Efficacy and Safety of Neurokinin-1 Receptor Antagonists for Prevention of Chemotherapy-Induced Nausea and Vomiting: Systematic Review and Meta-analysis of Randomized Controlled Trials

Yuan, Dong-Mei; Li, Qian; Zhang, Qin; Xiao, Xin-Wu; Yao, Yan-Wen; Zhang, Yan; Lv, Yan-Ling; Liu, Hong-Bin; Lv, Tang-Feng; Song, Yong

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저자정보: Yuan, Dong-Mei (Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine) Li, Qian (Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine) Zhang, Qin (Department of Gynecology, Jinling Hospital, Nanjing University School of Medicine) Xiao, Xin-Wu (Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine) Yao, Yan-Wen (Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine) Zhang, Yan (Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine) Lv, Yan-Ling (Department of Respiratory Medicine, the Second Affiliated Hospital, Southeast University) Liu, Hong-Bin (Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine) Lv, Tang-Feng (Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine) Song, Yong (Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine)

저널정보: 아시아태평양암예방학회 Asian Pacific journal of cancer prevention : APJCP Asian Pacific journal of cancer prevention : APJCP 제17권 제4호

발행연도: 2016.1

수록면: 1,661 - 1,675 (15page)

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Objectives: Can addition of neurokinin-1 receptor antagonists (NK1-RAs) be considered as an ideal strategy for the prevention of chemotherapy-induced nausea and vomiting (CINV)? Researchers differ on this question. Materials and Methods: Electronic databases were searched for randomized control trials (RCTs) that evaluated the effectiveness and safety of NK1-RAs in preventing CINV. The primary end point was complete response (CR) in the acute, delayed, and overall phases after chemotherapy. Subgroup analyses evaluated the types of NK1-RAs, routines of administration, types of malignancies, regimens used in combination with NK1-RAs, and age of patients included in the studies. The incidences of different types of adverse events were also extracted to estimate the safety of NK1-RAs. Results: A total of 38 RCTs involving 13,923 patients were identified. The CR rate of patients receiving NK-RAs was significantly higher than patients in the control groups during overall phase (70.8% vs 56.0%, P<0.001), acute phase (85.1% vs 79.6%, P<0.001), and delayed phase (71.4% vs 58.2%, P<0.001). There were three studies including patients of children or adolescents, the CR rate was also significantly higher in the treatment group (overall phase: OR=2.807, P<0.001; acute phase: OR=2.863, P =0.012; delayed phase: OR=2.417, P<0.001). For all the other outcomes, patients in the NK1-RAs groups showed improvements compared to the control groups (incidence of nausea: 45.2% vs 45.9%, P<0.001; occurrence of vomiting: 22.6% vs 38.9%, P<0.001; usage of rescue drugs: 23.5% vs 34.1%, P<0.001). The pooled side effects from NK1-RAs did not significantly differ from previous reports and the toxicity rates in patients less than eighteen years old also did not diff between the two groups (P=0.497). However, we found that constipation and insomnia were more common in the patients of control groups, whereas diarrhea and hiccups were more frequently detected in patients receiving NK1-RAs. Conclusions: NK1-RAs improved the CR rate of CINV. They are effective for both adults and children. The use of NK1-RAs might be associated with the appearance of diarrhea and hiccups, while decreasing the possibility of constipation and insomnia.

#Neurokinin-1 receptor antagonist #chemotherapy-induced nausea and vomiting #aprepitant #meta-analysis

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Yuan, Dong-Mei

소속기관 Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine