Document Detail

Serotonin receptor antagonists for highly emetogenic chemotherapy in adults.
MedLine Citation:
PMID:  20091591     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Serotonin receptor antagonists (5-HT(3) RAs) are used to control chemotherapy-induced emesis. Although they have the same general mechanism of action (blockade of serotonin receptors), they have different chemical structures and may have different effects.
OBJECTIVES: To compare efficacy of different serotonin receptor antagonists (5-HT(3) RAs) in the control of acute and delayed emesis induced by highly emetogenic chemotherapy.
SEARCH STRATEGY: We searched CENTRAL, the Specialised Register of the Cochrane PaPaS Group, PubMed, EMBASE, and LILACS databases. Our most recent search was in March 2009.
SELECTION CRITERIA: Randomised trials comparing 5-HT(3) RAs in an adult cancer population.
DATA COLLECTION AND ANALYSIS: We extracted information from the included studies on the control of acute and delayed nausea and vomiting, either as a single or a combined outcome. Where appropriate, we combined the results of similar trials. We carried out sensitivity and subgroup analyses to test the robustness of our findings.
MAIN RESULTS: We included 16 randomised trials (7808 participants). Nine of the trials compared granisetron versus ondansetron. No other drug comparison was studied in more than one trial. The meta-analyses of the granisetron versus ondansetron trials found similar results for the two drugs on acute vomiting (eight trials, 4256 participants, odds ratio (OR) 0.89; 95% CI 0.78 to 1.02), acute nausea (seven trials, 4160 participants, OR 0.97; 95% CI 0.85 to 1.10), delayed vomiting (three trials, 1119 participants, OR 1.00; 95% CI 0.74 to 1.34) and delayed nausea (two trials, 1024 participants, OR 0.96; 95% CI 0.75 to 1.24). Granisetron and ondansetron showed similar effects on headache and diarrhoea, with the possible exception of less constipation associated with ondansetron.One study of 1114 participants comparing palonosetron plus dexamethasone versus granisetron plus dexamethasone showed superiority of palonosetron in controlling delayed vomiting (OR 1.45; 95% CI 1.14 to 1.85) and delayed nausea (OR 1.63; 95% CI 1.27 to 2.10). Complete response for delayed nausea and vomiting was also in favour of the combination palonosetron and dexamethasone (OR 1.63; 95% CI 1.29 to 2.07).
AUTHORS' CONCLUSIONS: Ondansetron and granisetron appear to be equivalent drugs for the prevention of acute and delayed emesis following the use of highly emetogenic chemotherapy.According to one single trial the combination of palonosetron and dexamethasone was superior to granisetron and dexamethasone in controlling delayed emesis. However, more evidence is needed before palonosetron could become the candidate 5-HT(3) RA for the control of delayed emesis induced by highly emetogenic chemotherapy.
Atto Billio; Enrico Morello; Mike J Clarke
Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2010-01-20
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  -     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2010  
Date Detail:
Created Date:  2010-01-21     Completed Date:  2010-04-16     Revised Date:  2014-02-19    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD006272     Citation Subset:  IM    
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MeSH Terms
Dexamethasone / adverse effects,  therapeutic use
Granisetron / adverse effects,  therapeutic use
Isoquinolines / adverse effects,  therapeutic use
Nausea / chemically induced,  drug therapy*
Ondansetron / adverse effects,  therapeutic use
Quinuclidines / adverse effects,  therapeutic use
Randomized Controlled Trials as Topic
Serotonin 5-HT3 Receptor Antagonists*
Vomiting / chemically induced,  drug therapy*
Grant Support
MC_U137686860//Medical Research Council
Reg. No./Substance:
0/Isoquinolines; 0/Quinuclidines; 0/Serotonin 5-HT3 Receptor Antagonists; 4AF302ESOS/Ondansetron; 5D06587D6R/palonosetron; 7S5I7G3JQL/Dexamethasone; WZG3J2MCOL/Granisetron
Update In:
Cochrane Database Syst Rev. 2013;12:CD006272   [PMID:  24323437 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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