Table 9

Summary of the evidence by key question

Key Question 1. What is the comparative effectiveness/efficacy of newer antiemetics in treating or preventing nausea and/or vomiting?
ComparisonPopulation (No. trials)Strength of the evidenceConclusion
Dolasetron, granisetron, and ondansetron
Granisetron vs ondansetronChemotherapy, adults (32)GoodNo consistent significant differences on any antiemetic efficacy outcomes, regardless of population or formulation
Chemotherapy, children (3)Fair
Postoperative prevention, adults (10)Good
Postoperative treatment, adults (1)Fair-Poor
Radiation therapy, adults (1)Fair-Poor
Dolasetron vs ondansetronPostoperative prevention, adults (7)Good
Chemotherapy, adults (3)Good
Postoperative prevention, children (2)Fair
Postoperative treatment, adults (1)Fair-Poor
Dolasetron vs granisetronChemotherapy, adults (1)Good
Postoperative prevention, adults (2)Fair
Ondansetron: orally disintegrating tablet vs standard oral or IntravenousChemotherapy, adults (1)Fair-Poor
Postoperative prevention - Adults (2)Fair
Aprepitant/fosaprepitant
Aprepitant vs ondansetronPostoperative prevention, adults (2)GoodNoninferior on 24-hour complete response rates; superior for 24-hour no vomiting outcomes
Chemotherapy - Adults (1)FairSuperior on complete response over 5 days (NNT=9) and for improving quality of life
Fosaprepitant vs ondansetronChemotherapy - Adults (2)GoodFor complete response rates, inferior from 0 to 24 hours but superior from days 2 to 5
Palonosetron
Palonosetron vs ondansetronChemotherapy - Adults (2)GoodNoninferior to dolasetron and ondansetron on acute and delayed complete response following moderately to highly emetic Chemotherapy
Superior to dolasetron and ondansetron following moderately emetic chemotherapy in pooled analysis of 24-hour (NNT=9) and delayed (NNT=6) complete response rates and in improving delayed quality of Life
Palonosetron vs dolasetronChemotherapy - Adults (1)Fair
Palonosetron vs ondansetronChemotherapy - Children (1)PoorPossibly superior for early complete response rates following highly emetic chemotherapy
Key Question 2. What are the comparative safety and tolerability of newer antiemetics in treating or preventing nausea and/or vomiting?
Comparison Population Quality Conclusion
Aprepitant, dolasetron, granisetron, palonosetron, ondansetronMainly postoperative (prevention and treatment) and chemotherapy, adultsGood for dolasetron, granisetron, and ondansetron.

Fair for aprepitant and palonosetron.
No consistent significant differences in overall adverse events, withdrawals due to adverse events, or specific adverse events
Key Question 3. Are there subgroups of patients based on demographics (age, race, gender), pregnancy, other medications, or comorbidities for which one newer antiemetic is more effective or associated with fewer adverse events
Comparison Population Quality Conclusion
Dolasetron, granisetron, ondansetronDemographics and other medicationsFairNo consistent differences in comparisons of 5-HT3 antagonists in different patient subgroups
Prognostic risk factors: Patients with a predisposition to nausea/vomitingPoorOndansetron superior to granisetron in preventing vomiting in a subgroup analysis of a single trial
AprepitantGender, racePoorInconclusive based on mixed findings across pooled subgroup analysis from 2 of 6 placebo- controlled trials and small subgroup analyses from trials of aprepitant compared with ondansetron submitted by manufacturer

Abbreviations: 5-HT3, type 3 serotonin; NNT, number needed to treat.

From: Summary

Cover of Drug Class Review: Newer Antiemetics
Drug Class Review: Newer Antiemetics: Final Report Update 1 [Internet].
Peterson K, McDonagh M, Carson S, et al.
Portland (OR): Oregon Health & Science University; 2009 Jan.
Copyright © 2008, Oregon Health & Science University, Portland, Oregon.

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