Network Meta-analysis of the Clinical Efficacy of Six Kinds of Antiemetic Regimens in the Prevention of Nausea and Vomiting Caused by Highly Emetogenic Chemotherapy

OBJECTIVE To evaluate the efficacy of six antiemetic regimens in the prevention of nausea and vomiting caused by highly emetogenic chemotherapy(HEC)by network meta analysis. METHODS Retrieved from CNKI, Wanfang database, VIP, PubMed, EMbase and Cochrane Library(Issue 8, 2019), retrieval time was limited to 1 September 2019. Randomized controlled trials(RCTs) about serotonin-3 receptor antagonistinclude first-generation 5-HT₃ and second-generation 5-HT₃ palonosetron(PAL)+dexamethasone(DEX), NK-1 receptor antagonist(NK-1RA)+5-HT₃+DEX, olanzapine(OLZ)+ 5-HT₃+DEX and NEPA(netupitant 300 mg+PAL 0.50 mg)+DEX in the prevention of chemotherapy-induced nausea and vomiting (CINV) were collected. The data were extracted by 2 evaluators and the quality of the literature was evaluated according to the cochrane bias risk assessment tool. The network meta-analysis was carried out by using Stata 15.0 statistical software. RESULTS A total of 18 RCTs were included, involving 8 076 patients. Results of network meta-analysis showed that:compared with 5-HT₃+DEX, NEPA+DEX, NK-1RA+5-HT₃+DEX, NK-1RA+PAL+DEX and OLZ+PAL+DEX could significantly improve CINV acute complete response, with statistical significance(P<0.05). The probability ranking was OLZ+PAL+DEX > NK-1RA+PAL+DEX > NK-1RA+5-HT₃+DEX > NEPA+DEX > PAL+DEX=5-HT₃+DEX. Compared with 5-HT₃+DEX, NEPA+DEX, NK-1RA+5-HT₃+ DEX, NK-1RA+PAL+DEX, OLZ+PAL+DEX and PAL+DEX could significantly improve CINV delayed complete response, with statistical significance(P<0.05). The probability ranking was NK-1RA+PAL+DEX > OLZ+PAL+DEX > NEPA+DEX > NK-1RA+5-HT₃+DEX=PAL+DEX=5-HT₃+DEX. Compared with 5-HT₃+DEX, NEPA+DEX, NK-1RA+5-HT₃+DEX and NK-1RA+PAL+DEX could significantly improve CINV overall complete response, with statistical significance(P<0.05). The probability ranking was NK-1RA+PAL+DEX > OLZ+PAL+DEX > NEPA+DEX > NK-1RA+5-HT₃+DEX > PAL+DEX > 5-HT₃+DEX. CONCLUSION By network meta-Analysis, OLZ+PAL+DEX is most likely to be the most effective intervention to prevent CINV caused by HEC, while NK-1RA+PAL+DEX is most likely to be the most effective intervention to prevent delayed and persistent CINV.