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Meta-Analysis
. 2023 Jul 21;102(29):e34385.
doi: 10.1097/MD.0000000000034385.

The efficacy of aprepitant for the prevention of postoperative nausea and vomiting: A meta-analysis

Yingchao Liu  1 , Xinli Chen  1 , Xiaohua Wang  1 , Huohu Zhong  2 , Hefan He  1 , Yibin Liu  1 , Yuewen Liao  1 , Zhigang Pan  3 , Weipeng Hu  3 , Weifeng Liu  1 , Feng Zheng  3
Affiliations
Meta-Analysis

The efficacy of aprepitant for the prevention of postoperative nausea and vomiting: A meta-analysis

Yingchao Liu et al. Medicine (Baltimore). .

Abstract

Background: Postoperative nausea and vomiting (PONV) is one of the common adverse reactions after surgery. Recent randomized controlled trials (RCTs) investigating antiemetic drugs suggest that aprepitant has the strongest antiemetic effect of any single drug. This meta-analysis aimed to explore the efficacy of aprepitant for preventing PONV based on the existing literature.

Methods: To identify RCTs investigating the use of aprepitant for PONV prevention, we searched PubMed, Embase, and Cochrane Library databases for articles published prior to March 20, 2022. Seventeen RCTs were identified, with 3299 patients, meeting the inclusion criteria. PONV incidence, complete response, 80 mg aprepitant combined with dexamethasone and ondansetron, vomiting, nausea, and analgesic dose-response were the main outcomes measured.

Results: Compared with the control group, PONV incidence was significantly reduced among those receiving aprepitant (odds ratio [OR]: 0.34; 95% confidence interval [CI]: 0.26, 0.44; P < .0001), with a more complete response (OR: 1.35; 95% CI: 1.14, 1.59; P = .0004). Supplementation of 80 mg aprepitant in combination with dexamethasone and ondansetron substantially improved the effects of PONV (OR: 0.36; 95% CI: 0.16, 0.82; P = .01). Further, administration of 80 mg aprepitant was better at preventing vomiting than nausea (OR: 8.6; 95% CI: 3.84, 19. 29; P < .00001). No statistically significant difference between the dose-response of analgesics was identified (mean difference: -1.09; 95% CI: -6.48, 4.30; P = .69). The risk of bias was assessed independently by paired evaluators.

Conclusion: Aprepitant effectively reduces the incidence of PONV; however, the effects of postoperative analgesia require further exploration.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
The flow chart of the search algorithm.
Figure 2.
Figure 2.
Quality analysis of all 17 studies included in the meta-analysis. The risk of bias is summarized (A) and graphed (B).
Figure 3.
Figure 3.
Pooled data of the included studies. CI = confidence intervals, PONV = postoperative nausea and vomiting.
Figure 4.
Figure 4.
When the patient is stimulated surgically, substance P is produced via central and peripheral pathways. Binding of the substance to the NK-1 receptor leads to PONV. An Nk-1 receptor antagonist blocks binding of substance P to the NK-1 receptor, which can reduce the incidence of PONV. AP = area postrema, DMV = dorsal motor nucleus of vague nerve, NK-1 RA = K-1 receptor antagonist, NTS = nucleus tractus solitarily, PONV = postoperative nausea and vomiting.
See this image and copyright information in PMC

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