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

Chelkeba, Legese; Gidey, Kidu; Mamo, Ayele; Yohannes, Berhane; Matso, Tsehay; Melaku, Tsegaye

doi:10.18549/pharmpract.2017.01.877

Cited by 17 publications

(17 citation statements)

References 38 publications

(103 reference statements)

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“…SGAs have been increasingly prescribed for offlabel conditions such as anxiety, attention deficit hyperactivity disorder (ADHD), insomnia and chemotherapy-induced nausea (Maher et al, 2011;Pringsheim and Gardner, 2014;Devlin and Panagiotopoulos, 2015;Bun et al, 2017;Chelkeba et al, 2017). SGAs, such as olanzapine (OLZ), have numerous metabolic side effects (Newcomer, 2005).…”

Section: Introductionmentioning

confidence: 99%

AICAR Prevents Acute Olanzapine-Induced Disturbances in Glucose Homeostasis

Bush

Townsend

Wright

2018

J Pharmacol Exp Ther

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Section: Introductionmentioning

confidence: 99%

AICAR Prevents Acute Olanzapine-Induced Disturbances in Glucose Homeostasis

Bush

Townsend

Wright

2018

J Pharmacol Exp Ther

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Chow

Herrstedt

Aapro

et al. 2021

Support Care Cancer

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Introduction The aim of this study is to rigorously review the efficacy and safety of olanzapine in defined hematology oncology settings including (1) the setting of highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC) settings (2) at 5 mg and 10 mg doses, and (3) for response rates for use in the acute, delayed, and overall settings post-MEC and HEC. Methods Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched through April 23, 2020. The primary efficacy endpoints were the rate of complete response, in the acute (0-24 h post-chemotherapy), delayed (24-120 h post-chemotherapy), and overall (0-120 h post-chemotherapy) phases. The secondary efficacy endpoints were the rates of no nausea and no emesis, for each phase. Safety endpoints were the rate of no serious adverse events (i.e., no grade 3 or 4 toxicities), as assessed by Common Terminology Criteria for Adverse Events (CTCAE) criteria. The Mantel-Haenszel, random-effects analysis model was used to compute risk ratios and accompanying 95% confidence intervals for each endpoint. For endpoints that statistically favored one arm, absolute risk differences were computed to assess whether there is a 10% or greater difference, used as the threshold for clinical significance by MASCC/ESMO. Fragility indices were also calculated for each statistically significant endpoint, to quantitatively assess the robustness of the summary estimate. A cumulative meta-analysis was conducted for each efficacy meta-analysis with more than 5 studies, also using the Mantel-Haenszel random-effects analysis model. Results Three studies reported on olanzapine for the rescue of breakthrough chemotherapy-induced nausea and vomiting (CINV); 22 studies reported on olanzapine in the prophylactic setting. For studies reporting on HEC patients, olanzapinecontaining regimens were statistically and clinically superior in seven of nine efficacy endpoints in the prophylaxis setting. When olanzapine is administered at a 10-mg dose, it is statistically and clinically superior to control patients in eight of nine endpoints among adults. Olanzapine may be effective in the MEC setting and when administered at 5-mg doses, but the paucity of data leads to notable uncertainty. Conclusion Further RCTs are needed in the setting of MEC patients and administration of olanzapine at a lower 5-mg dose, which may be given to reduce the sedative effect of olanzapine at 10 mg.

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“…In 2014, olanzapine, an atypical antipsychotic agent, was incorporated into the National Comprehensive Cancer Network (NCCN) antiemetic guidelines, as phase 2 studies of olanzapine, in combination with a 5-HT3-receptor antagonist and dexamethasone, found the agent to be effective at controlling both acute and delayed chemotherapy-induced emesis in patients who are being treated with highly or moderately emetogenic drugs (27). Since then, olanzapine-containing antiemetic regimens have been compared extensively to other antiemetics regimens without olanzapine, with respect to efficacy and safety, including several systematic reviews and meta-analysis by our group and others (10,(29)(30)(31)(32)(33). As with all systematic reviews, there exists the possibility of publication bias, which was not assessed in the prior systematic reviews.…”

Section: Introductionmentioning

confidence: 99%

Secondary and cumulative meta-analysis of olanzapine for antiemetic prophylaxis for chemotherapy-induced nausea and vomiting: do we still need to study its effectiveness?

et al. 2021

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Background: Olanzapine has been found to have antiemetic properties due to its ability to inhibit multiple serotonergic, dopaminergic, alpha-1 adrenergic and histamine receptors. In 2016, a meta-analysis of 10 randomized controlled trials (RCTs) on olanzapine in the prophylactic setting found olanzapine to be more efficacious than other standard antiemetics in the prophylactic setting. However, since the review, many clinical trials using olanzapine for chemotherapy-induced nausea and vomiting (CINV) have been published-in many cases, contending that further trials would further help elucidate the efficacy of olanzapine for CINV given the continued paucity of literature. The primary aim of this study is to conduct a secondary, cumulative meta-analysis to assess the impact of the most recent trials on the published effect estimate of olanzapine and ultimately determine whether trials published since 2016 have significantly changed the summary estimate.Methods: As reported previously, a literature search was conducted up until 2015, of Ovid Medline, Embase and the Cochrane Central Register of Controlled Trials; 10 RCTs with a total of over 1,000 patients were included, that compared olanzapine to other antiemetics in the prophylactic setting, which reported on at least one of two endpoints-no emesis and no nausea. The Mantel-Haenszel, random-effects analysis model was used to compute cumulative risk ratios (RR) and their accompanying 95% confidence intervals (CIs).Results: For the endpoint of emetic control, the cumulative meta-analysis shows that the summary effect did not change noticeably with the inclusion of the most recent trials. In the acute phase, the RR shifted from 1.07 before 2011 to 1.10 after 2015, even after the inclusion of 7 trials. Similar small changes were noted in the delayed and overall phases. For the endpoint of nausea control, the cumulative meta-analysis does show a significant visual change in summary effect, except for nausea control in the acute phase. In the delayed

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

Cited by 17 publications

References 38 publications

AICAR Prevents Acute Olanzapine-Induced Disturbances in Glucose Homeostasis

AICAR Prevents Acute Olanzapine-Induced Disturbances in Glucose Homeostasis

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

Secondary and cumulative meta-analysis of olanzapine for antiemetic prophylaxis for chemotherapy-induced nausea and vomiting: do we still need to study its effectiveness?

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