Efficacy and safety of 1-day versus 3-day dexamethasone for the prophylaxis of chemotherapy-induced nausea and vomiting: a systematic review and meta-analysis of randomized controlled trials

Ronald Chow, David G. Warr, Rudolph M. Navari, May Tsao, Milica Milakovic, Marko Popovic, Leonard Chiu, Henry Lam, Carlo DeAngelis


Background: Dexamethasone is typically administered for multiple days after the start of chemotherapy to prevent delayed chemotherapy-induced nausea and vomiting (CINV). Frequent administration of corticosteroids has been associated with problematic side effects. Reducing the dose and frequency of corticosteroids administered during chemotherapy treatment may be beneficial in reducing the side effects experienced by patients, as long as it is possible to maintain its efficacy in the prophylaxis of CINV. The purpose of the review and meta-analysis is to compare the safety and efficacy of multi-day versus 1-day regimen of dexamethasone.
Methods: A comprehensive literature search was carried out in Ovid MEDLINE, Embase and the Cochrane Central Register of Controlled Trials. The primary endpoints were the proportion of patients achieving complete response and complete control in the acute, delayed and overall phases. Secondary endpoints were the percentage of patients who experienced no nausea, no emesis, no use of rescue medication, no adverse events, no constipation, no headache and no fatigue/insomnia.
Results: Seven randomized controlled trials (RCTs) were included in this meta-analysis, and a total of 659 and 649 patients were randomized to receive dexamethasone on 1 day and 3 days, respectively. The two treatments were equivalent in 16 of 17 endpoints.
Conclusions: Despite the paucity of data in this setting, we find that the 1-day dexamethasone therapy provides a similar efficacy and safety profile as a treatment of 3-day dexamethasone in the prophylaxis of CINV. The similarities in efficacy and safety of the two interventions suggests that 1-day dexamethasone can be administered as an alternative to 3 days.