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Nausea and VomitingPhase 2/3AFTR NV RCTNCT06382012

Antiemetic Fosaprepitant To Remedy Nausea and Vomiting

A Phase 2/3 study testing Fosaprepitant 150 mg and Ondansetron 4 mg in people with Nausea and Vomiting and Nausea, run by Montefiore Medical Center at 1 site in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The study team proposes a randomized, double-blind, RCT to address the following goal: to determine the relative efficacy and adverse event profile of fosaprepitant compared to the standard of care antiemetic ondansetron. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Nausea and Vomiting, Nausea, Vomiting
What is being tested?
Fosaprepitant 150 mg and Ondansetron 4 mg
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
200 participants
Where
1 siteUnited States
Study dates
13 Nov 2024to Mar 2027
Phase
Phase 2/3
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adults at least 18 years old
  • Present to an emergency department (ED) for nausea and/or vomiting as defined by the International Classification of Diseases (ICD-10), or identified by treating clinician
  • Following the approval of a protocol amendment, study patients who have received an antiemetic and remain persistently nauseated after 2 hours will be eligible to participate in the study

Who cannot join

  • Pregnancy, desiring pregnancy, or lactating
  • Antiemetic medication use less than 2 hours prior to screening
  • Bradycardia (heart rate less than 60 bpm heart rate)
  • Prolonged QTc (>480ms)
  • Not conversant in English or Spanish
  • Altered mental status
  • Dementia
  • Lack of phone for follow-up communication

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Mustfa K Manzur, MD MPH MS contact

718-920-6626

mmanzur@montefiore.org

United States1 site, 1 recruiting
  • Montefiore Medical Center (Montefiore and Weiler EDs)

    The Bronx, New York, 10467

    Mustfa K Manzur, MD, 718-920-6626, mmanzur@montefiore.org

    Recruiting

Other trials in United States

About this study

The study team proposes a randomized, double-blind, RCT to address the following goal: to determine the relative efficacy and adverse event profile of fosaprepitant compared to the standard of care antiemetic ondansetron. Fosaprepitant and its active metabolite aprepitant are a relatively new class of antiemetic that exclusively acts in the central nervous system by blocking neurokinin (NK-1) which is a key signaling molecule in the centrally mediated aspects of the vomiting reflex. Currently, fosaprepitant and aprepitant both have only two United Stated Food and Drug Administration (USFDA) approved indications for nausea and vomiting: chemotherapy-induced and postoperative. Neurokinin inhibitors are highly effective and generally well-tolerated. Therefore, this class of medication may be a more appropriate medication for the millions of patients with nausea and vomiting that seek care in EDs. Intravenous fosaprepitant is converted to the active metabolite aprepitant on the order of minutes and is significantly cheaper to procure at this time. The outcome for the efficacy analysis will be no need for additional medication to treat nausea and vomiting within 2 hours of investigational medication administration. The primary outcome for the tolerability analysis will be the development of any new symptom within 2 hours of medication administration.

Read the detailed description

Nausea and vomiting (NV) are common and interrelated conditions. Approximately 50% of adults experience nausea in a given year while 30% of adults experience vomiting over the same period. Of this population of symptomatic individuals with NV, 25% of patients seek care in any healthcare delivery setting. Health Care Utilization Project (HCUP) data indicates that nearly 9.0 million patients seek care for NV in emergency departments (EDs) each year in the United States.

Antiemetics are used to treat NV. Antiemetics currently utilized in the emergency department setting for NV do not always work on the first dose and have a plethora of side effects because of their peripheral mechanism of action outside of the vomiting reflex pathway in the central nervous system. These medications include ondansetron, promethazine, metoclopramide, olanzapine, haloperidol. Chief among these side effects is alteration of an aspect cardiac electrical signaling called the QT segment which represents the duration of ventricular contraction and relaxation. The QT segment is prolonged with commonly used antiemetics which can often be a prelude to cardiac dysrhythmias that are associated with mortality. As a result, patients with NV often have long length-of-stay (LOS) involving supportive care with intravenous fluids or empiric treatment with medications that can potentiate development of cardiac dysrhythmias. This is a problem in busy emergency departments (EDs) struggling to accelerate patient throughput in order to appropriately keep up with patient volume in an under-supplied hospital bed environment nationally.

Fosaprepitant and its active metabolite aprepitant are a relatively new class of antiemetic that exclusively acts in the central nervous system by blocking neurokinin (NK-1) which is a key signaling molecule in the centrally mediated aspects of the vomiting reflex. Currently, fosaprepitant and aprepitant both have only two United Stated Food and Drug Administration (USFDA) approved indications for nausea and vomiting: chemotherapy-induced and postoperative. Neurokinin inhibitors are highly effective and generally well-tolerated. Therefore, this class of medication may be a more appropriate medication for the millions of patients with nausea and vomiting that seek care in EDs. Intravenous fosaprepitant is converted to the active metabolite aprepitant on the order of minutes and is significantly cheaper to procure at this time.

Being tested
Fosaprepitant 150 mg, Ondansetron 4 mg
Keywords
Fosaprepitant, Vomiting, Randomized Control Trial, Ondansetron, Adults
Medical subject headings
Nausea, Vomiting

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Fosaprepitant 150 mgDrug

    Fosaprepitant 150mg IV administered over 15 minutes

  • Ondansetron 4 mgDrug

    Ondansetron 4mg IV administered over 15 minutes

Study groups in NCT06382012
Study groupRoleWhat they receive
Investigational InterventionExperimentalFosaprepitant 150mg IV administered over 15 minutes
Receives: Drug: Fosaprepitant 150 mg
Standard-of-Care InterventionActive comparatorOndansetron 4mg IV administered over 15 minutes
Receives: Drug: Ondansetron 4 mg

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Relief from NV

    Relief from nausea and vomiting will be determined by the intensity of nausea reported by participants following administration of antiemetic. Intensity of nausea will be reported as either "None," "Mild," "Moderate," or "Severe." Relief of nausea and vomiting requires a patient to present with a nausea intensity of either "Severe" or "Moderate," which is then reduced by treatment to at least "Mild" or "None," within two hours of medication administration, without the use or rescue medication. The number/percentage of participants who achieve relief from NV will be summarized by study arm.

    Measured: Within 2 hours of medication administration

  2. Occurrence of any treatment-related adverse event

    The primary safety/tolerability outcome for this study is the occurrence of any treatment related adverse event (TRAE) at 2 hours of medication administration. TRAEs - not including underlying pathology causing NV - and including, but not limited to: appendicitis, small bowel obstruction, constipation, gastroparesis, gastroenteritis, gastritis, will be summarized by study arm

    Measured: 2 hours following medication administration

  3. Requirement for additional medication

    Requirement of any additional medication specifically for treatment of NV at 2 hours of medication administration; the use of rescue medications to treat persistent NV, or other medications such as additional doses or use of adjunct medications will be recorded. The number/percentage of patients who require additional medication will be summarized by study arm.

    Measured: 2 hours following medication administration

Secondary outcomes (6)
  1. Freedom from nausea and vomiting (NV)

    Freedom from nausea and vomiting (NV) will be determined by the intensity of nausea reported by participants following administration of antiemetic. Intensity of nausea will be reported as either "None," "Mild," "Moderate," or "Severe." Sustained freedom from nausea and vomiting requires a patient to present with a nausea intensity of either "Severe" or "Moderate," which is then reduced by treatment to "None" within two hours of medication administration. The number/percentage of patients with freedom from nausea/vomiting (NV) will be measured every 15 minutes for the first 2 hours. The number/percentage of patients with freedom from NV at 2 hours will be summarized by study arm.

    Measured: 2 hours following medication administration

  2. Sustained Relief from nausea and vomiting (NV) (at 24 hours)

    The number/percentage of patients demonstrating relief from nausea/vomiting (NV) will be measured every 15 minutes for the first 2 hours (for assessment of the primary outcome), then during every hour up to the end of the follow up period at 24 hours. Relief from NV is defined as achieving a level of relief of either "Mild" or None" at 2 hours and maintaining that level of "Mild" or "None" for the entire 24-hour period following medication administration, without use of rescue medication. The number/percentage of participants who achieve relief from NV will be summarized by study arm.

    Measured: At 24-hours following medication administration

  3. Sustained NV Freedom (at 24 hours)

    Sustained freedom from nausea and vomiting (NV) will be determined by the intensity of nausea reported by participants following administration of antiemetic. Intensity of nausea will be reported as either "None," "Mild," "Moderate," or "Severe." Sustained freedom from nausea and vomiting requires a patient to present with a nausea intensity of either "Severe" or "Moderate," which is then reduced by treatment to "None" within two hours of medication administration (corresponding secondary outcome), and maintained at this level (i.e., "None") for the entire 24-hour follow-up period, without the use or rescue medication. The number/percentage of participants who achieve sustained freedom from NV will be summarized by study arm.

    Measured: At 24- hours following medication administration

  4. Disposition Plan

    A disposition determination plan will be documented at 4 hours. Patients will be categorized as either having been either "admitted," "discharged," or status "yet to be determined." Categorical data will be summarized by study arm.

    Measured: 4 hours following medication administration

  5. Patient Medication Preference for subsequent episode of NV

    Medication preference will be assessed based on patient's preference for receiving the same antiemetic medication as administered for a subsequent episode of nausea and vomiting. Binary ("Yes" for having the same medication administered, "No" for request of a different medication) responses of patient preference will be summarized by study arm.

    Measured: 24 hours following medication administration

  6. Emergency Department (ED) Length of Stay (LOS)

    ED LOS will be defined as the interval of time from initial presentation to final disposition in the ED, will be determined. Mean LOS results will be summarized by study arm.

    Measured: From initial presentation to disposition in ED, approximately 4 hours

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Apr 2024
  2. Study start13 Nov 2024
  3. Primary completionMar 2027 (estimated)
  4. Study completionMar 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2/3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
200 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06382012
Sponsor's protocol ID
2024-15703
Acronym
AFTR NV RCT
Status last verified
May 2026
First submitted
19 Apr 2024
Last updated
18 May 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Publications

  • Mechanisms and Control of Emesis: A Satellite Symposium of the European Neuroscience Association: Proceedings of an International Meeting Held in Marseille (France), 4-7 September 1992. John Libbey Eurotext

  • Singh P, Yoon SS, Kuo B. Nausea: a review of pathophysiology and therapeutics. Ther Adv Gastroenterol. 2016 Jan;9(1):98-112. doi: 10.1177/1756283X15618131.

    PubMed 26770271
  • Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006 Feb-. Available from http://www.ncbi.nlm.nih.gov/books/NBK52651/

    PubMed 21413206
  • Pourmand A, Mazer-Amirshahi M, Chistov S, Sabha Y, Vukomanovic D, Almulhim M. Emergency department approach to QTc prolongation. Am J Emerg Med. 2017 Dec;35(12):1928-1933. doi: 10.1016/j.ajem.2017.08.044. Epub 2017 Aug 24.

    PubMed 28855066
  • Franklin BJ, Vakili S, Huckman RS, Hosein S, Falk N, Cheng K, Murray M, Harris S, Morris CA, Goralnick E. The Inpatient Discharge Lounge as a Potential Mechanism to Mitigate Emergency Department Boarding and Crowding. Ann Emerg Med. 2020 Jun;75(6):704-714. doi: 10.1016/j.annemergmed.2019.12.002. Epub 2020 Jan 23.

    PubMed 31983501
  • Aapro M, Carides A, Rapoport BL, Schmoll HJ, Zhang L, Warr D. Aprepitant and fosaprepitant: a 10-year review of efficacy and safety. Oncologist. 2015 Apr;20(4):450-8. doi: 10.1634/theoncologist.2014-0229. Epub 2015 Mar 20.

    PubMed 25795636
  • Langford P, Chrisp P. Fosaprepitant and aprepitant: an update of the evidence for their place in the prevention of chemotherapy-induced nausea and vomiting. Core Evid. 2010 Oct 21;5:77-90. doi: 10.2147/ce.s6012.

    PubMed 21042544
  • Furyk JS, Meek RA, Egerton-Warburton D. Drugs for the treatment of nausea and vomiting in adults in the emergency department setting. Cochrane Database Syst Rev. 2015 Sep 28;2015(9):CD010106. doi: 10.1002/14651858.CD010106.pub2.

    PubMed 26411330
  • Yang Y, Yang N, Wu L, Ouyang Q, Fang J, Li J, Liao W, Cai K, Huang J, Li J, Zhang Y, Wang X, Zhang H, Xu N, Zhao Q, Hu X, Li W, Zhong W, Zhong D, Cheng G, Ye S, Zhong M, Wang D, Liu H, Zheng J, Liu X, Xu H, Zhang L. Safety and efficacy of aprepitant as mono and combination therapy for the prevention of emetogenic chemotherapy-induced nausea and vomiting: post-marketing surveillance in China. Chin Clin Oncol. 2020 Oct;9(5):68. doi: 10.21037/cco-20-160.

    PubMed 33161724
  • Tramer MR, Phillips C, Reynolds DJ, McQuay HJ, Moore RA. Cost-effectiveness of ondansetron for postoperative nausea and vomiting. Anaesthesia. 1999 Mar;54(3):226-34. doi: 10.1046/j.1365-2044.1999.00704.x.

    PubMed 10364857

Questions about this trial

What is this clinical trial studying?

A Phase 2/3 study testing Fosaprepitant 150 mg and Ondansetron 4 mg in people with Nausea and Vomiting and Nausea, run by Montefiore Medical Center at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 18 May 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this combined phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Mustfa K Manzur, MD MPH MS (718-920-6626, mmanzur@montefiore.org), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Relief from NV (time frame: Within 2 hours of medication administration). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06382012, which also lists 10 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 May 2026.

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