Objectives: We performed a pooled analysis to evaluate the efficacy and adverse events (AEs) of olanzapine combined with dexamethasone plus compared with 5 HT3 RA plus dexamethasone for the prevention and treatment of chemotherapy-induced nausea and vomiting (CINV) in high and moderate emetogenic chemotherapy based on randomized controlled trials (RCTs).
Methods: PubMed, EMBASE, Web of Science, the Cochrane Library, China Biomedical Literature database (CBM), WanFang Database, China National Knowledge Infrastructure (CNKI), and Chinese Science and Technology Periodical Database (VIP) (from their inception to April 2019) were searched to capture relevant articles. Relative risk (RR) with 95% confidence intervals (CIs) for CINV and AEs were all extracted or calculated.
Result: Eleven studies with 1107 cancer patients were involved in this review. The pooled RR of delayed CINV (RR=0.50, 95%CI: 0.38 0.66, P<0.01) were significant decreased in olanzapine group. Besides, the occurrence of insomnia was statistically decreased. The rate of acute CINV (RR=0.60, 95%CI: 0.48 0.75, P<0.01) was also significant decreased. However only the percent of CINV III and CINV IV were significant deceased in acute and delayed phase. Subgroup analysis demonstrated that the efficacy was no statistically significant difference between 5mg and 10mg for olanzapine.
Conclusion: Olanzapine significant decreased the occurrence of CINV III and CINV IV and insomnia in high and moderately emetogenic chemotherapy. Compared with 10mg per day, 5mg oral may be more appropriate for patients with cancer.
Olanzapine combined with 5-HT3 RA plus dexamethasone for prevention and treatment of chemotherapy-induced nausea and vomiting in high and moderate emetogenic chemotherapy: A systematic review and meta-analysis of randomized controlled trials