TY - JOUR T1 - Olanzapine-Based Triple Regimens Versus Neurokinin-1 Receptor Antagonist-Based Triple Regimens in Preventing Chemotherapy-Induced Nausea and Vomiting Associated with Highly Emetogenic Chemotherapy: A Network Meta-Analysis. AU - Zhang,Zhonghan, AU - Zhang,Yaxiong, AU - Chen,Gang, AU - Hong,Shaodong, AU - Yang,Yunpeng, AU - Fang,Wenfeng, AU - Luo,Fan, AU - Chen,Xi, AU - Ma,Yuxiang, AU - Zhao,Yuanyuan, AU - Zhan,Jianhua, AU - Xue,Cong, AU - Hou,Xue, AU - Zhou,Ting, AU - Ma,Shuxiang, AU - Gao,Fangfang, AU - Huang,Yan, AU - Chen,Likun, AU - Zhou,Ningning, AU - Zhao,Hongyun, AU - Zhang,Li, Y1 - 2018/01/12/ PY - 2017/08/05/received PY - 2017/11/07/accepted PY - 2018/1/14/pubmed PY - 2019/9/20/medline PY - 2018/1/14/entrez KW - Chemotherapy‐induced nausea and vomiting KW - Highly emetogenic chemotherapy KW - Nausea KW - Network meta‐analysis KW - Neurokinin‐1 receptor antagonists KW - Olanzapine SP - 603 EP - 616 JF - The oncologist JO - Oncologist VL - 23 IS - 5 N2 - BACKGROUND: The current antiemetic prophylaxis for patients treated with highly emetogenic chemotherapy (HEC) included the olanzapine-based triplet and neurokinin-1 receptor antagonists (NK-1RAs)-based triplet. However, which one shows better antiemetic effect remained unclear. MATERIALS AND METHODS: We systematically reviewed 43 trials, involving 16,609 patients with HEC, which compared the following antiemetics at therapeutic dose range for the treatment of chemotherapy-induced nausea and vomiting: olanzapine, aprepitant, casopitant, fosaprepitant, netupitant, and rolapitant. The main outcomes were the proportion of patients who achieved no nausea, complete response (CR), and drug-related adverse events. A Bayesian network meta-analysis was performed. RESULTS: Olanzapine-based triple regimens showed significantly better no-nausea rate in overall phase and delayed phase than aprepitant-based triplet (odds ratios 3.18, 3.00, respectively), casopitant-based triplet (3.78, 4.12, respectively), fosaprepitant-based triplet (3.08, 4.10, respectively), rolapitant-based triplet (3.45, 3.20, respectively), and conventional duplex regimens (4.66, 4.38, respectively). CRs of olanzapine-based triplet were roughly equal to different NK-1RAs-based triplet but better than the conventional duplet. Moreover, no significant drug-related adverse events were observed in olanzapine-based triple regimens when compared with NK-1RAs-based triple regimens and duplex regimens. Additionally, the costs of olanzapine-based regimens were obviously much lower than the NK-1RA-based regimens. CONCLUSION: Olanzapine-based triplet stood out in terms of nausea control and drug price but represented no significant difference of CRs in comparison with NK-1RAs-based triplet. Olanzapine-based triple regimens should be an optional antiemetic choice for patients with HEC, especially those suffering from delayed phase nausea. IMPLICATIONS FOR PRACTICE: According to the results of this study, olanzapine-based triple antiemetic regimens were superior in both overall and delayed-phase nausea control when compared with various neurokinin-1 receptor antagonists-based triple regimens in patients with highly emetogenic chemotherapy (HEC). Olanzapine-based triplet was outstanding in terms of nausea control and drug price. For cancer patients with HEC, especially those suffering from delayed-phase nausea, olanzapine-based triple regimens should be an optional antiemetic choice. SN - 1549-490X UR - https://www.unboundmedicine.com/medline/citation/29330211/Olanzapine_Based_Triple_Regimens_Versus_Neurokinin_1_Receptor_Antagonist_Based_Triple_Regimens_in_Preventing_Chemotherapy_Induced_Nausea_and_Vomiting_Associated_with_Highly_Emetogenic_Chemotherapy:_A_Network_Meta_Analysis_ DB - PRIME DP - Unbound Medicine ER -