Effect of renin-angiotensin system inhibitors on survival in glioma patients: A systematic review and meta-analysis.

Junyao He; Xue Sun; Yimin Wang; Wenzheng Feng; Jiali Cai; Tianhao Jiang; Tingting Wang; Tianshu Ren

doi:10.1016/j.ejphar.2026.179221

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Effect of renin-angiotensin system inhibitors on survival in glioma patients: A systematic review and meta-analysis.

Junyao He·Xue Sun·Yimin Wang·Wenzheng Feng·Jiali Cai·Tianhao Jiang·Tingting Wang·Tianshu Ren

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Abstract

PURPOSE: To evaluate the effect of renin-angiotensin system inhibitors (RASIs) on the survival outcomes of glioma patients, determine whether using RASIs correlates with survival benefit, and provide evidence-based guidance for the clinical treatment. METHODS: Studies assessing the effects of using RASIs versus non-use in glioma patients were retrieved from the PubMed, Cochrane Library, Web of Science, and Embase databases from inception to April 17, 2024. The included studies reported hazard ratios (HRs) with 95% confidence intervals (CIs) for overall survival (OS) and/or progression-free survival (PFS), as well as the effect on brain edema and steroid dosing in patients. RESULTS: Seven articles involving 2660 patients were included in this study. Pooled results indicated there was no significant difference in OS (HR = 0.89, 95% CI 0.75-1.06, P = 0.204) or PFS (HR = 0.98, 95% CI 0.82-1.18, P = 0.847) between RASIs-treated patients and non-RASIs-treated patients. Sensitivity analysis identified the ACEIs-focused trial reported by Happold et al. as a major contributor to inter-study heterogeneity. Subgroup analyses revealed that in recurrent glioblastoma, pooled OS was significantly longer in RASIs-treated patients than non-RASIs-treated patients (HR = 0.70, 95% CI 0.54-0.92, P = 0.01). Similarly, compared with bevacizumab monotherapy, bevacizumab combined with RASIs significantly extended OS in glioblastoma patients (HR = 0.73, 95% CI 0.63-0.86, P < 0.001). CONCLUSION: The results revealed that treatment with RASIs may show a trend toward prolonged overall survival (OS) in patients with glioma. For patients with glioblastoma, RASI therapy could prolong OS in those with recurrent disease. Furthermore, compared with bevacizumab monotherapy, the combination of RASIs and bevacizumab was associated with improved OS in glioblastoma patients.

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Humans Angiotensin Receptor Antagonists Angiotensin-Converting Enzyme Inhibitors Brain Neoplasms Glioma Renin-Angiotensin System Glioblastoma Renin-angiotensin system inhibitors Survival Journal Article Meta-Analysis Systematic Review

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Junyao He, Xue Sun, Yimin Wang, Wenzheng Feng, Jiali Cai, Tianhao Jiang, Tingting Wang, Tianshu Ren. 2026-08-20. Effect of renin-angiotensin system inhibitors on survival in glioma patients: A systematic review and meta-analysis.. https://doi.org/10.1016/j.ejphar.2026.179221

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Journal Article; Meta-Analysis; Systematic Review resource Angiotensin Receptor Antagonists subject Angiotensin-Converting Enzyme Inhibitors subject Brain Neoplasms subject Humans subject Journal Article subject Meta-Analysis subject Systematic reviews study

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