CINV: Cochrane review supports add-on olanzapine

  • Sutherland A & al.
  • Cochrane Database Syst Rev
  • 21 Sep 2018

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • A Cochrane review finds moderate-quality evidence that add-on oral olanzapine (Zyprexa) doubles the prophylactic value of standard antiemetic therapy for chemotherapy-induced nausea and vomiting (CINV).

Why this matters

Study design

  • Cochrane meta-analysis of 14 randomized controlled trials (n=1917) of oral olanzapine in 24 different cancers; most (12) involved highly or moderately emetogenic chemotherapy (HEC/MEC).
  • Funding: National Institute for Health Research.

Key results

  • 3 studies (n=561) with HEC/MEC in solid tumors, moderate-quality evidence:
    • Add-on olanzapine doubles likelihood of CINV absence vs placebo/standard therapy (50% vs 25%; risk ratio [RR]=1.98; 95% CI, 1.59-2.47).
    • Number needed to treat: 5 (95% CI, 3.3-6.6).
  • 7 studies (n=889; low-quality evidence): uncertain elevated risk for serious adverse events (absolute difference, +0.7% [95% CI, 0.2%-5.2%]; RR=2.46 [95% CI, 0.48-12.55]).
  • 5 studies (n=464; moderate-quality evidence): olanzapine likely increases somnolence and fatigue vs no treatment/placebo (anticipated absolute risk, +8.2% [95% CI, 1.9%-18.8%]; RR=2.33 [95% CI, 1.30-4.18]).
  • Olanzapine likely reduces delayed nausea (3 studies [n=585]: RR=1.71; 95% CI, 1.40-2.09) and vomiting (5 studies [n=702]: RR=1.28; 95% CI, 1.14-1.42).
  • Unclear whether 5-mg is similarly effective to 10-mg dose, but may lower odds of somnolence/fatigue.
  • Single studies suggest benefit over metoclopramide, 5-HT3 antagonists, and dexamethasone.

Limitations

  • Oral administration only.
  • Some studies await classification.

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