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Aprepitant in pediatric patients using moderate and highly emetogenic protocols: a systematic review and meta‐analyses of randomized controlled trials
Author(s) -
Okumura Lucas Miyake,
D'Athayde Rodrigues Fernanda,
Ferreira Maria Angelica Pires,
Moreira Leila Beltrami
Publication year - 2017
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.13193
Subject(s) - medicine , aprepitant , ondansetron , febrile neutropenia , neutropenia , population , meta analysis , relative risk , randomized controlled trial , incidence (geometry) , vomiting , chemotherapy , antiemetic , confidence interval , physics , environmental health , optics
Aims To review the efficacy and safety of aprepitant in combination with ondansetron and dexamethasone (triple therapy) in children and adolescents on moderate to highly emetogenic chemotherapy. Methods Medline, Embase, Scielo, Lilacs, Cochrane and congress abstracts published until September 2016 were used as data sources. Two reviewers independently selected manuscripts and extracted data. A third reviewer solved discrepancies in study selection and data extraction. The primary outcome was overall complete response (no vomiting from 0 to 120 h). Secondary outcomes were: response in acute phase, delayed phase and reported toxicities. Each study was considered a unit of analysis. Summarized relative risks were recalculated based on reported data. All meta‐analyses used a random‐effects model and heterogeneity was reported using the I 2 method. Results From 1004 studies, we screened 288 titles and abstracts and included three trials for data extraction. The population comprised 451 patients. Most patients were males, ranging from 6 months to 19 years of age, and weighing from 6 to 134 kg. Bone cancer was the most incident (≥50%) neoplasm, followed by rhabdomyosarcoma and Hodgkin's lymphoma. Triple therapy was associated with a reduced risk of developing chemotherapy‐induced vomiting (CIV) (RR = 0.48; 95% CI 0.34–0.67). There were no differences in incidence of febrile neutropenia between groups (RR = 1.02; 95% CI 0.66–1.58). Conclusions Triple therapy decreased CIV risk, without increasing the occurrence of febrile neutropenia. However, this review could not address which subpopulations would most benefit from using this strategy. Future studies should focus on assessing risk factors for nausea and vomiting, as many patients did not achieve a complete antiemetic response.