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

• Published in: BMC health services research 2012-07, Vol.12 (1), p.215-215, Article 215
• Main Authors: Lin, Swu-Jane, Hatoum, Hind T, Buchner, Deborah, Cox, David, Balu, Sanjeev
• Format: Article
• Language: English
• Subjects: Adult; Analysis; Antagonists (Biochemistry); Antiemetics; Antineoplastic Agents - adverse effects; Breast Neoplasms - drug therapy; Cancer; Cancer therapies; Carboplatin - adverse effects; Care and treatment; Chemotherapy; Cisplatin - adverse effects; Codes; Complications and side effects; Cost control; Cyclophosphamide; Demographics; Disease prevention; Drug stores; Drugstores; Female; Health aspects; Health Care Surveys; Health maintenance organizations; HMOs; Hospitalization; Hospitals; Humans; Isoquinolines - therapeutic use; Logistic Models; Lung cancer; Lung Neoplasms - drug therapy; Male; Middle Aged; Nausea; Nausea - chemically induced; Nausea - prevention & control; Older people; Palonosetron; Patients; Pharmacy; Prescription drugs; Quinuclidines - therapeutic use; Regression analysis; Retrospective Studies; Serotonin 5-HT3 Receptor Antagonists - therapeutic use; Studies; Vomiting; Vomiting - chemically induced; Vomiting - prevention & control; Writing
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/1472-6963-12-215

1st generation 5-hydroxytryptamine receptor antagonists (5-HT3 RAs), and palonosetron, a 2nd 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. Patients 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. Eligible 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