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Effect estimates, event rates, and numbers needed to treat (NNT) of meta-analyses examining medical cannabinoids versus placebo or other antiemetics for nausea and vomiting in chemotherapy (or in palliative patients for Mücke et al[1])

Effect estimates, event rates, and numbers needed to treat (NNT) of meta-analyses examining medical cannabinoids versus placebo or other antiemetics for nausea and vomiting in chemotherapy (or in palliative patients for Mücke et al[1])
Systematic review Outcome (comparison) No. of RCTs (no. of participants) Authors' meta-analysis result (95% CI), heterogeneity Meta-analysis re-analyzed (95% CI), heterogeneity Cannabinoid event rate, % Control event rate, % NNT
Whiting et al, 2015[2] Nausea and vomiting—complete response (versus placebo) 3 (102) OR = 3.82 (1.55 to 9.42), I[2] = 0% RR = 2.43 (1.30 to 4.52), I[2] = 0% 47 20 4
Smith et al, 2015[3] Absence of nausea and vomiting (versus placebo) 3 (288) RR = 2.86 (1.76 to 4.65), I[2] = 0% NA 37 12 4
Patient preference (versus placebo) 2 (256) RR = 4.82 (1.74 to 13.36), I[2] = 69% NA 72 18 2
Absence of nausea and vomiting (versus prochlorperazine) 4 (414) RR = 2.00 (0.74 to 5.38), I[2] = 60% NA 20 11 NS
Patient preference (versus other drugs) 9 (799) RR = 2.76 (1.88 to 4.03), I[2] = 61% NA 63 19 3
Mücke et al, 2016[1] Improvement in nausea and vomiting symptoms (versus placebo)* 2 (307) SMD = 0.20 (–0.03 to 0.44), I[2] = 0% NA NA NA NA
Machado Rocha et al, 2008[4] Nausea and vomiting within 1 day of chemotherapy (dronabinol versus placebo) 2 (185) RR = 0.47 (0.19 to 1.16), I[2] = 91% NA 40 87 NS
Nausea and vomiting within 1 day of chemotherapy (dronabinol versus neuroleptics) 5 (325) RR = 0.67 (0.47 to 0.96), I[2] = 79% NA 52 80 4
Nausea and vomiting within 1 day of chemotherapy (nabilone versus neuroleptics) 6 (277) RR = 0.88 (0.72 to 1.08), I[2] = 64% NA 75 85 NS
Tramèr et al, 2001[5] Control of nausea (versus placebo) 4 (231) RelR = 1.21 (1.03 to 1.42), I[2] = NR NA 70 57 8
Control of vomiting (versus placebo) 4 (231) RelR = 1.84 (1.42 to 2.38), I[2] = NR NA 66 36 4
Control of nausea (versus antiemetic) 7 (422) RelR = 1.38 (1.18 to 1.62), I[2] = NR NA 59 43 7
Control of vomiting (versus antiemetic) 6 (395) RelR = 1.28 (1.08 to 1.51), I[2] = NR NA 57 45 9
Patient preference (versus placebo) 4 (404) RelR = 5.67 (3.95 to 8.15), I[2] = NR NA 76 13 2
Patient preference (versus antiemetic) 14 (1212) RelR = 2.39 (2.05 to 2.78), I[2] = NR NA 61 26 3
All studies Control of nausea and vomiting (versus placebo) 7 (500) NA RR = 3.60 (2.55 to 5.09), I[2] = 18% 47 13 3
Control of nausea and vomiting (versus antiemetics) 14 (1022) NA RR = 1.85 (1.18 to 2.91), I[2] = 60% 31 16 7

NA: not applicable; NNT: number needed to treat; NR: not reported; NS: not significant; OR: odds ratio; RCT: randomized controlled trial; RelR: relative risk; RR: risk ratio; SMD: standardized mean difference.

* This was for palliative patients (1 HIV RCT and 1 refractory cancer pain RCT).
References:
  1. Mücke M, Carter C, Cuhls H, et al. Cannabinoids in palliative care: systematic review and meta-analysis of efficacy, tolerability and safety. Schmerz 2016; 30:25.
  2. Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA 2015; 313:2456.
  3. Smith LA, Azariah F, Lavender VT, et al. Cannabinoids for nausea andvomiting in adults with cancer receiving chemotherapy. Cochrane Database Syst Rev 2015; 11:CD009464.
  4. Machado Rocha FC, Stéfano SC, De Cássia Haiek R, et al. Therapeutic use of Cannabis sativa on chemotherapy-induced nausea and vomitingamong cancer patients: systematic review and meta-analysis. Eur J Cancer Care 2008; 17:431.
  5. Tramèr MR, Carroll D, Campbell FA, et al. Cannabinoidsfor control of chemotherapy induced nausea and vomiting: quantitative systematicreview. BMJ 2001; 323:16.

Reproduced with permission from: Allan GM, Finley CR, Ton J, et al. Systematic review of systematic reviews for medical cannabinoids: Pain, nausea and vomiting, spasticity, and harms. Can Fam Physician 2018; 64:e78. Copyright © 2018 The College of Family Physicians of Canada.

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