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Patient outcomes after therapeutic interchange of dolasetron for granisetron.

The impact of using therapeutic interchange (TI) of dolasetron for granisetron for the prevention of chemotherapy-induced nausea and vomiting (CINV) was evaluated. An outcomes evaluation was conducted in two cohorts of adult outpatients who had not previously received chemotherapy. Before the interchange, 20 patients were enrolled in a granisetron cohort, and after the interchange to dolasetron, 42 patients were matched to the initial cohort. Evaluations using the modified Functional Life Index--Emesis (MFLIE) compared changes in functional status before and after treatment. Nausea and vomiting frequency, satisfaction with antiemetics, reported adverse effects, changes in antiemetic therapy, and the use of antiemetics postchemotherapy were also evaluated. Success, defined as no vomiting and less than a 2.5-unit change in MFLIE score, was demonstrated in 45% of granisetron patients and 40% of dolasetron patients (p = 0.461). While functional status declined in both groups in response to chemotherapy, the changes in MFLIE scores did not differ between agents (-16.8 +/- 20.16 versus -19.39 +/- 26.36 in granisetron and dolasetron patients, respectively) (p = 0.650). Patients were equally satisfied with their prescribed antiemetic therapy, although less than half of patients achieved antiemetic success in the 72-hour study period. Self-reported adverse events attributed to serotonin type 3-receptor antagonist use were minimal and not significantly different between groups. The TI did not negatively affect patient outcomes and produced savings of $143,534 in the first year of the program. TI of dolasetron for granisetron for CINV did not affect functional status, nausea control, or patient satisfaction with antiemetic therapy.