Olanzapine combined with 5-hydroxytryptamine type 3 receptor antagonist (5-HT3 RA) plus dexamethasone for prevention and treatment of chemotherapy-induced nausea and vomiting in high and moderate emetogenic chemotherapy: a systematic review and meta-analysis of randomised controlled trials

Abstract

We performed a pooled analysis to evaluate the efficacy and adverse events (AEs) of olanzapine combined with dexamethasone plus 5-hydroxytryptamine type 3 receptor antagonist (5-HT3 RA) compared with 5-HT3 RA plus dexamethasone for the prevention and treatment of chemotherapy-induced nausea and vomiting (CINV) in high and moderate emetogenic chemotherapy based on randomised controlled trials (RCTs). PubMed, EMBASE, Web of Science, the Cochrane Library, China Biomedical Literature database (CBM), WanFang Database, China National Knowledge Infrastructure (CNKI), and Chinese Science and Technology Periodical Database (VIP) (from their inception to April 2019) were searched to capture relevant articles. Relative risk with 95% confidence intervals for CINV and AEs were all extracted or calculated. Eleven studies with 1107 cancer patients were involved in this review. The pooled RR of delayed CINV (RR 0.50, 95% CI 0.38 to 0.66; p<0.01) were significantly decreased in the olanzapine group. The occurrence of insomnia was also statistically decreased, as was the rate of acute CINV (RR 0.60, 95% CI 0.48 to 0.75; p<0.01). However, only the percentages of CINV III and CINV IV were significantly decreased in the acute and delayed phases. Subgroup analysis demonstrated that the efficacy was not statistically significantly different between 5 mg and 10 mg olanzapine. Olanzapine significantly decreased the occurrence of CINV III and IV and insomnia in high and moderately emetogenic chemotherapy. Compared with 10 mg per day, 5 mg oral olanzapine may be more appropriate for patients with cancer.

Olanzapine for the prophylaxis and rescue of chemotherapy-induced nausea and vomiting: a systematic review, meta-analysis, cumulative meta-analysis and fragility assessment of the literature

“…This review also has the highest statistical power and appraises all the clinically important endpoints. The most recent reviews by Zhou et al in 2020 included 11 studies with 1107 patients [ 21 ]; other reviews by Bahbah et al in 2019 and Sutherland et al in 2018 included 9 RCTs with 1572 patients, and 14 trials with 1917 participants, respectively [ 22 , 23 ]. This review summarizes the results across 25 studies, which reported on 4275 patients.…”

“…This review is the most rigorous systematic review to date investigating olanzapine in the CINV setting. A protocol was developed prior to the commencement, risk of bias for studies were assessed, and publication bias was assessed; some or all of these three methodological elements were omitted in prior reviews [21][22][23][24][25][26][27]. This review also has the highest statistical power and appraises all the clinically important endpoints.…”

“…This review also has the highest statistical power and appraises all the clinically important endpoints. The most recent reviews by Zhou et al in 2020 included 11 studies with 1107 patients [21]; other reviews by Bahbah et al in 2019 and Sutherland et al in 2018 included 9 RCTs with 1572 patients, and 14 trials with 1917 participants, respectively [22,23]. This For studies reporting on HEC patients, olanzapine is statistically and clinically superior in seven of nine efficacy endpoints in the prophylaxis setting; only complete emetic control in the acute and overall phases were not statistically different from comparative regimens.…”

“…A number of phase III randomized controlled trials were subsequently undertaken and published, and multiple systematic reviews and meta-analyses have been conducted [21][22][23][24][25][26][27]. However, no review has separately analyzed antiemetics for highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC) patients, an important distinction that leads to different clinical guideline recommendations.…”

Now we are 30: 10 more years of MASCC

“…Advances over 10 years in specific supportive care topics were identified. Antiemetics to control chemotherapy-induced emesis further improved with trials of olanzapine in combinations improving the control of chemotherapy-induced nausea as well as vomiting [ 7 ]. The introduction of oral anticoagulants simplified the management of cancer-associated thromboembolic disease [ 8 ].…”