New therapies to treat nausea and vomiting: clinical need, progress towards novelty and research challenges.

INTRODUCTION

Despite the availability of drugs which prevent vomiting, treatment gaps in controlling nausea and vomiting remain. New approaches are needed.

AREAS COVERED: We identify unmet clinical needs by examining clinical reviews (last 5-years), adding our experience in drug discovery/emesis research. Mechanisms of nausea and vomiting are given. We identify emerging research and new approaches before discussing the challenges of quantifying nausea and vomiting in future trials.

EXPERT OPINION: As single agents, drugs which prevent vomiting have efficacy in some but not all groups of patients, with NK1 receptor antagonists possessing the widest spectrum of action. Drug combinations have improved efficacy in specific clinical settings. However, treatment gaps remain (e.g. gastroparesis, cyclic vomiting syndrome) and efficacy is lower against nausea compared with vomiting. The latter requires greater attention in trial design and regulatory assessments. The issue of nausea is difficult because in humans it is inadequately quantified (with high temporal resolution), there is a lack of clinical research into nausea, and animal models only measure 'nausea-like behaviours,' with challenges in translating to humans. In drug discovery, more systematic and critical analysis of the pharmacology of the diverse agents which induce or reduce nausea and vomiting may help identify new therapeutic mechanisms.