5-HT3 receptor antagonists may be more effective against radiotherapy-induced vomiting (NNT 2.5) than metoclopramide.
A systematic review 1 including 5 studies with a total of 474 subjects was abstracted in DARE. Ondansetron was significantly more efficacious than metoclopramide for the complete control of acute vomiting (relative benefit 1.98, 95% CI: 1.47, 2.65; NNT 2.2) and acute nausea (relative benefit 1.71, 95% CI: 1.17, 2.51; NNT 3.6) in a placebo-controlled trial. Granisetron was significantly better than metoclopramide in preventing vomiting and mild nausea (relative benefit 4.0, 95% CI: 1.01, 15.8; NNT 2.5). There is no evidence that these drugs are of any benefit beyond 24 hours.
Comment: The quality of evidence is downgraded by potential reporting bias and limitations in review methodology.
1. Tramèr MR, Reynolds DJ, Stoner NS, Moore RA, McQuay HJ. Efficacy of 5-HT3 receptor antagonists in radiotherapy-induced nausea and vomiting: a quantitative systematic review. Eur J Cancer 1998 Nov;34(12):1836-44. [PMID:10023303]
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"5-HT3 Receptor Antagonists for Radiotherapy-induced Nausea and Vomiting." Evidence-Based Medicine Guidelines, Duodecim Medical Publications Limited, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/EBMG/455388/all/5_HT3_receptor_antagonists_for_radiotherapy_induced_nausea_and_vomiting.
5-HT3 receptor antagonists for radiotherapy-induced nausea and vomiting. Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. https://evidence.unboundmedicine.com/evidence/view/EBMG/455388/all/5_HT3_receptor_antagonists_for_radiotherapy_induced_nausea_and_vomiting. Accessed September 20, 2020.
5-HT3 receptor antagonists for radiotherapy-induced nausea and vomiting. (2019). In Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited. Retrieved September 20, 2020, from https://evidence.unboundmedicine.com/evidence/view/EBMG/455388/all/5_HT3_receptor_antagonists_for_radiotherapy_induced_nausea_and_vomiting
5-HT3 Receptor Antagonists for Radiotherapy-induced Nausea and Vomiting [Internet]. In: Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. [cited 2020 September 20]. Available from: https://evidence.unboundmedicine.com/evidence/view/EBMG/455388/all/5_HT3_receptor_antagonists_for_radiotherapy_induced_nausea_and_vomiting.
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