Decitabine vs. Azacitidine for Myelodysplastic Syndrome

The management of patients with low- or intermediate-risk myelodysplastic syndrome (MDS) includes supportive care, azacitidine, decitabine, lenalidomide, and immunosuppressive agents such as antithymocyte globulin and cyclosporine. Symptomatic patients often receive either azacitidine or decitabine, but which of these agents is the better choice?

To answer this question, investigators conducted a phase II study, in which 113 patients were randomized to receive either decitabine (20 mg/m² intravenously over 1 hour), or azacitidine (75 mg/m² IV over 1 hour or subcutaneously); each agent was given for 3 days, and courses were repeated every 4 weeks. The percentages of patients with low-, intermediate-, and high-risk MDS were 36%, 30%, and 20%, …