Aprepitant for postoperative nausea and vomiting: a systematic review and meta-analysis

Area of Science:

• Pharmacology and Clinical Medicine
• Gastroenterology
• Anesthesiology

Background:

• Postoperative nausea and vomiting (PONV) remains a significant clinical challenge.
• Aprepitant, a neurokinin-1 (NK-1) receptor antagonist, is a newer therapeutic option for PONV.
• Conventional antiemetics have limitations in efficacy and safety.

Purpose of the Study:

• To systematically review and analyze controlled trials comparing aprepitant with conventional antiemetics for PONV.
• To evaluate the efficacy of aprepitant in preventing vomiting on postoperative days 1 and 2.
• To assess the safety profile and need for rescue antiemetics with aprepitant use.

Main Methods:

• Systematic review of medical databases for controlled trials up to April 25, 2015.
• Keywords included 'Aprepitant for PONV', 'Aprepitant versus 5-HT3 antagonists', and 'NK-1 versus 5-HT3 for PONV'.
• Pooled analysis focused on the primary outcome of vomiting incidence on postoperative days 1 and 2.

Main Results:

• Aprepitant significantly reduced vomiting incidence: 9.7% vs 21.9% on POD1 and 6.8% vs 12.8% on POD2.
• Odds ratios for vomiting were 0.48 (POD1) and 0.54 (POD2) favoring aprepitant.
• Aprepitant demonstrated a lower need for rescue antiemetics and higher complete response rates, with various doses (40mg, 80mg, 125mg) showing efficacy without major adverse effects.

Conclusions:

• Aprepitant effectively reduces vomiting incidence on both postoperative days 1 and 2.
• Complete freedom from PONV and minimal need for rescue medication were highest with aprepitant.
• Oral aprepitant, particularly 80mg, provides sustained and safe antiemetic effects for PONV.