奈妥吡坦是治疗什么的药？

(Palonosetron) is a second-generation 5-HT receptor antagonist, mainly used to prevent chemotherapy-induced nausea and vomiting (CINV) and nausea and vomiting within 24 hours after surgery.

About Netupitant

Compared with the first-generation 5-HT3 receptor antagonists, Netupitant (palonosetron) has higher affinity and selectivity.

Guidelines and expert consensuses such as the "Chinese Expert Consensus on the Prevention and Treatment of Nausea and Vomiting Related to Cancer Treatment" and the "Guidelines for the Prevention and Treatment of Tumor Treatment-Related Vomiting (2014 Edition)" and the "Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting" and the "Guidelines for the Prevention and Treatment of Nausea and Vomiting Induced by Chemotherapy" all recommend palonosetron as the first-line drug for the prevention of nausea and vomiting caused by chemotherapy drugs with moderate to high emetogenic risks or after surgery.

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The role of Netupitant

Netupitant (palonosetron) is a very strong affinity 5-HT3 receptor selective antagonist with significant antiemetic effect. The drug receptors are mainly located in the emetic chemoreceptors in the posterior region of the medulla oblongata, and the central and peripheral vagus nerve endings can selectively act on this site to achieve an anti-emetic effect.

Efficacy of Netupitant

Research purpose: Systematically evaluate the effectiveness and safety of palonosetron combined with dexamethasone compared with palonosetron alone in the treatment of postoperative nausea and vomiting (PONV) after laparoscopic surgery.

Research methods: Computer search of CNKI, WanFangData, VIP, PubMed, EMbase, the Cochrane Library database, supplementary search of Google Academic: Randomized controlled trials (RCTs) of palonosetron combined with dexamethasone (combination group) versus palonosetron alone (alone group) in the treatment of PONV during laparoscopic surgery were collected. The search time limit was from the inception of the database to October 31, 2021. After two researchers independently screened the literature, extracted data, and evaluated the risk of bias of the included studies, RevMan 5.3 software was used to conduct a meta-analysis.

Research results: A total of 9 RCTs were included, including 830 patients. Meta-analysis results show that the 0~2 h PONV incidence rate [RR=0.63, 95%CI (0.44, 0.91), P=0.01] and 0~24 h PUNV reaction rate [RR=0.61, 95%CI (0.43,0.86), P=0.006], antiemetic rescue need rate [RR=0.58] of the combined therapy group , 95%CI (0.41, 0.84), P=0.004] and the incidence of adverse drug reactions [RR=0.62, 95%CI (0.42, 0.92), P=0.02] were significantly lower than those of the medication alone group, while the incidence of PONV at 0~6 h, PONV at 2~6 h, PONV at 0~48 h, and PONV at 24~48 h in both groups The incidence of PONV and the incidence of PONV between 0 and 72 h were similar (P > 0.05)).

Research conclusion: Current evidence shows that compared with palonosetron alone, palonosetron combined with dexamethasone cannot completely reduce the incidence of PONV in laparoscopic surgery, but it can significantly reduce the need for antiemetic rescue and the incidence of adverse drug reactions.

References

[1] Sun Bo, Liu Danna, Liu Xun, et al. Exploration of risk factors for failure of palonosetron combined with dexamethasone to prevent nausea and vomiting caused by chemotherapy [J]. Chinese Pharmacy, 2021, 32(21): 2640-2646.

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