RESUMO
BACKGROUND: Postoperative nausea and vomiting (PONV) are common and distressing complications following neurosurgical procedures, affecting up to 73â¯% of patients undergoing craniotomy. Therefore, we aimed to assess the placebo-controlled efficacy of 5-HT3 antagonists to prevent PONV following supratentorial craniotomies. METHODS: We searched Medline, Web of Science, and Embase databases following PRISMA guidelines for RCTs comparing the outcomes of prophylactic use of 5-HT3 antagonists with placebo to prevent PONV following supratentorial craniotomy. We pooled odds ratios (OR) with 95â¯% confidence intervals with a random-effects model. I2 statistics was used to assess heterogeneity. RESULTS: Five RCTs, comprising 347 patients, of which 145 received a placebo, were included. The analysis identified a lower likelihood of early postoperative vomiting in 5-HT3 antagonists group (OR=0.47; 95â¯% CI: 0.24-0.91, p<0.05; I2=7â¯%), a lower likelihood of vomit within the 24-h period in 5-HT3 antagonists group (OR=0.27; 95â¯% CI: 0.15-0.48, p<0.01; I2=40â¯%), a lower likelihood of nausea within the 24-h period in 5-HT3 antagonists group (OR=0.47; 95â¯% CI: 0.28-0.72, p<0.01; I2=34â¯%), and a lower likelihood of rescue interventions in 5-HT3 antagonists group (OR = 0.18; 95â¯% CI: 0.10-0.34; I2 = 0â¯%. Subgroup analyses focusing on ondansetron also identified a lower likelihood of nausea and vomiting within the 24-h period in the 5-HT3 antagonist group. CONCLUSION: This systematic review and meta-analysis identified that 5-HT3 antagonists are effective in preventing PONV in the postoperative period following supratentorial craniotomy when compared to placebo. Our findings provide synthesized and robust evidence derived from randomized studies to support the use of 5-HT3 antagonists in clinical practice.
RESUMO
BACKGROUND: Von Hippel-Lindau (VHL) disease is a rare autosomal dominant disorder that predisposes patients to develop multiple cysts and tumors, such as hemangioblastomas (HBs) and clear cell renal cell carcinoma (ccRCC), due to mutations in the VHL tumor suppressor gene. While treatment of HBs varies based on their characteristics and has improved patient survival, it still involves high morbidity and mortality, leading to ongoing debates and studies to refine therapy strategies. Recent developments include the emergence of Belzutifan, a novel inhibitor targeting hypoxia-inducible factor 2α (HIF-2α), which has shown promising results in ongoing trials, particularly for patients not immediately requiring surgery. METHODS: This systematic review and meta-analysis aimed to comprehensively evaluate the efficacy and safety of Belzutifan for treating HBs associated with VHL disease. Search was conducted across Medline, Embase, Cochrane, and Web of Science databases. Statistical Analysis was performed, with proportions and 95 % confidence intervals. Statistical analyses were carried out using R Studio. RESULTS: Ten studies were selected, comprising 553 patients. The population mean age was 40 (24-65), and 50 % of the population was formed by males. In terms of proportion, 6 analyses were performed: Disease Stability of 31 % [95 %CI:14 %-47 %; I2 = 2 %]; Disease Progression of 2 %[95 %CI:0 %-9 %; I2 = 0 %]; Partial Response of 75 % [95 %CI:54 %-96 %; I2 = 58 %]. Complete response of 1 % [95 %CI:0 %-7 %; I2 = 0 %];and Side effects, anemia 81 % rate [95 % CI:54 %-100 %; I2 = 94 %], and fatigue rate of 79 % [95 % CI:54 %-100 %;I2 = 94 %]. CONCLUSION: Results indicate that Belzutifan effectively stabilizes disease, reduces tumor progression, and achieves significant therapeutic responses, although side effects like anemia and fatigue were noted.