Journal Article

Comparative effectiveness of netupitant-palonosetron plus dexamethasone versus aprepitant-based regimens in mitigating chemotherapy-induced nausea and vomiting: a meta-analysis of randomized controlled trials

Gautama, Made Satya Nugraha, Chang, Chia-Lun, Luo, Wun-Ting, Huang, Tsai-Wei

2025

Overview

Abstract Background Despite guidelines for managing chemotherapy-induced nausea and vomiting (CINV), there remains a need to clarify the optimal use of neurokinin-1 (NK1) receptor antagonists. Comparing the effectiveness of NEPA (netupitant-palonosetron) plus dexamethasone with other NK1 antagonist-based regimens combined with a 5HT3 receptor antagonist and dexamethasone is crucial for informed decision-making and improving patient outcomes. Methods We conducted a systematic review of the literature to assess randomized controlled trials (RCTs) comparing the efficacy, safety, and cost-effectiveness of NEPA plus dexamethasone and other NK1 antagonist-based regimens combined with a 5HT3 receptor antagonist and dexamethasone. PubMed, Embase, and the Cochrane Library databases were systematically searched, with the latest update performed in December 2023. Data on patient demographics, chemotherapy regimen characteristics, and outcomes were extracted for meta-analysis using a random-effects model. Results Seven RCTs were analyzed. NEPA plus dexamethasone showed superior efficacy in achieving complete response in the overall (risk ratio [RR], 1.15; 95% CI, 1.02--1.30) and delayed phases (RR, 1.20; 95% CI, 1.03-1.41) of chemotherapy. It was more effective in controlling nausea (overall phase RR, 1.20; 95% CI, 1.05-1.36; delayed phase RR, 1.21; 95% CI, 1.05-1.40) and reducing rescue therapy use (overall phase RR, 1.45; 95% CI, 1.07-1.95; delayed phase RR, 1.75; 95% CI, 1.10-2.78). Adverse event rates were comparable (RR, 1.03; 95% CI, 0.96-1.10). Subgroup analysis indicated NEPA’s particular efficacy in patients receiving moderately emetogenic chemotherapy (RR, 1.31; 95% CI, 1.07-1.60). Conclusion NEPA plus dexamethasone regimens exhibit superior efficacy in preventing CINV, supporting their preferential inclusion in prophylactic treatment protocols. Its effective symptom control, safety profile, and cost-effectiveness endorse NEPA-based regimens as a beneficial option in CINV management. This article compares the efficacy of NEPA- and aprepitant-based regimens in mitigating chemotherapy-induced nausea and vomiting among cancer patients, with a particular focus on evidence garnered from randomized controlled trials. Graphical Abstract Graphical Abstract

• Publisher: Oxford University Press
• Subject: Antiemetics / Antiemetics - pharmacology / Antiemetics - therapeutic use / Antineoplastic Combined Chemotherapy Protocols - adverse effects / Aprepitant - pharmacology / Aprepitant - therapeutic use / Benzeneacetamides / Cancer / Chemotherapy / Clinical trials / Complications and side effects / Dexamethasone / Dexamethasone - pharmacology / Dexamethasone - therapeutic use / Dosage and administration / Drug Combinations / Drug therapy, Combination / Evaluation / Humans / Nausea / Nausea - chemically induced / Nausea - drug therapy / Palonosetron - pharmacology / Palonosetron - therapeutic use / Piperazines / Prevention / Pyridines - pharmacology / Pyridines - therapeutic use / Randomized Controlled Trials as Topic / Testing / Vomiting / Vomiting - chemically induced / Vomiting - drug therapy