Efficacy of olanzapine for the prophylaxis and rescue of chemotherapy-induced nausea and vomiting (CINV): a systematic review and meta-analysis

Chiu, Leonard; Chow, Ronald; Popović, Marko; Navari, Rudolph M.; Shumway, Nathan M.; Chiu, Nicholas; Lam, Henry; Milakovic, Milica; Pasetka, Mark; Vuong, Sherlyn; Chow, Edward; DeAngelis, Carlo

doi:10.1007/s00520-016-3075-8

Cited by 78 publications

(59 citation statements)

References 29 publications

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“…However, in this study, there were few trials included and additional clinical trials have been conducted since the publication of it. Including 4 more RCTs, a recent meta-analysis by Chiu and coworkers also reported similar findings 34. On another hand, a recent pilot study done in India showed that there was no significant difference between olanzapine and aprepitant in preventing nausea and emesis with highly emetogenic chemotherapy 31.…”

Section: Introductionmentioning

confidence: 79%

“…Currently available major RCTs exploring prevention of CINV in patients receiving HEC reported that rates of nausea were over 50% 38-40. So far, many studies documented the proven beneficial effect of olanzapine for preventing CINV 20-22,24-26,33,34…”

Section: Discussionmentioning

confidence: 99%

“…On another hand, a recent pilot study done in India showed that there was no significant difference between olanzapine and aprepitant in preventing nausea and emesis with highly emetogenic chemotherapy 31. After the publication of meta-analysis by Chiu et al34, the largest RCT so far done in this area included 380 patients 32. In addition, other small RCTs were also published elsewhere 20,31…”

Section: Introductionmentioning

confidence: 99%

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

Chelkeba¹,

Gidey²,

Mamo³

et al. 2017

Pharm Pract (Granada)

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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.

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Section: Introductionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Chelkeba¹,

Gidey²,

Mamo³

et al. 2017

Pharm Pract (Granada)

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“…Finally in CINV, olanzapine was better than metoclopramide in reducing breakthrough nausea and vomiting (62, 65). A systematic review and meta-analysis of ten controlled trials with 1082 patients reported that olanzapine was clinically superior to comparator treatment for 4 of 6 study endpoints, with better efficacy in producing no overall vomiting with a relative risk of 1.41 (95% CI, 1.18–1.68) and no nausea with an RR of 1.53 (95% CI, 1.18–1.97)(66). In patients with duloxetine-induced nausea, addition of olanzapine reduced nausea and vomiting scores by two thirds compared to patients on duloxetine alone (67).…”

Section: Medications Used To Treat Nausea and Vomitingmentioning

confidence: 99%

Newest Drugs for Chronic Unexplained Nausea and Vomiting

Hasler

2016

Curr Treat Options Gastro

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OPINION STATEMENT Chronic unexplained nausea and vomiting (CUNV) refers to a symptom complex defined by nausea and/or vomiting with normal diagnostic testing, including anatomic assessments (including upper endoscopy) and measures of upper gut function (e.g. gastric emptying testing). Nausea and vomiting in this condition are postulated to result from aberrant peripheral or central neurohumoral activity. A substantial subset of patients satisfies this diagnosis as more than half of individuals referred for scintigraphic testing exhibit normal gastric emptying rates. No randomized, placebo-controlled trials of any medication treatment have been performed in CUNV. However, agents with potential therapeutic benefit in CUNV include antiemetic drugs, neuromodulatory treatments which are proposed to act by reducing gastric sensitivity, and medications with prokinetic action to stimulate upper gut propulsion. Recently approved drugs with antiemetic capability include serotonin antagonists with novel modes of delivery and neurokinin antagonists with or without additional serotonergic blocking capabilities. Existing neuroleptics and pain modifying neuromodulatory therapies with fortuitous antiemetic benefits are being considered for their benefits in this disorder. Furthermore, current investigations will define potential therapeutic actions of agents that stimulate gastric emptying via action on gastroduodenal serotonin, motilin, and ghrelin receptors. This current research may broaden the treatment options for refractory cases of unexplained nausea and vomiting.

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“…Various trials have explored the efficacy of olanzapine in preventing both acute and delayed CINV. A metaanalysis of 10 randomised trials in patients receiving highly or moderately emetogenic chemotherapy [58] demonstrated the efficacy of olanzapine in preventing both acute and delayed emesis. However some of these studies did not use standard antiemetic regimens, especially use of a NK1 receptor antagonist.…”

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confidence: 99%

Chemotherapy Induced Nausea and Vomiting: Fear Makes the Wolf Bigger than He is

Sharma¹,

Bajpai²

2017

J Carcinog Mutagen

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Chemotherapy induced nausea and vomiting (CINV) is one of the most feared and severe side effects of cancer treatment. It is broadly categorised as anticipatory (a conditioned reflex, due to past experience, generally triggered by same stimuli), acute (within 24 hours of chemotherapy administration), delayed (after 24 hours and lasting up to 7 days of chemotherapy), breakthrough (inspite of primary prophylaxis for CINV), and refractory (unresponsive to prophylactic and breakthrough medications). The chemotherapeutic regimens are having varying potential (high, moderate, low, or minimal) for CINV. Incidence and timing of CINV depends upon the emetogenic potential of chemotherapy and also patient factors. This perspective highlights the underlying mechanism of CINV, state of the art therapeutic options and nuances in the field to better control this dreaded complication and in turn enhance the quality of life of these patients.

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Efficacy of olanzapine for the prophylaxis and rescue of chemotherapy-induced nausea and vomiting (CINV): a systematic review and meta-analysis

Cited by 78 publications

References 29 publications

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

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

Newest Drugs for Chronic Unexplained Nausea and Vomiting

Chemotherapy Induced Nausea and Vomiting: Fear Makes the Wolf Bigger than He is

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