Duration of dexamethasone administration for the prevention of chemotherapy-induced nausea and vomiting - a systematic review and meta-analysis. [Asia-Pacific Journal of Clinical Oncology]

Abstract

Aims: Chemotherapy-induced nausea and vomiting is the most common non-haematological toxicity of chemotherapy. Our objective was to determine the optimal duration of dexamethasone treatment in preventing chemotherapy-induced nausea and vomiting. Method(s): Searches were conducted inMEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov. Eligible studies were randomised controlled studies comparing a short course (1-2 days) to a long course (3 or more days) of dexamethasone in patients receiving chemotherapy. The same regimen of adjunctanti-emetics was required in both arms. Primary outcome was complete responsewith no nausea or vomiting and the secondary outcome was adverse effects. Screening and data extraction were conducted independently by two authors. A random effects model was used for both outcomes. Subgroup analysis was performed by chemotherapy emetogenicity and use of an NK1 inhibitor. Risk of bias was assessed with the Cochrane risk of bias tool. Result(s): One thousand thirty-five articles were screened to identify the 11 studies included in the review. Nine studies of 1892 patients were included in meta-analysis. There was no significant difference in complete response of nausea and vomiting between a short or long course of dexamethasone (RR 0.98, 95% CI 0.89-1.07, P = .58) There were no differences in subgroup analysis. There was a lower risk of adverse events with a short course of dexamethasone as compared to a long course of dexamethasone (RR 0.80, 95% CI 0.64-0.99, P = .04). No heterogeneity was found in either analysis. Conclusion(s): There was no significant difference between a short or long course of dexamethasone in preventing nausea or vomiting, but a short course was associated with fewer adverse effects. Further research is required to determine the appropriate duration of dexamethasone for different chemotherapy protocols when used with modern anti-emetic regimens.