阿瑞吡坦防治化疗致恶心呕吐的Meta分析

A meta-analysis of aprepitant for prevention of chemotherapy-induced nausea and vomiting

目的:系统评价阿瑞吡坦防治中、高度致吐风险化疗致恶心呕吐的有效性及安全性。方法:全面检索PubMed(1980年至2010年3月)、EMbase(1980年至2010年3月)、Cochrane Libraries(2010年第2期)、CNKI(1980年至2010年3月)、CBMdisc(1980年至2010年3月)、万方电子期刊(1982年至2010年3月)中纳入的阿瑞吡坦用于防治化疗致恶心呕吐的随机对照试验,并进行文献质量评价和资料提取,对同质研究作Meta分析。结果:共纳入10项研究(n=4376),均为高质量研究。Meta分析结果表明:(1)急性症状:"阿瑞吡坦+昂丹司琼+地塞米松"与"昂丹司琼+地塞米松"比较,呕吐的完全控制率提高了14.21%(分别为83.33%和72.96%,P<0.001),亚组分析显示接受顺铂化疗的患者获益高于AC方案化疗的患者,控制率分别提高了18.04%和10.85%;恶心的控制率仅提高3.92%(P=0.04),临床意义不大。(2)延迟性症状:"阿瑞吡坦"与"昂丹司琼"比较,呕吐的完全控制率提高了14.98%(P=0.004);"阿瑞吡坦+地塞米松"与"地塞米松"比较,呕吐的完全控制率提高了37.72%(P<0.001),恶心的控制率提高了11.24%(P=0.008)。(3)不良反应:阿瑞吡坦组疲劳/虚弱的发生率较高(P=0.001),便秘的发生率较低(P=0.002),其余发生率相似。结论:阿瑞吡坦可以改善肿瘤患者呕吐症状,对恶心作用不明显。接受顺铂化疗的患者获益高于AC方案。由于阿瑞吡坦价格昂贵,临床治疗需综合考虑化疗方案及患者的治疗意愿。此外,尚需进行药物经济学研究以考察其真实的临床价值。

Objective：To assess the efficacy and safety of aprepitant for the prevention of chemotherapy-induced nausea and vomiting （CINV） after moderately or highly emetogenic chemotherapy. Methods： Studies were identified by searching PubMed （1980 to March,2010）,EMbase （1980 to March,2010）,Cochrane Libraries （Issue 2,2010）,CNKI （1980 to March,2010）,CBMdisc （1980 to March,2010）,and WanFang Data （1982 to March,2010）. Randomized controlled trials of aprepitant for the prevention of CINV were included. The quality of included studies was assessed and meta-analysis was performed for the results of homogeneous studies by RevMan 5.0.23 software. Results： Ten studies involving 4 376 oncology patients were included. They were all high quality studies,with Jadad scores more than 5. The results of meta-analysis were as follows： （1） Acute CINV： The overall complete response rate was improved by 14.21% when aprepitant was combined with ondansetron and dexamethasone （83.33% vs 72.96%; P〈0.001）. Subgroup analysis showed the patients receiving AC （anthracycline/cyclophosphamide） regimen benefited less than the patients receiving cisplatin chemotherapy. The rate of no significant nausea was only improved by 3.92% （P=0.04）. （2） Delayed CINV： Compared with ondansetron,aprepitant could improve vomiting by 14.98% （P=0.004）. When aprepitant was added with dexamethasone,the response rate of vomiting and nausea was improved by 37.72% （P〈0.001） and 11.24% （P=0.008） respectively. （3） Adverse reactions：The incidence of fatigue/asthenia was higher in the aprepitant regimen （P=0.001）,while the incidence of constipation was lower （P=0.002）.Conclusion：Aprepitant can improve the control of vomiting,but has slight effect on nausea. Patients receiving AC regimen benefit less than patients receiving cisplatin chemotherapy. In view of its high cost,pharmacoeconomics researches of aprepitant should be considered.