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Efficacy and safety of darbepoetin alpha in patients with myelodysplastic
syndromes: a systematic review and meta-analysis
#MMPMID27214305
Park S
; Fenaux P
; Greenberg P
; Mehta B
; Callaghan F
; Kim C
; Tomita D
; Xu H
Br J Haematol
2016[Sep]; 174
(5
): 730-47
PMID27214305
show ga
We conducted a systematic review and meta-analysis to estimate the efficacy of
darbepoetin alpha (DA) for treatment of myelodysplastic syndrome (MDS)-related
anaemia. Eligible studies were prospective, interventional, and reported World
Health Organization, French-American-British, or International Prognostic Scoring
System (IPSS) criteria. Outcomes included erythroid response rate (primary);
haemoglobin response; change in haemoglobin, transfusion status, and
quality-of-life (QoL); and safety. Ten studies (N = 647) were analysed. Erythroid
response rate range was 38-72%; median response duration range was 12-51+ months.
Patients with erythropoietin (EPO) <100 iu/l had 35% [95% confidence interval
(CI): 22-48%; P < 0·001) better response than patients with EPO >100 iu/l.
Erythropoesis-stimulating agent (ESA)-naïve patients had 17% (95% CI: 3-32%;
P = 0·022) greater response rate than those previously treated with ESA.
Nonetheless, previously treated patients had response rates of 25-75%. Higher
baseline haemoglobin levels, higher dose, transfusion-independence and low-risk
IPSS status were reported by several studies to be associated with better
response. QoL, transfusion rates and haemoglobin levels improved with treatment.
Hypertension, thromboembolism and progression to acute myeloid leukaemia were
reported in 2%, 1% and 1% of patients, respectively. This meta-analysis suggests
that DA treatment can be useful for improving erythroid response in MDS patients
with anaemia, even among patients previously treated with ESA.
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