Disclosures: The authors report no relevant financial disclosures.
October 19, 2021
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Sodium thiosulfate during chemotherapy reduces risk for ototoxic effects

Disclosures: The authors report no relevant financial disclosures.
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Sodium thiosulfate appeared associated with a decreased risk for ototoxic effects when administered during platinum-based chemotherapy, according to results of a study published in JAMA Network Open.

The meta-analysis of four clinical trials included three randomized clinical trials conducted by researchers in Taiwan.

Infographic showing affect of sodium thiosulfate on ototoxic effects and survival
Data derived from Chen C, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2021.18895.

“We performed a meta-analysis to evaluate the association of sodium thiosulfate with the prevention of platinum-induced ototoxic effects,” Chih-Hao Chen, MD, otolaryngologist in the department of otolaryngology and head and neck surgery at Taipei Veterans General Hospital, and colleagues wrote. “We found that sodium thiosulfate was associated with a decreased risk for ototoxic effects among patients treated with [platinum-based] chemotherapy. However, investigating whether it is associated with an increased risk [for] poor event-free survival and overall survival requires further large-scale studies.”

The four studies in the analysis included a total of 278 patients. Of them, 158 were assigned to the experimental group, which received platinum-based chemotherapy with sodium thiosulfate, and 133 were assigned to the control group. Both groups included 13 patients using contralateral ears of the opposite group as samples.

Researchers obtained data from various databases, including the Cochrane Library, PubMed, Embase, Web of Science and Scopus, through Nov. 7, 2020. Two reviewers independently extracted the data and researchers used a random-effects model to explore objectives.

RRs for ototoxic effects development and hemopoietic event development, comparing the experimental group vs. the control group, served as primary outcomes. Chen and colleagues also reported HRs for EFS and OS.

Pooled results showed patients who received sodium thiosulfate had a statistically significantly decreased risk for ototoxic effects during platinum-based chemotherapy (RR = 0.61; 95% CI, 0.49-0.77), but not a statistically significantly increased risk for poor EFS (HR = 1.13, 95% CI, 0.70-1.82) or OS (HR = 1.9; 95% CI, 0.9-4.03).

“This meta-analysis found that sodium thiosulfate use during the course of platinum-based chemotherapy was associated with decreased risk [for] ototoxic effects,” Chen and colleagues wrote. “Furthermore, in the pooled survival estimates, there was no statistically significant difference in EFS or OS between patients receiving sodium thiosulfate and those not receiving sodium thiosulfate. To our knowledge, this is the first meta-analysis that provides evidence for otoprotective medication against platinum-induced ototoxic effects.”