title: Aprepitant in pediatric patients using moderate and highly emetogenic protocols: a systematic review and meta-analyses of randomized controlled trials.
abstract: To review the efficacy and safety of aprepitant in combination with ondansetron and dexamethasone (triple therapy) in children and adolescents on moderate to highly emetogenic chemotherapy.
  
  
  
  Medline, Embase, Scielo, Lilacs, Cochrane and congress abstracts published until September 2016 were used as data sources. Two reviewers independently selected manuscripts and extracted data. A third reviewer solved discrepancies in study selection and data extraction. The primary outcome was overall complete response (no vomiting from 0 to 120 h). Secondary outcomes were: response in acute phase, delayed phase and reported toxicities. Each study was considered a unit of analysis. Summarized relative risks were recalculated based on reported data. All meta-analyses used a random-effects model and heterogeneity was reported using the I2method.
  
  
  
  From 1004 studies, we screened 288 titles and abstracts and included three trials for data extraction. The population comprised 451 patients. Most patients were males, ranging from 6 months to 19 years of age, and weighing from 6 to 134 kg. Bone cancer was the most incident (≥50%) neoplasm, followed by rhabdomyosarcoma and Hodgkin's lymphoma. Triple therapy was associated with a reduced risk of developing chemotherapy-induced vomiting (CIV) (RR = 0.48; 95% CI 0.34-0.67). There were no differences in incidence of febrile neutropenia between groups (RR = 1.02; 95% CI 0.66-1.58).
  
  
  
  Triple therapy decreased CIV risk, without increasing the occurrence of febrile neutropenia. However, this review could not address which subpopulations would most benefit from using this strategy. Future studies should focus on assessing risk factors for nausea and vomiting, as many patients did not achieve a complete antiemetic response.
authors.affiliation: Clinical Pharmacy Division, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos St, Porto Alegre, Brazil.
authors.forename: Lucas Miyake
authors.identifier: 0000-0003-3607-619X
authors.initials: LM
authors.lastname: Okumura
authors.affiliation: Pharmacy and Therapeutics Committee, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos St, Porto Alegre, Brazil.
authors.forename: Fernanda
authors.initials: F
authors.lastname: D'Athayde Rodrigues
authors.affiliation: Pharmacy and Therapeutics Committee, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos St, Porto Alegre, Brazil.
authors.forename: Maria Angelica Pires
authors.initials: MAP
authors.lastname: Ferreira
authors.affiliation: Pharmacy and Therapeutics Committee, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos St, Porto Alegre, Brazil.
authors.forename: Leila Beltrami
authors.initials: LB
authors.lastname: Moreira
mesh_terms: D000293:Adolescent; D000932:Antiemetics / Q000008:administration & dosage* / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D000077608:Aprepitant; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D004359:Drug Therapy, Combination; D006801:Humans; D007223:Infant; D009025:Morpholines / Q000008:administration & dosage* / Q000009:adverse effects; D009325:Nausea / Q000139:chemically induced / Q000517:prevention & control; D009369:Neoplasms / Q000188:drug therapy / Q000473:pathology; D017294:Ondansetron / Q000008:administration & dosage / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000932:Antiemetics; D000970:Antineoplastic Agents; D009025:Morpholines; D000077608:Aprepitant; D017294:Ondansetron; D003907:Dexamethasone
keywords: child; nausea; paediatrics; randomized controlled trials; vomiting