Jin, Y., Wu, X., Guan, Y., Gu, D., Shen, Y., Xu, Z., … Chen, J. (2011). Efficacy and safety of aprepitant in the prevention of chemotherapy-induced nausea and vomiting: A pooled analysis. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 20, 1815–1822.

To evaluate the therapeutic efficacy and safety of aprepitant for the treatment of chemotherapy-induced nausea and vomiting (CINV) during the first five days following highly or moderately emetogenic chemotherapy

Databases searched were MEDLINE and Embase. Abstracts were searched in the American Society of Clinical Oncology, Cochrane Library, and National Cancer Institute.

Search keywords were aprepitant, MK-869, substance P receptor antagonist, NK-1 receptor antagonist, and chemotherapy-induced nausea and vomiting.

Studies were included in the review if they

• Were randomized controlled trials.
• Compared the efficacy of aprepitant with placebo or no intervention for the prophylaxis of CINV.
• Contained information regarding the complete control of vomiting or nausea during the first 24 hours or the first 24 hours after chemotherapy administration.
• Had at least 80% follow up.

Studies were excluded if they

• Involved patients receiving radiotherapy treatment.
• Only provided pharmacokinetic information.
• Included healthy people or animals.
• Involved patients with depression and other nervous system diseases.
• Had insufficient data on efficacy of aprepitant.
• Had subjects who were applied more than once.
   

• The total number of references initially identified was 327; of these, 29 were retrieved for detailed evaluation.
• The evaluation method was not specified.
• When abstracts and published articles were found on the same population, only the articles were used for analysis.
• When studies used a crossover design, only data during the first cycle was used for analysis.

• The final number of studies included was 15 representing a total of 4,798 patients (2,419 experimental and 2,379 control).
• The sample range across all studies was 45–866.
• Key sample characteristics were not specified.

All patients were in active treatment.

• Incidence of emesis was significantly reduced in the aprepitant group on the first day of chemotherapy (relative response [RR] = 1.13, 95% CI = 1.10–1.16). 
• Incidence of delayed nausea and vomiting from days 2–5 after chemotherapy was also significantly reduced (RR = 1.35, 95% CI = 1.22–1.48). 
• Aprepitant and ondansetron or granisetron demonstrated superior nausea and vomiting control compared to nonaprepitant regimens; however, aprepitant plus palonosetron did not show any superiority. 
• No significant differences were found regarding the occurrence of adverse effects in aprepitant versus control groups.

Aprepitant is effective in the prevention of delayed CINV. Aprepitant improves the antiemetic effect of ondansetron and dexamethasone in patients receiving cisplatin-based chemotherapy.

Aprepitant is effective and safe for the prevention of CINV in the acute and delayed phases of treatment.