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

Abstract

BackgroundSerotonin (5-HT3) receptor antagonists are commonly used to decrease nausea and vomiting for surgery patients, but these agents may be harmful. We conducted a systematic review on the comparative safety of 5-HT3 receptor antagonists.MethodsSearches 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 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.ResultsOverall, 120 studies and 27,787 patients were included after screening of 7,608 citations and 1,014 full-text articles. Significantly more patients receiving granisetron plus dexamethasone experienced an arrhythmia relative to placebo (odds ratio (OR) 2.96, 95 % confidence interval (CI) 1.11–7.94), ondansetron (OR 3.23, 95 % CI 1.17–8.95), dolasetron (OR 4.37, 95 % CI 1.51–12.62), tropisetron (OR 3.27, 95 % CI 1.02–10.43), and ondansetron plus dexamethasone (OR 5.75, 95 % CI 1.71–19.34) in a NMA including 31 randomized clinical trials (RCTs) and 6,623 patients of all ages. No statistically significant differences in delirium frequency were observed across all treatment comparisons in a NMA including 18 RCTs and 3,652 patients.ConclusionGranisetron plus dexamethasone increases the risk of arrhythmia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0379-3) contains supplementary material, which is available to authorized users.

Current and prospective sights in mechanism of deoxynivalenol‐induced emesis for future scientific study and clinical treatment

“…Therefore, 5-HT 3 R antagonist (tropisetron, ondansetron, emetron, granisetron, dolasetron, ondansetron and palonosetron) Glatzle et al, 2002) and inhibitor of RyRs (azumolene and dantrolene) (Krause et al, 2004) could be used as therapeutic drugs for clinical treatment. Cohort studies further confirmed that particularly ondansetron has fewer side effects in humans up to now (Tricco et al, 2015). In addition, a recent study on poultry would be of interest, which showed that DON reduces the Na + -dependent glucose cotransport and has an effect on Ca 2+ homeostasis (Awad et al, 2014).…”

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

“…Furthermore, it was assumed that the effects of the different doses and durations were identical across the treatments, and that they defined the same node they belong to. We are currently exploring these assumptions in another paper [69]. Although study designs above and beyond RCTs were included, the network meta-analysis was limited to the RCTs in order to increase the confidence of the results.…”

Expert Consensus on Effective Management of Chemotherapy-Induced Nausea and Vomiting: An Indian Perspective

“…QT prolongation is a class adverse effect of these agents. In the light of evidence, special attention is warranted for cancer patients with cardiac disease or elderly cancer patients on polypharmacy (48)(49)(50). The NCCN guidelines recommend intravenous palonosetron as the preferred 5-HT3 antagonist (22).…”