Carlo A Marra

5-HT3 receptor antagonistsvs traditional agents for the prophylaxis of postoperative nausea and vomiting

Purpose: Numerous antiemetics have been studied for the prevention of postoperative nausea and vomiting (PONV) including traditional agents (metodopramide, perphenazine, prochlorperazine, cyclizine and droperidol) and the 5-HT3 receptor antagonists (ondansetron, dolasetron, granisetron and tropisetron). The results have been divergent and inconsistent. The purpose of this quantitative systematic review was to evaluate the effectiveness of 5HT3 receptor antagonists compared to traditional antiemetics for the prevention of PONV.Methods: A systematic search of the English language literature using computerized MEDLINE, EMBASE, and Pre-MEDLINE databases from 1966 to October 1999 and a manual search of references from retrieved articles were performed. Individual efficacy and adverse effect data was extracted from each of the studies according to a predefined protocol. The summary odds ratios were calculated using the Dersimonian and Laird method under a random effects model.Results: A total of 41 trials met our pre-defined inclusion criteria and were included in our analysis. Results in the 32 studies examining PONV indicated a 46% reduction in the odds of PONV in the 5-HT3-treated group (0.54 [95% Cl 0.42–0.71],P<0.001). evaluation of PONV by traditional antiemetic agent demonstrated a 39% reduction compared with droperidol (0.61 [95% Cl 0.42–0.89],P<0.001) and a 56% reduction compared with metodopramide (0.44 [95% Cl 0.31–0.62],P<0.001). Results in the 34 studies examining vomiting indicated a 38% reduction in the odds of vomiting in the 5-HT3-treated group (0.62 [95% Cl 0.48–0.81],P<0.001).Conclusions: The 5-HT3 receptor antagonists are superior to traditional antiemetic agents for the prevention of PONV and vomiting. The reduction in the odds of PONV and vomiting is significant in the overall analysis and the subgroup analyses comparing 5-HT3 receptor antagonists with droperidol and metoclopramide.RésuméObjectif: La recherche de moyens de prévention des nausées et vomissement postopératoires (NVPO) a porté sur de nombreux antiémétiques induant des médicaments traditionnels (métoclopramide, perphénazine, prochlorpérazine, cyclinzine et dropéridol) et des antagonistes du récepteur 5-HT3 (ondansétron, dolasétron, granisétron et tropisétron). Les résultats ont été divergents et contradictoires. La présente révision systématique quantitative évalue l’efficacité comparée des antagonistes du récepteur 5HT3 et des antiémétiques traditionnels dans la prévention des NVPO.Méthode: Une recherche systématique des documents de langue anglaise a été faite dans MEDLINE, EMBASE et Pre-MEDLINE, de 1966 à octobre 1999, suivie d’une recherche manuelle des articles retenus. Les données sur l’efficacité individuelle et les effets indésirables ont été extraites de chaque étude selon un protocole prédéfini. Les risques relatifs d’ensemble ont été calculés à l’aide de la méthode de Dersimonian et Laird d’après un modèle d’effet aléatoire.Résultats: Quarante et un essais répondaient à nos critères d’indusion prédéfinis et ont été retenus dans notre analyse. Les résultats de 32 études sur les NVPO ont indiqué une réduction de 46% du risque relatif de NVPO chez les patients traités avec anti-5-HT3 (0,54 [IC de 95%; 0,42–0,71];P<0,001). Comparés aux autres antiémétiques traditionnels, les anti-5-HT3 ont démontré une réduction du risque relatif de 39% comparés au dropéridol (0,61 [IC de 95%; 0,42–0,89];P<0,001) et de 56% comparés au métoclopramide (0,44 [IC de 95%; 0,31–0,62];P<0,001). Les résultats de 34 études sur les vomissements ont indiqué une réduction de 38% du risque relatif chez les patients traités avec anti-5-HT3 (0,62 [IC de 95%; 0,48–0,81];P<0,001).Conclusion: Les antagonistes du récepteur 5-HT3 ont une action supérieure aux antiémétiques traditionnels pour prévenir les NVPO et les vomissements. La réduction de la probabilité de NVPO et de vomissements est significative dans l’analyse globale et dans les analyses de sous-groupes où on a comparé les antagonistes du récepteur 5-HT3 avec le dropériodol et le métodopramide.

Meta-Analysis of Proton Pump Inhibitors in Treatment of Bleeding Peptic Ulcers

OBJECTIVE: To evaluate the efficacy of proton pump inhibitors (PPIs) compared with placebo and histamine receptor antagonists (H2RAs) for reducing the incidence of rebleeding, surgery, and death in acute gastrointestinal bleeding (GIB) associated with peptic ulcer disease. DATA SOURCES: A systematic search of the English-language literature was performed using MEDLINE, EMBASE, and Pre-MEDLINE (from 1966 to September 2000) and a manual search of references. STUDY SELECTION: Randomized, controlled trials evaluating any PPI for acute GIB in adults with the end points of rebleeding, surgery or death. DATA SYNTHESIS: Nine trials (1829 pts.) were included. The relative odds of rebleeding indicated a 50% reduction in the PPI-treated group (OR 0.50, 95% CI 0.33 to 0.77; p = 0.002, NNTB 9; 95% CI NNTB 6 to 13). The relative odds of surgery indicated a 53% reduction in the PPI-treated group (OR 0.47, 95% CI 0.29 to 0.77; p = 0.003; NNTB 17, 95% CI 12 to 35). The relative odds for mortality indicated a nonsignificant 8% decrease in the odds of death in the PPI-treated group (OR 0.92, 95% CI 0.46 to 1.83, p = 0.81; NNTB 323, 95% CI NNTB 47 to ∞ to NNTH 33). CONCLUSIONS: PPIs are superior to H2RAs and placebo in preventing rebleeding and the need for surgery in patients with GIB, although they do not appear to reduce mortality.

Cost-effectiveness of prophylactic dolasétron or droperidolvs rescue therapy in the prevention of PONV in ambulatory gynecologic surgery

PurposeTo assess the cost-effectiveness of prophylactic therapy (1.25 mg droperidol or 50 mg dolasétroniv) vs no prophylaxis (rescue therapy) for the prevention of post-operative nausea and vomiting (PONV) from a Canadian hospital perspective.MethodsDesign: A predictive decision analytic model using previously published clinical and economic evaluations, and costs of medical care in Canada. Subjects: Ambulatory gynecology surgery patients,Interventions: Three strategies administered prior to emergence from anesthesia were compared: 1.25 mg droperidoliv, 50 mg dolasétroniv; and no prophylaxis (rescue therapy).ResultsThe base case mean cost per patient receiving dolasétron prophylaxis was

Quality-of-Life Assessment in an Outpatient Parenteral Antibiotic Program

28.08 CAN compared with

Willingness to pay to assess patient preferences for therapy in a Canadian setting

26.88 CAN per patient receiving droperidol prophylaxis, resulting in a marginal cost of

Systematic Review of the Treatment of Early Lyme Disease

1.20 CAN. This difference translated in an additional cost of

Cost-Effectiveness Analysis of Abciximab: A Canadian Hospital Perspective

12.00 CAN for the dolasétron strategy per adverse event avoided over the droperidol strategy. The base case mean cost per patient not receiving prophylaxis was

Cost-Minimization Analysis of Piperacillin/Tazobactam versus Imipenem/Cilastatin for the Treatment of Serious Infections: A Canadian Hospital Perspective

26.92 resulting in marginal costs of

Influence of Standardized Orders on Postoperative Nausea and Vomiting after Gynecologic Surgery

1.16 CAN and

Patients’ Perceptions about Substitution of a Reference Drug while in Hospital: Focus on H2-Receptor Antagonists

0.04 CAN when compared to dolasétron and droperidol, respectively. Compared with the no prophylaxis strategy, dolasétron prophylaxis resulted in an incremental cost-effectiveness ratio of