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Sildenafil for Primary Prevention of Anthracycline-Induced Cardiac Toxicity: A Phase I/II Randomized Clinical Trial,

Armin Attar1, Masoumeh Heydari1,2, Firoozeh Abtahi1,3

  • 1Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Cardiology Research and Practice
|April 7, 2022
PubMed
Abstract

Insights

Sildenafil did not prevent cancer therapeutics-related cardiac dysfunction (CTRCD) in patients receiving anthracyclines. This randomized trial found no significant benefit of sildenafil in preserving left ventricular ejection fraction (LVEF) or reducing CTRCD incidence.

Area of Science:

  • Cardiology
  • Oncology
  • Pharmacology

Background:

  • Animal studies suggested 5-phosphodiesterase inhibitors protect against anthracycline-induced cardiac dysfunction.
  • Cancer therapeutics-related cardiac dysfunction (CTRCD) is a significant concern with anthracycline chemotherapy.

Purpose of the Study:

  • To evaluate the clinical efficacy of sildenafil in the primary prevention of CTRCD in humans.
  • To assess sildenafil's effect on left ventricular ejection fraction (LVEF) in patients undergoing anthracycline therapy.

Main Methods:

  • A randomized, double-blind, placebo-controlled trial involving 52 patients.
  • Intervention group received sildenafil 25 mg twice daily; control group received placebo.
  • Echocardiography, cardiac MRI, hs-troponin I, and NT-Pro-BNP measurements were used to assess cardiac function over a 6-month follow-up.

Main Results:

  • Both groups experienced a significant reduction in LVEF (p<0.003 for intervention, p<0.001 for control).
  • No significant difference in LVEF reduction was observed between the sildenafil and placebo groups (p=0.26).
  • The incidence of CTRCD was similar in both groups (41.6% intervention vs. 42.8% control, p=0.51).

Conclusions:

  • Sildenafil does not appear to be beneficial for the primary prevention of anthracycline-induced cardiac toxicity.
  • Further research may be needed to explore alternative strategies for preventing CTRCD.

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