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. 2017 Jan-Mar;15(1):877.
doi: 10.18549/PharmPract.2017.01.877. Epub 2017 Mar 15.

Olanzapine for chemotherapy-induced nausea and vomiting: systematic review and meta-analysis

Legese Chelkeba  1 , Kidu Gidey  2 , Ayele Mamo  3 , Berhane Yohannes  4 , Tsehay Matso  5 , Tsegaye Melaku  6
Affiliations

Olanzapine for chemotherapy-induced nausea and vomiting: systematic review and meta-analysis

Legese Chelkeba et al. Pharm Pract (Granada). 2017 Jan-Mar.

Abstract

Background: Chemotherapy induced nausea and vomiting (CINV) remains the most distressing event in patients receiving highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC).

Objective: Therefore, this meta-analysis was conducted to evaluate the efficacy of olanzapine containing regimen in preventing acute, delayed and overall phases of CINV.

Methods: PubMed, EBSCO, and Cochrane central register of controlled trials electronic databases were searched to identify RCTs that compared the effects of olanzapine with non-olanzapine regimen in preventing CINV. Randomized clinical trials (RCTs) that compared olanzapine containing regimen with non-olanzapine regimen were included. The primary outcomes were the percentage of patients achieving no vomiting or no nausea in acute, delayed and overall phases.

Results: 13 RCTs that enrolled 1686 participants were included in this meta-analysis. 852 patients were assigned to olanzapine and 834 patients were assigned to non-olanzapine regimen (other standard antiemetic regimen). The percentages of no emesis achieved were 87.5%, 76.2%, 73.6% in olanzapine versus 76.7%, 61.8%, and 56.4% in non-olanzapine regimen in acute, delayed and overall phases, respectively. The percentages of no nausea were 82%, 64.3%, 61.6% in olanzapine group versus 71.3%, 41.8%, and 40.6% in non-olanzapine group in acute, delayed and overall phases, respectively. In general, olanzapine containing regimen achieved statistical superiority to non-olanzapine regimen in no vomiting endpoint in acute phase (OR 2.16; 95%CI 1.60 to 2.91, p<0.00001; I-square=5%; p=0.40), delayed phase (OR 2.28; 95%CI 1.1.46 to 3.54, p=0.0003; I-square=65%; p=0.001) and overall phase (OR 2.48; 95%CI 1.59 to 3.86, p<0.0001; I-square=69%; p< 0.0001).

Conclusion: The current meta-analysis showed that olanzapine was statistically and clinically superior to non-olanzapine regimen in preventing CINV in most domains of the parameters.

Keywords: Antineoplastic Agents; Drug-Related Side Effects and Adverse Reactions; Meta-Analysis as Topic; Nausea; Primary Prevention; Vomiting.

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Conflict of interest statement

CONFLICT OF INTEREST The authors have no conflict of interests declare. We have full control of all primary data and agree to allow the journal to review the data if requested.

Figures

Figure 1
Figure 1
Study selection process (PRISMA).
Figure 2
Figure 2
Forest plot of efficacy of olanzapine containing regimen compared to standard regimen in preventing CTINV- A) No vomiting in acute phase B) No vomiting in delayed phase C) No vomiting in overall phase. M-H: Mantel-Haenszel; CI: confidence interval
Figure 3
Figure 3
Forest plot of efficacy of olanzapine containing regimen compared to standard regimen in preventing CTINV based on degree of Emetogenicity - A) No vomiting in acute phase B) No vomiting in delayed phase C) No vomiting in overall phase. HEC: highly emetogenic chemotherapy; MEC: moderately emetogenic chemotherapy; M-H: Mantel-Haenszel; CI: confidence interval
Figure 4
Figure 4
Forest plot of efficacy of olanzapine containing regimen compared to standard regimen in preventing CTINV based on presence or absence of NK-1 receptor antagonists- A) No vomiting in acute phase B) No vomiting in delayed phase C) No vomiting in overall phases. M-H: Mantel-Haenszel; CI: confidence interval; NK-1: neurokinin-1.
Figure 5
Figure 5
Forest plot of efficacy of olanzapine containing regimen compared to standard regimen in preventing CTINV- A) No nausea in acute phase B) No nausea in delayed phase C) No nausea in overall phase. M-H: Mantel-Haenszel; CI: confidence interval
Figure 6
Figure 6
Forest plot of efficacy of olanzapine containing regimen compared to standard regimen in preventing CTINV in combination or as alternative to neurokinin-1 antagonist (NK-1)- A) No nausea in acute phase B) No nausea in delayed phase C) No nausea in overall phase. M-H: Mantel-Haenszel; CI: confidence interval
Figure 7
Figure 7
Forest plot of efficacy of olanzapine containing regimen compared to standard regimen in preventing CTINV in combination or as alternative to dexamethasone A) No nausea in acute phase B) No nausea in delayed phase C) No nausea in overall phase. M-H, Mantel-Haenszel; CI, confidence interval
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References

    1. Rao KV, Faso A. Chemotherapy-induced nausea and vomiting: optimizing prevention and management. Am Health Drug Benefits. 2012;5(4):232–240. - PMC - PubMed
    1. Bloechl-Daum B, Deuson RR, Mavros P, Hansen M, Herrstedt J. Delayed nausea and vomiting continue to reduce patients’ quality of life after highly and moderately emetogenic chemotherapy despite antiemetic treatment. J Clin Oncol. 2006;24(27):4472–4478. - PubMed
    1. Hesketh PJ, Bohlke K, Lyman GH, Basch E, Chesney M, Clark-Snow RA, Danso MA, Jordan K, Somerfield MR, Kris MG American Society of Clinical Oncology. Antiemetics: American Society of Clinical Oncology focused guideline update. J Clin Oncol. 2016;34(4):381–386. doi: 10.1200/JCO.2015.64.3635. - PubMed
    1. Schwartzberg LS. Highlights in CINV From the 2016 MASCC/ISOO Annual Meeting. Clin Adv Hematol Oncol. 2016;14(Suppl 10)(8):20–23. - PubMed
    1. Takahashi T, Hoshi E, Takagi M, Katsumata N, Kawahara M, Eguchi K. Multicenter, phase II, placebo-controlled, double-blind, randomized study of aprepitant in Japanese patients receiving high-dose cisplatin. Cancer Sci. 2010;101(11):2455–2461. doi: 10.1111/j.1349-7006.2010.01689.x. - PMC - PubMed

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