Efficacy and safety of olanzapine for the prevention of chemotherapy-induced nausea and vomiting: A systematic review and meta-analysis.
BACKGROUND
Olanzapine is an anti-psychotic drug that has been used for preventing and treating Chemotherapy-Induced Nausea and Vomiting (CINV). This study aimed to systematically review and meta-analyze the efficacy and safety of olanzapine for prophylaxis and treatment of CINV.


METHODS
We conducted a systematic literature search of MEDLINE, EMBASE, SCOPUS, and the Cochrane Central Register of Controlled Trials-CENTRAL up to July 15, 2016. All observational and intervention studies were included, but only the intervention studies were pooled for meta-analysis. The efficacy outcome was the proportion of patients achieving complete response (CR) - no emesis and no rescue therapy, in the acute, delayed, and overall phases. The safety outcomes were the adverse events associated with olanzapine according to Common Terminology Criteria for Adverse Events (CTCAE).


RESULTS
Sixteen studies were eligible: 15 clinical trials and 1 observational study. Nine of the interventional studies were pooled for meta-analysis. The CR of olanzapine was superior to other anti-emetic regimens, in both the delayed and overall phases (RR=1.27, 95% CI 1.07-1.49, RR=1.32, 95% CI 1.08-1.62, respectively). However, olanzapine was not better than standard CINV prophylaxis of the nausea and emesis outcome in the acute phase. Drowsiness and constipation were the most reported adverse events. No grade 3 or 4 adverse events were reported.


CONCLUSIONS
Olanzapine is effective and safe at reducing during the delayed and overall phase of the CINV prevention. Other regimens might be added, in cases of CINV during the acute phase of CINV.
Faculty of Pharmacy, Chiang Mai University,Suthep Road, Muang District, Chiang Mai, 50200, Thailand.
Jukapun
J
Yoodee
Faculty of Pharmacy, Chiang Mai University,Suthep Road, Muang District, Chiang Mai, 50200, Thailand.
Unchalee
U
Permsuwan
Faculty of Pharmacy, Chiang Mai University,Suthep Road, Muang District, Chiang Mai, 50200, Thailand. Electronic address: mantiwee@gmail.com.
Mantiwee
M
Nimworapan
D000932:Antiemetics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D009325:Nausea / Q000139:chemically induced / Q000517:prevention & control*; D000077152:Olanzapine; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control*
D000932:Antiemetics; D000970:Antineoplastic Agents; D001569:Benzodiazepines; D000077152:Olanzapine
Antiemetic; Chemotherapy-induced nausea and vomiting; Meta-analysis; Olanzapine; Systemic review