Intravenous versus oral dexamethasone premedication in preventing paclitaxel infusion hypersensitivity reactions in gynecological malignancies

O'Cathail, S. M. , Shaboodien, R., Mahmoud, S., Carty, K., O'Sullivan, P., Blagden, S., Gabra, H., Whear, S., Kwon, J. S. and Agarwal, R. (2013) Intravenous versus oral dexamethasone premedication in preventing paclitaxel infusion hypersensitivity reactions in gynecological malignancies. International Journal of Gynecologic Cancer, 23(7), pp. 1318-1325. (doi: 10.1097/IGC.0b013e31829f1799) (PMID:23907557)

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Abstract

Objective: Dexamethasone premedication is required with paclitaxel to prevent infusion-related hypersensitivity reactions (HSRs). Both oral dexamethasone (PO-D; 20 mg 12 and 6 hours before paclitaxel) and intravenous dexamethasone (IV-D; 20 mg 30 minutes before paclitaxel) regimens are used. The optimal premedication regimen and management of patients after HSR are unclear. Methods: Data on HSRs in women receiving paclitaxel, 175 mg/m2, every 3 weeks at Imperial College Healthcare Trust from May 2011 to February 2012 were obtained from the pharmacy database. During this period, dexamethasone premedication for paclitaxel was administered orally (PO-D; 20 mg 12 and 6 hours before paclitaxel) from May to August 2011, then changed to intravenous dexamethasone (IV-D; 20 mg 30 minutes before paclitaxel) for 3 months, and then reverted to PO-D from November 2011. There were 93 and 55 patients who received PO-D and IV-D before paclitaxel, respectively. Hypersensitivity reaction rates were pooled with those from published studies for analysis. Gynecologic oncology centers in the UK and Canada were surveyed regarding premedication and post-HSR management. A Markov Monte-Carlo simulation model compared costs and benefits of different strategies. Results: Hypersensitivity reaction rates with PO-D and IV-D were 5.4% (5/93) versus 14.5% (8/55) (P = 0.07) in Imperial College Healthcare Trust patients, and 6.8% (20/290) versus 14.1% (30/212) (P = 0.009) on pooled analysis with data from 2 additional studies (502 patients), respectively. However, IV-D is the most common premedication regimen used in the UK and Canada (48.5% and 34.2% of centers). Post-HSR paclitaxel on a desensitization protocol is a cost-effective alternative to discontinuing paclitaxel altogether. Conclusion: Oral dexamethasone seems to be superior to IV-D in preventing HSRs. Post-HSR patients should be considered for desensitization.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Carty, Mrs Karen and O'Cathail, Dr Sean
Authors: O'Cathail, S. M., Shaboodien, R., Mahmoud, S., Carty, K., O'Sullivan, P., Blagden, S., Gabra, H., Whear, S., Kwon, J. S., and Agarwal, R.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cancer Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:International Journal of Gynecologic Cancer
Publisher:BMJ Publishing Group
ISSN:1048-891X
ISSN (Online):1525-1438

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