The Efficacy, Safety, and Cost Benefit of Olanzapine versus Aprepitant in Highly Emetogenic Chemotherapy: A Pilot Study from South India

Babu, Govind; Smitha, S.; Chinnagiriyappa, Lakshmaiah K; Jacob, Linu Abraham; Mallekavu, Suresh Babu; Dasappa, Lokanatha; Kiran, Pretesh Rohan; Sreevatsa, Aparna; Appachu, Sandhya; Unnikrishnan, Vineetha; Arroju, Venugopal

doi:10.1155/2016/3439707

Cited by 31 publications

(55 citation statements)

References 20 publications

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“…A Phase II study [16] also showed that olanzapine combined with a single dose of dexamethasone, and a single dose of palonosetron was very effective in controlling acute and delayed CINV in patients receiving both HEC and MEC. A recent study [30] evaluated the efficacy, safety, and cost benefit of olanzapine as compared to aprepitant for the prevention of CINV in patients receiving palonosetron and dexamethasone combination regimens. There was no difference in safety and efficacy but olanzapine was a cost-effective alternative to aprepitant.…”

Section: Discussionmentioning

confidence: 99%

Olanzapine Combined With Standard Antiemetic Regimens for Prevention of Chemotherapy Therapy-Induced Nausea and Vomiting: A Single-Center Experience From South India

James

Jose

2017

Asian J Pharm Clin Res

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Objectives: Olanzapine, an antipsychotic agent, exhibits significant antiemetic properties due to its inhibitory activity on neurotransmitters at multiple receptors involved in chemotherapy-induced nausea and vomiting (CINV). CINV can have an immensely negative impact on patient's quality of life (QOL) and daily activities. Our objectives were to determine the effectiveness of adding olanzapine to standard antiemetic regimens for the prevention of CINV in cancer patients and to compare the QOL of such patients with those receiving standard antiemetic regimens. Methods:A prospective, observational, cohort study was done on patients receiving either highly or moderately emetogenic chemotherapy (MEC). The patients who received only the standard antiemetic regimens were considered as the control group and those who received 10 mg of olanzapine once daily on days 1-5 of chemotherapy in addition to the standard antiemetic regimens were considered to be the study group. The patients were assessed for grades of nausea and vomiting using National Cancer Institute common terminology criteria for adverse events and for QOL using European Organization in Research and Treatment of Cancer QOL questionnaire. Results:Patients were evaluated for a total of 168 cycles of chemotherapy. Compared to the control group, the study group patients showed significant improvement in response to acute nausea (p=0.02) but not in acute vomiting (p=0.09). However, response to delayed nausea and vomiting improved significantly (p=0.004 and p=0.05, respectively). The QOL of study group patients showed significant improvement in functional scales and symptom scales (p<0.02). Global health status also increased significantly (p=0.02) in the study group patients. Conclusion:Olanzapine containing pre-medication regimens can reduce acute and delayed nausea and delayed vomiting and improve the QOL of cancer patients receiving highly or moderately emetogenic chemotherapeutic agents as compared to the standard pre-medication regimens.

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Section: Discussionmentioning

confidence: 99%

Olanzapine Combined With Standard Antiemetic Regimens for Prevention of Chemotherapy Therapy-Induced Nausea and Vomiting: A Single-Center Experience From South India

James

Jose

2017

Asian J Pharm Clin Res

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“…Two of the studies were double-blinded RCTs20,32, three were single blinded and the rest were unblinded. Finally, 8 studies reported participants of Asian background; two from India30,31, one from Japan29 and five from China 24-28. Five of the studies reported that the patients included where from USA 20-23,32…”

Section: Resultsmentioning

confidence: 99%

“…Many randomized controlled trials (RCTs) have been then conducted to confirm the effect of addition of olanzapine to the standard antiemetic regimen 20,21,22,23,24,25,26,27,28,29,30,31,32. A previous meta-analysis conducted by Wang et al33 revealed that the rate of patients achieving total control of nausea and vomiting was significantly higher in the olanzapine group.…”

Section: Introductionmentioning

confidence: 99%

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Olanzapine for chemotherapy-induced nausea and vomiting: systematic review and meta-analysis

Chelkeba¹,

Gidey²,

Mamo³

et al. 2017

Pharm Pract (Granada)

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Background:Chemotherapy induced nausea and vomiting (CINV) remains the most distressing event in patients receiving highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC).Objective:Therefore, this meta-analysis was conducted to evaluate the efficacy of olanzapine containing regimen in preventing acute, delayed and overall phases of CINV.Methods:PubMed, EBSCO, and Cochrane central register of controlled trials electronic databases were searched to identify RCTs that compared the effects of olanzapine with non-olanzapine regimen in preventing CINV. Randomized clinical trials (RCTs) that compared olanzapine containing regimen with non-olanzapine regimen were included. The primary outcomes were the percentage of patients achieving no vomiting or no nausea in acute, delayed and overall phases.Results:13 RCTs that enrolled 1686 participants were included in this meta-analysis. 852 patients were assigned to olanzapine and 834 patients were assigned to non-olanzapine regimen (other standard antiemetic regimen). The percentages of no emesis achieved were 87.5%, 76.2%, 73.6% in olanzapine versus 76.7%, 61.8%, and 56.4% in non-olanzapine regimen in acute, delayed and overall phases, respectively. The percentages of no nausea were 82%, 64.3%, 61.6% in olanzapine group versus 71.3%, 41.8%, and 40.6% in non-olanzapine group in acute, delayed and overall phases, respectively. In general, olanzapine containing regimen achieved statistical superiority to non-olanzapine regimen in no vomiting endpoint in acute phase (OR 2.16; 95%CI 1.60 to 2.91, p<0.00001; I-square=5%; p=0.40), delayed phase (OR 2.28; 95%CI 1.1.46 to 3.54, p=0.0003; I-square=65%; p=0.001) and overall phase (OR 2.48; 95%CI 1.59 to 3.86, p<0.0001; I-square=69%; p< 0.0001).Conclusion:The current meta-analysis showed that olanzapine was statistically and clinically superior to non-olanzapine regimen in preventing CINV in most domains of the parameters.

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“…Meanwhile, although 5CN is recommended by ESMO guidelines, there is no direct evidence concerning the relative efficacy between 5CO and 5CN in the setting of AC‐based chemotherapy. Only two publications characterized by unspecific chemotherapy have reported that both combinations have no significant disparity in terms of acute CINV prophylaxis . Moreover, there is no mechanistic advantage of 5CN since the peripheral pathway is the primary signaling responsible for acute CINV, which involves serotonin receptors instead of neurokinin transduction .…”

Section: Discussionmentioning

confidence: 99%

Comparative efficacy and tolerability of antiemetic prophylaxis for adult highly emetogenic chemotherapy: A network meta‐analysis of 143 randomized controlled trials

Cheng

Cai

Shuai

et al. 2017

Intl Journal of Cancer

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Chemotherapy-induced nausea and vomiting (CINV) is one of the commonest side-effects among cancer patients. However, there is lacking of hierarchical evidences comparing different antiemetics against highly emetogenic chemotherapy. Therefore, we conducted a network meta-analysis to investigate their comparative efficacy and tolerability. Randomized controlled trials that compared different antiemetic categories for adult highly emetogenic chemotherapy were included after searching PubMed, Web of Science, Embase and Cochrane Central. Acute-phase no emesis and no nausea were identified as primary endpoints. We made pairwise and hierarchical calculations by random-effects model. Effect sizes were presented by odds ratio and 95% confidential interval. Subgroup analysis was additionally performed. 143 randomized trials were included into pooled analysis, containing 22,776 patients and 18 antiemetic categories. 5-HT RA plus corticosteroid plus NK-1 RA plus other (5CNO) displayed best protection against both acute emesis (SUCRA: 99.7%) and nausea (95.6%). 5CNO (99.7%) and 5-HT RA plus corticosteroid plus other (5CO, 85.3%) topped subgroup hierarchies for no-naivety and anthracycline plus cyclophosphamide (AC)-based studies. On the other hand, 5-HT RA plus dopamine RA plus other (5DO) may be best fit for delayed emesis (92.0%) and nausea (92.7%). Subgroups featuring no-naivety and AC-based trials preferred 5DO (91.9%) and 5CN (88.6%), respectively. In addition, dopamine RA plus other (DO) had the lowest incidence of TRAE in most circumstances, except for AC-based subgroup where corticosteroid plus dopamine RA plus other (CDO) preponderated (69.2%). 5CNO and 5DO should be considered as first-line regimens against highly emetogenic chemotherapy induced acute and delayed CINV, respectively.

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The Efficacy, Safety, and Cost Benefit of Olanzapine versus Aprepitant in Highly Emetogenic Chemotherapy: A Pilot Study from South India

Cited by 31 publications

References 20 publications

Olanzapine Combined With Standard Antiemetic Regimens for Prevention of Chemotherapy Therapy-Induced Nausea and Vomiting: A Single-Center Experience From South India

Olanzapine Combined With Standard Antiemetic Regimens for Prevention of Chemotherapy Therapy-Induced Nausea and Vomiting: A Single-Center Experience From South India

Olanzapine for chemotherapy-induced nausea and vomiting: systematic review and meta-analysis

Comparative efficacy and tolerability of antiemetic prophylaxis for adult highly emetogenic chemotherapy: A network meta‐analysis of 143 randomized controlled trials

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