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Impact of 5-HT(3) RA selection within triple antiemetic regimens on uncontrolled highly emetogenic chemotherapy-induced nausea/vomiting.
Expert Rev Pharmacoecon Outcomes Res. 2011 Aug; 11(4):481-8.ER

Abstract

BACKGROUND

It is recommended that patients initiate triple antiemetic therapy with one of the 5-hydroxytryptamine receptor antagonists (5-HT(3) RAs), aprepitant (or its intravenous prodrug fosaprepitant) and dexamethasone prior to the start of highly emetogenic chemotherapy (HEC). However, the impact of 5-HT(3) RA selection within triple antiemetic regimens on the risk of uncontrolled chemotherapy-induced nausea and vomiting (CINV) with HEC has not been well studied.

AIM

To assess the likelihood of an uncontrolled CINV event following antiemetic prophylaxis with the 5-HT(3) RA palonosetron + aprepitant/fosaprepitant + dexamethasone (palonosetron cohort) versus any of the other 5-HT(3) RAs + aprepitant/fosaprepitant + dexamethasone (other 5-HT(3) RA cohort) among single-day HEC cycles.

METHODS

Single-day HEC cycles (a gap of at least 5 days between two administrations) among patients with a cancer diagnosis and receiving antiemetic prophylaxis with the aforementioned regimens between 1/1/2006 and 6/30/2010 were identified from the IMS LifeLink claims database. Uncontrolled CINV events were identified through ICD-9-CM codes (nausea and vomiting), Current Procedural Terminology codes (hydration), rescue medications and/or use of antiemetic therapy from days 2-5 following HEC administration. Risks for an uncontrolled CINV event among all patients, and within breast cancer and multiple cancer subpopulations, were analyzed at cycle level using logistic multivariate regression models.

RESULTS

A total of 8018 cycles for the palonosetron cohort and 1926 cycles for the other 5-HT(3) RA cohort (3574 and 978 patients, respectively) were analyzed. Single-day HEC cycles received by the palonosetron cohort had a significantly lower unadjusted risk of an uncontrolled CINV event (17.5 vs 20.7% for the other 5-HT(3) RA cohort; p = 0.0010), with a 17% lower adjusted risk for palonosetron-administered cycles (odds ratio: 0.83; 95% CI: 0.73-0.94; p = 0.0042). Results in the breast cancer and multiple cancer subgroups were consistent with those for the overall population.

CONCLUSION

In this retrospective claims data analysis, single-day HEC cycles administered with palonosetron + aprepitant/fosaprepitant + dexamethasone had a lower risk for an uncontrolled CINV event versus other 5-HT(3) RAs + aprepitant/fosaprepitant + dexamethasone.

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Authors+Show Affiliations

Schwartzberg L
Accelerated Community Oncology Research Network, Memphis, TN, USA.
Jackson J
No affiliation info available
Jain G
No affiliation info available
Balu S
No affiliation info available
Buchner D
No affiliation info available

MeSH

AdultAntiemeticsAntineoplastic AgentsAprepitantDatabases, FactualDexamethasoneDrug Therapy, CombinationFemaleHumansIsoquinolinesLogistic ModelsMaleMiddle AgedMorpholinesMultivariate AnalysisNauseaPalonosetronQuinuclidinesRetrospective StudiesSerotonin 5-HT3 Receptor AntagonistsVomiting

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21711119

Citation

Schwartzberg, Lee, et al. "Impact of 5-HT(3) RA Selection Within Triple Antiemetic Regimens On Uncontrolled Highly Emetogenic Chemotherapy-induced Nausea/vomiting." Expert Review of Pharmacoeconomics & Outcomes Research, vol. 11, no. 4, 2011, pp. 481-8.
Schwartzberg L, Jackson J, Jain G, et al. Impact of 5-HT(3) RA selection within triple antiemetic regimens on uncontrolled highly emetogenic chemotherapy-induced nausea/vomiting. Expert Rev Pharmacoecon Outcomes Res. 2011;11(4):481-8.
Schwartzberg, L., Jackson, J., Jain, G., Balu, S., & Buchner, D. (2011). Impact of 5-HT(3) RA selection within triple antiemetic regimens on uncontrolled highly emetogenic chemotherapy-induced nausea/vomiting. Expert Review of Pharmacoeconomics & Outcomes Research, 11(4), 481-8. https://doi.org/10.1586/erp.11.47
Schwartzberg L, et al. Impact of 5-HT(3) RA Selection Within Triple Antiemetic Regimens On Uncontrolled Highly Emetogenic Chemotherapy-induced Nausea/vomiting. Expert Rev Pharmacoecon Outcomes Res. 2011;11(4):481-8. PubMed PMID: 21711119.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of 5-HT(3) RA selection within triple antiemetic regimens on uncontrolled highly emetogenic chemotherapy-induced nausea/vomiting. AU - Schwartzberg,Lee, AU - Jackson,James, AU - Jain,Gagan, AU - Balu,Sanjeev, AU - Buchner,Deborah, Y1 - 2011/06/28/ PY - 2011/6/30/entrez PY - 2011/6/30/pubmed PY - 2011/12/14/medline SP - 481 EP - 8 JF - Expert review of pharmacoeconomics & outcomes research JO - Expert Rev Pharmacoecon Outcomes Res VL - 11 IS - 4 N2 - BACKGROUND: It is recommended that patients initiate triple antiemetic therapy with one of the 5-hydroxytryptamine receptor antagonists (5-HT(3) RAs), aprepitant (or its intravenous prodrug fosaprepitant) and dexamethasone prior to the start of highly emetogenic chemotherapy (HEC). However, the impact of 5-HT(3) RA selection within triple antiemetic regimens on the risk of uncontrolled chemotherapy-induced nausea and vomiting (CINV) with HEC has not been well studied. AIM: To assess the likelihood of an uncontrolled CINV event following antiemetic prophylaxis with the 5-HT(3) RA palonosetron + aprepitant/fosaprepitant + dexamethasone (palonosetron cohort) versus any of the other 5-HT(3) RAs + aprepitant/fosaprepitant + dexamethasone (other 5-HT(3) RA cohort) among single-day HEC cycles. METHODS: Single-day HEC cycles (a gap of at least 5 days between two administrations) among patients with a cancer diagnosis and receiving antiemetic prophylaxis with the aforementioned regimens between 1/1/2006 and 6/30/2010 were identified from the IMS LifeLink claims database. Uncontrolled CINV events were identified through ICD-9-CM codes (nausea and vomiting), Current Procedural Terminology codes (hydration), rescue medications and/or use of antiemetic therapy from days 2-5 following HEC administration. Risks for an uncontrolled CINV event among all patients, and within breast cancer and multiple cancer subpopulations, were analyzed at cycle level using logistic multivariate regression models. RESULTS: A total of 8018 cycles for the palonosetron cohort and 1926 cycles for the other 5-HT(3) RA cohort (3574 and 978 patients, respectively) were analyzed. Single-day HEC cycles received by the palonosetron cohort had a significantly lower unadjusted risk of an uncontrolled CINV event (17.5 vs 20.7% for the other 5-HT(3) RA cohort; p = 0.0010), with a 17% lower adjusted risk for palonosetron-administered cycles (odds ratio: 0.83; 95% CI: 0.73-0.94; p = 0.0042). Results in the breast cancer and multiple cancer subgroups were consistent with those for the overall population. CONCLUSION: In this retrospective claims data analysis, single-day HEC cycles administered with palonosetron + aprepitant/fosaprepitant + dexamethasone had a lower risk for an uncontrolled CINV event versus other 5-HT(3) RAs + aprepitant/fosaprepitant + dexamethasone. SN - 1744-8379 UR - https://www.unboundmedicine.com/medline/citation/21711119/Impact_of_5_HT_3__RA_selection_within_triple_antiemetic_regimens_on_uncontrolled_highly_emetogenic_chemotherapy_induced_nausea/vomiting_ L2 - https://www.tandfonline.com/doi/full/10.1586/erp.11.47 DB - PRIME DP - Unbound Medicine ER -
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