Receptor‐Targeted Antiemetic Strategies in Cats: A Systematic Review and Intervention‐Specific Meta‐Analysis

BACKGROUND: Emesis is a common adverse effect in cats receiving alpha-2 adrenergic agonists and opioids and may compromise perioperative welfare and safety. Comparative evidence for feline antiemetic protocols remains limited by heterogeneity in triggers, timing and outcomes. OBJECTIVES: To evaluate receptor-targeted antiemetic strategies in cats and quantitatively synthesise controlled event-level evidence for emesis incidence where appropriate. METHODS: This systematic review followed PRISMA 2020 principles. Controlled feline studies assessing maropitant, ondansetron or metoclopramide for prevention or treatment of emesis were eligible. The primary meta-analysis was restricted to maropitant versus control. Risk ratios (RRs) were pooled on the log scale using a random-effects model with Paule-Mandel estimation and Hartung-Knapp adjustment. RESULTS: = 23.2%; Q = 5.21, p = 0.27; tau = 0.37). Leave-one-out analyses consistently favoured maropitant. The approximate prediction interval was 0.04-1.05, indicating uncertainty about the magnitude of effect in future settings. Ondansetron evidence was limited to two evidence sources and suggested possible timing-dependent benefit, whereas metoclopramide evidence was limited to one directly comparable binary study and was insufficient for pooled inference. CONCLUSIONS: Maropitant currently has the most consistent controlled evidence for reducing emesis incidence in cats under perioperative or induced-emesis conditions. Further adequately powered, blinded and randomised trials using standardised vomiting, retching and nausea outcomes are needed.