis to synthesize available evidence on the efficacy of SGLT2i in reducing heart failure incidence and mortality in patients undergoing anthracycline-based cancer therapy. Relevant studies were identified through comprehensive database searches and screened based on predefined criteria. Data extraction and quality assessment were performed independently by two reviewers. Four observational studies, encompassing 5,590 patients, were included. The pooled analysis showed a higher but non-significant risk of developing heart failure in the non-SGLT2i group compared to the SGLT2i group (RR = 0.67, 95% CI: 0.40-1.41). The risk of all-cause mortality was significantly lower in patients receiving SGLT2i (RR = 0.55, 95% CI: 0.39-0.77). This meta-analysis suggests SGLT2i are associated with a lower risk of mortality and heart failure incidence in anthracycline-treated patients, although larger studies are needed to confirm these findings. The mechanisms underlying these potential benefits require further elucidation. Despite limitations, this analysis highlights the promising role of SGLT2i as a cardioprotective strategy in this high-risk population.
ABSTRACT
Introduction As coronavirus disease 2019 (COVID-19) immunizations become more common, concerns about their safety and reactogenicity have grown. It is important to assess and analyze the post-vaccination side effects of several COVID-19 vaccines that have been licensed in Pakistan. Methods and results A comparative cross-sectional study was conducted between October 2021 and January 2022 to collect data on the side effects produced by different COVID-19 vaccines. An online survey was conducted to gather data on participants' demographics, clinical profiles, COVID-19 profiles as well as the intensity and side effects of COVID-19 vaccines. Statistical Package for the Social Sciences (SPSS) version 22.0 (IBM Corp., Armonk, NY) was used to analyze the data collected. Out of 421 participants, 63.2% were males, 36.8% of participants received messenger RNA (mRNA) vaccine, 33.2% received viral vector vaccine, 29.9% received inactivated vaccine, and further 71.7% of the total subjects were completely immunized. The majority of the symptoms were mild to moderate in degree. Approximately, 0.7% of the individuals reported experiencing serious adverse effects. Injection site pain (35.9%) was noted to be the most remarkable post-vaccination side effect followed by fever (33.2%) and fatigue (23.1%). Prior COVID-19 infection was not associated with the severity of any COVID-19 vaccine-related side effect (p > 0.05), except dyspnea. Younger participants and the female gender were substantially linked to post-vaccination adverse effects. Conclusion In comparison to viral vector and inactivated vaccines, our data suggest that the mRNA-based vaccination causes more severe adverse effects, and the majority of them were mild to moderate in severity. Participants who had previously contracted COVID-19 were not at a higher risk of developing additional vaccine-related side effects.
