Wang, X.F., Feng, Y., Chen, Y., Gao, B.L., & Han, B.H. (2014). A meta-analysis of olanzapine for the prevention of chemotherapy-induced nausea and vomiting. Scientific Reports, 4, 4813. 

DOI Link

Purpose

STUDY PURPOSE: To determine the effectiveness of olanzapine in the prevention of chemotherapy-induced nausea and vomiting (CINV) after moderately to highly emetogenic chemotherapy
 
TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: MEDLINE, PubMed, The China National Knowledge Infrastructure, Wanfang Data, and the Weipu Periodical Database  
 
KEYWORDS: Olanzapine, CINV, chemotherapy-induced nausea and vomiting, nausea, and vomiting 
 
INCLUSION CRITERIA: Randomized controlled trials; olanzapine use in CINV; blinded studies; published studies; cost-effective studies; published in English or Chinese; date range 1990 through October 2013
 
EXCLUSION CRITERIA: Studies that were not cost-effective; repetition with former research; retrospective studies; use in patients with incomplete bowel obstruction; and use for breakthrough emesis

Literature Evaluated

TOTAL REFERENCES RETRIEVED: Thirteen relevant articles
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: A flow diagram of the search strategy was developed by the investigators and used to select relevant articles. Both English and Chinese literature were searched.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 6 
  • TOTAL PATIENTS INCLUDED IN REVIEW = 726
  • KEY SAMPLE CHARACTERISTICS: All studies defined complete response as no vomiting or use of rescue medications. Five studies compared standard antiemetic regimens without olanzapine to standard antiemetic regimens with olanzapine.

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment
 
APPLICATIONS: Elder care, palliative care

Results

Five out of six studies demonstrated an increase in complete response in patients receiving standard antiemetic regimens plus olanzapine on day 1 of chemotherapy (odds ratio [OR] = 1.95, 95%; confidence interval [CI] = 1.17–3.23; p = 0.01). Five out of six studies showed a cumulative delay in vomiting (OR = 2.65, 95%; CI = 1.36–5.15; p = 0.004). Overall complete response relative risk was improved (4.07, 95%; CI = 1.59–10.43). Also note the following: delayed-phase antinausea effects in olanzapine-containing antiemetic regimens (OR = 2.79, 95%; CI = 1.76–4.43; p = 0.0001); antinausea effects in the overall phase (OR = 3.40, 95% CI = 2.32–5.00; p = 0.00001); and no superiority in the acute phase (RR = 1.34, 95%; CI = 0.77–2.34; p = 0.30).

Conclusions

Complete response is more likely in patients who received antiemetic regimens containing olanzapine compared to patients who did not receive olanzapine. Olanzapine is more effective in delayed CINV than acute.

Limitations

  • Small sample
  • Differences in what drugs were included in standard antiemetic regimens in each study
  • One study used aprepitant in the standard antiemetic regimen.

Nursing Implications

Olanzapine may add CINV control when added to a standard antiemetic regimen during the delayed phase.

Legacy ID

4477