Acupuncture for nausea and vomiting induced by highly emetogenic chemotherapy: a systematic review and meta-analysis

Acupuncture shows potential in treating nausea and vomiting (CINV) induced by highly emetogenic chemotherapy (HEC). However, the certainty of its efficacy evidence remains unclear, warranting a comprehensive evaluation.

Two independent reviewers systematically searched eight databases from inception to December 2024 to identify eligible randomized controlled trials (RCTs). Relevant data were extracted using a standardized form, and risk of bias was assessed using the Cochrane risk of bias tool version 2.0 (ROB 2.0). Meta-analysis was performed using R Studio 4.4 software. Subgroup analysis was conducted based on acupuncture type. Additionally, publication bias was detected using appropriate methods according to the heterogeneity of different outcomes, where appropriate. Finally, evidence quality was rated using the GRADE system.

A total of 58 RCTs were included in this meta-analysis. Rob 2.0 result indicated that most studies were at high risk of bias, with low methodological quality. For the primary outcome, acupuncture significantly improved the complete control rate during the overall (RR 1.54, 95% CI 1.36-1.75; P < 0.001; I ² = 36%) and the delayed phase (RR 1.56, 95% CI 1.32-1.86; P < 0.001; I ² = 0%). For other CINV outcomes, acupuncture demonstrated considerable therapeutic potential for vomiting-related outcomes, while uncertainty in alleviating nausea symptoms. Subgroup analyses showed that different acupuncture types had distinct advantages. Sensitivity analyses for several outcomes were unstable, and there were indications of publication bias. According to GRADE, only the acute vomiting duration score was rated as moderate quality; all other outcomes were rated as low or very low quality.

Although acupuncture for HEC-induced CINV shows some positive effects, there are various limitations that render the current evidence insufficient to conclusively establish its efficacy; therefore, further high-quality studies are required.

PROSPERO, identifier: CRD42024588165.