Okumura, L.M., Rodrigues, F.A., Ferreira, M.A., & Moreira, L.B. (2016). Aprepitant in pediatric patients using moderate and highly emetogenic protocols: A systematic review and meta-analyses of randomized controlled trials. British Journal of Clinical Pharmacology. Advance online publication. 

DOI Link

Purpose

STUDY PURPOSE: To review the safety and efficacy associated with triple therapy (aprepitant, ondansetron, and dexamethasone) when given to children and adolescents receiving moderately emetogenic chemotherapy (MEC) and highly emetogenic chemotherapy (HEC)

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Lilacs, and Scielo; also reviewed published abstracts from Oncology Specialty Congress
 
INCLUSION CRITERIA: Randomized, controlled trials; studies involving children and adolescents receiving MEC and HEC; studies evaluating aprepitant in combination with dexamethasone and ondansetron to prevent CINV; studies that used an active placebo containing ondansetron and dexamethasone 
 
EXCLUSION CRITERIA: None identified

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 1,004 articles and abstracts were retrieved; 1,001 were excluded because they were duplicate studies, involved adults, involved surgical patients, or were not randomized, controlled trials. Three articles were included in the systematic review.
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The overall complete response was the primary outcome and defined as the absence of chemotherapy-induced vomiting from 0–120 hours. The secondary outcomes included adverse events, acute response, and delayed response. Meta-analyses were performed to evaluate the safety and efficacy of triple therapy.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 3
  • TOTAL PATIENTS INCLUDED IN REVIEW = 451
  • SAMPLE RANGE ACROSS STUDIES: Unknown
  • KEY SAMPLE CHARACTERISTICS: Aged 0.5–19 years; common diagnoses included bone cancers (Ewing sarcoma, rhabdomyosarcoma, and Hodgkin lymphoma).

Results

Triple therapy with aprepitant, dexamethasone, and ondansetron had a 52% relative risk reduction in the development of chemotherapy-induced vomiting, and febrile neutropenia was not significantly different in patients receiving triple therapy compared to patients receiving dual therapy.

Conclusions

Triple therapy may reduce chemotherapy-induced vomiting in pediatric patients receiving MEC and HEC.

Nursing Implications

Pediatric patients receiving MEC and HEC may benefit from receiving triple therapy (aprepitant, ondansetron, and dexamethasone) for the prevention of chemotherapy-induced vomiting.

Legacy ID

6414