title: Meta-analysis of adjunctive non-NK1 receptor antagonist medications for the control of acute and delayed chemotherapy-induced nausea and vomiting.
abstract: OBJECTIVE
  Chemotherapy-induced nausea and vomiting (CINV) is a distressing chemotherapy-induced symptom that may adversely impact the quality of life of cancer patients.
  
  
  METHODS
  We conducted a systematic search of the Pubmed, Bireme, and Cochrane databases for randomized clinical trials that were published in English and that evaluated the combination of adjunctive non-neurokinin 1 (NK1) antagonist drugs (i.e., neuroleptics, anticonvulsants, benzodiazepines, and cannabinoids) with 5-hydroxytryptamine 3 (5-HT3) antagonists for adult cancer patients who were scheduled to receive moderate or highly emetogenic chemotherapy. We employed the Review Manager (RevMan) Computer program Version 5.2 for statistical calculations.
  
  
  RESULTS
  We included 13 studies with a total of 1,669 patients. We observed a higher complete protection for acute CINV with adjunctive medications (risk ratio (RR) = 0.55; 95% confidence interval (CI) 0.30-1.01; p = 0.05; I2 = 47%), which was not the case for the delayed period (RR = 0.89; 95% CI 0.73-1.10, p = 0.29, I2 = 15%). We also observed that these adjunctive medications significantly increased the complete control of nausea (RR = 0.72; 95% CI 0.55-0.95; p = 0.02, I2 = 83%) and vomiting (RR = 0.61; 95% CI 0.50-0.75; p < 0.00001; I2 = 60%). There was no subgroup analysis evidence of the superiority of any single group of adjunctive medications.
  
  
  CONCLUSIONS
  We conclude that adjunctive non-NK1 antagonist medications may be useful for CINV control. Prospective randomized studies incorporating these low-cost medications into new regimens combining 5-HT3 and NK1 antagonists may be warranted.
authors.affiliation: Oncology Department, ABC Medical School (FMABC), Av. Principe de Gales, São Paulo, 09060-650, Brazil, thaianaa@yahoo.com.br.
authors.forename: Thaiana Aragão
authors.initials: TA
authors.lastname: Santana
authors.forename: Damila Cristina
authors.initials: DC
authors.lastname: Trufelli
authors.forename: Leandro Luongo de
authors.initials: LL
authors.lastname: Matos
authors.forename: Felipe Melo
authors.initials: FM
authors.lastname: Cruz
authors.forename: Auro
authors.initials: A
authors.lastname: Del Giglio
mesh_terms: D000328:Adult; D000932:Antiemetics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D060828:Induction Chemotherapy / Q000009:adverse effects; D009325:Nausea / Q000139:chemically induced / Q000188:drug therapy*; D009369:Neoplasms / Q000188:drug therapy; D064729:Neurokinin-1 Receptor Antagonists / Q000627:therapeutic use*; D016017:Odds Ratio; D011788:Quality of Life; D018040:Receptors, Neurokinin-1 / Q000187:drug effects; D058831:Serotonin 5-HT3 Receptor Antagonists / Q000627:therapeutic use*; D014839:Vomiting / Q000139:chemically induced / Q000188:drug therapy*
chemical_list: D000932:Antiemetics; D000970:Antineoplastic Agents; D064729:Neurokinin-1 Receptor Antagonists; D018040:Receptors, Neurokinin-1; D058831:Serotonin 5-HT3 Receptor Antagonists; D001569:Benzodiazepines