Receptor-Targeted Antiemetic Strategies in Cats: A Systematic Review and Intervention-Specific Meta-Analysis

Area of Science:

• Veterinary pharmacology
• Clinical toxicology
• Evidence-based medicine

Background:

• Emesis (vomiting) is a frequent adverse event in cats receiving alpha-2 adrenergic agonists and opioids.
• Vomiting can negatively impact feline perioperative welfare and safety.
• Limited comparative data exists for feline antiemetic protocols due to study heterogeneity.

Purpose of the Study:

• To evaluate receptor-targeted antiemetic strategies in cats.
• To quantitatively synthesize controlled evidence for emesis incidence.
• To compare the efficacy of maropitant, ondansetron, and metoclopramide.

Main Methods:

• Systematic review adhering to PRISMA 2020 guidelines.
• Inclusion of controlled feline studies on maropitant, ondansetron, or metoclopramide for emesis prevention/treatment.
• Primary meta-analysis focused on maropitant versus control, using random-effects modeling.

Main Results:

• Maropitant significantly reduced the risk of emesis in cats (Risk Ratio = 0.20).
• Analysis included five controlled studies with low-to-moderate heterogeneity.
• Evidence for ondansetron suggested timing-dependent benefits, while metoclopramide data was insufficient for pooled analysis.

Conclusions:

• Maropitant demonstrates the most consistent evidence for reducing feline emesis in perioperative or induced settings.
• Further high-quality, blinded, randomized trials with standardized outcomes are necessary.
• Standardized assessment of vomiting, retching, and nausea is recommended for future feline antiemetic research.