Efficacy and Safety of Different 5-HT3 Receptor Antagonists as Monotherapy for Preventing Nausea and Vomiting in Patients Undergoing Surgery or Chemotherapy: A Network Meta-Analysis of Randomized Controlled Trials.

This study aims to compare the efficacy and safety of different 5-HT3 receptor antagonists as monotherapy for nausea and vomiting in patients undergoing surgery or chemotherapy. A thorough search of various electronic databases was conducted to determine the randomized controlled trials comparing the efficacy and safety of different 5-HT3 receptor antagonists as monotherapy for preventing nausea and vomiting in patients undergoing surgery or chemotherapy. Primary outcomes included nausea, vomiting, and adverse events. A network meta-analysis was performed to compare each outcome. Seventeen trials were included in this study. For the control of nausea, palonosetron was the optimal choice among 5-HT3 receptor antagonists (surface under the cumulative ranking curve, SUCRA = 86.95%), regardless of whether the patients were undergoing surgery (SUCRA = 82.04%) or chemotherapy (SUCRA = 71.63%). As for controlling vomiting, palonosetron was still the optimal choice among different 5-HT3 receptor antagonists (SUCRA = 80.87%). In surgical patients, granisetron was the most effective in controlling vomiting (SUCRA = 88.04%). When considering the drug doses, palonosetron 0.25 mg was the optimal regimen for controlling both nausea and vomiting. In terms of safety, palonosetron 0.25 mg and granisetron 3 mg were the safest regimens among different 5-HT3 receptor antagonists. Among the various 5-HT3 receptor antagonists, palonosetron at a dosage of 0.25 mg emerged as the optimal choice for chemotherapy patients, while granisetron at a dosage of 3 mg proved to be the best option for surgical patients, taking into account both efficacy and safety. The study protocol was registered with PROSPERO (CRD42024552117).