| DOI: 10.29090/psa.2021.01.19.049 | Pharm Sci Asia 2021; 48(1), 25-36 |
The effect of magnesium supplementation on cisplatin induced nephrotoxicity: a systematic review and meta-analysisKwanjit Danwilai1, Ornrat Lohitnavy1,2, Itsarawan Sakunrag1, Piyameth Dilokthornsakul1,3*
1 Department of Pharmacy Practice, Faculty
of Pharmaceutical Sciences, Naresuan
University, Phitsanulok, Thailand
2 Center of Excellence for Environmental
Health & Toxicology, Faculty of
Pharmaceutical Sciences, Naresuan
University, Phitsanulok, Thailand
3 Center of Pharmaceutical Outcomes
Research, Faculty of Pharmaceutical
Sciences, Naresuan University, Phitsanulok,
Thailand
Nephrotoxicity is a serious side effect of cisplatin. Magnesium supplement can reduce this side effect, although previous studies demonstrated the effect on cisplatin - induced nephrotoxicity (CIN), with some showing no effect. This study aimed to summarize the effect of magnesium supplement on CIN. We systematically searched PubMed, Cochrane Library, Web of Science, Scopus, EMBASE and www.clinicaltrial.gov for all relevant studies. All clinical studies comparing the risk of CIN in patients who received magnesium supplement and the control groups were included. Our primary outcome examined the occurrence of severe nephrotoxicity. The secondary outcome was the occurrence of all grades of nephrotoxicity and changes in serum creatinine (SCr) and creatinine clearance (CrCl). Random-effects model was used to determine pooled effect size for nephrotoxicityrelated outcomes. A total of 4,053 studies were retrieved but only 12 studies were included. Nine studies were retrospective observational studies, while two studies were randomized controlled trials and one study was prospective study. All studies were conducted with patients that had solid tumors and receiving cisplatin >50 mg/m2/cycle. Meta-analysis indicated that magnesium supplementation could reduce the occurrence of severe CIN in the first cycle and all other cycles of cisplatin-based chemotherapy (RR 0.19, 95%CI; 0.11 - 0.33 and RR 0.28, 95%CI; 0.19 - 0.43,respectively). Similarly, changes in SCr and CrCl in the magnesium-supplemented group were significantly lower than those in the control group for both the first cycle and all other cycles (p<0.001). With the current evidence, magnesium supplementation possesses a protective effect for CIN, especially for severe nephrotoxicity. Oncologists may well consider supplementing magnesium for patients who are treated with cisplatin.
Keyword:
magnesium, supplementation,
cisplatin, nephrotoxicity
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