Olanzapine cost-effectiveness in vomiting and nausea from highly emetogenic chemotherapy in children and adolescents

Singh, Manraj; Ganguly, Shuvadeep; Naik, Ramavath Devendra; Sasi, Archana; Sharma, Priya; Giri, Rupak Kumar; Rasheed, Azgar Abdul; Bakhshi, Sameer

doi:10.1136/spcare-2022-004069

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…Additionally, the cost-effectiveness of newer anti-emetics is an important aspect that needs to be incorporated while designing institute-or country-specific anti-emetic guidelines. Aprepitant as a third prophylactic agent and olanzapine as a fourth prophylactic agent for CINV were found to be cost-effective from both a high-income and a low-middle income perspective; yet, such studies should be prospectively conducted with newer agents before including the use of these drugs in guidelines [92,93].…”

Section: Discussionmentioning

confidence: 99%

Anti-Emetics in Children Receiving Chemotherapy for Solid Tumors and Leukemia: Pharmacology and Optimization of Therapy for Nausea and Vomiting

Ganguly,

Sasi,

Nagaraju

et al. 2024

Pharmaceuticals

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The management of chemotherapy-induced nausea and vomiting (CINV) in children remains challenging due to differences in the chemotherapy regimens, their relative emetogenicity compared to that in adults and differences in drug metabolism and the available formulations. The common four classes of anti-emetics used for the treatment and prophylaxis of CINV in children include dexamethasone, neurokinin-1 receptor antagonists, 5-hydroxytryptamine-3 receptor antagonists (5HT3RAs), and olanzapine. The appropriate dose of dexamethasone for CINV prophylaxis in children is unknown, with a significant variability in dosage ranging between 6 and 32 mg/m2/day. The dose of dexamethasone is decreased by 30% when this drug is combined with (fos)aprepitant in children, in contrast to a decrease of 50% required in adults. The use of aprepitant in younger children (<12 years) is often hampered by the non-availability of oral suspension formulations in many countries; alternatively, 80 mg capsules are administered for 1–3 days in certain institutes to children weighing between 15 and 40 kg. Among the different 5HT3RAs, palonosetron is comparatively metabolized faster in children than in adults, requiring a higher dosage for similar efficacy to that achieved in adults. Olanzapine is a newer agent, used in doses between 0.1 and 0.14 mg/kg/day in children, with good anti-emetic efficacy, but has sedation and hyperglycemia as concerning adverse effects. Drug interactions between anti-emetics and between anti-emetics and chemotherapy/supportive agents (azole antifungals, cyclosporine, arsenic trioxide), especially QTc prolongation, should be considered during prescription.

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Section: Discussionmentioning

confidence: 99%

Anti-Emetics in Children Receiving Chemotherapy for Solid Tumors and Leukemia: Pharmacology and Optimization of Therapy for Nausea and Vomiting

Ganguly,

Sasi,

Nagaraju

et al. 2024

Pharmaceuticals

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“…In a study done by M S Sra et al 31 , in AIIMS the cost-effectiveness of addition of olanzapine to a prophylactic antiemetic regimen containing aprepitant, dexamethasone and ondansetron among children receiving highly emetogenic chemotherapy (HEC) in India, Bangladesh, Indonesia, the UK and the USA was assessed. The incremental cost-utility ratio (ICUR), incremental cost-effectiveness ratio and net monetary benefit (NMB) were calculated from the patient perspective for India, Bangladesh, Indonesia, the UK and the USA.…”

Section: Cost-effective Analysis Of Four Drug Antiemetic Regimen Used...mentioning

confidence: 99%

A phase III, randomized, open label non inferiority study to evaluate the efficacy of oral Ondansetron and Dexamethasone vs intravenous Ondansetron and Dexamethasone in prevention of chemotherapy induced nausea and vomiting in patients receiving highly emetogenic chemotherapy (HEC)- ONDEXCEL TRIAL.

Kaur,

Jha,

Gogia

et al. 2024

Preprint

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Chemotherapy induced nausea and vomiting (CINV) is one of the common complications experienced by patients and affects up to 40% of patients receiving chemotherapy. Most Guidelines (ASCO, NCCN, and MASCC/ESMO) recommend the use of triple drug or 4 drug antiemetic regimens for prevention of CINV caused by highly emetogenic chemotherapy (HEC) i.e 5HT3 receptor antagonist, steroids, NK receptor antagonist and olanzapine. Both oral as well as intravenous antiemetics are recommended. However, no head to head trials are available to compare efficacy of oral vs intravenous ondansetron and dexamethasone combination for prevention of CINV in treatment naïve newly diagnosed cancer patients. Therefore, we conducted a randomized, phase III, open label non inferiority study to evaluate the efficacy of oral vs intravenous ondansetron and dexamethasone in prevention of chemotherapy induced nausea and vomiting in newly diagnosed cancer patients receiving 1st cycle of highly emetogenic chemotherapy. This study initiated in March 2023. A total of 210 patients are planned to be enrolled over a period of 1.5 years. The study has been registered with clinical trial registry of India (CTRI/2024/03/063697).

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Antiemetic medications for preventing chemotherapy-induced nausea and vomiting in children: a systematic review and Bayesian network meta-analysis

Walker,

Dias,

Phillips

2024

Support Care Cancer

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Purpose Children continue to experience chemotherapy-induced nausea and vomiting (CINV), despite effective antiemetic medications. Recommendations in clinical practice guidelines are underpinned by narrative syntheses and meta-analyses that compare only two treatments. This means not all antiemetics have been compared to one another, and estimates remain imprecise. We apply network meta-analysis (NMA) to overcome these limitations by comparing multiple treatments simultaneously. Methods A systematic review identified and critically appraised RCTs comparing antiemetics recommended and licensed for the prevention of CINV in children. Bayesian NMA compared and ranked antiemetic effectiveness for the outcomes complete (CR) and partial response (PR) in the acute, delayed, and overall phases, nausea, and decreased food intake. Antiemetics given with and without dexamethasone were compared in separate networks as their underlying populations differed. Results Sixteen RCTs (3115 patients receiving moderately (MEC) or highly emetogenic chemotherapy (HEC)) were included. When given with dexamethasone, NK1 antagonists with ondansetron ranked highest for CR and PR in the acute and overall phases, PR in the delayed phase, and decreased food intake. Post hoc analysis shows further a benefit of adding olanzapine to regimens of aprepitant and ondansetron. Ondansetron ranked lower than palonosetron, for CR in the delayed and overall phases, and ondansetron was less effective than palonosetron for nausea prevention. Rankings for other regimens, including those given without dexamethasone, were uncertain or inconsistent across outcomes. Conclusions Our findings serve to support the current recommendations of olanzapine (when given with aprepitant and ondansetron) and NK1 antagonists’ regimens receiving HEC, but note that evidence of a significant difference in relative benefit, between patients receiving MEC and HEC, does not yet exist. Recommendations for palonosetron as the preferred 5HT3 antagonists may be extended, particularly, to those who are at high risk of nausea.

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Olanzapine cost-effectiveness in vomiting and nausea from highly emetogenic chemotherapy in children and adolescents

Cited by 3 publications

References 19 publications

Anti-Emetics in Children Receiving Chemotherapy for Solid Tumors and Leukemia: Pharmacology and Optimization of Therapy for Nausea and Vomiting

Anti-Emetics in Children Receiving Chemotherapy for Solid Tumors and Leukemia: Pharmacology and Optimization of Therapy for Nausea and Vomiting

A phase III, randomized, open label non inferiority study to evaluate the efficacy of oral Ondansetron and Dexamethasone vs intravenous Ondansetron and Dexamethasone in prevention of chemotherapy induced nausea and vomiting in patients receiving highly emetogenic chemotherapy (HEC)- ONDEXCEL TRIAL.

Antiemetic medications for preventing chemotherapy-induced nausea and vomiting in children: a systematic review and Bayesian network meta-analysis

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