Qiu Tingting, Men Peng, Xu Xiaohan, Zhai Suodi, Cui Xiangli
Department of Pharmacy, Peking University Third Hospital.
Institute for Drug Evaluation, Peking University Health Science Center.
Medicine (Baltimore). 2020 Aug 14;99(33):e21559. doi: 10.1097/MD.0000000000021559.
To systematically evaluate the efficacy and safety of antiemetic regimen with aprepitant in the prevention of chemotherapy-induced nausea and vomiting (CINV) and provide updated information for clinical practice.
Pubmed, Embase, the Cochrane Library, and 3 Chinese literature databases were systematically searched. Randomized controlled trials comparing standard regimen (5-hydroxytryptamine-3 receptor antagonist and glucocorticoid) with aprepitant triple regimen (aprepitant plus the standard regimen) for preventing CINV were screened. Literature selection, data extraction, and quality evaluation were performed by 2 reviewers independently. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated in the meta-analysis using RevMan 5.3 software.
A total of 51 randomized controlled trials were finally included in the systematic review. Compared with the standard regimen, the aprepitant triple regimen significantly improved the complete response in the overall (OR 1.88, 95% CI 1.71-2.07), acute (OR 1.96, 95% CI 1.65-2.32) and delayed (OR 1.96, 95% CI 1.70-2.27) phases, regardless of emetogenic risk of chemotherapy. Aprepitant could also significantly enhance the proportions of patients who have no emesis, nausea, or use of rescue medication respectively in the overall, acute and/or delayed phases. Aprepitant was found to be associated with decreased risk of constipation (OR 0.85, 95% CI 0.74-0.97), but increased the incidence of hiccup (OR 1.26, 95% CI 1.05, 1.51). There were no statistically significant differences between the 2 groups on other safety outcomes.
The aprepitant triple regimen is effective for the prevention of CINV in patients being treated with moderately or highly emetogenic chemotherapy, and has a significant tendency to reduce the risk of constipation and increase the incidence of hiccup.
系统评价阿瑞匹坦止吐方案预防化疗所致恶心和呕吐（CINV）的有效性和安全性，为临床实践提供最新信息。
系统检索PubMed、Embase、Cochrane图书馆及3个中文文献数据库。筛选比较标准方案（5-羟色胺-3受体拮抗剂和糖皮质激素）与阿瑞匹坦三联方案（阿瑞匹坦加标准方案）预防CINV的随机对照试验。由2名评价员独立进行文献筛选、数据提取和质量评价。使用RevMan 5.3软件进行Meta分析，计算比值比（OR）和95%置信区间（CI）。
系统评价最终纳入51项随机对照试验。与标准方案相比，无论化疗的致吐风险如何，阿瑞匹坦三联方案在总体（OR 1.88，95%CI 1.71-2.07）、急性（OR 1.96，95%CI 1.65-2.32）和延迟（OR 1.96，95%CI 1.70-2.27）期均显著提高了完全缓解率。阿瑞匹坦还可分别显著提高总体、急性和/或延迟期无呕吐、无恶心或未使用解救药物的患者比例。发现阿瑞匹坦与便秘风险降低相关（OR 0.85，95%CI 0.74-0.97），但呃逆发生率增加（OR 1.26，95%CI 1.05，1.51）。两组在其他安全性指标上无统计学显著差异。
阿瑞匹坦三联方案对接受中度或高度致吐性化疗的患者预防CINV有效，且有显著降低便秘风险和增加呃逆发生率的趋势。
