Kubota Yutaka, Mihara Kiyoshi, Ishii Fumiyoshi, Ohno Keiko, Ogata Hiroyasu, Makimura Mizue, Kikuchi Norikazu, Kitano Taeko
Graduate School, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose City, Tokyo 204-8588, Japan.
Yakugaku Zasshi. 2004 Jan;124(1):1-11. doi: 10.1248/yakushi.124.1.
We performed a systematic review of the effectiveness of anti-emetics for prophylaxis of cisplatin-induced delayed emesis using meta-analysis. We selected 12 reports of randomized controlled trials from MEDLINE (1966-2003. 4) and The Cochrane Library Issue 1, 2003. Nine of these reports were evaluated as high quality and the others as low quality according to the evaluation criteria of Jadad et al., and only the high-quality reports were subjected to meta-analysis. The statistical results obtained from all 12 reports were also compared with those obtained from the 9 reports of high quality. Corticosteroids significantly reduced the occurrence of delayed emesis. Metoclopramide tended to reduce the occurrence of delayed emesis, although not to a significant extent. In contrast, 5-HT3 receptor antagonists did not show a significant prophylactic effect on delayed emesis. Combination treatments using corticosteroids with metoclopramide or 5-HT3 receptor antagonists did not show significant additional benefits over corticosteroids alone. In conclusion, treatment with corticosteroids without additional metoclopramide or 5-HT3 receptor antagonists appears to be preferable for the prevention of delayed emesis induced by cisplatin.
我们采用荟萃分析的方法，对预防顺铂所致延迟性呕吐的止吐药有效性进行了系统评价。我们从MEDLINE（1966年至2003年4月）以及《Cochrane图书馆》2003年第1期选取了12篇随机对照试验报告。根据Jadad等人的评价标准，其中9篇报告被评估为高质量，其余为低质量，仅对高质量报告进行了荟萃分析。还将12篇报告所得的统计结果与9篇高质量报告所得结果进行了比较。皮质类固醇显著降低了延迟性呕吐的发生率。胃复安虽有降低延迟性呕吐发生率的趋势，但程度不显著。相比之下，5-羟色胺3（5-HT3）受体拮抗剂对延迟性呕吐未显示出显著的预防作用。皮质类固醇与胃复安或5-HT3受体拮抗剂联合治疗，相较于单独使用皮质类固醇，未显示出显著的额外益处。总之，对于预防顺铂所致延迟性呕吐，不额外使用胃复安或5-HT3受体拮抗剂的皮质类固醇治疗似乎更为可取。
