2026 Eastern States Conference

Title: Aprepitant and fosaprepitant use and the effect on time to discharge in cyclic vomiting syndrome patients 
Authors: Abigail Christman, PharmD; Joel Wagner, PharmD 
Learning Objective: Audience members will be able to describe how use of aprepitant and fosapreptiant effects other antiemetic use for patients with cyclic vomiting syndrome 
 
Overview/Background:
Aprepitant and fosaprepitant are options for abortive therapy in patients with cyclic vomiting syndrome (CVS). The goal of this project was to assess how the updated restriction criteria affected the length of stay of patients with CVS. 
 
Methods:
This is a single-center, retrospective chart review of patients on a pediatric service who received neurokinin-1 receptor antagonists (NK-1 RA) for CVS from 1/1/2022-9/15/2025. Patients who received these medications for chemotherapy-induced nausea were excluded. Patients included had a comparator admission for CVS without receiving NK-1 RA. For patients that did not have a comparator admission, the same characteristics were pulled and assessed separately. A paired t-test was used to analyze the primary outcome. Other outcomes were assessed using descriptive statistics. The primary outcome was hospital length of stay when patients received a NK-1 RA compared to when they did not receive one. Secondary outcomes included time from admission to NK-1 RA use, time from NK-1 RA to discharge, number of agents used prior to NK-1 RA use, and readmissions for CVS within 30 days from discharge. 
  
Results:
There were 13 people that met inclusion criteria for the paired cohort. For baseline characteristics the patients were a majority female (77%), and mostly white (69.2%) with the median age in the NK-1 RA group being 15 years and the median age where no NK-1 RA was given was 14 years The average length of stay for the admissions where patients did not receive an NK-1 RA agent was 4.23 days, and for admissions where they did receive a NK-1 RA agent, the average length of stay was 7 days (p=0.279). Admissions where patients did not receive an NK-1 RA had fewer total antiemetics administrations on average compared to admissions where NK-1 RAs were used (21 vs. 29).  
 
Conclusion:
There was no statistically significant difference in the length of stay in the admissions where an NK-1 RA was given compared to admissions where an NK-1 RA was not given. Patients given an NK-1 RA required more anti-emetics. While length of stay results were not statistically significant, illness severity and being refractory to other treatment modalities may have influenced outcomes. This information will be used to review restriction criteria for the use of NK-1 RA agents in this population.  
 
Self-Assessment Question: 
Do NK-1 RA agents have a place in management of cyclic vomiting syndrome?