Comparative efficacy of serotonin (5-HT 3) receptor antagonists in patients undergoing surgery: a systematic review and network meta-analysis

BMC Medicine

Sharon E. Straus⁶  David Moher¹  Brenda R. Hemmelgarn³  Brian Hutton¹  Kelly Mrklas³  Jesmin Antony⁴  Carmen Ng⁴  Joanne Ho⁴  Reid Robson⁴  Emily Reynen⁴  Heather MacDonald⁴  Huda Ashoor⁴  Lisa Strifler⁴  John Ivory⁴  Afshin Vafaei⁴  Paul A. Khan⁴  Areti A. Veroniki⁴  Erik Blondal⁴  Charlene Soobiah²  Andrea C. Tricco⁵ 

[1] Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa K1Y 4E9, ON, Canada;Institute for Health Policy Management & Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto M5T 3M6, ON, Canada;Departments of Community Health Sciences, Faculty of Medicine, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Drive, Calgary T2N 4Z6, AB, Canada;Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto M5B 1W8, ON, Canada;Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 6th floor, 155 College St, Toronto M5T 3M7, ON, Canada;Department of Geriatric Medicine, University of Toronto, 27 Kings College Circle, Toronto M5S 1A1, ON, Canada

关键词: Systematic review;    Serotonin receptor antagonists;    Postoperative vomiting;    Postoperative nausea;    Network meta-analysis;   

Others  :  1216037
DOI  :  10.1186/s12916-015-0371-y

 received in 2015-03-10, accepted in 2015-05-15,  发布年份 2015

【 摘 要 】

Background

Serotonin (5-HT ₃ ) receptor antagonists are commonly used to decrease nausea and vomiting for surgery patients. We conducted a systematic review on the comparative efficacy of 5-HT ₃receptor antagonists.

Methods

Searches were done in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify studies comparing 5-HT ₃receptor antagonists with each other, placebo, and/or combined with other antiemetic agents for patients undergoing surgical procedures. Screening search results, data abstraction, and risk of bias assessment were conducted by two reviewers independently. Random-effects pairwise meta-analysis and network meta-analysis (NMA) were conducted. PROSPERO registry number: CRD42013003564.

Results

Overall, 450 studies and 80,410 patients were included after the screening of 7,608 citations and 1,014 full-text articles. Significantly fewer patients experienced nausea with any drug relative to placebo, except for ondansetron plus metoclopramide in a NMA including 195 RCTs and 24,230 patients. Significantly fewer patients experienced vomiting with any drug relative to placebo except for palonosetron plus dexamethasone in NMA including 238 RCTs and 12,781 patients. All agents resulted in significantly fewer patients with postoperative nausea and vomiting versus placebo in a NMA including 125 RCTs and 16,667 patients.

Conclusions

Granisetron plus dexamethasone was often the most effective antiemetic, with the number needed to treat ranging from two to nine.

【 授权许可】

   
2015 Tricco et al.

【 图 表 】

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【 参考文献 】

• [1]Habib AS, Chen YT, Taguchi A, Hu XH, Gan TJ. Postoperative nausea and vomiting following inpatient surgeries in a teaching hospital: a retrospective database analysis. Curr Med Res Opin. 2006; 22:1093-9.
• [2]Sarin P, Urman RD, Ohno-Machado L. An improved model for predicting postoperative nausea and vomiting in ambulatory surgery patients using physician-modifiable risk factors. J Am Med Inform Assoc. 2012; 19:995-1002.
• [3]Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999; 91:693-700.
• [4]Ballatori E, Roila F, Ruggeri B, Betti M, Sarti S, Soru G et al.. The impact of chemotherapy-induced nausea and vomiting on health-related quality of life. Support Care Cancer. 2007; 15:179-85.
• [5]Osoba D, Zee B, Warr D, Latreille J, Kaizer L, Pater J. Effect of postchemotherapy nausea and vomiting on health-related quality of life. The Quality of Life and Symptom Control Committees of the National Cancer Institute of Canada Clinical Trials Group. Support Care Cancer. 1997; 5:307-13.
• [6]Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I et al.. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med. 2004; 350:2441-51.
• [7]Chung F, Mezei G. Factors contributing to a prolonged stay after ambulatory surgery. Anesth Analg. 1999; 89:1352-9.
• [8]Constenla M. 5-HT3 receptor antagonists for prevention of late acute-onset emesis. Ann Pharmacother. 2004; 38:1683-91.
• [9]Gan TJ, Meyer T, Apfel CC, Chung F, Davis PJ, Eubanks S et al.. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg. 2003; 97:62-71.
• [10]McCracken G, Houston P, Lefebvre G. Guideline for the management of postoperative nausea and vomiting. J Obstet Gynaecol Can. 2008; 30:600-7.
• [11]Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M et al.. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015; 349:g7647.
• [12]Tricco AC, Soobiah C, Antony J, Hemmelgarn B, Moher D, Hutton B et al.. Safety of serotonin (5-HT3) receptor antagonists in patients undergoing surgery and chemotherapy: protocol for a systematic review and network meta-analysis. Syst Rev. 2013; 2:46. BioMed Central Full Text
• [13]Tricco AC, Soobiah C, Blondal E, Veroniki AA, Khan A, Vafaei A, et al. Comparative safety of serotonin (5-HT3) receptor antagonists in patients undergoing surgery: a systematic review and network meta-analysis. BMC Med. 2015; ahead of print.
• [14]Carlisle JB. The analysis of 168 randomised controlled trials to test data integrity. Anaesthesia. 2012; 67:521-37.
• [15]Effective Practice and Organization of Care (EPOC). Suggested risk of bias criteria for EPOC reviews. EPOC Resources for review authors. Oslo: Norwegian Knowledge Centre for the Health Services; 2014. http://epoc.cochrane.org/sites/epoc.cochrane.org/files/uploads/14%20Suggested%20risk%20of%20bias%20criteria%20for%20EPOC%20reviews%202013%2008%2012_0.pdf. Accessed: Jan 2015.
• [16]Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm. Accessed: Jan 2015
• [17]Raudenbush SW. Analyzing effect sizes: random-effects models. In: The Handbook of Research Synthesis and Meta-analysis. 2nd ed. Cooper H, Hedges LV, Valentine JC, editors. The Russell Sage Foundation, New York; 2009: p.295-316.
• [18]Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002; 21:1539-58.
• [19]R Core Team. R: A language and environment for statistical computing. http://www.R-project.org. Accessed Jan 2015.
• [20]Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010; 36:1-48.
• [21]White IR, Barrett JK, Jackson D, Higgins J. Consistency and inconsistency in network meta‐analysis: model estimation using multivariate meta‐regression. Res Synth Methods. 2012; 3:111-25.
• [22]Chen C-C, Lin C-S, Ko Y-P, Hung Y-C, Lao H-C, Hsu Y-W. Premedication with mirtazapine reduces preoperative anxiety and postoperative nausea and vomiting. Anesth Analg. 2008; 106:109-13.
• [23]Omran HASA, Nasr DAM. Effect of premedication with mirtazapine versus ondansetron on postoperative nausea and vomiting in breast surgery. Egyp J Anaesth. 2011; 27:135-9.
• [24]Homesley HD, Hahne WF, McLees B, Heck K, Barrett RJ, Lentz SS et al.. Randomized comparison of the antiemetic efficacy of a serotonin type 3 receptor antagonist (MDL 72,222) with a high-dose metoclopramide regimen. Am J Clin Oncol. 1993; 16:175-9.
• [25]Gan TJ, Meyer TA, Apfel CC, Chung F, Davis PJ, Habib AS et al.. Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2007; 105:1615-28.
• [26]Golembiewski J, Chernin E, Chopra T. Prevention and treatment of postoperative nausea and vomiting. Am J Health Syst Pharm. 2005; 62:1247-60.
• [27]Kovac AL. Prevention and treatment of postoperative nausea and vomiting. Drugs. 2000; 59:213-43.
• [28]Yun MJ, Kim YH, Kim AR. Comparison of azasetron and ondansetron for preventing postoperative nausea and vomiting in patients undergoing gynecological laparoscopic surgery. Yonsei Med J. 2010; 51:88-92.
• [29]MIMS. Ramosetron. http://www.mims.com/Thailand/drug/search/Ramosetron. Accessed: Jan 2015.
• [30]MIMS. Azasetron. http://www.mims.com/Thailand/drug/search/Azasetron?AllFlag=ALL. Accessed: Jan 2015.
• [31]Salanti G. Indirect and mixed-treatment comparison, network, or multiple-treatments meta-analysis: many names, many benefits, many concerns for the next generation evidence synthesis tool. Res Synth Methods. 2012; 3:80-97.
• [32]Chaimani A, Higgins JP, Mavridis D, Spyridonos P, Salanti G. Graphical tools for network meta-analysis in STATA. PLoS One. 2013; 8:e76654.
• [33]Song F, Altman DG, Glenny A-M, Deeks JJ. Validity of indirect comparison for estimating efficacy of competing interventions: empirical evidence from published meta-analyses. BMJ. 2003; 326:472.
• [34]Veroniki AA, Vasiliadis HS, Higgins JP, Salanti G. Evaluation of inconsistency in networks of interventions. Int J Epidemiol. 2013; 42:332-45.
• [35]Riley RD, Higgins JPT, Deeks JJ. Interpretation of random effects meta-analyses. BMJ. 2011; 342:d549.
• [36]Higgins JP, Thompson SG, Spiegelhalter DJ. A re-evaluation of random-effects meta-analysis. J R Stat Soc Ser A Stat Soc. 2009; 172:137-59.
• [37]Salanti G, Ades AE, Ioannidis JPA. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol. 2011; 64:163-71.
• [38]Stata Statistical Software: Release 13. StataCorp LP, College Station, TX; 2013.
• [39]White IR. Multivariate random-effects meta-regression: updates to mvmeta. Stata J. 2011; 11:255-70.
• [40]Apfel CC, Candiotti K, Gan TJ, Ahmed R, Cox D. Palonosetron or ondansetron for rescue treatment of PONV after failed prophylaxis with ondansetron. Anesth Analg. 2011; 112:S16.
• [41]Gaynes B, Fiscella R, Larson B, Kiesling D. Intravenous ondansetron versus placebo for post-operative nausea and vomiting following cataract surgery. In: American Academy of Optometry. 1996: 170p.
• [42]Gurha P, Kaur RD, Sanjay RR. Prophylactic intravenous palonosetron, granisetron and ondansetron in the prevention of post operative nausea and vomiting in laparoscopic surgeries. Br J Anaesth. vol. 108: Oxford Univ Press; 2012: 376–376.
• [43]Samra SK, Williams B, Ciarralo C, Turner C, Smythe P. Lack of effect of droperidol, ondansetron, and dolasetron administration on PONV in a placebo controlled trial. Anesthesiology. 2003; 99:A305.
• [44]White PF, Scuderi PE. Prevention of postoperative nausea and vomiting (PONV): A dose-ranging study involving palonosetron, a potent 5-HT3 receptor antagonist. Anesthesiology. 2005; 103:A703.
• [45]American Society of Anesthesiologists. ASA Physical Status Classification System. http://www.asahq.org/resources/clinical-information/asa-physical-status-classification-system. Accessed: Jan 2015.
• [46]Chen YF, Yeh WL, Lee KH, Li MC, Yang TH, Huang HC et al.. Intravenous ondansetron as antiemetic prophylaxis for postoperative nausea and vomiting after shoulder arthroscopy. Chang Gung Med J. 2011; 34:205-12.
• [47]Flynn BC, Nemergut EC. Postoperative nausea and vomiting and pain after transsphenoidal surgery: a review of 877 patients. Anesth Analg. 2006; 103:162-7.
• [48]Shakeel M, Trinidade A, Al-Adhami A, Khan I, Supriya M, Kubba H. Retrospective review of three antiemetic regimens versus no therapy in the prevention of postoperative and vomiting following adenotonsillar surgery. J Otolaryngol Head Neck Surg. 2012; 41:35-40.
• [49]Walker JB. Efficacy of single-dose intravenous dolasetron versus ondansetron in the prevention of postoperative nausea and vomiting. Clin Ther. 2001; 23:932-8.
• [50]Biedler A, Wermelt J, Kunitz O, Muller A, Wilhelm W, Dethling J et al.. A risk adapted approach reduces the overall institutional incidence of postoperative nausea and vomiting. Can J Anaesth. 2004; 51:13-9.
• [51]Kim EJ, Ko JS, Kim CS, Lee SM, Choi DH. Combination of antiemetics for the prevention of postoperative nausea and vomiting in high-risk patients. J Korean Med Sci. 2007; 22:878-82.
• [52]Wagner DS, Gauger V, Chiravuri D, Faust K. Ondansetron oral disintegrating tablets for the prevention of postoperative vomiting in children undergoing strabismus surgery. Ther Clin Risk Manag. 2007; 3:691-4.
• [53]Alexander R, Fennelly M. Comparison of ondansetron, metoclopramide and placebo as premedicants to reduce nausea and vomiting after major surgery. Anaesthesia. 1997; 52:695-8.
• [54]Aouad MT, Siddik-Sayyid SM, Taha SK, Azar MS, Nasr VG, Hakki MA et al.. Haloperidol vs. ondansetron for the prevention of postoperative nausea and vomiting following gynaecological surgery. Eur J Anaesthesiol. 2007; 24:171-8.
• [55]Gan TJ, Gu J, Singla N, Chung F, Pearman MH, Bergese SD et al.. Rolapitant for the prevention of postoperative nausea and vomiting: a prospective, double-blinded, placebo-controlled randomized trial. Anesth Analg. 2011; 112:804-12.
• [56]McKenzie R, Sharifi-Azad S, Dershwitz M, Miguel R, Joslyn AF, Tantisira B et al.. A randomized, double-blind pilot study examining the use of intravenous ondansetron in the prevention of postoperative nausea and vomiting in female inpatients. J Clin Anesth. 1993; 5:30-6.
• [57]Metaxari M, Papaioannou A, Petrou A, Chatzimichali A, Pharmakalidou E, Askitopoulou H. Antiemetic prophylaxis in thyroid surgery: a randomized, double-blind comparison of three 5-HT3 agents. J Anesth. 2011; 25:356-62.
• [58]Munro FJ, Fisher S, Dickson U, Morton N. The addition of antiemetics to the morphine solution in patient controlled analgesia syringes used by children after an appendicectomy does not reduce the incidence of postoperative nausea and vomiting. Paediatr Anaesth. 2002; 12:600-3.
• [59]Sarvela PJ, Halonen PM, Soikkeli AI, Kainu JP, Korttila KT. Ondansetron and tropisetron do not prevent intraspinal morphine- and fentanyl-induced pruritus in elective cesarean delivery. Acta Anaesthesiol Scand. 2006; 50:239-44.
• [60]Tang J, Watcha MF, White PF. A comparison of costs and efficacy of ondansetron and droperidol as prophylactic antiemetic therapy for elective outpatient gynecologic procedures. Anesth Analg. 1996; 83:304-13.
• [61]Jain V, Mitra JK, Rath GP, Prabhakar H, Bithal PK, Dash HH. A randomized, double-blinded comparison of ondansetron, granisetron, and placebo for prevention of postoperative nausea and vomiting after supratentorial craniotomy. J Neurosurg Anesthesiol. 2009; 21:226-30.
• [62]Jokela R, Koivuranta M, Kangas-Saarela T, Purhonen S, Alahuhta S. Oral ondansetron, tropisetron or metoclopramide to prevent postoperative nausea and vomiting: a comparison in high-risk patients undergoing thyroid or parathyroid surgery. Acta Anaesthesiol Scand. 2002; 46:519-24.
• [63]Bacic A, Rumboldt Z, Gluncic I, Buklijas J. The impact of the menstrual cycle and ondansetron on postoperative nausea and vomiting. Int J Clin Pharmacol Res. 1998; 18:153-8.
• [64]Iatrou CA, Dragoumanis CK, Vogiatzaki TD, Vretzakis GI, Simopoulos CE, Dimitriou VK. Prophylactic intravenous ondansetron and dolasetron in intrathecal morphine-induced pruritus: a randomized, double-blinded, placebo-controlled study. Anesth Analg. 2005; 101:1516-20.
• [65]Ruiz de Adana J, Tobalina Bonis R, Garcia Galan F, Hernandez Matias A, Fernandez Luengas D, Ortega Deballon P, et al. Antiemetic efficacy of ondansetron in laparoscopic cholecystectomy. A randomized, double-blind, placebo-controlled study. Rev Esp Enferm Dig. 1999;91:639–43.
• [66]Manani G, Cantele P, Dona B, Meroni M, Tiberio I, Ceschin C et al.. Oculo-emetic and oculo-cardiac reflex in the prevention of postoperative nausea and vomitus by diehydrobenzperidol and ondansetron after squint surgery. Acta Anaesthesiol Italica. 1996; 47:201-9.
• [67]Tang DH, Malone DC. A network meta-analysis on the efficacy of serotonin type 3 receptor antagonists used in adults during the first 24 h for postoperative nausea and vomiting prophylaxis. Clin Ther. 2012; 34:282-94.
• [68]Rawlinson A, Kitchingham N, Hart C, McMahon G, Ong SL, Khanna A. Mechanisms of reducing postoperative pain, nausea and vomiting: a systematic review of current techniques. Evid Based Med. 2012; 17:75-80.
• [69]Tricco A, Veroniki A, Blondal E, Hamid J, Straus S. Incorporating dosages increases the relevance of network meta-analysis for decision-makers: A case example using data from a systematic review of serotonin (5-HT3) receptor antagonists in patients undergoing surgery. Canadian Association of Pharmacy Technicians (CAPT) Conference, Toronto; 2014.
• [70]Veroniki AA, Del Giovane C, Blondal E, Thavorn K, Straus SE, Tricco A. How to model different dose-effects in networks of interventions? 2015 Canadian Agency for Drugs and Technologies in Health (CADTH) Symposium. Saskatoon, Saskatchewan; 2015. http://www.slideshare.net/CADTH_Symposium/cadth-2015-d5-veroniki-modeling-dose-effects-in-nma-cadth-14-apr2015-v3. Accessed: Apr 2015.