在过去20年的临床实践中，已引入多种方案用于治疗化疗诱发的恶心和呕吐（CINV）。然而，由于许多新方案缺乏直接比较数据，直接比较的数据仍然不充足。在本研究中，通过间接比较，我们提供了对所有用于HEC引起的恶心和呕吐的组合的疗效和安全性的最新估计，从而克服了这一限制。我们检索了在2022年6月30日之前发布在Pubmed、Embase和Cochrane图书馆中的随机对照试验（RCT）。我们包括II-III期的RCTs，包括接受HEC治疗的任何癌症成年人，并比较不同的抗恶心方案预防CINV。主要结局是整体完全缓解（定义为从化疗开始0至120小时内没有呕吐和救援药物的使用）；次要结局包括急性（化疗后0至24小时没有呕吐和使用救援药物）和延迟（24-120小时）反应和不良事件。总共包括53个RCT，招募了22,228名患者。我们将不同的抗恶心方案分为21组。总体而言，含有地塞米松、5HT3拮抗剂、米氮平或奥氮平以及可或吡坦或不含NK拮抗剂的3或4种药物方案在完全反应方面具有最高的有效性概率。含有地塞米松和5-HT3拮抗剂的方案在完成、急性和延迟反应方面最具有效性的概率最低。在我们的网络荟萃分析中，含有奥氮平的四种药物方案显示出完全反应方面的最高有效性概率。在资源有限的情况下，含有奥氮平的三种药物方案是一个有效的选择。©2023 Elsevier Ltd. All rights reserved.

Several regimens have been introduced in clinical practice in the last twenty years to treat chemotherapy-induced nausea and vomiting (CINV). However, direct comparative data remain insufficient, as many new regimes lack head-to-head comparisons. In this study, through an indirect comparison, we overcome this limit by providing the most up-to-date estimate of the efficacy and safety of all combinations used for HEC-induced nausea and vomiting.We retrieved randomized controlled trials (RCTs) published in Pubmed, Embase, and Cochrane Library until June, 30th 2022. We included phase II-III RCTs, including adults with any cancer receiving HEC, and compared different antiemetic regimes to prevent CINV. The primary outcome was the overall complete response (defined as the absence of vomiting and of the use of rescue drugs from 0 to 120 hrs since chemotherapy); secondary outcomes were acute (absence of vomiting and use of rescue medicine 0-24 hrs after chemotherapy) and delayed (24-120 hrs) response and adverse events.A total of 53 RCTs enrolling 22 228 patients were included. We classified the different antiemetic regimes into 21 different groups. Overall, 3- or 4-drug regimens containing a combination of dexamethasone, 5HT3 antagonists, mirtazapine or olanzapine with or without NK antagonists, yielded the highest probability to be the most effective regimen in terms of complete response. Regimens containing a combination of dexamethasone and 5-HT3 antagonist have the lowest probability of being the most effective regimen in terms of complete, acute, and delayed response.In our network meta-analysis, 4-drug regimens with olanzapine displayed the highest probability of efficacy in terms of complete response. A 3-drug regimen with olanzapine represents a valid option in a limited resource context.Copyright © 2023 Elsevier Ltd. All rights reserved.