Summary of findings 3. Summary of findings: complete control of vomiting during the overall phase (MEC) when compared to treatment with granisetron.
| Efficacy | ||||||
| Antiemetics for adults for prevention of nausea and vomiting caused by moderately emetogenic chemotherapy | ||||||
|
Patient or population: adult cancer patients at risk for CINV caused by moderately emetogenic chemotherapy Settings: inpatient and outpatient care Intervention
Comparison: granisetron (5‐HT₃) + corticosteroid Outcome: complete control of vomiting during the overall phase (0 to 120 h of treatment with chemotherapy) RR < 1 indicates an advantage for the intervention Combinations of these interventions at any dose and by any route as mentioned above have been compared to one another in a full network | ||||||
| Interventions (corticosteroids included in all regimens)a | Illustrative comparative risks* (95% CI) | Risk ratio (95% CI) | No. of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk with granisetron | Corresponding risk with the intervention | |||||
| aprepitant + palonosetron | 555 of 1000 | 716 of 1000 (555 to 921) | RR 1.29 (1.00 to 1.66) | 7800 (22) | ⊕⊕⊝⊝ lowb,c |
Aprepitant + palonosetron may increase complete response in the overall phase when compared to granisetron |
| netupitant + palonosetron | 555 of 1000 | 694 of 1000 (510 to 944) | RR 1.25 (0.92 to 1.70) | 7800 (22) | ⊕⊕⊝⊝ lowb,d |
Netupitant + palonosetron may increase complete response in the overall phase when compared to granisetron |
| rolapitant + granisetron | 555 of 1000 | 660 of 1000 (588 to 738) | RR 1.19 (1.06 to 1.33) | 7800 (22) | ⊕⊕⊕⊕ high |
Rolapitant + granisetron results in an increase in complete response in the overall phase when compared to granisetron |
| palonosetron | 555 of 1000 | 588 of 1000 (472 to 733) | RR 1.06 (0.85 to 1.32) | 7800 (22) | ⊕⊕⊝⊝ lowb,d |
Palonosetron may or may not increase complete response in the overall phase when compared to granisetron |
| aprepitant + granisetron | 555 of 1000 | 577 of 1000 (483 to 694) | RR 1.06 (0.85 to 1.32) | 7800 (22) | ⊕⊕⊝⊝ lowb,d |
Aprepitant + palonosetron may or may not increase complete response in the overall phase when compared to granisetron |
| azasetron | 555 of 1000 | 561 of 1000 (422 to 738) | RR 1.01 (0.76 to 1.33) | 7800 (22) | ⊕⊕⊝⊝ lowb,e |
Azasetron may result in little to no difference in complete response in the overall phase when compared to granisetron |
| fosaprepitant + ondansetron | 555 of 1000 | 500 of 1000 (366 to 677) | RR 0.90 (0.66 to 1.22) | 7800 (22) | ⊕⊕⊝⊝ lowb,d |
Fosaprepitant + ondansetron may decrease complete response in the overall phase when compared to granisetron |
| aprepitant + ondansetron | 555 of 1000 | 477 of 1000 (355 to 649) | RR 0.86 (0.64 to 1.17) | 7800 (22) | ⊕⊕⊝⊝ lowb,d |
Aprepitant + ondansetron may decrease complete response in the overall phase when compared to granisetron |
| casopitant + ondansetron | 555 of 1000 | 461 of 1000 (344 to 622) | RR 0.83 (0.62 to 1.12) |
7800 (22) | ⊕⊕⊝⊝ lowb,d |
Casopitant + ondansetron may decrease complete response in the overall phase when compared to granisetron |
| ondansetron | 555 of 1000 | 433 of 1000 (327 to 577) | RR 0.78 (0.59 to 1.04) | 7800 (22) | ⊕⊕⊝⊝ lowb,d |
Ondansetron may decrease complete response in the overall phase when compared to granisetron |
| *Basis for the assumed risk is actual event rates reported for the main comparator summed across studies: 623 of 1123 (55.5%) participants treated with granisetron achieved complete response during the overall phase (granisetron was used in 5 studies reporting the outcome). The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the risk ratio of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence.
High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
|
aEither dexamethasone or methylprednisolone was used in all treatment regimens. bDowngraded once for serious study limitations due to high risk of bias. cDowngraded once for serious imprecision because 95% CIs included zero effect line. dDowngraded once for serious imprecision because 95% CIs cross unity. eDowngraded once for serious imprecision due to wide confidence intervals. | ||||||