Individual patient data meta-analysis of NEPA versus aprepitant-based antiemetic regimens for preventing chemotherapy-induced nausea and vomiting

Aim: Because no conclusive data demonstrate superiority among NK₁ receptor antagonists (RA), existing antiemetic guidelines regard them as interchangeable. This individual patient data (IPD) meta-analysis compared the efficacy of NEPA (netupitant/fosnetupitant) and aprepitant/fosaprepitant-based regimens in preventing chemotherapy-induced nausea and vomiting (CINV). Materials & Methods: Head-to-head comparative studies published between 2003 and 2022 that evaluated antiemetic prophylaxis of aprepitant or fosaprepitant versus oral or intravenous (IV) NEPA in patients with various cancers receiving highly (HEC) or moderately emetogenic chemotherapy (MEC) were identified through a literature search. We combined individual patient data to assess complete response (no emesis/no rescue medication) and no significant nausea using a two-stage approach. Results: A total of six studies involving 2,767 patients were included evaluating NEPA plus dexamethasone versus aprepitant/fosaprepitant plus any 5-HT₃RA plus dexamethasone for patients with cancer receiving HEC/MEC. Complete response and no significant nausea rates were similar during the acute (0–24 h) phase but NEPA showed significantly higher rates than aprepitant during the delayed (> 24–120 h) and overall (0–120 h) phases and on Days 3–5 following chemotherapy. Conclusion: Improved CINV prevention was observed with NEPA-based regimens, particularly during Days 3–5, highlighting its potential for managing prolonged nausea and vomiting associated with emerging anticancer targeted therapies.