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1.
J Assoc Physicians India ; 68(2): 61-66, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32009365

RESUMEN

Background: Considering the prevailing concerns about extrapyramidal symptoms (EPS) associated with oral prochlorperazine, this study was conducted to assess the safety of oral prochlorperazine (in recommended dose/duration) in the management of acute dizziness. Effectiveness was also assessed in the Indian real-world setting. Methods: A prospective, multicentric, single-arm observational study was conducted across 20 centers in India. Data from 500 patients were analyzed. Patients presenting with a complaint of dizziness, receiving prochlorperazine (Stemetil® MD-5 mg, t.i.d.) as per the routine clinical practice were enrolled. Safety and effectiveness at Week-1, compared to baseline, were assessed. Results: The mean (SD) age of the population was 43.3 (11.93) years with a marginally higher proportion of women (women: 52.2% Vs men 47.8%). The mean (SD) dose of prochlorperazine was 14.9 (0.24) mg/day. Only three patients (0.006%) reported adverse drug reactions (headache, asthenia, somnolence) during the conduct of the study, which were mild in severity and were completely resolved. Further, a significant reduction in the number of episodes of dizziness was noted at the end of Week-1(p<.0001). Moreover, improvement in the number of episodes from baseline to Week-1 was significant for nausea, vomiting, lightheadedness, and headache. Conclusion: Prochlorperazine was well-tolerated in the management of acute dizziness when administered at a mean dose of 14.9 mg/day, and mean duration of 7.2 days. Additionally, prochlorperazine was effective in providing significant symptomatic relief from dizziness and associated vomiting and nausea.


Asunto(s)
Antieméticos , Mareo , Proclorperazina , Antieméticos/efectos adversos , Antieméticos/uso terapéutico , Mareo/tratamiento farmacológico , Femenino , Humanos , India , Masculino , Proclorperazina/efectos adversos , Proclorperazina/uso terapéutico , Estudios Prospectivos , Vómitos
2.
Ann Otol Rhinol Laryngol ; 129(1): 55-62, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31801377

RESUMEN

OBJECTIVE: The purpose of this study was to describe typical anesthesia practices for children with obstructive sleep apnea (OSA). STUDY DESIGN: Online survey. METHOD: A sample of pediatric anesthesiologists received the survey by email. RESULTS: 110 respondents were included. 46.4% worked in a free-standing children's hospital and 32.7% worked in a children's facility within a general hospital. 73.6% taught residents. 44.4% saw at least one child with OSA per week, 25.5% saw them daily. On a 100-mm visual analog scale, respondents rated their comfort with managing these children as 84.94 (SD 17.59). For children with severe OSA, 53.6% gave oral midazolam preoperatively, but 24.5% typically withheld premedication and had the parent present for induction. 68.2% would typically use nitrous oxide for inhalational induction. 68.2% used fentanyl intraoperatively, while 20.0% used morphine. 61.5% reduced their intraop narcotic dose for children with OSA. 98.2% used intraoperative dexamethasone, 58.2% used 0.5 mg/kg for the dose. 98.2% used ondansetron, 62.7% used IV acetaminophen, and 8.2% used IV NSAIDs. 83.6% extubated awake. 27.3% of respondents stated that their institution had standardized guidelines for perioperative management of children with OSA undergoing adenotonsillectomy. People who worked in children's hospitals, who had >10 years of experience, or who saw children with OSA frequently were significantly more comfortable dealing with children with OSA (P < 0.05). CONCLUSION: Apart from using intraoperative dexamethasone and ondansetron, management varied. These children would likely benefit from best practices perioperative management guidelines.


Asunto(s)
Analgésicos/uso terapéutico , Anestesiología , Anestésicos/uso terapéutico , Antieméticos/uso terapéutico , Pediatría , Pautas de la Práctica en Medicina , Apnea Obstructiva del Sueño/cirugía , Tonsilectomía , Acetaminofén/uso terapéutico , Adenoidectomía , Extubación Traqueal/métodos , Antiinflamatorios no Esteroideos/uso terapéutico , Dexametasona/uso terapéutico , Fentanilo/uso terapéutico , Humanos , Midazolam/uso terapéutico , Morfina/uso terapéutico , Óxido Nitroso/uso terapéutico , Ondansetrón/uso terapéutico , Guías de Práctica Clínica como Asunto , Encuestas y Cuestionarios
3.
Medicine (Baltimore) ; 98(51): e18365, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31860996

RESUMEN

INTRODUCTION: Cyclic vomiting syndrome (CVS) is a potentially exhausting disorder and has an adverse impact on quality of life, but it is poorly recognized and is always misdiagnosed leading to a diagnostic delay of several years, especially in adults. PATIENT CONCERNS: We report a case of a 32-year-old woman with recurrent severe nausea, vomiting, and abdominal pain, and repeated visits to the emergency department or the outpatient department for 4 years. Each time she was diagnosed with gastroenteritis or gastritis, and recovered after supportive treatment including antiemetics, maintenance of water and electrolyte balance, and a proton pump inhibitor. DIAGNOSIS: Laboratory examinations, gastroenteroscopy, chest and abdominal computed tomography, and brain magnetic resonance imaging all failed to reveal abnormalities that would explain her symptoms. Based on typical symptoms and the exclusion of other diseases associated with repeated vomiting, the diagnosis was made as CVS. INTERVENTIONS: She was given orally amitriptyline, 50 mg per night, and olanzapine, 1.25 mg per night. OUTCOMES: The treatment was effective in inducing remission, and symptoms did not recur after treatment. The treatment lasted for 2 months and stopped. Her symptoms did not recur over the 10-month follow up. CONCLUSION: CVS is not rare in adults, but its diagnosis is usually delayed due to poor recognition of the condition. Clinician awareness of CVS should be enhanced to improve early diagnosis.Core tip: Cyclic vomiting syndrome has a tremendous impact on the quality of life, but it is poorly recognized and is always misdiagnosed leading to a diagnostic delay of several years, especially in adults. The article presented a case report of cyclic vomiting syndrome of adult; we hope the article will attribute to increased awareness of physician and reduce delayed diagnosis.


Asunto(s)
Gastritis/diagnóstico , Gastritis/terapia , Vómitos/diagnóstico , Vómitos/terapia , Dolor Abdominal/etiología , Adulto , Antieméticos/uso terapéutico , Enfermedad Crónica , Diagnóstico Precoz , Femenino , Humanos , Náusea/etiología , Inhibidores de la Bomba de Protones/uso terapéutico , Recurrencia , Síndrome , Equilibrio Hidroelectrolítico
4.
Gan To Kagaku Ryoho ; 46(11): 1683-1685, 2019 Nov.
Artículo en Japonés | MEDLINE | ID: mdl-31748472

RESUMEN

For anti-emetic therapy, the first guideline was published 2010, following second version was open for public in 2015. The latest guideline for anti-emetic therapy in Japan, version 2.2 was disclosed on web site of Japan Society of Clinical Oncology. The point of new version were included 3 points which were a new categorization of moderately emetic chemotherapy, improvement of olanzapine for anti-emetic drug, and steroid spearing for MEC.


Asunto(s)
Antieméticos/uso terapéutico , Guías de Práctica Clínica como Asunto , Antineoplásicos , Humanos , Japón , Náusea , Vómitos
5.
Gan To Kagaku Ryoho ; 46(11): 1686-1690, 2019 Nov.
Artículo en Japonés | MEDLINE | ID: mdl-31748473

RESUMEN

Chemotherapy induced nausea and vomiting(CINV)have been improved by several clinical trials. However, it is necessary to select antiemetic therapy for each patient, as there are cases where nausea and vomiting have not improved or are experiencing unpleasant adverse events. In this report, we would like to introduce the latest findings in antiemetic therapy for highly emetic chemotherapy by categorized NK1 receptor antagonist, steroids, and olanzapine. Especially for olanzapine, we are going to introduce the J-FORCE as one of the latest findings. This study was confirmed the usefulness of 5 mg olanzapine to improve side effects such as sleepiness caused by olanzapine 10 mg used in the United States. We hope that these findings will be fully utilized to help provide the best antiemetic therapy for many patients.


Asunto(s)
Antieméticos/uso terapéutico , Antineoplásicos , Humanos , Náusea/prevención & control , Farmacéuticos , Vómitos/prevención & control
6.
Gan To Kagaku Ryoho ; 46(11): 1691-1694, 2019 Nov.
Artículo en Japonés | MEDLINE | ID: mdl-31748474

RESUMEN

Chemotherapy-induced nausea and vomiting(CINV)has been one of the most significant side effect, which needs symptom management.Nurses should enough knowledgeable to take roles of antiemetic administration, assessment, patient education, self-care.Therefore nursing contribute to improve patients' quality of life to minimize occurrence of CINV.The time of patients receiving anti-cancer drug therapy become longer, and more patients take medical care at home care setting or community based hospitals.These change CINV management with new aspects which include continuity, economy community. Nurses need to expand their roles to improve their knowledge, assessment, quality of nursing intervention.


Asunto(s)
Antieméticos/uso terapéutico , Neoplasias , Antineoplásicos , Humanos , Náusea/tratamiento farmacológico , Rol de la Enfermera , Calidad de Vida , Vómitos/tratamiento farmacológico
7.
Gan To Kagaku Ryoho ; 46(10): 1553-1559, 2019 Oct.
Artículo en Japonés | MEDLINE | ID: mdl-31631138

RESUMEN

While many studies have demonstrated the prevention of nausea and vomiting in patients receiving moderately or highly emetogenic anti-cancer agents, there are few reports of mildly emetogenic anti-cancer agents. In the present study, we performed a 2-year multi-center study to determine the types and efficacy of antiemetic therapy administered in a total of 77 cancer patients who received mildly emetogenic anti-cancer agents between September 2015 and August 2017. The effectiveness of antiemetic therapy was evaluated based on the frequency of nausea and vomiting and use of rescue medication. This information was reported by patients and collected every 24 hours for 120 hours after the administration of anti-cancer agents with a mild emetogenic risk. The combination of 5-HT3 receptor antagonist(1 or 3 mg granisetron, 0.75 mg palonosetron) and 6.6 mg dexamethasone was the most common antiemetic therapy used in our patient population. There was no significant difference in the effectiveness of all 5-HT3 receptor antagonists that were evaluated. Gemcitabine and nab-paclitaxel were the most commonly used with a total of 64 patients receiving a combination of these mildly emetogenic agents. Poor performance status was associated with failure to achieve total control(TC)of nausea and vomiting(p=0.0304), while habitual alcohol consumption was associated with TC of nausea and vomiting(p=0.0331).


Asunto(s)
Antieméticos/uso terapéutico , Náusea/prevención & control , Vómitos/prevención & control , Antineoplásicos , Dexametasona , Humanos , Quinuclidinas , Encuestas y Cuestionarios
9.
Zhonghua Yi Xue Za Zhi ; 99(33): 2606-2610, 2019 Sep 03.
Artículo en Chino | MEDLINE | ID: mdl-31510721

RESUMEN

Objective: To observe the effects of intravenous granisetron and acupuncture point injection at PC6(Neiguan) with 0.9% sodium chloride on postoperative nausea and vomiting (PONV) after gynecological laparoscopic surgery. Methods: Qualified cases were collected according to prospective randomized controlled clinical trial design. 94 cases patients undergoing gynecological laparoscopic surgery without postoperative intravenous analgesia were selected from February 2017 to November 2018 in Beijing Aerospace General Hospital and The Affiliated Hangzhou Hospital of Nanjing Medical University. The patients were randomly divided into three groups: bilateral PC6 sham injection of 0.9% sodium chloride+ intravenous granisetron(group A, n=31); bilateral acupuncture point injection at PC6 of 0.9% sodium chloride+ intravenous 0.9% sodium chloride(group B, n=33); bilateral acupuncture point injection at PC6 of 0.9% sodium chloride+ intravenous granisetron(group C, n=30). The indexes including age, body mass index(BMI), type of surgery, surgery time, anesthesia time, liquid intake and output volume, the time from the completion of the operation to the removal of the tracheal catheter, the time from the completion to follow the instruction, respiratory depression, restlessness, arrhythmias and other adverse reactions during anesthesia recovery were recorded. Evaluated the nausea and vomiting according to the visual analogue scales (nausea visual analog scale, NVAS) 12 hours after the operation. Not only the dose and the related frequency of antiemetic drugs for rescue, but also the time of the first anal exsufflation and the pain 24 hours after the operation were recorded. Detected the concentration of motilin (MTL), when the operation started/awake after extubation/12 hours after the operation Results: The incidence of nausea and vomiting 12 hours after the operation in group A, B and C was 35.5%, 33.3%, 10.0%. The difference was statistically significant (χ(2)=0.654, P<0.05). The motilin after 12 hours of operation in group A, B and C was (564±76),(559±84),(472±69) ng/L. The difference was statistically significant (F=14.033, P<0.05). The incidence of nausea and vomiting and the motilin after 12 hours of operation in group C were lower than group A and B. The time for the first anal exsufflation in group A, B and C was (19±8),(19±7),(14±8)h.The difference was statistically significant (F=4.523, P<0.05). The time for the first anal exsufflation in group C was earlier than group A and B. Conclusion: Either intravenous granisetron or acupuncture point injection at PC6 of 0.9% sodium chloride can effectively reduce the incidence of postoperative nausea and vomiting after gynecological laparoscopic surgery. Intravenous granisetron combined with acupuncture point injection at PC6 of 0.9% sodium chloride has better effect and promotes the first anal exsufflation time, which is conducive to the rapid postoperative recovery of patients.


Asunto(s)
Puntos de Acupuntura , Antieméticos/uso terapéutico , Granisetrón/uso terapéutico , Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Laparoscopía , Náusea y Vómito Posoperatorios/terapia , Femenino , Humanos , Extractos Vegetales , Estudios Prospectivos , Sodio
10.
Arq Gastroenterol ; 56(2): 202-208, 2019 Aug 13.
Artículo en Inglés | MEDLINE | ID: mdl-31460587

RESUMEN

BACKGROUND: Gastroesophageal reflux disease (GERD) is one of the most prevalent gastrointestinal diseases. GERD generates significant impairment in patients' quality of life and it is associated to relevant medical resources utilization. A better understanding of GERD pathophysiology in the past five decades has favored the evolution of therapeutic strategies from non-drug interventions and antacids to more efficacious and safer alternatives. OBJECTIVE: To summarize data about the historical evolution of GERD management in Brazil, focusing on medical therapy and addressing evidence on efficacy and safety of drug classes currently recommended. METHODS: A narrative review was conducted by systematizing information about discoveries on GERD pathophysiology. We also addressed efficacy and safety of medications currently used to reduce symptoms and improve endoscopic healing of esophageal lesions. A structured search on Pubmed was performed to identify systematic reviews and meta-analysis investigating GERD outcomes positively impacted by proton pump inhibitors (PPIs), the first choice of pharmacotherapy for the disease. RESULTS: The chronological development of therapeutic measures for GERD in Brazil evolved from lifestyle interventions with relative poor effect on symptoms related to esophageal acid exposure, particularly heartburn, to effective and safe pharmacological interventions such as histamine H2-receptor antagonists and PPIs. In the present days, some drug classes play a minor role in disease management, namely prokinetics and antacids, due to their reduced efficacy and relevant safety concerns (particularly with prokinetics). The main challenge for prescribers and researchers seems to be finding long-acting acid suppressants strategies able to ameliorate patients' symptoms and quality of life, thereafter, reducing medical resource consumption. The dual delayed-release PPI dexlansoprazole seems to respond for some of the limitations other PPIs have. CONCLUSION: Recognizing the historical evolution of GERD management can help care providers to better understand therapeutic options for their patients, as well as focus on unmet needs that deserve further attention. PPIs are still the first choice therapy, with good evidence in favor of their efficacy, despite some safety concerns. However, as with any medical intervention, it is recommended to prescribe PPIs for patients with clear indication, using adequate dosing and monitoring for adverse events.


Asunto(s)
Terapia Conductista/métodos , Medicina Basada en la Evidencia , Reflujo Gastroesofágico/terapia , Estilo de Vida , Antiácidos/uso terapéutico , Antieméticos/uso terapéutico , Antagonistas de los Receptores Histamínicos H2/uso terapéutico , Humanos , Inhibidores de la Bomba de Protones/uso terapéutico
11.
Crit Rev Oncol Hematol ; 142: 164-186, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31419719

RESUMEN

INTRODUCTION: The aim is to conduct an updated systematic review comparing palonosetron to other 5-HT3RAs for the prophylaxis of CINV, assess for publication biases, and determine whether further RCTs are required, that could potentially lead to a different meta-conclusion. METHODS: Random-effects analysis model was used to generate odds ratio (OR), risk differences (RD) and accompanying 95% confidence intervals (CI). Funnel plots to assess for biases and cumulative meta-analyses to assess effect size over time were generated. RESULTS: 4145 patients were randomized to palonosetron and 4911 received other 5-HT3RAs. In the majority of efficacy endpoints, the meta-conclusion has not changed over time - recent clinical trials simply narrow CIs the meta-conclusion. Safety profile boasts a stable conclusion over time. No publication biases exist. CONCLUSION: Considering the vast amount of resources needed to conduct RCTs, resources should be dedicated to other prophylactic treatments/settings which have not been as well explored.


Asunto(s)
Antieméticos/uso terapéutico , Antineoplásicos/efectos adversos , Náusea/prevención & control , Palonosetrón/uso terapéutico , Vómitos/prevención & control , Antineoplásicos/uso terapéutico , Humanos , Náusea/inducido químicamente , Neoplasias/tratamiento farmacológico , Oportunidad Relativa , Antagonistas del Receptor de Serotonina 5-HT3/uso terapéutico , Vómitos/inducido químicamente
12.
Medicine (Baltimore) ; 98(29): e16605, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31335743

RESUMEN

BACKGROUND: We aimed to conduct a systematic review and network meta-analysis (NMA) of published studies to comprehensively compare and rank the efficacy and safety of pharmacological interventions for preventing nausea and vomiting after ambulatory surgery. METHODS: A systematic and comprehensive search will be performed using the MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and Google Scholar databases, beginning from their inceptions to July and August 2019. Only randomized clinical trials on the efficacy and safety of pharmacologic interventions for preventing nausea and vomiting after ambulatory surgery will be included.The primary endpoints will be the incidences of postoperative nausea (PON), postoperative vomiting (POV), and postoperative nausea and vomiting (PONV) in the following recovery phases: before discharge (recovery phase I and II), after discharge but within 24 hours following surgery, and after discharge, after the initial 24-hour postoperative period.The incidences of delayed post-discharge nausea, post-discharge vomiting, and post-discharge nausea and vomiting, which occur after the initial 24-hour postoperative period, severities of PON, POV, and PONV, use of rescue antiemetics, and the incidence of complete response, as well as safety issues, including complications, such as headache, dizziness, and drowsiness, will be also assessed.We will conduct both pairwise meta-analysis and NMA. We will use surface under the cumulative ranking curve values and rankograms to present the hierarchy of the pharmacologic interventions. A comparison-adjusted funnel plot will be used to assess the presence of small-study effects. The quality of the studies included will be assessed using the risk of bias tool 2.0. All statistical analyses will be performed using Stata SE, version 15.0 (StataCorp, College Station, TX). RESULTS: The results of this systematic review and NMA will be published in a peer-reviewed journal. CONCLUSION: This systematic review and NMA will provide comprehensive and convincing evidence summarizing the efficacy and safety of pharmacological interventions for preventing nausea and vomiting after ambulatory surgery. TRIAL REGISTRATION NUMBER: CRD42018103068.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Antieméticos/efectos adversos , Antieméticos/uso terapéutico , Náusea y Vómito Posoperatorios/prevención & control , Humanos , Metaanálisis en Red
13.
Clin Drug Investig ; 39(11): 1057-1066, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31325111

RESUMEN

BACKGROUND AND OBJECTIVE: Risk-minimization measures (RMM), including label revisions were implemented in Europe for domperidone because of evidence of increased incidence of cardiac arrhythmia and sudden cardiac death. In accordance with the guideline on good pharmacovigilance practices, the European Medicines Agency Pharmacovigilance Risk Assessment Committee requested to conduct two studies to evaluate the effectiveness of these risk minimization measures. METHODS: In Belgium, France, Germany, Spain, and the UK, surveys were conducted to assess physicians' knowledge on the updated domperidone labeling information, and a drug-utilization study (DUS) was conducted using healthcare databases to assess domperidone prescribing patterns before and after the RMM. Four DUS sensitivity analyses (scenarios) evaluated uncertainty regarding domperidone treatment duration and indication. RESULTS: Among 1805 physicians participating in the survey, most were aware of the approved indication (nausea and vomiting, 80%), treatment duration (≤ 7 days, 70%), and maximum adult daily dose (10 mg three times daily, 84%). Only 33% selected the on-label indication from a list of indications for which they would prescribe domperidone. Awareness was low for medications contraindicated for concomitant use (26%) and contraindicated conditions (4%). In the DUS, under the optimistic scenario, a large improvement in labeling compliance from pre- to post-implementation period was observed in France (27% vs. 69%), while Belgium, Germany, Spain, and the UK showed small improvements (< 10%). In the other scenarios, there was little to no improvement in compliance with the revised labeling from the pre- to post-implementation periods in most countries. CONCLUSIONS: The survey findings documented that most physicians in all five countries were aware of the main aspects of the revised labeling. Results of the DUS were inconclusive regarding the effect of the RMM and compliance with the revised labeling for all countries except France.


Asunto(s)
Antieméticos/uso terapéutico , Domperidona/uso terapéutico , Etiquetado de Medicamentos/normas , Utilización de Medicamentos/normas , Médicos/normas , Adulto , Antieméticos/efectos adversos , Arritmias Cardíacas/inducido químicamente , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/prevención & control , Trastorno del Sistema de Conducción Cardíaco/inducido químicamente , Trastorno del Sistema de Conducción Cardíaco/epidemiología , Trastorno del Sistema de Conducción Cardíaco/prevención & control , Estudios Transversales , Muerte Súbita Cardíaca/etiología , Domperidona/efectos adversos , Europa (Continente) , Femenino , Humanos , Masculino , Persona de Mediana Edad , Náusea/tratamiento farmacológico , Náusea/epidemiología , Estudios Retrospectivos , Medición de Riesgo , Encuestas y Cuestionarios , Vómitos/tratamiento farmacológico , Vómitos/epidemiología
14.
BMC Health Serv Res ; 19(1): 438, 2019 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-31262292

RESUMEN

BACKGROUND: An antiemetic triplet regimen of 5-hydrotryptamine-3 receptor antagonist, dexamethasone, and aprepitant is the standard prophylaxis with highly emetogenic chemotherapy (HEC). A randomized phase III trial comparing palonosetron (PALO) versus granisetron (GRA) in the triplet antiemetic regimen (The TRIPLE study) showed the superiority of PALO over GRA for delayed-phase vomiting in patients receiving cisplatin-based HEC. However, economic efficiency evaluations including quality of life have not been done. The present study was a cost-utility analysis of PALO within the Japanese medical insurance system. METHODS: The data source was the results of the TRIPLE study. A decision tree was constructed to assess the incremental cost-effectiveness ratio (ICER) using quality-adjusted life years (QALYs) and the medical service fees and the drug price for 2018 from the perspective of the payer. A one-way sensitivity analysis and a probabilistic sensitivity analysis (PSA) were performed to assess the robustness of the model. A threshold analysis was performed to determine the cost-effective price of PALO. RESULTS: In the base case, the estimated incremental effect of PALO addition was 0.000645 QALYs, the estimated incremental cost was 10,455 JPY (93.21 USD), and the ICER was 16,204,591 JPY QALY (144,465 USD/QALY). In the PSA, the probability of superior cost-effectiveness was 3.64%. In the threshold analysis, the acceptable price of PALO was estimated to be 7,743 JPY (69.03 USD). CONCLUSIONS: If willingness-to-pay is taken as 5,000,000 JPY/QALY (44,575 USD/QALY), the antiemetic regimen using PALO for cisplatin-containing HEC was not cost-effective at this time. The cost of drugs, with the arrival of inexpensive generic drugs, will make a major contribution to its cost-effectiveness.


Asunto(s)
Antieméticos/uso terapéutico , Antineoplásicos/efectos adversos , Cisplatino/efectos adversos , Palonosetrón/uso terapéutico , Vómitos/inducido químicamente , Adulto , Antieméticos/economía , Protocolos Clínicos , Análisis Costo-Beneficio , Femenino , Humanos , Japón , Palonosetrón/economía
15.
Int J Surg ; 69: 1-12, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31299429

RESUMEN

BACKGROUND: Different categories of drugs are used to reduce the incidence of post-operative nausea and vomiting (PONV) following laparoscopic cholecystectomy (LC). This study is a network meta-analysis of randomized clinical trials with such drugs. METHODS: Electronic databases were searched for appropriate randomized clinical trials evaluating drugs reducing PONV in LC. Number of patients without PONV at 24 h was the primary outcome; and incidence of nausea and/or vomiting at 6 h and 24 h, and adverse events were the secondary outcome measures. Risk of bias was evaluated for each study. Mixed treatment comparison estimates were derived by random-effects modelling. Trial sequential analysis was carried out to assess the adequacy of evidence; and surface area under cumulative ranking curve was generated to identify the best intervention in the pool. Grading of the evidence for key comparisons was done. RESULTS: Ninety clinical trials were included. Metoclopramide, gabapentin, dixyrazine, ondansetron, granisetron, dexamethasone, tropisetron, droperidol, droperidol/dexamethasone, droperidol/metoclopramide, granisetron/droperidol and granisetron/dexamethasone, haloperidol, dexmedetomidine, palonosetron, droperidol/ondansetron, metoclopramide/dexamethasone, haloperidol/ondansetron, haloperidol/dexamethasone, palonosetron/dexamethasone and ramosetron/dexamethasone were observed with significant benefits compared to placebo. Corticosteroid/serotonin receptor antagonists was observed with the highest probability of being the 'best' in this pool. However, the moderate quality of evidence obtained was adequate to confirm the benefits of dexamethasone and ondansetron only. CONCLUSION: The relative effect sizes for various prophylactic anti-emetics for LC was modelled using the principles of network meta-analysis. Dexamethasone and ondansetron have the best evidence as stand-alone options and the combination is preferred in high-risk category. Caution should be exercised while interpreting the evidence as the estimates might change with head-to-head clinical trial data.


Asunto(s)
Antieméticos/uso terapéutico , Colecistectomía Laparoscópica , Metaanálisis en Red , Náusea y Vómito Posoperatorios/prevención & control , Dexametasona/uso terapéutico , Quimioterapia Combinada , Humanos , Ondansetrón/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto
16.
In Vivo ; 33(4): 1355-1362, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31280230

RESUMEN

BACKGROUND/AIM: Although neurokinin-1 receptor antagonists are approved chemotherapy drugs in Japan, no nationwide surveys have been performed to validate chemotherapy-induced nausea and vomiting (CINV) guidelines in clinical practice. This study evaluated CINV in patients with haematological malignancies starting first-time chemotherapy. PATIENTS AND METHODS: A nationwide CINV survey on patients with haematological malignancies was conducted at 118 institutions. Patients undergoing moderately emetic chemotherapy (n=17) and highly emetic chemotherapy (HEC; n=180) were compared. RESULTS: Forty-one patients undergoing HEC received triple antiemetics. Female gender and young age were risk factors for early-phase nausea, while female gender remained a risk factor for late-phase nausea and vomiting. Among 125 patients receiving CHOP (doxorubicin, cyclophosphamide, vincristine, prednisone)-like regimens, complete response and complete control were increased in patients receiving triple antiemetics, compared to those with double antiemetics. CONCLUSION: Guideline compliance was very low. Although not statistically significant, there was a trend for reduced CINV and improved disease control for triple versus double antiemetics, suggesting that triple antiemetics should be considered for HEC, especially in young female patients with non-Hodgkin lymphoma receiving CHOP-like regimens.


Asunto(s)
Antieméticos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias Hematológicas/complicaciones , Náusea/etiología , Náusea/prevención & control , Vómitos/etiología , Vómitos/prevención & control , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Femenino , Encuestas de Atención de la Salud , Neoplasias Hematológicas/tratamiento farmacológico , Neoplasias Hematológicas/epidemiología , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Náusea/diagnóstico , Náusea/epidemiología , Premedicación , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Resultado del Tratamiento , Vómitos/diagnóstico , Vómitos/epidemiología
18.
Support Care Cancer ; 27(9): 3195-3207, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31062109

RESUMEN

PURPOSE: This systematic literature review examines research into the use of medicinal cannabis in cancer management. The aim was to identify the gaps in knowledge on the dose, dosing schedule and absorption of the administration routes of medicinal cannabis use in oncology. METHODS: A comprehensive search of the literature was conducted across six databases to identify original data reporting the pharmacology of medicinal cannabis in oncology. RESULTS: Eighteen articles were selected for review. Of the selected articles, ten were identified as randomised control trials, two experimental studies, two retrospective cohort studies and four case studies. Four articles reported absorption data and one drug interaction study was identified. CONCLUSIONS: There is little evidence reported in the literature on the absorption of medicinal cannabis in cancer populations. Various reasons are explored for the lack of pharmacokinetic studies for medicinal cannabis in cancer populations, including the availability of assays to accurately assess cannabinoid levels, lack of clinical biomarkers and patient enrolment for pharmacokinetic studies.


Asunto(s)
Cannabinoides/uso terapéutico , Marihuana Medicinal/uso terapéutico , Neoplasias/tratamiento farmacológico , Analgésicos/uso terapéutico , Antieméticos/uso terapéutico , Antineoplásicos/uso terapéutico , Cannabinoides/farmacocinética , Cannabis/química , Antagonistas Colinérgicos/uso terapéutico , Cálculo de Dosificación de Drogas , Humanos , Marihuana Medicinal/farmacocinética , Preparaciones de Plantas/uso terapéutico , Estudios Retrospectivos
19.
Am J Vet Res ; 80(6): 601-606, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31140850

RESUMEN

OBJECTIVE: To evaluate the efficacy of maropitant and loperamide for the prevention and reduction of adverse gastrointestinal effects associated with administration of paclitaxel to dogs with cancer. ANIMALS: 168 dogs with cancer. PROCEDURES: The study comprised 2 phases. For phase 1, dogs in the intervention group were administered maropitant and loperamide followed by paclitaxel. Outcomes were compared with those for a control group that received only maropitant and paclitaxel. For phase 2, all dogs of phase 1 that did not receive maropitant and loperamide and that had adverse gastrointestinal effects were enrolled; they received maropitant and loperamide and another dose of paclitaxel. RESULTS: In phase 1, significantly fewer dogs in the intervention group had adverse effects. For dogs that had adverse effects, the intervention group had a lower severity of lack of appetite and lethargy. Also, adverse effects for dogs in the intervention group were of significantly shorter duration than for the control group. In phase 2, significant reductions in adverse effects were observed after administration of maropitant and loperamide. In those dogs that still had adverse effects after administration of maropitant and loperamide, there was a significant reduction in severity of signs of nausea and lethargy. CONCLUSIONS AND CLINICAL RELEVANCE: A combination of maropitant and loperamide was found to be safe for use and effective for reducing or preventing signs of paclitaxel-induced gastrointestinal effects in dogs.


Asunto(s)
Antineoplásicos Fitogénicos/uso terapéutico , Enfermedades de los Perros/tratamiento farmacológico , Loperamida/uso terapéutico , Neoplasias/veterinaria , Paclitaxel/efectos adversos , Quinuclidinas/uso terapéutico , Animales , Antidiarreicos/uso terapéutico , Antieméticos/uso terapéutico , Antineoplásicos Fitogénicos/efectos adversos , Diarrea/inducido químicamente , Diarrea/prevención & control , Diarrea/veterinaria , Perros , Quimioterapia Combinada , Femenino , Masculino , Neoplasias/tratamiento farmacológico , Paclitaxel/uso terapéutico , Distribución Aleatoria , Vómitos/inducido químicamente , Vómitos/prevención & control , Vómitos/veterinaria
20.
J Med Econ ; 22(8): 840-847, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31094589

RESUMEN

Background: Chemotherapy-induced nausea and vomiting (CINV) are among the most common and debilitating side-effects patients experience during chemotherapy, and are associated with considerable acute care use and healthcare cost. It is estimated that 70-80% of CINV could be prevented through appropriate use of CINV prophylaxis; however, suboptimal CINV compliance and control remains an issue in clinical practice. Netupitant/palonosetron (NEPA) is a fixed combination of serotonin-3 (5-HT3) and neurokinin-1 (NK1) receptor antagonists (RAs), respectively, indicated for the prevention of acute and delayed nausea and vomiting associated with highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC). Phase 3 clinical trials showed a significantly higher complete response rate in both acute and delayed CINV in chemotherapy-naïve patients receiving NEPA compared to patients receiving palonosetron. Objective: The objective of this study was to estimate the budgetary impact of adding NEPA to a US payer or practice formulary for CINV prophylaxis. Methods: A model was developed to estimate the impact of adding NEPA to the formulary of a hypothetical US payer with 1.15 million members, including 150,000 (13%) Medicare beneficiaries. The model compared the annual total costs of CINV-related events and CINV prophylaxis in two scenarios: base year (no NEPA) and comparator year (10% and 5% NEPA usage in HEC and MEC patients, respectively). A univariate sensitivity analysis was conducted to explore the effect of variability in model parameters on the budget impact. Results: A total of 2,021 patients were eligible to receive CINV prophylaxis. With NEPA, CINV prophylaxis costs increased by 0.7% ($3,493,630 vs $3,518,760) while medical costs associated with CINV events decreased by 3.9% ($15,118,639 vs $14,532,442), resulting in a net cost saving of $561,067 (3.0%) for the health plan ($18,612,269 vs $18,051,202), or $0.04 per member per month. This was equivalent to saving $5,011 per patient moved to NEPA. Among all 5-HT3 RA + NK1 RA regimens, NEPA was associated with the lowest CINV-related costs, leading to the lowest total cost of care. Conclusions: Adding NEPA to a payer or practice formulary results in a net decrease in the total budget due to a substantial reduction in CINV event-related resource utilization and medical costs, and an increase in pharmacy costs <1%, saving over $5,000 per patient.


Asunto(s)
Antieméticos/economía , Presupuestos/estadística & datos numéricos , Náusea/prevención & control , Palonosetrón/economía , Piridinas/economía , Vómitos/prevención & control , Anciano , Anciano de 80 o más Años , Antieméticos/uso terapéutico , Antineoplásicos/efectos adversos , Combinación de Medicamentos , Femenino , Humanos , Masculino , Medicare/estadística & datos numéricos , Náusea/inducido químicamente , Palonosetrón/uso terapéutico , Piridinas/uso terapéutico , Estados Unidos , Vómitos/inducido químicamente
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