EFEKTIVITAS ZINGIBER OFFICINALE (EKSTRAK JAHE) SEBAGAI PROFILAKSIS TAMBAHAN DALAM MENURUNKAN KEJADIAN CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING DERAJAT SEDANG-BERAT

dr. Dian Pratiwi, dr. Johan Kurnianda, SpPD, K-HOM.

2013 | Tesis | S2 Kedokteran Klinik

Latar Belakang: Chemotherapy-induced nausea and vomiting (CINV), merupakan salah satu efek samping dapat berdampak pada penurunan kepatuhan terapi dan kualitas hidup. Pencegahan CINV selama ini belum sepenuhnya memberikan perlindungan terhadap kejadian CINV. Penambahan ekstrak jahe diketahui mampu mengurangi kejadian CINV. Tujuan: Mengukur efektifitas ekstrak jahe sebagai profilaksis tambahan pada antiemesis standar ondansetron dan deksametason dalam menurunkan kejadian CINV derajat sedang-berat. Metode: Metode penelitian adalah randomized, placebo controlled trial, double blind dengan populasi 50 pasien karsinoma payudara stadium awal yang berkunjung ke poliklinik Tulip dan yang menjalani kemoterapi di bangsal penyakit dalam RSUP Dr. Sardjito Yogyakarta. Subyek dibagi menjadi 2 kelompok secara acak. Kedua kelompok mendapatkan antiemetik standar ditambah kapsul ekstrak jahe 1 g/hari (terbagi 2 dosis) atau plasebo. Waktu pemberian adalah 3 hari sebelum kemoterapi dilanjutkan sampai 5 hari kemudian terhitung sejak hari pertama mendapat kemoterapi (8 hari) dengan interval 12 jam sebelum makan. Penilaian outcome menggunakan kriteria National Cancer Institute–Common Toxicity Criteria Adverse Events V4.0 (NCI CTCAE V4.0). Hasil penelitian dianalisis dengan chi square dengan nilai p=0.05 dianggap signifikan. Bila tidak terpenuhi syarat untuk chi square dilakukan alternatif dengan Fisher axact test. Hasil: Tidak ada pasien yang mengalami CINV derajat ≥3. Kelompok ekstrak jahe yang mengalami acute nausea derajat sedang sebanyak 2/50 (4%) orang dan kelompok plasebo sebanyak 8/50 (16%) orang dengan p=0.037. Delayed nausea derajat sedang dialami lebih banyak pada kelompok plasebo yaitu 14/50 orang (28%) dibandingkan kelompok ekstrak jahe 9/50 (18%) dengan nilai p=0.128. Kejadian acute dan delayed vomiting derajat sedang memiliki frekuensi yang hampir sama (1/50 (2%) vs 3/50 (6%) dengan p=0.305; dan 2/50 (4%) vs 2/50 (4%) dengan p=0.695 secara berurutan). Simpulan: Profilaksis tambahan ekstrak jahe pada antiemesis standar, signifikan menurunkan kejadian acute nausea derajat sedang-berat

Background: Chemotherapy-induced nausea and vomiting (CINV) remains one of the most feared side effects of chemotherapy. It negatively impacts health-related quality of life. Many antiemetic drugs have been employed for their prevention and treatment CINV, but CINV was still not fully prevented. Ginger has been used to treat numerous types of nausea and vomiting and has been studied for its efficacy for CINV. Objective: To assess the efficacy of ginger as add-on a standard antiemetic prophylaxis (5-HT3 RAs-ondansetron and dexamethasone) to reduce the incidence of moderate to severe CINV Method: This study was conducted in Tulip Cancer Clinic and Internal Medicine wards Dr Sardjito Hospital Yogyakarta Indonesia. In this randomized, double-blind, placebo-controlled trial, assigned 50 patients with early stage breast cancer who received the first cycle anthracycline-based chemotherapy. Participants were randomized into 2 arms. All patients received 8 mg 5-HT3 receptor antagonist injection (ondansetron) and 20 mg dexamethasone     injection  on day 1 of cycle to prevent acute CINV plus two 250 mg capsules of ginger   or placebo twice daily antecoenam as add-on for three days administered three days before   the first day of cycle. Dexamethasone 8 mg single dose orally were administered for 3 days starting the same day after chemotherapy completed to prevent delayed CINV as standard prophylaxis plus two 250 mg capsules of ginger   or placebo twice daily ante-coenam as add-on for five days on day 4 continuing previous administering . Outcome was measured with National Cancer Institute–Common Toxicity Criteria Adverse Events V4.0 (NCI CTCAE V4.0). Differences in incidences in two arms were analyzed by the chi-square test and fisher’s exact test respectively. Results: None of participants experienced severe CINV. Acute moderate nausea was observed in 2/50 (4%) in ginger group as compared to 8/50 (16%) in control group (p=0.037). Delayed moderate nausea was more in the control group compared to the ginger group [14/50 (28%) vs 9/50 (18%) respectively (p=0.128)]. Acute and delayed moderate vomiting was observed almost equal in the both groups [(1/50 (2%) vs 3/50 (6%) with p=0.305; and 2/50 (4%) vs 2/50 (4%) with p=0.695 respectively)] Conclusion: Ginger as add-on a standard CINV antiemetic prophylaxis, significantly reduced acute moderate nausea induced by chemotherapy

Kata Kunci : Profilaksis tambahan ekstrak jahe, CINV derajat sedang-berat