Association between roxadustat use and suppression of thyroid function: a systematic review and meta-analysis

Area of Science:

• Pharmacology
• Endocrinology
• Nephrology

Background:

• Growing concern exists regarding roxadustat's potential to suppress thyroid function, based on case reports and observational studies.
• Roxadustat is a hypoxia-inducible factor prolyl-hydroxylase inhibitor used for renal anemia.

Purpose of the Study:

• To systematically review and meta-analyze the relationship between roxadustat use and thyroid function suppression.
• To evaluate the risk of hypothyroidism associated with roxadustat treatment.

Main Methods:

• Comprehensive literature search of MEDLINE, ClinicalTrials.gov, and Cochrane Central Register.
• Meta-analysis of randomized controlled trials and observational studies comparing roxadustat with placebo or ESAs.
• Primary outcome: suppression of thyroid function; Secondary outcome: hypothyroidism. Assessed risk of bias using ROBINS-I tool.

Main Results:

• Six studies were included; meta-analysis of two observational studies showed significantly higher incidence of thyroid function suppression with roxadustat versus ESA (OR: 6.45; 95% CI: 3.39-12.27).
• Roxadustat use appears to increase the risk for thyroid function suppression in patients with renal anemia when compared to ESA.

Conclusions:

• Monitoring thyroid function is essential for patients treated with roxadustat.
• Early recognition of thyroid function suppression risk can enhance the safe use of roxadustat for renal anemia.