title: Efficacy and Safety of Neurokinin-1 Receptor Antagonists for Prevention of Chemotherapy-Induced Nausea and Vomiting: Systematic Review and Meta-analysis of Randomized Controlled Trials.
abstract: OBJECTIVE
  Can addition of neurokinin-1 receptor antagonists (NK1-RAs) be considered as an ideal strategy for the prevention of chemotherapy-induced nausea and vomiting (CINV)? Researchers differ on this question.
  
  
  METHODS
  Electronic databases were searched for randomized control trials (RCTs) that evaluated the effectiveness and safety of NK1-RAs in preventing CINV. The primary end point was complete response (CR) in the acute, delayed, and overall phases after chemotherapy. Subgroup analyses evaluated the types of NK1-RAs, routines of administration, types of malignancies, regimens used in combination with NK1-RAs, and age of patients included in the studies. The incidences of different types of adverse events were also extracted to estimate the safety of NK1-RAs.
  
  
  RESULTS
  A total of 38 RCTs involving 13,923 patients were identified. The CR rate of patients receiving NK-RAs was significantly higher than patients in the control groups during overall phase (70.8% vs 56.0%, <0.001), acute phase (85.1% vs 79.6%, <0.001), and delayed phase (71.4% vs 58.2%, <0.001). There were three studies including patients of children or adolescents, the CR rate was also significantly higher in the treatment group (overall phase: OR=2.807, <0.001; acute phase: OR=2.863, P =0.012; delayed phase: OR=2.417, <0.001). For all the other outcomes, patients in the NK1-RAs groups showed improvements compared to the control groups (incidence of nausea: 45.2% vs 45.9%, <0.001; occurrence of vomiting: 22.6% vs 38.9%, <0.001; usage of rescue drugs: 23.5% vs 34.1%, <0.001). The pooled side effects from NK1-RAs did not significantly differ from previous reports and the toxicity rates in patients less than eighteen years old also did not diff between the two groups (P=0.497). However, we found that constipation and insomnia were more common in the patients of control groups, whereas diarrhea and hiccups were more frequently detected in patients receiving NK1-RAs.
  
  
  CONCLUSIONS
  NK1-RAs improved the CR rate of CINV. They are effective for both adults and children. The use of NK1-RAs might be associated with the appearance of diarrhea and hiccups, while decreasing the possibility of constipation and insomnia.
authors.affiliation: Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China E-mail : yong_song6310@yahoo.com.
authors.forename: Dong-Mei
authors.initials: DM
authors.lastname: Yuan
authors.forename: Qian
authors.initials: Q
authors.lastname: Li
authors.forename: Qin
authors.initials: Q
authors.lastname: Zhang
authors.forename: Xin-Wu
authors.initials: XW
authors.lastname: Xiao
authors.forename: Yan-Wen
authors.initials: YW
authors.lastname: Yao
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.forename: Yan-Ling
authors.initials: YL
authors.lastname: Lv
authors.forename: Hong-Bin
authors.initials: HB
authors.lastname: Liu
authors.forename: Tang-Feng
authors.initials: TF
authors.lastname: Lv
authors.forename: Yong
authors.initials: Y
authors.lastname: Song
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D006801:Humans; D009325:Nausea / Q000139:chemically induced / Q000517:prevention & control*; D009369:Neoplasms / Q000188:drug therapy*; D064729:Neurokinin-1 Receptor Antagonists / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012449:Safety; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control*
chemical_list: D000970:Antineoplastic Agents; D064729:Neurokinin-1 Receptor Antagonists