Billio Atto, Morello Enrico, Clarke Mike J
Department of Haematology and Bone Marrow Transplantation, Central Hospital S, Maurizio, Bolzano, Italy, 39100.
Cochrane Database Syst Rev. 2010 Jan 20(1):CD006272. doi: 10.1002/14651858.CD006272.pub2.
Serotonin receptor antagonists (5-HT(3) RAs) are used to control chemotherapy-induced emesis. Although they have the same general mechanism of action (blockade of serotonin receptors), they have different chemical structures and may have different effects.
To compare efficacy of different serotonin receptor antagonists (5-HT(3) RAs) in the control of acute and delayed emesis induced by highly emetogenic chemotherapy.
We searched CENTRAL, the Specialised Register of the Cochrane PaPaS Group, PubMed, EMBASE, and LILACS databases. Our most recent search was in March 2009.
Randomised trials comparing 5-HT(3) RAs in an adult cancer population.
We extracted information from the included studies on the control of acute and delayed nausea and vomiting, either as a single or a combined outcome. Where appropriate, we combined the results of similar trials. We carried out sensitivity and subgroup analyses to test the robustness of our findings.
We included 16 randomised trials (7808 participants). Nine of the trials compared granisetron versus ondansetron. No other drug comparison was studied in more than one trial. The meta-analyses of the granisetron versus ondansetron trials found similar results for the two drugs on acute vomiting (eight trials, 4256 participants, odds ratio (OR) 0.89; 95% CI 0.78 to 1.02), acute nausea (seven trials, 4160 participants, OR 0.97; 95% CI 0.85 to 1.10), delayed vomiting (three trials, 1119 participants, OR 1.00; 95% CI 0.74 to 1.34) and delayed nausea (two trials, 1024 participants, OR 0.96; 95% CI 0.75 to 1.24). Granisetron and ondansetron showed similar effects on headache and diarrhoea, with the possible exception of less constipation associated with ondansetron.One study of 1114 participants comparing palonosetron plus dexamethasone versus granisetron plus dexamethasone showed superiority of palonosetron in controlling delayed vomiting (OR 1.45; 95% CI 1.14 to 1.85) and delayed nausea (OR 1.63; 95% CI 1.27 to 2.10). Complete response for delayed nausea and vomiting was also in favour of the combination palonosetron and dexamethasone (OR 1.63; 95% CI 1.29 to 2.07).
AUTHORS' CONCLUSIONS: Ondansetron and granisetron appear to be equivalent drugs for the prevention of acute and delayed emesis following the use of highly emetogenic chemotherapy.According to one single trial the combination of palonosetron and dexamethasone was superior to granisetron and dexamethasone in controlling delayed emesis. However, more evidence is needed before palonosetron could become the candidate 5-HT(3) RA for the control of delayed emesis induced by highly emetogenic chemotherapy.
血清素受体拮抗剂（5-HT(3) RAs）用于控制化疗引起的呕吐。尽管它们具有相同的一般作用机制（阻断血清素受体），但其化学结构不同，可能具有不同的效果。
比较不同血清素受体拮抗剂（5-HT(3) RAs）在控制由高致吐性化疗引起的急性和延迟性呕吐方面的疗效。
我们检索了Cochrane PaPaS小组的专业注册库CENTRAL、PubMed、EMBASE和LILACS数据库。我们最近一次检索是在2009年3月。
比较成人癌症患者中5-HT(3) RAs的随机试验。
我们从纳入的研究中提取了关于控制急性和延迟性恶心及呕吐的信息，作为单一或综合结果。在适当情况下，我们合并了类似试验的结果。我们进行了敏感性和亚组分析以检验研究结果的稳健性。
我们纳入了16项随机试验（7808名参与者）。其中9项试验比较了格拉司琼与昂丹司琼。没有其他药物比较在超过一项试验中进行研究。格拉司琼与昂丹司琼试验的荟萃分析发现，两种药物在急性呕吐（8项试验，4256名参与者，比值比（OR）0.89；95%可信区间0.78至1.02）、急性恶心（7项试验，4160名参与者，OR 0.97；95%可信区间0.85至1.10）、延迟性呕吐（3项试验，1119名参与者，OR 1.00；95%可信区间0.74至1.34）和延迟性恶心（2项试验，1024名参与者，OR 0.96；95%可信区间0.75至1.24）方面结果相似。格拉司琼和昂丹司琼在头痛和腹泻方面显示出相似的效果，昂丹司琼可能除外，其便秘情况较少。一项对1114名参与者的研究比较了帕洛诺司琼加地塞米松与格拉司琼加地塞米松，结果显示帕洛诺司琼在控制延迟性呕吐（OR 1.45；95%可信区间1.14至1.85）和延迟性恶心（OR 1.63；95%可信区间1.27至2.10）方面更具优势。延迟性恶心和呕吐的完全缓解情况也有利于帕洛诺司琼和地塞米松的联合使用（OR 1.63；95%可信区间1.29至2.07）。
昂丹司琼和格拉司琼在预防高致吐性化疗后的急性和延迟性呕吐方面似乎是等效药物。根据一项单一试验，帕洛诺司琼和地塞米松的联合使用在控制延迟性呕吐方面优于格拉司琼和地塞米松。然而，在帕洛诺司琼能够成为控制高致吐性化疗引起的延迟性呕吐的候选5-HT(3) RA之前，还需要更多证据。
