医学
消炎药
安慰剂
干呕
昂丹司琼
呕吐
化疗
恶心
麻醉
临床终点
内科学
随机对照试验
止吐药
外科
病理
替代医学
作者
Venkatraman Radhakrishnan,Archit Joshi,Jaikumar Govindaswamy Ramamoorthy,Rajaraman Swaminathan,Prasanth Ganesan,Trivadi S. Ganesan,Manikandan Dhanushkodi,Tenali Gnana Sagar
摘要
Abstract Background Fosaprepitant is a neurokinin‐1 receptor antagonist, approved for the prevention of chemotherapy‐induced nausea and vomiting. The data on the use of fosaprepitant in children are limited and therefore we conducted a phase III randomized controlled trial. Procedure Children aged 1‐12 years scheduled to receive moderately or highly emetogenic chemotherapy were randomly assigned to arm‐A (fosaprepitant) or arm‐B (placebo). Children recruited to arm‐A received intravenous ondansetron plus dexamethasone followed by fosaprepitant infusion. Children recruited to arm‐B received the same drugs as those given to children in arm‐A, except that fosaprepitant was substituted with a placebo. Ondansetron and dexamethasone were continued for 48 hours after completion of chemotherapy. The primary end point of the study was to determine the proportion of patients who achieved a complete response (CR), defined as no vomiting, no retching, and no use of rescue medication, during the 24‐120 hours (delayed phase) after administration of the last dose of chemotherapy. Secondary end points were the proportion of patients who achieved a CR during the acute phase (0‐24 hours) and overall after administration of the last dose of chemotherapy. Results One‐hundred‐sixty‐three patients were analyzed (81 in the fosaprepitant arm and 82 in the placebo arm). CR rates were significantly higher in the fosaprepitant arm compared to those in the placebo arm during the acute phase (86% vs 60%, P < 0.001), delayed phase (79% vs 51%, P < 0.001), and overall phase (70% vs 41%, P < 0.001). Three (4%) patients in the fosaprepitant arm and sixteen (20%) in the placebo arm required rescue anti‐emetics ( P = 0.0017). Conclusion Addition of fosaprepitant to ondansetron and dexamethasone improved chemotherapy‐induced vomiting control in children treated with moderately or highly emetogenic chemotherapy.
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