Patterns of antiemetic prophylaxis for chemotherapy-induced nausea and vomiting in China
Patterns of antiemetic prophylaxis for chemotherapy-induced nausea and vomiting in China
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DOI：
10.21147/j.issn.1000-9604.2016.02.04
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发表时间：
2016-04-01
影响因子：
5.1
通讯作者：
Ji, Jiafu
中科院分区：
文献类型：
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作者：
Zong, Xianglong;Zhang, Jie;Ji, Jiafu
背景资料：在中国，很少有研究试图在全国范围内评价止吐药治疗化疗引起的恶心和呕吐（CINV）的效果，或评估治疗方案是否符合现行指南。方法：我们检索了中国健康保险研究会（CHIRA）数据库，以确定年龄≥ 18岁并接受中度或高度致吐化疗的癌症患者（分别为MEC和HEC）。采用描述性统计分析患者的特征以及特定止吐方案的使用情况。结果：在纳入研究的14，548例患者中，6，477例接受HEC治疗，8，071例接受MEC治疗。大约89.9%的患者使用止吐药预防急性CINV，71.5%的患者使用止吐药预防迟发性CINV，而9.0%的患者使用止吐药作为补救治疗。与MEC组相比，HEC组接受预防性止吐治疗的迟发性CINV患者比例明显较低（59.4% vs. 81.3%; P < 0.001）。HEC组使用含5-HT 3拮抗剂的混合方案预防急性和迟发性CINV的患者比例略低于MEC组（P = 0.012）;然而，接受含皮质类固醇的混合方案的患者比例较高（P = 0.007）。HEC组半数以上患者服用三种止吐药预防急性和迟发性CINV，但其发生率明显低于MEC组（均P < 0.001）。最后，使用的方案的分析表明，有过度利用的药物在同一类antiemetic.Conclusions：这些研究结果表明，需要更多的关注，治疗延迟CINV，在整体使用和组件的一个典型的治疗方案。
Background: Few studies have attempted to evaluate the use of antiemetic therapy for chemotherapy-induced nausea and vomiting (CINV) at a national level in China or to assess how treatment regimens adhere to current guidelines.Methods: We searched the China Health Insurance Research Association (CHIRA) Database to identify patients with cancer who were >= 18 years old and received either moderately or highly emetogenic chemotherapy (MEC and HEC, respectively) between 2008 and 2012. Patients' characteristics as well as usage of specific antiemetic regimens were analyzed using descriptive statistics.Results: Of the 14,548 patients included in the study, 6,477 received HEC while 8,071 were treated with MEC. Approximately 89.9% used antiemetics prophylactically to prevent acute CINV and 71.5% for delayed CINV while 9.0% were prescribed antiemetics as rescue therapy. A significantly lower proportion of patients treated with HEC received prophylactic antiemetic therapy for delayed CINV as compared to those treated with MEC (59.4% vs. 81.3%; P < 0.001). The HEC group had a slightly lower proportion of patients using a mixed regimen containing a 5-HT3 antagonist to prevent both acute and delayed CINV than the MEC group (P = 0.012); however, a higher proportion received a mixed regimen containing corticosteroids (P = 0.007). Although more than half of the patients in the HEC group took three antiemetics to prevent acute and delayed CINV, these rates were significantly lower than those of the MEC group (both P < 0.001). Finally, analysis of the regimens used revealed that there is over-utilization of drugs within the same class of antiemetic.Conclusions: These findings indicate that more attention is needed for treatment of delayed CINV, in terms of both overall use and the components of a typical treatment regimen.