• Beijing Da Xue Xue Bao · Dec 2010

    Meta Analysis

    [A meta-analysis of aprepitant for prevention of chemotherapy-induced nausea and vomiting].

    • Zhen-wei Fang and Suo-di Zhai.
    • Department of Pharmacy, Peking University Third Hospital, and Department of Pharmacy Administration and Clinical Pharmacy, Peking University School of Pharmaceutical Sciences, Beijing 100191, China.
    • Beijing Da Xue Xue Bao. 2010 Dec 18;42(6):756-63.

    ObjectiveTo assess the efficacy and safety of aprepitant for the prevention of chemotherapy-induced nausea and vomiting (CINV) after moderately or highly emetogenic chemotherapy.MethodsStudies were identified by searching PubMed (1980 to March, 2010), EMbase (1980 to March, 2010), Cochrane Libraries (Issue 2, 2010), CNKI (1980 to March, 2010), CBMdisc (1980 to March, 2010), and WanFang Data (1982 to March, 2010). Randomized controlled trials of aprepitant for the prevention of CINV were included. The quality of included studies was assessed and meta-analysis was performed for the results of homogeneous studies by RevMan 5.0.23 software.ResultsTen studies involving 4 376 oncology patients were included. They were all high quality studies, with Jadad scores more than 5. The results of meta-analysis were as follows: (1) Acute CINV: The overall complete response rate was improved by 14.21% when aprepitant was combined with ondansetron and dexamethasone (83.33% vs 72.96%; P<0.001). Subgroup analysis showed the patients receiving AC (anthracycline/cyclophosphamide) regimen benefited less than the patients receiving cisplatin chemotherapy. The rate of no significant nausea was only improved by 3.92% (P=0.04). (2) Delayed CINV: Compared with ondansetron, aprepitant could improve vomiting by 14.98% (P=0.004). When aprepitant was added with dexamethasone, the response rate of vomiting and nausea was improved by 37.72% (P<0.001) and 11.24% (P=0.008) respectively. (3) Adverse reactions: The incidence of fatigue/asthenia was higher in the aprepitant regimen (P=0.001), while the incidence of constipation was lower (P=0.002).ConclusionAprepitant can improve the control of vomiting, but has slight effect on nausea. Patients receiving AC regimen benefit less than patients receiving cisplatin chemotherapy. In view of its high cost, pharmacoeconomics researches of aprepitant should be considered.

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