Zhou Jian-Guo, Huang Lang, Jin Su-Han, Xu Cheng, Frey Benjamin, Ma Hu, Gaipl Udo S
Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China.
Department of Radiation Oncology, Universitätsklinikum Erlangen, Erlangen, Germany.
ESMO Open. 2020 Feb;5(1). doi: 10.1136/esmoopen-2019-000621.
We performed a pooled analysis to evaluate the efficacy and adverse events (AEs) of olanzapine combined with dexamethasone plus 5-hydroxytryptamine type 3 receptor antagonist (5-HT3 RA) compared with 5-HT3 RA plus dexamethasone for the prevention and treatment of chemotherapy-induced nausea and vomiting (CINV) in high and moderate emetogenic chemotherapy based on randomised controlled trials (RCTs). PubMed, EMBASE, Web of Science, the Cochrane Library, China Biomedical Literature database (CBM), WanFang Database, China National Knowledge Infrastructure (CNKI), and Chinese Science and Technology Periodical Database (VIP) (from their inception to April 2019) were searched to capture relevant articles. Relative risk with 95% confidence intervals for CINV and AEs were all extracted or calculated. Eleven studies with 1107 cancer patients were involved in this review. The pooled RR of delayed CINV (RR 0.50, 95% CI 0.38 to 0.66; p<0.01) were significantly decreased in the olanzapine group. The occurrence of insomnia was also statistically decreased, as was the rate of acute CINV (RR 0.60, 95% CI 0.48 to 0.75; p<0.01). However, only the percentages of CINV III and CINV IV were significantly decreased in the acute and delayed phases. Subgroup analysis demonstrated that the efficacy was not statistically significantly different between 5 mg and 10 mg olanzapine. Olanzapine significantly decreased the occurrence of CINV III and IV and insomnia in high and moderately emetogenic chemotherapy. Compared with 10 mg per day, 5 mg oral olanzapine may be more appropriate for patients with cancer.
我们进行了一项汇总分析，以评估在高致吐性和中度致吐性化疗中，与5-羟色胺3型受体拮抗剂（5-HT3 RA）加地塞米松相比，奥氮平联合地塞米松加5-HT3 RA预防和治疗化疗引起的恶心和呕吐（CINV）的疗效及不良事件（AE）。检索了PubMed、EMBASE、科学网、考克兰图书馆、中国生物医学文献数据库（CBM）、万方数据库、中国知网和中文科技期刊数据库（维普）（自建库至2019年4月），以获取相关文章。提取或计算了CINV和AE的相对风险及95%置信区间。本综述纳入了11项研究，涉及1107例癌症患者。奥氮平组延迟性CINV的汇总相对风险（RR 0.50，95%CI 0.38至0.66；p<0.01）显著降低。失眠的发生率也有统计学意义的降低，急性CINV的发生率同样降低（RR 0.60，95%CI 0.48至0.75；p<0.01）。然而，仅急性和延迟期CINV III级和CINV IV级的百分比显著降低。亚组分析表明，5 mg和10 mg奥氮平之间的疗效在统计学上无显著差异。在高致吐性和中度致吐性化疗中，奥氮平显著降低了CINV III级和IV级的发生率以及失眠的发生率。与每日10 mg相比，5 mg口服奥氮平可能更适合癌症患者。
