Simino, G.P., Marra, L.P., Andrade, E.I., Acurcio, F.A., Reis, I.A., de Araujo, V.E., & Cherchiglia, M.L. (2016). Efficacy, safety and effectiveness of ondansetron compared to other serotonin-3 receptor antagonists (5-HTRAs) used to control chemotherapy-induced nausea and vomiting: Systematic review and meta-analysis. Expert Review of Clinical Pharmacology, 9, 1183–1194. 

DOI Link

Purpose

STUDY PURPOSE: To assess the effectiveness and safety of 5HT3s for antiemetic prophylaxis

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED:  PubMed, LILACS, CINAHL, Cochrane Collaboration, Medical Analysis and Retrieval System Online, Literature in the Health Sciences in Latin America and the Caribbean, and a manual search of the Journal of Clinical Oncology. Multiple databases for grey literature were used.
 
INCLUSION CRITERIA: Samples were 18 years and older; undergoing chemotherapy and receiving a 5HT3; reporting of acute and delayed chemotherapy-induced nausea and vomiting (CINV); and English, Spanish, or Portuguese.
 
EXCLUSION CRITERIA: Samples younger than 30 years

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 1,810
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Jadad scale. Twenty-three studies were randomized controlled trials. The Newcastle-Ottawa Scale was used for cohort studies. Five had a low risk of bias, four had a high risk of bias, and 10 studies had conflict of interest.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 25
  • TOTAL PATIENTS INCLUDED IN REVIEW = 8,813
  • SAMPLE RANGE ACROSS STUDIES: 23–542 patients
  • KEY SAMPLE CHARACTERISTICS: Multiple tumor types

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results

Meta-analysis of ondansetron versus granisetron or tropisetron did not show any significant differences in the risk of CINV. The risk ratio with palonosetron versus ondansetron was lower (–1.28, p = 0.033).

Conclusions

The findings suggested a similar efficacy of the various 5HT3 preparations for CINV prophylaxis.

Limitations

Some regimens contained a steroid and some did not. Meta-analysis did not consider all possible drug combinations. Varied emetogenicity of chemotherapy regimens was present.

Nursing Implications

The findings support the general efficacy of various 5HT3 drugs for CINV prophylaxis.

Legacy ID

5989