Yuan, D.M., Li, Q., Zhang, Q., Xiao, X.W., Yao, Y.W., Zhang, Y., . . . Song, Y. (2016). Efficacy and safety of neurokinin-1 receptor antagonists for prevention of chemotherapy-induced nausea and vomiting: Systematic review and meta-analysis of randomized controlled trials. Asian Pacific Journal of Cancer Prevention, 17, 1661–1675.
STUDY PURPOSE: To evaluate the efficacy and safety of neurokinin-1 receptor antagonists (NK1s) for the prevention of chemotherapy-induced nausea and vomiting (CINV) among children and adolescents
TYPE OF STUDY: Meta-analysis and systematic review
PHASE OF CARE: Multiple phases of care
APPLICATIONS: Pediatrics, elder care
Overall: Those with NK1 had 71% CR, and those with out NK1 (control group) had 56% CR (p < 0.001). Subgroup analysis showed that aprepitant had significantly higher CR than the control (64% versus 51%, p < 0.001), but fosaprepitant had no difference (p = 0.311).
Acute Phase: Those with NK1 had 85% CR, and those without NK1 had 79.6% CR (p < 0.001). Subgroup analysis showed that those with oral or IV NK1 had significantly better CR (p < 0.001 for both groups) than those without NK1, but no significant difference occurred if NK1 was used intravenously on day 1 followed with oral NK1 (p = 0.685). NK1 used in combination with 5-HT3 alone or 5-HT3 plus dexamethasone had higher CR (p = 0.001 and < 0.001, respectively), but no difference occurred if NK1 was used with dexamethasone alone (p = 0.274).
Delayed Phase: Those with NK1 had 71% CR, and those without NK1 had 58% CR (p < 0.001). Children or Adolescents: NK1 had increased CR in the overall phase (p < 0.001), acute phase (p = 0.012), and delayed phase (p < 0.001).
Other Outcomes: Compared to the control group, NK1 showed less incidence of nausea (45.2% versus 45.9%, p < 0.001), less vomiting (22.6% versus 38.9%, p < 0.001), and less use of rescue drugs (23.5% versus 34.1%, p < 0.001).
Adverse Events: NK1 did not increase the incidence of adverse events (69% versus 65%, p = 0.204), and no difference was noted among the three pediatric studies (80% versus 77%, p = 0.497).
The review confirms that the addition of NK1 to 5-HT3 alone or 5-HT3 plus dexamethasone is effective in achieving complete remission of chemotherapy-induced nausea and vomiting (CINV) in the acute and delayed phases with no significant increase in adverse events. The addition of NK1 is also effective for children and adolescents in the acute and delayed phases with no significant increase in adverse events.
A NK1, specifically aprepitant, is effective in preventing CINV during the acute or delayed phases of treatment, but the medication should be administered consistently either orally or intravenously. Changing the IV route to oral is not effective.