title: Neurokinin-1 receptor antagonists in preventing postoperative nausea and vomiting: a systematic review and meta-analysis.
abstract: Newly developed neurokinin-1 receptor (NK-1R) antagonists have been recently tried in the prevention of postoperative nausea and vomiting (PONV). This systematic review and meta-analysis was conducted to explore whether NK-1R antagonists were effective in preventing PONV.The PRISMA statement guidelines were followed. Randomized clinical trials (RCTs) that tested the preventive effects of NK-1R antagonists on PONV were identified by searching EMBASE, CINAHL, PubMed, and the Cochrane Library databases followed by screening. Data extraction was performed using a predefined form and trial quality was assessed using a modified Jadad scale. The primary outcome measure was the incidence of PONV. Meta-analysis was performed for studies using similar interventions. Network meta-analysis (NMA) was conducted to compare the anti-vomiting effects of placebo, ondansetron, and aprepitant at different doses.Fourteen RCTs were included. Meta-analysis found that 80 mg of aprepitant could reduce the incidences of nausea (3 RCTs with 224 patients, pooled risk ratio (RR) = 0.60, 95% confidence interval (CI) = 0.47 to 0.75), and vomiting (3 RCTs with 224 patients, pooled RR = 0.13, 95% CI = 0.04 to 0.37) compared with placebo. Neither 40 mg (3 RCTs with 1171 patients, RR = 0.47, 95% CI = 0.37 to 0.60) nor 125 mg (2 RCTs with 1058 patients, RR = 0.32, 95% CI = 0.13 to 0.78) of aprepitant showed superiority over 4 mg of ondansetron in preventing postoperative vomiting. NMA did not find a dose-dependent effect of aprepitant on preventing postoperative vomiting.Limited data suggested that NK-1R antagonists, especially aprepitant were effective in preventing PONV compared with placebo. More large-sampled high-quality RCTs are needed.
authors.affiliation: From the Department of Anesthesiology (ML, BD, FX, ZZ, XS), Changzheng Hospital Affiliated to Second Military Medical University, Shanghai, China; Department of Anesthesiology, Second Artillery General Hospital PLA, Beijing, China; Department of Anesthesiology (BD), Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China; Department of Anesthesiology (XS), Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Meng
authors.initials: M
authors.lastname: Liu
authors.forename: Hao
authors.initials: H
authors.lastname: Zhang
authors.forename: Bo-Xiang
authors.initials: BX
authors.lastname: Du
authors.forename: Feng-Ying
authors.initials: FY
authors.lastname: Xu
authors.forename: Zui
authors.initials: Z
authors.lastname: Zou
authors.forename: Bo
authors.initials: B
authors.lastname: Sui
authors.forename: Xue-Yin
authors.initials: XY
authors.lastname: Shi
mesh_terms: D006801:Humans; D000932:Antiemetics / Q000008:administration & dosage; D000077608:Aprepitant; D004305:Dose-Response Relationship, Drug; D009025:Morpholines / Q000008:administration & dosage; D064729:Neurokinin-1 Receptor Antagonists / Q000008:administration & dosage; D017294:Ondansetron / Q000008:administration & dosage; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic
chemical_list: D000932:Antiemetics; D000077608:Aprepitant; D009025:Morpholines; D064729:Neurokinin-1 Receptor Antagonists; D017294:Ondansetron