Metformin as an Adjunct Treatment to Temozolomide for High-Grade Gliomas: A Systematic Review and Meta-Analysis
Abstract
OBJECTIVE: High-grade gliomas (HGGs) are aggressive tumors known for their poor prognosis. Despite research into its molecular and clinical aspects, current management minimally impacts survival. It is unclear whether combining temozolomide (TMZ) with metformin (MET) could enhance survival in this population.
METHODS: A systematic search on PubMed, Embase, and Cochrane Library databases was conducted for studies comparing TMZ+MET versus TMZ alone for HGG. The outcomes of interest were overall survival, progression-free survival, and subgroup analysis with O6-methylguanine-DNA methyltransferase and patients with diabetes. The analysis comprised outcomes reported as hazard ratios (HRs) and odds ratios with corresponding 95% confidence intervals (CIs) as all the outcomes are continuous. A significance level of P 25% were considered significant for heterogeneity. The random effects model was employed for all outcomes.
RESULTS: Ten studies were included, comprising 3623 patients, of which 346 (9.5%) were assigned for TMZ+MET. The TMZ+MET group was associated with a significant reduction in mortality rates when compared to the TMZ alone group (HR 0.74; 95% CI 0.59, 0.93; P < 0.01; I2 29%). There was no significant difference between groups for progression-free survival (HR 0.87; 95% CI 0.68-1.12; P = 0.29). In a subgroup analysis restricted to patients who received TMZ+MET, the diabetic subgroup had a significantly higher mortality rate than the normoglycemic subgroup (odds ratio…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 3,623 participants or records.
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