阿瑞匹坦预防中高度致吐性化疗方案所致恶心呕吐的Meta分析  

Meta-analysis of aprepitant in the prevention of nausea and vomiting induced by moderately and highly emetogenic chemotherapy

作　　者：邱钰芹[1] 崔慧娟 彭艳梅[1] 刘戴维 宋亚中 刘凡[1] 段桦[1] 李嫱[1] 

机构地区：[1]北京中医药大学,北京100029 [2]中日医院中西医结合肿瘤科,北京100029

出　　处：《中国新药杂志》2017年第21期2559-2567,共9页Chinese Journal of New Drugs

摘　　要：目的:评价阿瑞匹坦预防中高度致吐性化疗方案所致恶心、呕吐的疗效及安全性。方法:检索Medline,Cochrane Library,Pubmed,CNKI,CBM,万方和VIP 7个数据库(建库起至2016年10月),纳入以比较阿瑞匹坦与常规止吐药预防化疗相关性恶心呕吐(CINV)为目的的随机对照试验,结局判断指标为急性和/或延迟性呕吐的完全缓解率(CR)、恶心的控制率以及不良反应等。结果:最终纳入18项符合标准的高质量随机对照试验。结果表明:(1)与对照组相比,阿瑞匹坦组急性呕吐CR明显提高(84.5%vs 77.4%,OR=1.60,P<0.01),亚组分析显示顺铂方案化疗患者的获益高于卡铂及AC方案化疗者;但2组对急性恶心控制率差异不大(88.6%vs 85.4%,OR=1.41,P=0.02)。(2)阿瑞匹坦能明显提高延迟性呕吐CR:阿瑞匹坦对比5-HT3RA,CR提高了7.8%(62.9%vs 55.1%,OR=1.39,P<0.01);阿瑞匹坦对比安慰剂,CR提高了14%(67.4%vs 53.4%,OR=1.85,P<0.01);阿瑞匹坦联合地塞米松比单用地塞米松CR提高了17.9%(73.2%vs 55.3%,OR=2.22,P<0.01)。(3)阿瑞匹坦联合地塞米松比地塞米松对延迟性恶心控制率提高了9.3%(74.4%vs 65.1%,OR=1.55,P=0.01)。(4)不良反应:阿瑞匹坦组疲劳的发生率高于对照组(P=0.01),而便秘的发生率低于对照组(P=0.03),头痛、腹泻、厌食等发生率2组无明显差异。结论:阿瑞匹坦临床耐受性好,对延迟性呕吐、恶心及急性呕吐改善明显,尤其是顺铂方案化疗患者受益明显,但对急性恶心症状作用不大。临床上仍需进一步观察阿瑞匹坦对不同化疗方案所致CINV的改善情况。Objective： To evaluate the efficacy and safety of aprepitant in the prevention of nausea and vomiting induced by moderately and highly emetogenic chemotherapy. Methods： Medline,Cochrane Library,Pubmed,CNKI,CBM,Wanfang and VIP were searched（ up to October 2016）. Eligible randomized controlled trials evaluating the efficacy of aprepitant versus conventional antiemetics in the prevention of chemotherapy-related nausea and vomiting（ CINV） were included. The outcome indicators were complete response（ CR） during acute or delayed vomiting,control rate of nausea and adverse reactions. Results： Eighteen high quality RCTs were included.Compared with the control group,the acute CR was significantly improved in the aprepitant group（ 84. 5% vs77. 4%,OR = 1. 60,P〈0. 01） and the subgroup analysis showed that the cisplatin regimen was superior to thecarboplatin and AC regimen. However,the control rate of acute nausea was no significantly different between the two groups（ 88. 6% vs 85. 4%,OR = 1. 41,P = 0. 02）. Aprepitant could significantly improve the complete response of delayed vomiting. Compared with 5-HT3 RA,aprepitant could improve vomiting by 7. 8%（ 62. 9% vs55. 1%,OR = 1. 39,P〈0. 01）. Compared with placebo,aprepitant could improve vomiting by 14%（ 67. 4% vs53. 4%,OR = 1. 85,P〈0. 01）. When aprepitant was combined with dexamethasone,the delayed CR was improved by 17. 9%（ 73. 2% vs 55. 3%,OR = 2. 22,P〈0. 01）. The control rate of delayed nausea was improved by 9. 3% when aprepitant was combined with dexamethasone（ 74. 4% vs 65. 1%,OR = 1. 55,P =0. 01）. As for the adverse reactions,the incidence of fatigue was higher for the aprepitant regimen（ P = 0. 01）,while the incidence of constipation was lower（ P = 0. 03）. The incidences of headache,diarrhea and anorexia were not significantly different between the two groups. Conclusion： Aprepitant is well tolerated and can improve the control of delayed CINV and acute vomiting,especially in patients receiving cisplatin chemo

关 键 词：阿瑞匹坦 化疗 恶心 呕吐 META分析 

分 类 号：R975.4[医药卫生—药品]