PMID- 34483903
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230522
IS  - 1663-9812 (Print)
IS  - 1663-9812 (Electronic)
IS  - 1663-9812 (Linking)
VI  - 12
DP  - 2021
TI  - Comparison Between Decitabine and Azacitidine for Patients With Acute Myeloid 
      Leukemia and Higher-Risk Myelodysplastic Syndrome: A Systematic Review and 
      Network Meta-Analysis.
PG  - 701690
LID - 10.3389/fphar.2021.701690 [doi]
LID - 701690
AB  - Background: The hypomethylating agents (HMAs) azacitidine (AZA) and decitabine 
      (DAC) have been widely used in patients with acute myeloid leukemia (AML) and 
      higher-risk myelodysplastic syndrome (HR-MDS). However, few direct clinical 
      trials have been carried out to compare the efficacy and adverse events (AEs) 
      between these two agents. The clinical choice between them is controversial. A 
      systematic review and network meta-analysis (NMA) was performed to compare the 
      efficacy, safety, and survival of DAC and AZA in AML and HR-MDS patients. 
      Methods: We systematically searched MEDLINE, Embase, Web of Science, and Cochrane 
      Library through March 15, 2021. Randomized controlled trials (RCTs) on AML or 
      HR-MDS patients comparing the efficacy and safety between DAC and AZA or 
      comparing one of HMAs to conventional care regimens (CCR) were selected. Results: 
      Eight RCTs (n = 2,184) were identified in the NMA. Four trials compared AZA to 
      CCR, and four compared DAC to CCR. Direct comparisons indicated that, compared to 
      CCR, both AZA and DAC were associated with higher overall response (OR) rate (AZA 
      vs. CCR: relative risk (RR) = 1.48, 95% CI 1.05-2.1; DAC vs. CCR: RR = 2.14, 95% 
      CI 1.21-3.79) and longer overall survival (OS) (AZA vs. CCR: HR = 0.64, 95% CI 
      0.50-0.82; DAC vs. CCR: HR = 0.84, 95% CI 0.72-0.98), and AZA showed higher rate 
      of complete remission with incomplete blood count recovery (CRi) (HR = 2.52, 95% 
      CI 1.27-5). For the indirect method, DAC showed a higher complete remission (CR) 
      rate than AZA in patients with both AML (RR = 2.28, 95% CI 1.12-4.65) and MDS (RR 
      = 7.57, 95% CI 1.26-45.54). Additionally, DAC significantly increased the risk of 
      3/4 grade anemia (RR = 1.61, 95% CI: 1.03-2.51), febrile neutropenia (RR = 4.03, 
      95% CI: 1.41-11.52), and leukopenia (RR = 3.43, 95% CI 1.64-7.16) compared with 
      AZA. No statistical significance was found for the other studied outcomes. 
      Conclusion: Compared to CCR, both AZA and DAC can promote outcomes in patients 
      with AML and HR-MDS. DAC showed higher efficacy especially CR rate than AZA 
      (low-certainty evidence), while AZA experienced lower frequent grade 3/4 
      cytopenia than patients receiving DAC treatment.
CI  - Copyright (c) 2021 Ma and Ge.
FAU - Ma, Jiale
AU  - Ma J
AD  - Department of Hematology, Zhongda Hospital, School of Medicine, Southeast 
      University, Institute of Hematology Southeast University, Nanjing, China.
AD  - Department of Hematology, Xuzhou Central Hospital, Xuzhou, China.
FAU - Ge, Zheng
AU  - Ge Z
AD  - Department of Hematology, Zhongda Hospital, School of Medicine, Southeast 
      University, Institute of Hematology Southeast University, Nanjing, China.
LA  - eng
PT  - Journal Article
DEP - 20210817
PL  - Switzerland
TA  - Front Pharmacol
JT  - Frontiers in pharmacology
JID - 101548923
EIN - Front Pharmacol. 2023 May 05;14:1213053. PMID: 37214470
PMC - PMC8416074
OTO - NOTNLM
OT  - acute myeloid leukemia
OT  - azacitidine
OT  - decitabine
OT  - higher-risk myelodysplastic syndrome
OT  - network meta-analysis
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2021/09/07 06:00
MHDA- 2021/09/07 06:01
PMCR- 2021/08/17
CRDT- 2021/09/06 05:54
PHST- 2021/04/28 00:00 [received]
PHST- 2021/07/14 00:00 [accepted]
PHST- 2021/09/06 05:54 [entrez]
PHST- 2021/09/07 06:00 [pubmed]
PHST- 2021/09/07 06:01 [medline]
PHST- 2021/08/17 00:00 [pmc-release]
AID - 701690 [pii]
AID - 10.3389/fphar.2021.701690 [doi]
PST - epublish
SO  - Front Pharmacol. 2021 Aug 17;12:701690. doi: 10.3389/fphar.2021.701690. 
      eCollection 2021.