Effect Of Different 5-HT Receptor Antagonists On Prevention And Treatment Of Highly Emetic Chemotherapy-induced Nausea And Vomiting

Objective:To observe the efficacy and adverse reactions of different 5-HT receptor antagonists in the prevention and treatment of nausea and vomiting caused by highly emetic chemotherapeutic drugs,and to verify the observation results by measuring the plasma 5-HT concentration.Methods:1)Fifty patients with malignant tumors who received chemotherapy with eupatorium≥50 mg/m~2 and/or ifosfamide≥10 g/m~2 at the Department of Gamma Knife Therapy,the Cancer Center of the Second Hospital of Lanzhou University from November 2018 to November 2019 were enrolled.A self-controlled,three-period randomized crossover design was used.Palonosetron injection 0.5 mg,palonosetron capsules 0.5 mg or ramosetron injection 0.3 mg were randomly given in three consecutive chemotherapy cycles.The severity of CINV and the occurrence of adverse reactions in each stage in the three groups were observed.The plasma 5-HT concentration at different time points of chemotherapy in each group was measured by ELISA to analyze the correlation between the increase and the efficacy.The cost-effectiveness analysis was performed for each group.2)Statistical methods:SPSS 21.0 statistical software was used to analyze the data.The classification data were analyzed by?2test.The measurement data were analyzed by independent sample t test and expressed as x±s.The relevant data of ELISA test were analyzed by one-way analysis of variance.The differences were considered statistically significant at p<0.05.Results:1)Comparison of clinical efficacy among groups:(1)There was no significant difference in the remission rates of palonosetron injection,palonosetron capsule and ramosetron injection in preventing acute nausea and vomiting among groups(p>0.05).(2)For delayed nausea,the remission rates of palonosetron injection and palonosetron capsule groups were significantly higher than that of Ramosetron group(79.2%vs46.5%,67.3%vs 46.5%,respectively),and the remission rate of palonosetron injection group was higher than that of palonosetron capsule group(79.2%vs 67.3%),and the differences had statistical significance(p<0.05).(3)For nausea of whole period of chemotherapy,the remission rates in the palonosetron injection group and palonosetron capsule group were also significantly higher than that in the ramosetron group(77.1%vs 41.9%,65.3%vs 41.9%,respectively),and the remission rate in the palonosetron injection group was also significantly higher than that in the palonosetron capsule group(77.1%vs 63.3%),and the differences were statistically significant(p<0.05).(4)In the study of prevention and treatment of delayed and whole phases of chemotherapy-induced vomiting,the same statistical results were obtained as those in the above(2)(3).2)Comparison of efficacy in different population groups:there was no statistical difference in remission rate between three antiemetics in preventing CINV in different age or gender groups(p>0.05),while the remission rate of nausea and vomiting in patients with number of chemotherapy cycles≤3 was higher than that in patients with number of chemotherapy cycles>3,and the difference had statistical significance(p<0.05).3)Comparison of drug safety:the highest incidence rate of adverse reactions in each group was constipation,followed by headache,dizziness,diarrhea,etc.There was no serious adverse reaction in each group,and there was no significant difference among the three groups(p>0.05).4)Correlation analysis between the increase of 5-HT concentration and clinical efficacy:There was statistical difference in the increase of plasma 5-HT concentration between different efficacy groups in the three groups(p<0.05),and the better the efficacy,the more significant the increase of 5-HT concentration.In the acute phase of CINV,there was no statistically significant difference in the increase of plasma 5-HT concentration among the three groups(p>0.05),and in the CINV phase,there was a statistically significant difference in the increase of plasma 5-HT concentration among the three groups(p<0.05),and multiple comparisons showed that the increase of plasma 5-HT concentration from high to low was palonosetron injection group,palonosetron capsule group,and ramosetron injection group.5)Cost-effectiveness analysis:The C/E of the three groups from low to high were palonosetron capsule group(4.63±0.16),palonosetron injection group(5.40±0.14),and ramosetron group(5.93±0.54),and the difference in C/E among the three groups was statistically significant(p<0.05).Conclusions:1)Palonosetron injection and palonosetron capsule have good effect in preventing and treating CINV,especially for delayed CINV,the efficacy is superior to ramosetron,and the control effect of palonosetron injection at the same dose on delayed CINV is superior to palonosetron capsule.2)There was no difference in the efficacy of the three antiemetics for CINV in patients of different ages and genders,but the efficacy was better in patients with≤3chemotherapy cycles than in patients with>3 chemotherapy cycles.3)Palonosetron injection,palonosetron capsule and ramosetron can produce constipation,headache,dizziness,diarrhea and other adverse reactions in the prevention and treatment of CINV,but the adverse reactions are mild and the safety is good.4)The most ideal three antiemetics for the prevention and treatment of CINV caused by HEC is palonosetron capsule,which is safe,effective,economical and convenient,and is worthy of clinical use.