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Evidence summaries

Antiemetic Medication for Prevention and Treatment of Chemotherapy Induced Nausea and Vomiting in Childhood

5-HT3 antagonists may be more effective than older antiemetic agents in children who are to receive highly emetogenic chemotherapy. The addition of dexamethasone to 5-HT3 antagonists appears to make them even better, although it remains uncertain how the proven benefit of steroid in reducing emesis balances with the in vitro reduction in chemotherapy sensitivity. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 34 studies with a total of 2 023 children examining 26 different pairs of combinations of antiemetic medications. The majority of quantitative data related to the complete control of acute vomiting (27 studies). Adverse events were reported in 29 studies and nausea outcomes in 16 studies.

The addition of dexamethasone to 5-HT3 antagonists was assessed in 2 studies for complete control of vomiting (RR 2.03, 95% CI 1.35 to 3.04, statistical heterogeneity I2 =56%; 2 studies, n=100). Three studies compared granisetron 20 mcg/kg with 40 mcg/kg for complete control of vomiting (RR 0.93, 95% CI 0.80 to 1.07; 3 studies, n= 453). Three studies compared granisetron with ondansetron for complete control of acute nausea (RR 1.05; 95% CI 0.94 to 1.17; 2 studies, n=101), acute vomiting (RR 2.26; 95% CI 2.04 to 2.51; statistical heterogeneity I2 =94%; 3 studies, n=167), delayed nausea (RR 1.13; 95% CI 0.93 to 1.38; statistical heterogeneity I2 =84%; 2 studies, n=101), and delayed vomiting (RR 1.13; 95% CI 0.98 to 1.29; statistical heterogeneity I2 =70%; 2 studies, n=101). No other pooled analyses were possible. Narrative synthesis suggests 5-HT3 antagonists are more effective than older antiemetic agents even when those agents are combined with a steroid. Cannabinoids are probably effective but produce frequent side effects.

Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment) and by inconsistency (heterogeneity in interventions and outcomes).

    References

    • Phillips RS, Friend AJ, Gibson F et al. Antiemetic medication for prevention and treatment of chemotherapy-induced nausea and vomiting in childhood. Cochrane Database Syst Rev 2016;2():CD007786. [PubMed].

Primary/Secondary Keywords