A Network Meta-Analysis on the Efficacy of Serotonin Type 3 Receptor Antagonists Used in Adults During the First 24 Hours for Postoperative Nausea and Vomiting Prophylaxis

BackgroundThe serotonin type 3 receptor antagonists (5-HT3 antagonists) ondansetron, granisetron, tropisetron, and dolasetron are potential prophylactic agents for patients with mild to moderate risk of postoperative nausea and vomiting (PONV). A few trials have been conducted to compare the efficacy among 2 to 3 of these 4 agents. However, the comparative efficacy of all four 5-HT3 antagonists has not yet been quantitatively investigated.ObjectiveThe goal of this study was to investigate whether the 5-HT3 antagonists—ondansetron, granisetron, tropisetron, and dolasetron—differ in efficacy when used for the prevention of PONV.MethodsPubMed and the Cochrane Library were searched for randomized controlled, double-blind studies measuring efficacy in terms of PONV prophylaxis. A Bayesian meta-analysis was conducted using published studies of 5-HT3 antagonists for PONV prophylaxis. The odds of patients with no PONV and postoperative vomiting (POV) within each study arm 24 hours after surgery were the primary indices of drug efficacy. Data were extracted and analyzed via indirect comparisons using random effects Bayesian models in WinBUGS version 1.4.3.ResultsA total of 85 studies were identified, representing 15,269 patients. The results indicate that granisetron was significantly better than ondansetron (odds ratio [OR] = 1.53 [95% credible interval (CI), 1.15–2.00]) and dolasetron (OR = 1.67 [95% CI, 1.12–2.38]) in preventing PONV. Four antiemetic drugs had comparable efficacy in terms of preventing POV: granisetron showed similar efficacy compared with ondansetron (OR = 1.49 [95% CI, 0.90–2.43]), tropisetron (OR = 1.69 [95% CI, 0.92–3.13]), and dolasetron (OR = 1.32 [95% CI, 0.71–2.38]). Ondansetron exhibited comparable efficacy compared with tropisetron (OR = 1.14 [95% CI, 0.66–1.96]) and dolasetron (OR = 0.88 [95% CI, 0.51–1.47]). Tropisetron and dolasetron were also similar in efficacy (OR = 0.78 [95% CI, 0.40–1.45]). All 5-HT3 antagonists were statistically significantly better at preventing PONV or POV than placebo.ConclusionsWith respect to PONV prophylaxis, granisetron was significantly better than ondansetron and dolasetron; ondansetron, tropisetron, and dolasetron exhibited similar efficacy. With respect to POV prophylaxis, ondansetron, granisetron, tropisetron, and dolasetron seemed to have comparable efficacy.