Comparison of aprepitant versus ondansetron for prevention of postoperative nausea and vomiting: A systematic review and meta-analysis with trial sequential analysis
Background and Aims: Postoperative nausea and vomiting (PONV) is a common complication after surgery. Preventing PONV in high-risk patients often requires a multimodal approach combining antiemetic drugs with diverse mechanisms. While aprepitant, a neurokinin-1 receptor antagonist, is recognised as...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2024-09-01
|
| Series: | Indian Journal of Anaesthesia |
| Subjects: | |
| Online Access: | https://journals.lww.com/10.4103/ija.ija_106_24 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832590579645546496 |
|---|---|
| author | Madhusudan P. Singh Meenalotchini P. Gurunthalingam Ayushee Gupta Juhi Singh |
| author_facet | Madhusudan P. Singh Meenalotchini P. Gurunthalingam Ayushee Gupta Juhi Singh |
| author_sort | Madhusudan P. Singh |
| collection | DOAJ |
| description | Background and Aims:
Postoperative nausea and vomiting (PONV) is a common complication after surgery. Preventing PONV in high-risk patients often requires a multimodal approach combining antiemetic drugs with diverse mechanisms. While aprepitant, a neurokinin-1 receptor antagonist, is recognised as highly effective for PONV prevention, uncertainties remain regarding its effectiveness.
Methods:
This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The analysis assessed the effectiveness of aprepitant (A), aprepitant plus ondansetron (AO) and aprepitant plus dexamethasone and ondansetron (ADO) in preventing PONV compared to ondansetron alone (O) or in combination with dexamethasone (DO).
Results:
In the analysis of 12 studies involving 2729 patients, aprepitant demonstrated significant efficacy in preventing PONV compared to ondansetron alone (A versus [vs.] O: PONV incidence 12.5% vs. 28.5%, relative risk [RR] = 0.45, P < 0.001; complete response rate 55.97% vs. 50.35%, RR = 1.13, P = 0.010). The combination of aprepitant with ondansetron (AO) also showed a significantly lower incidence of PONV compared to ondansetron alone (11.3% vs. 26.8%, RR = 0.43, P < 0.001) and a higher complete response rate (38.1% vs. 26.84%, RR = 1.41, P = 0.020). In addition, ADO significantly reduced PONV incidence compared to DO (ADO vs. DO: 13.63% vs. 35.38%, RR = 0.38, P = 0.006).
Conclusion:
Aprepitant, whether used alone or in combination with ondansetron or both ondansetron and dexamethasone, consistently outperforms ondansetron in achieving a complete response as it lowers vomiting rates and reduces the need for rescue therapy during the crucial 24–48-h postoperative period. |
| format | Article |
| id | doaj-art-0193110bd61e4ea2bd11fcddfbe92d6d |
| institution | Kabale University |
| issn | 0019-5049 0976-2817 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Anaesthesia |
| spelling | doaj-art-0193110bd61e4ea2bd11fcddfbe92d6d2025-01-23T09:22:39ZengWolters Kluwer Medknow PublicationsIndian Journal of Anaesthesia0019-50490976-28172024-09-0168976277510.4103/ija.ija_106_24Comparison of aprepitant versus ondansetron for prevention of postoperative nausea and vomiting: A systematic review and meta-analysis with trial sequential analysisMadhusudan P. SinghMeenalotchini P. GurunthalingamAyushee GuptaJuhi SinghBackground and Aims: Postoperative nausea and vomiting (PONV) is a common complication after surgery. Preventing PONV in high-risk patients often requires a multimodal approach combining antiemetic drugs with diverse mechanisms. While aprepitant, a neurokinin-1 receptor antagonist, is recognised as highly effective for PONV prevention, uncertainties remain regarding its effectiveness. Methods: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The analysis assessed the effectiveness of aprepitant (A), aprepitant plus ondansetron (AO) and aprepitant plus dexamethasone and ondansetron (ADO) in preventing PONV compared to ondansetron alone (O) or in combination with dexamethasone (DO). Results: In the analysis of 12 studies involving 2729 patients, aprepitant demonstrated significant efficacy in preventing PONV compared to ondansetron alone (A versus [vs.] O: PONV incidence 12.5% vs. 28.5%, relative risk [RR] = 0.45, P < 0.001; complete response rate 55.97% vs. 50.35%, RR = 1.13, P = 0.010). The combination of aprepitant with ondansetron (AO) also showed a significantly lower incidence of PONV compared to ondansetron alone (11.3% vs. 26.8%, RR = 0.43, P < 0.001) and a higher complete response rate (38.1% vs. 26.84%, RR = 1.41, P = 0.020). In addition, ADO significantly reduced PONV incidence compared to DO (ADO vs. DO: 13.63% vs. 35.38%, RR = 0.38, P = 0.006). Conclusion: Aprepitant, whether used alone or in combination with ondansetron or both ondansetron and dexamethasone, consistently outperforms ondansetron in achieving a complete response as it lowers vomiting rates and reduces the need for rescue therapy during the crucial 24–48-h postoperative period.https://journals.lww.com/10.4103/ija.ija_106_24antiemeticsaprepitantdexamethasoneneurokinin-1 receptor antagonistondansetronpostoperative nausea and vomitingsubstance p |
| spellingShingle | Madhusudan P. Singh Meenalotchini P. Gurunthalingam Ayushee Gupta Juhi Singh Comparison of aprepitant versus ondansetron for prevention of postoperative nausea and vomiting: A systematic review and meta-analysis with trial sequential analysis Indian Journal of Anaesthesia antiemetics aprepitant dexamethasone neurokinin-1 receptor antagonist ondansetron postoperative nausea and vomiting substance p |
| title | Comparison of aprepitant versus ondansetron for prevention of postoperative nausea and vomiting: A systematic review and meta-analysis with trial sequential analysis |
| title_full | Comparison of aprepitant versus ondansetron for prevention of postoperative nausea and vomiting: A systematic review and meta-analysis with trial sequential analysis |
| title_fullStr | Comparison of aprepitant versus ondansetron for prevention of postoperative nausea and vomiting: A systematic review and meta-analysis with trial sequential analysis |
| title_full_unstemmed | Comparison of aprepitant versus ondansetron for prevention of postoperative nausea and vomiting: A systematic review and meta-analysis with trial sequential analysis |
| title_short | Comparison of aprepitant versus ondansetron for prevention of postoperative nausea and vomiting: A systematic review and meta-analysis with trial sequential analysis |
| title_sort | comparison of aprepitant versus ondansetron for prevention of postoperative nausea and vomiting a systematic review and meta analysis with trial sequential analysis |
| topic | antiemetics aprepitant dexamethasone neurokinin-1 receptor antagonist ondansetron postoperative nausea and vomiting substance p |
| url | https://journals.lww.com/10.4103/ija.ija_106_24 |
| work_keys_str_mv | AT madhusudanpsingh comparisonofaprepitantversusondansetronforpreventionofpostoperativenauseaandvomitingasystematicreviewandmetaanalysiswithtrialsequentialanalysis AT meenalotchinipgurunthalingam comparisonofaprepitantversusondansetronforpreventionofpostoperativenauseaandvomitingasystematicreviewandmetaanalysiswithtrialsequentialanalysis AT ayusheegupta comparisonofaprepitantversusondansetronforpreventionofpostoperativenauseaandvomitingasystematicreviewandmetaanalysiswithtrialsequentialanalysis AT juhisingh comparisonofaprepitantversusondansetronforpreventionofpostoperativenauseaandvomitingasystematicreviewandmetaanalysiswithtrialsequentialanalysis |