Neurokinin-1 receptor antagonists in preventing postoperative nausea and vomiting: a systematic review and meta-analysis.

Abstract

Newly developed neurokinin-1 receptor (NK-1R) antagonists have been recently tried in the prevention of postoperative nausea and vomiting (PONV). This systematic review and meta-analysis was conducted to explore whether NK-1R antagonists were effective in preventing PONV.The PRISMA statement guidelines were followed. Randomized clinical trials (RCTs) that tested the preventive effects of NK-1R antagonists on PONV were identified by searching EMBASE, CINAHL, PubMed, and the Cochrane Library databases followed by screening. Data extraction was performed using a predefined form and trial quality was assessed using a modified Jadad scale. The primary outcome measure was the incidence of PONV. Meta-analysis was performed for studies using similar interventions. Network meta-analysis (NMA) was conducted to compare the anti-vomiting effects of placebo, ondansetron, and aprepitant at different doses.Fourteen RCTs were included. Meta-analysis found that 80 mg of aprepitant could reduce the incidences of nausea (3 RCTs with 224 patients, pooled risk ratio (RR) = 0.60, 95% confidence interval (CI) = 0.47 to 0.75), and vomiting (3 RCTs with 224 patients, pooled RR = 0.13, 95% CI = 0.04 to 0.37) compared with placebo. Neither 40 mg (3 RCTs with 1171 patients, RR = 0.47, 95% CI = 0.37 to 0.60) nor 125 mg (2 RCTs with 1058 patients, RR = 0.32, 95% CI = 0.13 to 0.78) of aprepitant showed superiority over 4 mg of ondansetron in preventing postoperative vomiting. NMA did not find a dose-dependent effect of aprepitant on preventing postoperative vomiting.Limited data suggested that NK-1R antagonists, especially aprepitant were effective in preventing PONV compared with placebo. More large-sampled high-quality RCTs are needed.

• Authors: Meng Liu, Hao Zhang, Bo-Xiang Du, Feng-Ying Xu, Zui Zou, Bo Sui, Xue-Yin Shi
• Journal: Medicine (Medicine (Baltimore)) Vol. 94 Issue 19 Pg. e762 (May 2015) ISSN: 1536-5964 [Electronic] United States
• PMID: 25984662 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)

Chemical References

• Antiemetics
• Morpholines
• Neurokinin-1 Receptor Antagonists
• Aprepitant
• Ondansetron

Topics

• Antiemetics (administration & dosage)
• Aprepitant
• Dose-Response Relationship, Drug
• Humans
• Morpholines (administration & dosage)
• Neurokinin-1 Receptor Antagonists (administration & dosage)
• Ondansetron (administration & dosage)
• Postoperative Nausea and Vomiting (prevention & control)
• Randomized Controlled Trials as Topic