Prophylactic dexamethasone for prevention of opioid-induced nausea and vomiting in cancer patients: a randomised controlled trial (DEX-OINV Trial).
Suhana Sulfiker, Seema Mishra, Ajay Ram A et al.
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In 30 seconds
This open-label randomised controlled trial at a tertiary cancer centre evaluated prophylactic oral dexamethasone in opioid-naïve adults with cancer starting oral morphine. Among 150 randomised patients, mean nausea severity was lower with dexamethasone than with no prophylaxis on Day 1 (1.36 vs 2.93) and Day 5 (0.74 vs 1.53; both p ≤ 0.01). The Day 1 number needed to treat to prevent one episode of clinically meaningful nausea (NRS ≥ 4) was 5. Vomiting episodes were also reduced on Day 1. No serious adverse events occurred.
Key findings
- Mean nausea severity was lower with dexamethasone on Day 1 (1.36 vs 2.93) and Day 5 (0.74 vs 1.53; both p ≤ 0.01).
- The Day 1 number needed to treat to prevent one episode of clinically meaningful nausea (NRS ≥ 4) was 5.
- After adjustment, dexamethasone remained associated with lower odds of nausea on Day 1 (aOR 0.38, 95% CI 0.19-0.75).
- Vomiting episodes were significantly reduced on Day 1; no serious adverse events occurred.
Why it matters
Nausea and vomiting can complicate opioid initiation in cancer care. This trial provides randomised evidence that prophylactic dexamethasone may reduce early nausea severity and Day 1 vomiting when oral morphine is started, with no serious adverse events reported. The findings add evidence in a setting where the abstract describes prophylaxis data as limited.
What to keep in mind
The trial was open-label and conducted at a single tertiary cancer centre. The authors state that the findings warrant confirmation in larger multicentre trials.