A meta-analysis comparing the efficacy of four 5-HT3-receptor antagonists for acute chemotherapy-induced emesis

Goal of work: Comparing antiemetic efficacy of different 5-HT3-receptor antagonists (5-HT3RAs) is difficult due to inter-study variability. Therefore, a meta-analysis was performed to comparatively evaluate dolasetron, granisetron, ondansetron and tropisetron for acute chemotherapy-induced nausea and vomiting (CINV). Patients and methods:Comparisons between 5-HT3RAs were based on 44 randomized studies (including 12,343 patients) identified by MEDLINE, CANCERLIT or EMBASE searches and subcategorized by chemotherapy type (cisplatin- or non-cisplatin-based). Main results: When all studies were combined, granisetron was equivalent to ondansetron (n=27), and showed an advantage vs tropisetron (p=0.018; n=12). Ondansetron vs tropisetron (n=11) and ondansetron vs dolasetron (n=3) revealed equivalence in each comparison. An advantage for 3 mg granisetron vs 8 mg ondansetron was found in non-cisplatin-based studies (p=0.015; n=6). Overall equivalence was seen between ondansetron, 24 or 32 mg, and granisetron, 2 or 3 mg, for all studies (n=13). There was a possible advantage for higher (24 or 32 mg) vs lower (8 mg) ondansetron dose regimens with cisplatin-based trials (n=6). No differences were seen between 3 and 1 mg granisetron doses (n=6). Conclusions: Efficacy of 5-HT3RAs for preventing CINV following cisplatin- and non-cisplatin-based chemotherapy is comparable, with the exception of granisetron vs tropisetron. Some differences were noted in dosing subanalyses.