A cross-over comparison of nabilone and prochlorperazine for emesis induced by cancer chemotherapy.
Niiranen et al.·American Journal of Clinical OncologyImpact 1.3
GemischtGRADEModerat52 Zitate
Stichproben = 24 Pat.
Dauerzwei konsekutive identische…
KontrolleProchlorperazin 15 mg oral alle 12 Stunden
EndpunktAnzahl der…
Verblindungdoppelblind
DesignRCT (Cross-over)
Cannabinoidthc
Max. Dosis4.0 mg
Applikationoral
”Kernaussage
Nabilon war antiemetisch signifikant wirksamer als Prochlorperazin, jedoch mit erheblich mehr Nebenwirkungen assoziiert.
Zusammenfassung
Cross-over-RCT (n=24 Lungenkrebspatienten unter Chemotherapie); Nabilon 2 mg vs. Prochlorperazin 15 mg oral; Nabilon signifikant überlegen bei Reduktion von Erbrechepisoden (p<0.05); zwei Drittel der Patienten bevorzugten Nabilon. Nebenwirkungen (Schwindel/Koordinationsstörungen) bei ca. 50% der Patienten unter Nabilon; 3 Abbrüche wegen ZNS-Nebenwirkungen.
P
PopulationLungenkrebspatienten unter Chemotherapie, n=24
I
InterventionNabilon 2 mg oral alle 12 Stunden (beginnend am Vorabend der Chemotherapie)
C
KontrolleProchlorperazin 15 mg oral alle 12 Stunden
O
OutcomeNabilon signifikant überlegen gegenüber Prochlorperazin in der Reduktion von Erbrechensereignissen (p nicht explizit genannt); 2/3 der Patienten bevorzugten Nabilon
Vertrauen in die Evidenz
Sehr niedrigNiedrigModeratHoch
Moderat
Dritte von vier GRADE-Stufen, die Effektschätzung ist wahrscheinlich verlässlich.
An anti-emetic drug, nabilone, a synthetic cannabinoid, has been compared with prochlorperazine in 24 lung cancer patients receiving cancer chemotherapy. Each of the drugs studied was given orally every 12 hours, starting the night before chemotherapy, during one of two consecutive identical chemotherapy cycles in accordance with a double-blind cross-over random order assignment. Single doses were 2 mg of nabilone, or 15 mg of prochlorperazine. The chemotherapeutic regimens given included the following drugs in various combinations: cis-platinum, vincristine, cyclophosphamide, adriamycin, vindesine, and etoposide (VP16). Nabilone was significantly superior to prochlorperazine in the reduction of vomiting episodes. Side effects, mainly vertigo, were evident in nearly half of the patients after nabilone, and three patients were withdrawn from the study due to decreased coordination and hallucinations after nabilone. Side effects from prochlorperazine were limited to mild drowsiness in one patient. Two-thirds of the patients preferred nabilone to prochlorperazine. We conclude that nabilone is a moderately effective anti-emetic drug, but that the unpredictability of its side effects call for careful patient information, especially with elderly outpatients. We recommend that at least after the first dose of nabilone, the patient should be kept under close observation during 4 hours.