McDonagh, M., Peterson, K., & Thakurta, S. (22 July, 2010). Consideration of evidence on antiemetic drugs for nausea and vomiting associated with chemotherapy or radiation therapy in adults. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK254005/

Purpose

STUDY PURPOSE: To compare the benefits and harms of antiemetic regimens using 5HT3 antagonists plus corticosteroids with or without aprepitant in patients receiving chemotherapy or radiation therapy
 
TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: MEDLINE and the Cochrane databases
 
KEYWORDS: Aprepitant, dolasetron, granisetron, ondansetron, palonosetron, chemotherapy, radiation, radiotherapy, neoplasms, antineoplastic agents, nausea, and vomiting
 
INCLUSION CRITERIA: English, humans, and 2008–2009
 
EXCLUSION CRITERIA: Use a 5HT3 antagonist alone or in combination with another noncorticosteriod drug; unclear dosage form or variable route

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 510
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Research articles were identified based on the inclusion and exclusion criteria. The articles' strength of evidence was graded by guidelines established for the Evidence-Based Practice Center Program of ​the Agency for Healthcare Research and Quality (AHRQ). AHRQ grades strength of evidence on risk of bias, consistency, directness, and precision of evidence. Grades of evidence include high, moderate, low, and insufficient. 

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 26
  • TOTAL PATIENTS INCLUDED IN REVIEW = Not stated
  • KEY SAMPLE CHARACTERISTICS: Adults at risk for nausea related to chemotherapy or radiotherapy

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results

Using the inclusion and exclusion criteria, 26 articles were identified. Articles included head-to-head trials, active-controlled trials, placebo-controlled trails, observational studies, pooled-analysis trials, and data submitted by drug companies. Tables of evidence were constructed, and evidence was graded using guidelines established for AHRQ. Relevant statistical analyses (e.g., random-effects models, Forest plots, Q statistic, I2 statistics) were done when applicable.
 
For total control of nausea and vomiting (no emesis, no use of rescue medications, and only mild nausea) and complete response (no emesis and no rescue medication), evidence strongly recommended three-drug antiemetic regimens containing aprepitant compared to two-drug regimens without aprepitant. Evidence suggested that three-drug antiemetic regimens containing aprepitant can produce total control or complete response if given IV or as mixed PO and IV routes. If given exclusively PO, the three-drug regimen produced no differences for total control compared to the two-drug regimen.

Conclusions

The strongest evidence suggested that three-drug regimens (5HT3 antagonists plus corticosteroids and aprepitant) with mixed delivery methods (PO plus IV) offered maximal relief of chemotherapy-induced nausea and vomiting (CINV).

Limitations

  • The evidence combined patients receiving chemotherapy and radiotherapy, so the results may not be completely applicable to CINV.
  • Many of the studies included in this review had a low strength of evidence in the AHRQ grading system.

Nursing Implications

The addition of aprepitant to standard antiemetic regimens with mixed PO and IV antiemetics can greatly improve CINV in patients with cancer.

Legacy ID

5430