Schwartzberg, L., Jackson, J., Jain, G., Balu, S., & Buchner, D. (2011). Impact of 5-HT(3) RA selection within triple antiemetic regimens on uncontrolled highly emetogenic chemotherapy-induced nausea/vomiting. Expert Review of Pharmacoeconomics & Outcomes Research, 11(4), 481–488.
To assess the likelihood of uncontrolled chemotherapy-induced nausea and vomiting (CINV) events following antiemetic prophylaxis with the 5-HT3 receptor antagonist (RA) palonosetron plus aprepitant or fosaprepitant and dexamethasone versus any of the other 5-HT3 RAs (granisetron, dolesetron, ondansetron) plus aprepitant or fosaprepitant and dexamethasone among single-day, highly emetogneic chemotherapy (HEC) cycles
This was a retrospective analysis of a healthcare claims database from January 2006 through June 2010 using data from International Classification of Diseases book 9 (ICD-9), Current Procedural Terminology (CPT), and pharmacy claims. Investigators evaluated two cohorts. The palonosetron cohort consisted of patients initiating antiemetic prophylaxis with palonosetron plus aprepitant or fosaprepitant and dexamethasone. The \"other 5-HT3 cohort\" consisted of patients receiving any other 5-HT3 RA plus aprepitant or fosaprepitant and dexamethasone.
Patients were undergoing the active treatment phase of care.
This was a retrospective data analysis.
CINV was defined as at least one of the following during days 2–5 post chemotherapy: a diagnosis of nausea or vomiting (ICD-9 code); hydration procedure (CPT code); rescue medication use of any of the following: dexamethasone, diphenhydramine, olanzapine, promethazine, haloperidol, prochlorperazine, lorazepam, or metoclopramide; or antiemetic administration of palonosetron, ondansetron, granisetron, dolasetron and fosaprepitant/aprepitant by oral or IV routes.
A total of 8,018 cycles for the palonosetron cohort and 1,926 cycles for the other 5-HT3-RA cohort were analyzed. Single-day HEC cycles received by the palonosetron cohort had a significantly lower unadjusted risk of an uncontrolled CINV event with a 17% lower risk for palonosetron-administered cycles versus 21% risk for other 5-HT3 RAs (p = 0.0010). Results in the breast cancer and multiple cancer subgroups were consistent with those for the overall population.
This study suggests that all 5-HT3 RAs may not be equivalent in preventing delayed CINV for patients receiving single-day HEC; however, the study design limits the strength of the evidence.
Nurses may want to consider substituting palonosetron as 5-HT3 in antiemetic regimen for single day HEC.