Yang Ting, Liu Qianxin, Lu Min, Ma Lingyue, Zhou Ying, Cui Yimin
Department of Pharmacy, Peking University First Hospital, 6 Dahongluochang Street, Xicheng District, Beijing, 100034, China.
Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, 38 Xueyuan Street, Haidian District, Beijing, 100034, China.
Br J Clin Pharmacol. 2017 Jul;83(7):1369-1379. doi: 10.1111/bcp.13242. Epub 2017 Mar 23.
The aim of the present study was to evaluate the efficacy of olanzapine for the prevention of chemotherapy-induced nausea and vomiting (CINV).
The literature was searched for randomized controlled trials (RCTs) evaluating the efficacy of olanzapine for the prophylaxis of CINV using PubMed, Embase, Central, as well as clinicaltrials.gov for unpublished studies. The endpoints of the study were the number of patients who achieved a complete response (CR; no emesis and no rescue) and no nausea in the acute, delayed and overall phases. Two authors independently selected studies, assessed the risk of bias and extracted data. The included RCTs were analysed using RevMan 5.3 provided by the Cochrane Collaboration.
Ten RCTs were identified for the meta-analysis. Compared with other antiemetic agents, olanzapine significantly improved the CR in the delayed and overall phases, but did not enhance the CR in the acute phase. For the control of CINV, olanzapine was better than and comparable with aprepitant in the acute phase and delayed phase, respectively. Compared with placebo, treatment with 5 mg and 10 mg olanzapine exhibited similar efficacy in terms of the CR in the delayed and overall phases.
Olanzapine is an excellent alternative for the prophylaxis of CINV. Olanzapine 5 mg per day should be recommended as the initial dose because of equivalent efficacy to a 10 mg dose but a lower potential risk of side effects. Further studies are needed to explore the optimal combination of medicines.
本研究旨在评估奥氮平预防化疗引起的恶心和呕吐（CINV）的疗效。
通过PubMed、Embase、Central以及clinicaltrials.gov检索评估奥氮平预防CINV疗效的随机对照试验（RCT），以查找未发表的研究。研究终点为在急性、延迟和总体阶段达到完全缓解（CR；无呕吐且无需救援）且无恶心的患者数量。两位作者独立选择研究、评估偏倚风险并提取数据。使用Cochrane协作网提供的RevMan 5.3对纳入的RCT进行分析。
共纳入10项RCT进行荟萃分析。与其他止吐药相比，奥氮平在延迟和总体阶段显著提高了CR，但在急性期未提高CR。对于CINV的控制，奥氮平在急性期和延迟期分别优于阿瑞匹坦且与之相当。与安慰剂相比，5 mg和10 mg奥氮平治疗在延迟和总体阶段的CR方面表现出相似的疗效。
奥氮平是预防CINV的极佳选择。由于5 mg/天的奥氮平与10 mg剂量疗效相当但副作用潜在风险较低，应推荐其作为初始剂量。需要进一步研究以探索最佳药物组合。
