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. 2015 Jun 18:13:136.
doi: 10.1186/s12916-015-0371-y.

Comparative efficacy of serotonin (5-HT3) receptor antagonists in patients undergoing surgery: a systematic review and network meta-analysis

Andrea C Tricco  1   2 , Charlene Soobiah  3   4 , Erik Blondal  5 , Areti A Veroniki  6 , Paul A Khan  7 , Afshin Vafaei  8 , John Ivory  9 , Lisa Strifler  10 , Huda Ashoor  11 , Heather MacDonald  12 , Emily Reynen  13 , Reid Robson  14 , Joanne Ho  15 , Carmen Ng  16 , Jesmin Antony  17 , Kelly Mrklas  18   19 , Brian Hutton  20 , Brenda R Hemmelgarn  21 , David Moher  22 , Sharon E Straus  23   24
Affiliations

Comparative efficacy of serotonin (5-HT3) receptor antagonists in patients undergoing surgery: a systematic review and network meta-analysis

Andrea C Tricco et al. BMC Med. .

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.

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Figures

Fig. 1
Fig. 1
Study flow. Details the flow of information through the different phases of the review, mapping out the number of records identified, included and excluded, and the reasons for their exclusion
Fig. 2
Fig. 2
Network geometry. Network meta-analysis diagrams for vomiting, nausea, and PONV. Nodes are weighted according to the number of patients included in the corresponding treatments, and edges are weighted according to the number of studies included in the respective comparisons
Fig. 3
Fig. 3
Network meta-analysis results for vomiting. All treatments are compared to placebo. The black horizontal lines represent the 95 % confidence intervals (CI) of the summary treatment effects and red horizontal lines the 95 % predictive intervals (PrI). Results are presented on the odds ratio scale
See this image and copyright information in PMC

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