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Published in: BMC Medicine 1/2015

Open Access 01-12-2015 | Research article

Comparative efficacy of serotonin (5-HT3) receptor antagonists in patients undergoing surgery: a systematic review and network meta-analysis

Authors: Andrea C. Tricco, Charlene Soobiah, Erik Blondal, Areti A. Veroniki, Paul A. Khan, Afshin Vafaei, John Ivory, Lisa Strifler, Huda Ashoor, Heather MacDonald, Emily Reynen, Reid Robson, Joanne Ho, Carmen Ng, Jesmin Antony, Kelly Mrklas, Brian Hutton, Brenda R. Hemmelgarn, David Moher, Sharon E. Straus

Published in: BMC Medicine | Issue 1/2015

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Abstract

Background

Serotonin (5-HT3) receptor antagonists are commonly used to decrease nausea and vomiting for surgery patients. We conducted a systematic review on the comparative efficacy of 5-HT3 receptor antagonists.

Methods

Searches were done in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify studies comparing 5-HT3 receptor antagonists with each other, placebo, and/or combined with other antiemetic agents for patients undergoing surgical procedures. Screening search results, data abstraction, and risk of bias assessment were conducted by two reviewers independently. Random-effects pairwise meta-analysis and network meta-analysis (NMA) were conducted. PROSPERO registry number: CRD42013003564.

Results

Overall, 450 studies and 80,410 patients were included after the screening of 7,608 citations and 1,014 full-text articles. Significantly fewer patients experienced nausea with any drug relative to placebo, except for ondansetron plus metoclopramide in a NMA including 195 RCTs and 24,230 patients. Significantly fewer patients experienced vomiting with any drug relative to placebo except for palonosetron plus dexamethasone in NMA including 238 RCTs and 12,781 patients. All agents resulted in significantly fewer patients with postoperative nausea and vomiting versus placebo in a NMA including 125 RCTs and 16,667 patients.

Conclusions

Granisetron plus dexamethasone was often the most effective antiemetic, with the number needed to treat ranging from two to nine.
Appendix
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Metadata
Title
Comparative efficacy of serotonin (5-HT3) receptor antagonists in patients undergoing surgery: a systematic review and network meta-analysis
Authors
Andrea C. Tricco
Charlene Soobiah
Erik Blondal
Areti A. Veroniki
Paul A. Khan
Afshin Vafaei
John Ivory
Lisa Strifler
Huda Ashoor
Heather MacDonald
Emily Reynen
Reid Robson
Joanne Ho
Carmen Ng
Jesmin Antony
Kelly Mrklas
Brian Hutton
Brenda R. Hemmelgarn
David Moher
Sharon E. Straus
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2015
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-015-0371-y

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