Impact of 5-HT3 receptor antagonists on chemotherapy-induced nausea and vomiting: a retrospective cohort studyReport as inadecuate

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BMC Health Services Research

, 12:215

Quality, performance, safety and outcomes


Background1 generation 5-hydroxytryptamine receptor antagonists 5-HT3 RAs, and palonosetron, a 2 generation 5-HT3 RA, are indicated for the prevention of chemotherapy CT-induced nausea and vomiting CINV associated with moderately MEC and highly emetogenic CT agents HEC. This study explores the impact of step therapy policies requiring use of an older 5-HT3 RA before palonosetron on risk of CINV associated with hospital or emergency department ED admissions.

MethodsPatients who received cyclophosphamide post breast cancer BC surgery or who were diagnosed with lung cancer on carboplatin LC-carboplatin or cisplatin LC-cisplatin were selected from PharMetrics’ IMS LifeLink claims dataset 2005-2008. Patients were followed for 6 months from initial CT administration for CINV events identified through ICD-9-CM codes. Patients were grouped into those initiated with older, generic 5-HT3 RAs ondansetron, granisetron, and dolasetron and those initiated and maintained on palonosetron throughout study follow-up. CINV events and CINV days were analyzed using multivariate regressions controlling for demographic and clinical variables.

ResultsEligible patients numbered 3,606 in BC, 4,497 in LC-carboplatin and 1,154 in LC-cisplatin cohorts, with 52%, 40%, and 34% in the palonosetron group, respectively. There was no significant difference between the two 5-HT3 RA groups in age or Charlson Comorbidity Index among the two MEC cohorts BC and LC-carboplatin. Among the LC-cisplatin cohort, palonosetron users were older with more males than the older 5-HT3 RA group age: 60.1 vs. 61.3; males, 66.9% vs. 56.9%. Compared to the older 5-HT3 RAs, the palonosetron groups incurred 22%-51% fewer 5-HT3 RA pharmacy claims, had fewer patients with CINV events 3.5% vs. 5.5% in BC, 9.5% vs. 12.8% in LC-carboplatin, 16.4% vs. 21.7% in LC-cisplatin, and had lower risk for CINV events odds ratios 0.62, 0.71, or 0.71, respectively; p < 0.05. The BC and LC-carboplatin palonosetron groups experienced 50% and 30% fewer CINV days than the generic 5-HT3 RA group p < 0.05.

ConclusionsPatients with breast or lung cancer initiated and maintained on palonosetron were at significantly lower risk for potentially costly CINV versus those on older 5-HT3 RAs. Further studies on impact of step therapy policy are warranted in order to minimize the clinical and economic burden of CINV.

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Author: Swu-Jane Lin - Hind T Hatoum - Deborah Buchner - David Cox - Sanjeev Balu


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