title: Comparative efficacy of serotonin (5-HT3) receptor antagonists in patients undergoing surgery: a systematic review and network meta-analysis.
abstract: BACKGROUND
  Serotonin (5-HT3) receptor antagonists are commonly used to decrease nausea and vomiting for surgery patients. We conducted a systematic review on the comparative efficacy of 5-HT3 receptor antagonists.
  
  
  METHODS
  Searches were done in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify studies comparing 5-HT3 receptor antagonists with each other, placebo, and/or combined with other antiemetic agents for patients undergoing surgical procedures. Screening search results, data abstraction, and risk of bias assessment were conducted by two reviewers independently. Random-effects pairwise meta-analysis and network meta-analysis (NMA) were conducted. PROSPERO registry number: CRD42013003564.
  
  
  RESULTS
  Overall, 450 studies and 80,410 patients were included after the screening of 7,608 citations and 1,014 full-text articles. Significantly fewer patients experienced nausea with any drug relative to placebo, except for ondansetron plus metoclopramide in a NMA including 195 RCTs and 24,230 patients. Significantly fewer patients experienced vomiting with any drug relative to placebo except for palonosetron plus dexamethasone in NMA including 238 RCTs and 12,781 patients. All agents resulted in significantly fewer patients with postoperative nausea and vomiting versus placebo in a NMA including 125 RCTs and 16,667 patients.
  
  
  CONCLUSIONS
  Granisetron plus dexamethasone was often the most effective antiemetic, with the number needed to treat ranging from two to nine.
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada. triccoa@smh.ca.|Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 6th floor, 155 College St, Toronto, ON, M5T 3M7, Canada. triccoa@smh.ca.
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Tricco
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada. soobiahc@smh.ca.|Institute for Health Policy Management & Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada. soobiahc@smh.ca.
authors.forename: Charlene
authors.initials: C
authors.lastname: Soobiah
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada. blondale@smh.ca.
authors.forename: Erik
authors.initials: E
authors.lastname: Blondal
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada. veronikia@smh.ca.
authors.forename: Areti A
authors.initials: AA
authors.lastname: Veroniki
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada. pakahn@hotmail.com.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Khan
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada. vafaeia@smh.ca.
authors.forename: Afshin
authors.initials: A
authors.lastname: Vafaei
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada. john.d.ivory@gmail.com.
authors.forename: John
authors.initials: J
authors.lastname: Ivory
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada. striflerl@smh.ca.
authors.forename: Lisa
authors.initials: L
authors.lastname: Strifler
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada. ashoorh@smh.ca.
authors.forename: Huda
authors.initials: H
authors.lastname: Ashoor
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada. hrmacdonald@gmail.com.
authors.forename: Heather
authors.initials: H
authors.lastname: MacDonald
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada. ereynen@gmail.com.
authors.forename: Emily
authors.initials: E
authors.lastname: Reynen
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada. reidcrobson@gmail.com.
authors.forename: Reid
authors.initials: R
authors.lastname: Robson
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada. jmho2001@gmail.com.
authors.forename: Joanne
authors.initials: J
authors.lastname: Ho
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada. carmen_hm_ng@yahoo.ca.
authors.forename: Carmen
authors.initials: C
authors.lastname: Ng
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada. antonyj@smh.ca.
authors.forename: Jesmin
authors.initials: J
authors.lastname: Antony
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada. kmrklas@gmail.com.|Departments of Community Health Sciences, Faculty of Medicine, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Drive, Calgary, AB, T2N 4Z6, Canada. kmrklas@gmail.com.
authors.forename: Kelly
authors.initials: K
authors.lastname: Mrklas
authors.affiliation: Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, ON, K1Y 4E9, Canada. bhutton@ohri.ca.
authors.forename: Brian
authors.initials: B
authors.lastname: Hutton
authors.affiliation: Departments of Community Health Sciences, Faculty of Medicine, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Drive, Calgary, AB, T2N 4Z6, Canada. brenda.hemmelgarn@albertahealthservices.ca.
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn
authors.affiliation: Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, ON, K1Y 4E9, Canada. dmoher@ohri.ca.
authors.forename: David
authors.initials: D
authors.lastname: Moher
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada. sharon.straus@utoronto.ca.|Department of Geriatric Medicine, University of Toronto, 27 Kings College Circle, Toronto, ON, M5S 1A1, Canada. sharon.straus@utoronto.ca.
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Straus
mesh_terms: D000932:Antiemetics / Q000627:therapeutic use*; D006801:Humans; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D012042:Registries; D058831:Serotonin 5-HT3 Receptor Antagonists / Q000627:therapeutic use*; D014839:Vomiting / Q000517:prevention & control*
chemical_list: D000932:Antiemetics; D058831:Serotonin 5-HT3 Receptor Antagonists