H2-antagonists in paclitaxel premedication: systematic review and meta-analysis

Area of Science:

• Oncology
• Pharmacology
• Clinical Pharmacy

Background:

• Paclitaxel is a widely used chemotherapy agent associated with hypersensitivity reactions (HSRs).
• Histamine-2 antagonists (H2As) are often included in premedication protocols to mitigate these reactions.
• The necessity and efficacy of H2As in paclitaxel premedication remain a subject of clinical debate.

Purpose of the Study:

• To systematically review and meta-analyze the existing literature on the use of H2As in paclitaxel premedication.
• To determine if H2As significantly reduce the incidence of paclitaxel-induced HSRs.
• To assess the safety of omitting H2As from paclitaxel premedication regimens.

Main Methods:

• A comprehensive literature search was performed across MEDLINE, Cochrane, and Web of Science databases up to December 2023.
• Included studies involved adult cancer patients receiving paclitaxel infusions and evaluated the use of prophylactic H2As.
• Risk of bias was assessed using the RoBINS-I tool, and a random-effects model was employed for meta-analysis.

Main Results:

• Six studies were included in the meta-analysis.
• No statistically significant difference was found in the incidence of grade III or higher HSRs (RR 1.04, 95% CI 0.65-1.67) or all-grade HSRs (RR 1.40, 95% CI 0.82-2.39) between groups with and without H2As.
• Subgroup analysis excluding prospective studies showed minimal heterogeneity for all-grade reactions.

Conclusions:

• The findings support the safe omission of H2As, specifically ranitidine, from paclitaxel premedication protocols.
• Omitting H2As does not appear to compromise patient safety concerning paclitaxel-induced HSRs.
• This evidence can inform clinical practice guidelines regarding paclitaxel premedication.