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Open Access 01-12-2018 | Research

A systematic review and network meta-analysis comparing azacitidine and decitabine for the treatment of myelodysplastic syndrome

Authors: Jehad Almasri, Hassan B. Alkhateeb, Belal Firwana, Mohamad Bassam Sonbol, Moussab Damlaj, Zhen Wang, M. Hassan Murad, Aref Al-Kali

Published in: Systematic Reviews | Issue 1/2018

Abstract

Background

Hypomethylating agents (HMA), azacitidine, and decitabine are frequently used in the management of myelodysplastic syndromes (MDS). However, there are no clinical trials that have directly compared these agents. We conducted a systematic review and indirectly compared the efficacy of azacitidine to decitabine in MDS.

Methods

We conducted a comprehensive search of several databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus) through June 28, 2018, without language or time restrictions. Studies were screened by two independent reviewers, and differences were resolved by consensus. The fixed effect model and adjusted indirect comparison methods were used to pool relative risks (RR) of major outcomes of interest (mortality, response rate, quality of life, hematologic improvement, hospitalization, leukemia transformation, transfusion independence).

Results

Only four trials met the eligibility criteria. Two trials compared azacitidine to the best supportive care (BSC) and included 549 patients, and the other two compared decitabine to BSC and included 403 patients. The risk of bias was unclear overall. Compared to BSC, azacitidine was significantly associated with lower mortality (RR = 0.83, 95% CI 0.74–0.94, I² = 89%) whereas decitabine did not significantly reduce mortality (RR = 0.88, 95% CI 0.77–1.00, I² = 53%). Both drugs were associated with higher partial and complete response compared to BSC. Indirect comparisons were not statistically significant for all the studied outcomes, except for complete response where azacitidine was less likely to induce complete response compared to decitabine (RR = 0.11, 95% CI = 0.01–0.86, very low-certainty evidence).

Conclusions

Azacitidine and decitabine are both associated with improved outcomes compared to BSC. The available indirect evidence comparing the two agents warrants very low certainty and cannot reliably confirm the superiority of either agent. Head-to-head trials are needed. In the meantime, the choice of agent should be driven by patient preferences, adverse effects, drug availability, and cost.

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Title: A systematic review and network meta-analysis comparing azacitidine and decitabine for the treatment of myelodysplastic syndrome
Authors: Jehad Almasri
Hassan B. Alkhateeb
Belal Firwana
Mohamad Bassam Sonbol
Moussab Damlaj
Zhen Wang
M. Hassan Murad
Aref Al-Kali
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Systematic Reviews / Issue 1/2018
Electronic ISSN: 2046-4053
DOI: https://doi.org/10.1186/s13643-018-0805-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

A systematic review and network meta-analysis comparing azacitidine and decitabine for the treatment of myelodysplastic syndrome

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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