三联方案防治中高度致吐风险化疗药物致急性恶心呕吐疗效的网状Meta分析

Network meta-analysis of triple therapy for the prevention and treatment of acute nausea and vomiting caused by emetogenic chemotherapy drugs with moderate and high risk

目的评价5-羟色胺3(5-HT3)受体拮抗剂、神经激肽-1(NK-1)受体拮抗剂和地塞米松联用方案(以下简称“三联方案”)防治中高度致吐风险化疗药物致急性恶心呕吐的疗效。方法检索PubMed、Embase、Cochrane图书馆、中国期刊全文数据库、万方数据,收集不同三联方案或5-HT3受体拮抗剂联用地塞米松(以下简称“二联方案”)的随机对照试验(RCT),检索时限为建库至2023年5月。筛选文献、提取资料、评价文献质量后,采用Stata16.0软件进行网状Meta分析。结果共纳入59项RCT,共计23418例患者,涉及15种干预措施。网状Meta分析结果显示,急性恶心呕吐控制率方面,以福沙匹坦+帕洛诺司琼+地塞米松(FPD)疗效最优,其次为福沙匹坦+格拉司琼+地塞米松(FGD)和阿瑞匹坦+雷莫司琼+地塞米松(AMD);急性恶心控制率方面,以FPD的疗效最优,其次为阿瑞匹坦+帕洛诺司琼+地塞米松(APD)和FGD;急性呕吐控制率方面,以FPD疗效最优,其次为FGD和APD。结论福沙匹坦+格拉司琼+地塞米松较其他三联方案或二联方案防治中高度致吐风险化疗药物所致急性恶心呕吐的疗效更好。

OBJECTIVE To evaluate the efficacy of the triple therapy of 5-HT3 receptor antagonists,neurokinin-1 receptor antagonists and dexamethasone(referred to as“triple therapy”)in the prevention and treatment of acute nausea and vomiting caused by moderately and highly emetogenic chemotherapy drugs.METHODS Retrieved from PubMed,Embase,the Cochrane Library,CNKI and Wanfang data,randomized controlled trials(RCTs)about triple therapy or 5-HT3 receptor antagonist combined with dexamethasone(referred to as“dual therapy”)were collected during the inception to May 2023.After literature screening,data extraction and literature evaluation,network meta-analysis was performed by using Stata 16.0 software.RESULTS A total of 59 RCTs were included,involving 23418 patients and 15 interventions.Results of network meta-analysis showed that fosaprepitant+palonosetron+dexamethasone(FPD)was most effective in terms of acute nausea and vomiting control rate,followed by fosaprepitant+granisetron+dexamethasone(FGD)and aprepitant+ramosetron+dexamethasone(AMD).In terms of acute nausea control rate,FPD was the most effective,followed by aprepitant+palonosetron+dexamethasone(APD)and FGD.In terms of acute vomiting control rate,FPD was the most effective,followed by FGD and APD.CONCLUSIONS Fosaprepitant+palonosetron+dexamethasone is better than other triple therapy or dual therapy in preventing acute nausea and vomiting caused by moderately and highly emetogenic chemotherapy drugs.