Ondansetron versus metoclopramide for the management of hyperemesis gravidarum: A systematic review and meta-analysis of randomized controlled trials

Objective: This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to examine the efficacy of ondansetron (intervention) versus metoclopramide (control) in managing pregnant women with hyperemesis gravidarum (HG).
Methods: PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar databases were screened from inception until January 2022. Risk of bias of the included studies was evaluated according to the Cochrane Collaboration tool (version 2). The study outcomes were summarized as mean difference (MD) with 95% confidence interval (CI) under the fixed- or random-effects model.
Results: Five RCTs were included, comprising a total of 695 patients (355 and 340 participants were allocated to ondansetron and metoclopramide, respectively). Four RCTs had an overall “low” risk of bias, whereas one RCT had an overall “some concerns” due to lack of sufficient information about randomization. There was no significant difference between both groups regarding the pregnancy-unique quantification of emesis and nausea (PUQE) score (MD=0.23, 95% CI [-0.42, 0.88], p=0.49), length of hospital stay (MD=-0.17 days, 95% CI [-0.35, 0.02], p=0.08), number of doses of drug received (MD=0.45, 95% CI [-0.08, 0.98], p=0.10), and duration of intravenous fluids (MD=-1.73 hours, 95% CI [-5.79, 2.33], p=0.40).
Conclusion: Among patients with HG, there was no significant difference in efficacy between ondansetron and metoclopramide. Nevertheless, ondansetron is favored over metoclopramide in view of its trending therapeutic efficacy and better safety profile.