2113P - Efficacy and effectiveness of prophylactic magnesium supplementation on prevention of cisplatin-induced nephrotoxicity: A systematic review and meta-analysis

Background

Cisplatin-induced nephrotoxicity (CIN) is a frequent dose-limiting adverse effect, and many nephroprotective strategies have been proposed to prevent its occurrence. Although multiple studies support premedication with magnesium (Mg) and hydration, this intervention has not been widely implemented, as some centers still replace it only after the occurrence of hypomagnesemia. We performed a systematic review and meta-analysis to evaluate the efficacy and effectiveness of Mg supplementation (suppl) prior to cisplatin.

Methods

We systematically searched Pubmed, Embase, and Cochrane databases for randomized clinical trials (RCT) and observational studies assessing prophylactic Mg suppl compared with placebo for patients receiving cisplatin-based chemotherapy. Primary outcomes were acute nephrotoxicity and hypomagnesemia events; secondary outcome included the association of CIN with variations on serum creatinine levels (ΔSCr). We used RevMan 5.1.7 and RStudio for statistical analysis; random-effects models to pool studies; and I² statistics to assess heterogeneity.

Results

We included 24 studies with 3,803 patients. Nine were RCT and 15 observational cohort studies. We found a significant reduction of risk of CIN (all grades) in patients treated with prophylactic Mg compared to placebo (OR = 0.16; 95%CI 0.11 – 0.24; p<0.001). The pooled analysis including only studies adjusted for confounding variables demonstrated a 67% risk reduction of CIN with Mg suppl (p<0.0001). Mg prophylaxis was effective in both the clinical trial setting (OR = 0.22) and in the real-world data analysis (OR = 0.15). The benefit was seen across all tumor types and combinations of cisplatin-based chemotherapies included in the study. Hypomagnesemia events were significantly less frequent in the intervention group (OR = 0.27; 95%CI 0.16–0.45; p<0.000001). There was no difference regarding doses of Mg administered, and the ΔSCr were not significantly associated with the risk of CIN.

Conclusions

In patients undergoing cisplatin-based chemotherapy, prophylactic Mg suppl significantly reduces the risk of CIN and hypomagnesemia as compared with no prophylaxis.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.