Efficacy of current antiemetic treatments for preventing delayed chemotherapy-induced nausea and vomiting: A meta-analysis of randomized controlled trials

Abstract

Treatments consisting of dexamethasone with a 5-HT3 receptor antagonist (5-HT3RA) or metoclopramide are commonly used for controlling delayed chemotherapy-induced nausea and vomiting (CINV). We evaluated systematically the efficacy of these treatments for preventing delayed CINV. We undertook a meta-analysis of studies that met the following entry criteria: randomized clinical trials comparing dexamethasone and a 5-HT 3RA versus dexamethasone alone or dexamethasone with metoclopramide for preventing delayed CINV; same prophylactic treatment must be used for acute CINV. A comprehensive literature search was conducted. Of 54 potentially useful studies, eight reports met the criteria and were analyzed. The overall total protection from delayed CINV was similar between patients receiving a 5-HT 3RA combined with dexamethasone (53.2%, 454/853) and dexamethasone alone (53.3%, 450/844), yielding a relative risk (RR) of 1.03 (95% CI 0.97-1.09). Similar efficacy between the two treatment groups was also observed for preventing delayed nausea [RR 1.03 (95% CI 0.98-1.09)] and vomiting [RR 1.03 (95% CI 0.99-1.07)]. No significant difference in the efficacy of preventing delayed CINV was observed between patients receiving dexamethasone combined with either a 5-HT3RA or metoclopramide. We conclude that treatments consisting of dexamethasone and a 5-HT3RA or metoclopramide have similar efficacy to dexamethasone alone for preventing delayed CINV. Copyright © 2004 by Taylor & Francis Inc.