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Evidence summaries

5-HT3 Receptor Antagonists in Chemotherapy-Induced Nausea and Vomiting

5-HT3 receptorantagonists alone or combined with steroids are effective for chemotherapy induced nausea and vomiting compared to placebo or conventional anti-emetics. Level of evidence: "A"

A systematic review 1 comparing 5-HT3 receptor antagonists to conventional anti-emetics in the prophylaxis of acute chemotherapy-induced vomiting included 30 RCTs. 5-HT3 antagonists reduced the risk of acute vomiting compared to conventional anti-emetics both with cisplatin treatments (OR 0.60, 95% CI 0.51 to 0.70; 15 studies) and with moderately emetogenic treatments (OR 0.47, 95% CI 0.39 to 0.58; 11 studies). The risk of acute vomiting seemed to be further reduced when 5-HT3 antagonists were combined with dexamethasone.

Another systematic review and network meta-analysis 2 on 5-HT3 receptor antagonists (dolasetron, granisetron, ondansetron, palonosetron, tropisetron) for patients undergoing chemotherapy included 299 studies with a total of 58 412 subjects.

In the network meta-analysis, all 5-HT3 receptor antagonists were effective for reducing risk of nausea (44 studies, n=11 664, 12 treatments), vomiting (63 studies, n=15 460, 12 treatments), and chemotherapy-induced nausea or vomiting (27 studies, n=10 924, 9 treatments) compared to placebo. All treatments decreased the risk of severe vomiting (10 studies, n=917), but only ondansetron and ramosetron were significantly superior to placebo. Accordingto the rank-heat plot, palonosetron + steroid was most likelythe safest and most effective treatment. Across the effectiveness outcomes,the following treatments ranked as most superior on3 effectiveness outcomes during the first 24 h afterchemotherapy for adults: ondansetron + steroid, palonosetron + steroid, granisetron + steroid, and ramosetron +steroid.

    References

    • Jantunen IT, Kataja VV, Muhonen TT. An overview of randomised studies comparing 5-HT3 receptor antagonists to conventional anti-emetics in the prophylaxis of acute chemotherapy-induced vomiting. Eur J Cancer 1997 Jan;33(1):66-74. [PubMed]
    • Tricco AC, Blondal E, Veroniki AA et al. Comparative safety and effectiveness of serotonin receptor antagonists in patients undergoing chemotherapy: a systematic review and network meta-analysis. BMC Med 2016;14(1):216. [PubMed]

Primary/Secondary Keywords