Carvedilol to prevent anthracycline-related cardiotoxicity: a randomized controlled trial

  • Avila MS & al.
  • J Am Coll Cardiol
  • 3 Mar 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Carvedilol (Coreg) may reduce risk for diastolic dysfunction if given during anthracycline treatment for breast cancer.

Why this matters

  • Previous studies of beta-blockade as primary prevention for anthracycline-related cardiotoxicity have had important limitations.
  • The PRADA trial found no benefit for metoprolol (Lopressor), but carvedilol has different properties.

Study design

  • CECCY, a prospective, double-blind study that evaluated 192 patients with HER-2-negative breast cancer and normal left ventricular ejection fraction (LVEF), referred for anthracycline (240 mg/m2) chemotherapy.
  • Patients randomly allocated to either carvedilol or placebo until chemotherapy completion.
  • Carvedilol/placebo were initially administered at 3.125 mg twice daily, progressively increased to a maximum of 25 mg/12 hours.
  • Funding: São Paulo Research Foundation.

Key results

  • Incidence of diastolic function was lower in carvedilol vs placebo group (P=.039).
  • Troponin I levels decreased over time in the carvedilol group (P=.003).
  • 14.5% vs 13.5% patients in carvedilol vs placebo group had ≥10% reduction in LVEF at 6 months (P=1.0).
  • No difference across groups was observed for brain natriuretic peptide (P=.85).

Limitations

  • Few cases of lowered LVEF reduced analytic power.
  • Cases of diastolic dysfunction were mostly low-grade.
  • Short follow-up period.

Coauthored with Antara Ghosh, PhD

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