The added value of H2 antagonists in premedication regimens during paclitaxel treatment

• Published in: British journal of cancer Vol. 124; no. 10; pp. 1647 - 1652
• Main Authors: Cox, Juul M., van Doorn, Leni, Malmberg, Ruben, Oomen-de Hoop, Esther, Bosch, Tessa M., van den Bemt, Patricia M. L. A., Boere, Ingrid A., Jager, Agnes, Mathijssen, Ron H. J., van Leeuwen, Roelof W. F.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 11.05.2021; Nature Publishing Group
• Subjects: 692/308/575; 692/4028/67/1059/99; 692/700/565/1436/99; 692/700/565/2194; Biomedical and Life Sciences; Biomedicine; Cancer; Cancer Research; Confidence intervals; Dexamethasone; Drug Resistance; Epidemiology; Histamine; Hypersensitivity; Molecular Medicine; Oncology; Paclitaxel; Pharmacy; Prevention; Ranitidine
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/s41416-021-01313-0

Background Ranitidine, a histamine 2 blocker, is the standard of care to prevent hypersensitivity reactions (HSRs) caused by paclitaxel infusion. However, the added value of ranitidine in this premedication regimen is controversial. Therefore, we compared the incidence of HSRs during paclitaxel treatment between a standard regimen including ranitidine and a regimen without ranitidine. Methods This prospective, pre–post interventional, non-inferiority study compared the standard premedication regimen ( N  = 183) with dexamethasone, clemastine and ranitidine with a premedication regimen without ranitidine ( N  = 183). The primary outcome was the incidence of HSR grade ≥3. Non-inferiority was determined by checking whether the upper bound of the two-sided 90% confidence interval (CI) for the difference in HSR rates excluded the +6% non-inferiority margin. Results In both the pre-intervention (with ranitidine) and post-intervention (without ranitidine) group 183 patients were included. The incidence of HSR grade ≥3 was 4.4% ( N  = 8) in the pre-intervention group and 1.6% ( N  = 3) in the post-intervention group: difference −2.7% (90% CI: −6.2 to 0.1). Conclusions As the upper boundary of the 90% CI does not exceed the predefined non-inferiority margin of +6%, it can be concluded that a premedication regimen without ranitidine is non-inferior to a premedication regimen with ranitidine. Clinical Trial Registration www.trialregister.nl ; NL8173.