Background: This evidence review was conducted to inform the accompanying clinical practice guideline on the management of cyclic vomiting syndrome (CVS) in adults. Methods: We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and focused on interventions aimed at prophylactic management and abortive treatment of adults with CVS. Specifically, this evidence review addresses the following clinical questions: (a) Should the following pharmacologic agents be used for prophylaxis of CVS: amitriptyline, topiramate, aprepitant, zonisamide/levetiracetam, or mitochondrial supplements? (b) Should the following pharmacologic agents be used for abortive treatment: triptans or aprepitant?. Results: We found very low-quality evidence to support the use of the following agents for prophylactic and abortive treatment of CVS: amitriptyline, topiramate, aprepitant, zonisamide/levetiracetam, and mitochondrial supplements. We have moderate certainty of evidence for the use of triptans as abortive therapy. We found limited evidence to support the use of ondansetron and the treatment of co-morbid conditions and complementary therapies. Conclusions: This evidence review helps inform the accompanying guideline for the management of adults with CVS which is aimed at helping clinicians, patients, and policymakers, and should improve patient outcomes.
Bibliographical noteFunding Information:
None of the authors had any competing interests. Full disclo‐ sure statement included. Dr. Sharaf was supported by Academy Health DSSF, NY State ECRIP Award, NCI K07CA216326 and NCI R01CA211723. Dr. Sharaf is a paid consultant for the non‐profit Institute for Clinical and Economic Review, Boston, Massachusetts. Dr. Sultan has no financial disclosures.
This work was funded by the Cyclic Vomiting Syndrome Association (CVSA), a non‐profit organization for patients with CVS and their caregivers.
© 2019 The Authors. Neurogastroenterology & Motility Published by John Wiley & Sons Ltd
- cyclic vomiting
- technical review
PubMed: MeSH publication types
- Journal Article