Chua 2000.

Study characteristics
Methods	Randomised, cross‐over trial with 3 arms comparison of granisetron + dexamethasone vs tropisetron + dexamethasone vs ondansetron + dexamethasone Recruitment period: March 1996 to May 1998 94 patients recruited 89 patients included in analysis Masking: open‐label Baseline patient characteristics: reported Follow‐up: n.r.
Participants	Inclusion criteria age ≥ 18 years chemotherapy‐naïve patients who were to receive at least 3 cycles of high‐dose cisplatin (100 mg/m²) ECOG performance status 0 to 2 no significant cardiac, hepatic, or renal disease Exclusion criteria gastrointestinal obstruction, brain tumour, increase in intracranial pressure, or pre‐existing nausea or vomiting Median age (range), years: 48 (22 to 74) Gender: male (86.5%) + female (13.5 %) Tumour/cancer type: solid malignancy (nasopharynx, oral cavity, hypopharynx, larynx, ear) Chemotherapy regimen: cisplatin at a dose of 100 mg/m² on Day 1 and 5‐fluorouracil (5‐FU) 1000 mg/m² on Days 1 to 3, repeated every 21 days Country: Hong Kong, China
Interventions	Cross‐over study: patients were randomised to receive 1 of the 3 5‐HT₃ antagonists in the first cycle; treatment was crossed over to the other 2 5‐HT₃ antagonists in the second and third cycles Experimental: arm A: granisetron granisetron 3 mg i.v. + dexamethasone 20 mg i.v. Experimental: arm B: tropisetron tropisetron 5 mg i.v. + dexamethasone 20 mg i.v. Experimental: arm C: ondansetron ondansetron 8 mg i.v. + dexamethasone 20 mg i.v. before cisplatin, followed by 2 p.o. doses of 8 mg at 4 and 8 hours after the start of chemotherapy on Day 1
Outcomes	Primary endpoint proportion of patients with complete (no nausea or vomiting, or mild nausea only in the 24 h after the start of chemotherapy) or major (single vomiting episode in the 24 h after the start of chemotherapy, or no vomiting but moderate to severe nausea) response
Notes	"supported by grants from the University of Hong Kong (CRCG grant no. 337/037/0001, 335/037/0001, and 335/037/0002)" study authors did not provide disclosure of potential conflicts of interest
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "randomization was performed using a computer‐generated code"
Allocation concealment (selection bias)	Unclear risk	Comment: allocation concealment not reported
Blinding of participants and personnel (performance bias) Blinding of participants	High risk	Quote: "... open‐label ..."
Blinding of participants and personnel (performance bias) Blinding of personnel	High risk	Quote: "... open‐label ..."
Blinding of outcome assessment (detection bias) Subjective outcomes (Patient reported outcomes)	High risk	Comment: patients and personnel were not blinded towards the intervention and therefore might influence subjective outcomes analysis
Incomplete outcome data (attrition bias) Subjective outcomes (Patient reported outcomes)	Low risk	Comment: all patients were included in the antiemetic efficacy analysis
Selective reporting (reporting bias)	Low risk	Comment: all outcome measures were reported in the results section
Other bias	Low risk	Comment: no information to suggest other sources of bias