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

Emesis is a common adverse effect in cats receiving alpha-2 adrenergic agonists and opioids and may compromise perioperative welfare and safety. Comparative evidence for feline antiemetic protocols remains limited by heterogeneity in triggers, timing and outcomes.

To evaluate receptor-targeted antiemetic strategies in cats and quantitatively synthesise controlled event-level evidence for emesis incidence where appropriate.

This systematic review followed PRISMA 2020 principles. Controlled feline studies assessing maropitant, ondansetron or metoclopramide for prevention or treatment of emesis were eligible. The primary meta-analysis was restricted to maropitant versus control. Risk ratios (RRs) were pooled on the log scale using a random-effects model with Paule-Mandel estimation and Hartung-Knapp adjustment.

Five controlled studies contributed to the primary maropitant analysis. Emesis occurred in 11/141 cats given maropitant and 70/152 controls. Maropitant reduced emesis risk (RR = 0.20, 95% confidence interval [CI]: 0.08-0.55), with low-to-moderate heterogeneity (I² = 23.2%; Q = 5.21, p = 0.27; tau = 0.37). Leave-one-out analyses consistently favoured maropitant. The approximate prediction interval was 0.04-1.05, indicating uncertainty about the magnitude of effect in future settings. Ondansetron evidence was limited to two evidence sources and suggested possible timing-dependent benefit, whereas metoclopramide evidence was limited to one directly comparable binary study and was insufficient for pooled inference.

Maropitant currently has the most consistent controlled evidence for reducing emesis incidence in cats under perioperative or induced-emesis conditions. Further adequately powered, blinded and randomised trials using standardised vomiting, retching and nausea outcomes are needed.