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Dernoncourt A, Schmidt J, Duhaut P, Liabeuf S, Gras-Champel V, Masmoudi K, Bennis Y, Batteux B. COVID-19 in DMARD-treated patients with inflammatory rheumatic diseases: Insights from an analysis of the World Health Organization pharmacovigilance database. Fundam Clin Pharmacol 2021; 36:199-209. [PMID: 33973280 PMCID: PMC8239613 DOI: 10.1111/fcp.12695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/09/2021] [Accepted: 05/06/2021] [Indexed: 12/31/2022]
Abstract
Background To determine whether the use of disease‐modifying antirheumatic drugs (DMARDs) is linked to the risk of COVID‐19 among patients with inflammatory rheumatic diseases (IRDs). Methods We performed a disproportionality analysis of the World Health Organization pharmacovigilance database between January 1, 2020, and June 10, 2020. The frequency of COVID‐19 reports for all DMARD classes identified was compared with that for all other reports for all other drugs and quoted as the reporting odds ratio (ROR) (95% confidence interval [CI]). Results Among 980,446 individual case‐safety reports voluntarily recorded in the database, 398 identified COVID‐19 in DMARD‐treated patients with IRDs. There were 177 (44.5%) patients with rheumatoid arthritis (RA), 120 (30.1%) with ankylosing spondylitis (AS), 93 (23.4%) with psoriatic arthritis (PsA), and 8 (2.0%) with juvenile idiopathic arthritis. Most of the cases of COVID‐19 occurred in patients taking anti‐TNF agents (84.2%), resulting in a significant disproportionality signal (ROR [95% CI]: 8.31 [7.48–9.23]) – particularly in patients with RA, AS or PsA. A significant inverse disproportionality was found for the anti‐IL‐6 agent tocilizumab (ROR [95% CI]: 0.12 [0.02–0.88]) and JAK inhibitors (ROR [95% CI]: 0.33 [0.19–0.58]) in patients with RA – suggesting that these two drug classes are safer in the context of RA. Conclusion Our results are in line with the literature on a potentially better safety profile for anti‐IL‐6 agents and JAK inhibitors. The WHO pharmacovigilance data suggest that COVID‐19 is significantly more frequent in patients with IRDs treated with TNF inhibitors.
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Affiliation(s)
- Amandine Dernoncourt
- Department of Internal Medicine, Amiens-Picardie University Medical Center, Amiens, France.,RECIF, Amiens-Picardie University Medical Center, Amiens, France
| | - Jean Schmidt
- Department of Internal Medicine, Amiens-Picardie University Medical Center, Amiens, France.,RECIF, Amiens-Picardie University Medical Center, Amiens, France
| | - Pierre Duhaut
- Department of Internal Medicine, Amiens-Picardie University Medical Center, Amiens, France.,RECIF, Amiens-Picardie University Medical Center, Amiens, France
| | - Sophie Liabeuf
- Department of Clinical Pharmacology, Amiens University Medical Center, Amiens, France.,MP3CV Laboratory, Jules Verne University of Picardie, Amiens, France
| | - Valérie Gras-Champel
- Department of Clinical Pharmacology, Amiens University Medical Center, Amiens, France.,MP3CV Laboratory, Jules Verne University of Picardie, Amiens, France
| | - Kamel Masmoudi
- Department of Clinical Pharmacology, Amiens University Medical Center, Amiens, France
| | - Youssef Bennis
- Department of Clinical Pharmacology, Amiens University Medical Center, Amiens, France.,MP3CV Laboratory, Jules Verne University of Picardie, Amiens, France
| | - Benjamin Batteux
- RECIF, Amiens-Picardie University Medical Center, Amiens, France.,Department of Clinical Pharmacology, Amiens University Medical Center, Amiens, France.,MP3CV Laboratory, Jules Verne University of Picardie, Amiens, France.,Department of Rheumatology, Saint-Quentin Medical Center, Saint-Quentin, France
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da Rocha LSN, Bunduki V, de Amorim Filho AG, Cardeal DD, Matushita H, Fernandes HS, Nani FS, de Francisco RPV, de Carvalho MHB. Open fetal myelomeningocele repair at a university hospital: surgery and pregnancy outcomes. Arch Gynecol Obstet 2021; 304:1443-1454. [PMID: 33932174 DOI: 10.1007/s00404-021-06066-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Myelomeningocele (MMC) is an open neural tube defect that causes great morbidity. Prenatal open repair is the standard treatment; however, there are many complications related to the procedure. This study reports preliminary findings of open in utero repair of MMC in a public tertiary hospital in Brazil and describes factors that could be associated with increased surgical morbidity. METHODS Thirty-nine patients underwent open in utero repair of MMC from October 2015 to August 2019. The Clavien-Dindo classification of surgical complications and a classification system with the preterm definitions of the World Health Organization were used, respectively, for maternal and fetal complications. RESULTS A total of 28 mothers (71.8%) and 31 fetuses (79.5%) experienced at least one minor to major complication. Three mothers (7.7%) had a severe grade 4 complication. Fetal complications grades 3 to 5 occurred in 13 fetuses (33.3%). Gestational age at surgery and at birth were 24.88 ± 1.16 weeks and 33.23 ± 3.68 weeks, respectively. Preterm delivery occurred in 30 patients (76.9%), membrane rupture in 18 patients (46.2%) and chorioamnionitis in 13 patients (33.3%). CONCLUSION Open fetal surgery for MMC was performed at a Brazilian public tertiary care center, resulting in three grade 4 maternal complications. Relevant fetal complications were also present. The use of a standard classification system for complications renders studies more comparable and data more useful for counseling patients. Adjustments of perioperative procedures and long-term follow-up are needed to determine the real benefit of open in utero repair of MMC at our hospital.
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Affiliation(s)
- Luana Sarmento Neves da Rocha
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 255 - 10° andar - Cerqueira Cesar, Sao Paulo, CEP 05403-000, Brazil
| | - Victor Bunduki
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 255 - 10° andar - Cerqueira Cesar, Sao Paulo, CEP 05403-000, Brazil
| | - Antônio Gomes de Amorim Filho
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 255 - 10° andar - Cerqueira Cesar, Sao Paulo, CEP 05403-000, Brazil
| | - Daniel Dante Cardeal
- Disciplina de Neurocirurgia, Departamento de Neurologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR, Brazil
| | - Hamilton Matushita
- Disciplina de Neurocirurgia, Departamento de Neurologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR, Brazil
| | - Hermann Santos Fernandes
- Disciplina de Anestesiologia, Departamento de Cirurgia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR, Brazil
| | - Fernando Souza Nani
- Disciplina de Anestesiologia, Departamento de Cirurgia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR, Brazil
| | - Rossana Pulcineli Vieira de Francisco
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 255 - 10° andar - Cerqueira Cesar, Sao Paulo, CEP 05403-000, Brazil
| | - Mário Henrique Burlacchini de Carvalho
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 255 - 10° andar - Cerqueira Cesar, Sao Paulo, CEP 05403-000, Brazil.
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Dey A, Wang H, Quinn H, Pillsbury A, Glover C, Hickie M, Wood N, Beard F, Macartney K. Surveillance of adverse events following immunisation in Australia annual report, 2019. ACTA ACUST UNITED AC 2021; 45. [PMID: 33934694 DOI: 10.33321/cdi.2021.45.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract This report summarises Australian spontaneous surveillance data for adverse events following immunisation (AEFI) for 2019 reported to the Therapeutic Goods Administration (TGA) and describes reporting trends over the 20-year period from 1 January 2000 to 31 December 2019. There were 3,782 AEFI records for vaccines administered in 2019, an annual AEFI reporting rate of 14.9 per 100,000 population. There was an 11.8% decrease in the overall AEFI reporting rate in 2019 compared to 2018 (16.9 per 100,000 population). This decrease in the AEFI reporting rate in 2019 was mainly attributable to a decline in reported adverse events related to the human papillomavirus (HPV), dTpa, meningococcal ACWY and seasonal influenza vaccines. AEFI reporting rates for most individual vaccines in 2019 were similar to 2018. The most commonly-reported adverse events were injection site reaction (35.8%), rash (16.6%), pyrexia (15.3%), vomiting (8.1%), urticaria (5.8%), pain (5.8%) and headache (5.7%). There were five deaths reported to the TGA. In one report, the timing and clinical findings were consistent with a causal association with vaccination. In the remaining four reports, no clear causal relationship with vaccination was found.
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Affiliation(s)
- Aditi Dey
- National Centre for Immunisation Research and Surveillance, The University of Sydney and The Children's Hospital at Westmead, Sydney, Australia
| | - Han Wang
- National Centre for Immunisation Research and Surveillance, The University of Sydney and The Children's Hospital at Westmead, Sydney, Australia
| | - Helen Quinn
- National Centre for Immunisation Research and Surveillance, The University of Sydney and The Children's Hospital at Westmead, Sydney, Australia
| | - Alexis Pillsbury
- National Centre for Immunisation Research and Surveillance, The University of Sydney and The Children's Hospital at Westmead, Sydney, Australia
| | - Catherine Glover
- National Centre for Immunisation Research and Surveillance, The University of Sydney and The Children's Hospital at Westmead, Sydney, Australia
| | - Megan Hickie
- Pharmacovigilance and Special Access Branch, Therapeutic Goods Administration, Department of Health, Canberra, Australia
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance, The University of Sydney and The Children's Hospital at Westmead, Sydney, Australia
| | - Frank Beard
- National Centre for Immunisation Research and Surveillance, The University of Sydney and The Children's Hospital at Westmead, Sydney, Australia
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance, The University of Sydney and The Children's Hospital at Westmead, Sydney, Australia
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Hieronymus F, Lisinski A, Eriksson E, Østergaard SD. Do side effects of antidepressants impact efficacy estimates based on the Hamilton Depression Rating Scale? A pooled patient-level analysis. Transl Psychiatry 2021; 11:249. [PMID: 33907188 PMCID: PMC8079707 DOI: 10.1038/s41398-021-01364-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/26/2021] [Accepted: 04/09/2021] [Indexed: 12/14/2022] Open
Abstract
The Hamilton Depression Rating Scale (HDRS-17) measures symptoms that may overlap with common antidepressant side effects (e.g., sexual dysfunction), thus making it possible that side effects of antidepressant treatment are erroneously rated as symptoms of depression, and vice versa. This study uses patient-level data from previously conducted antidepressant treatment trials to assess whether side effect ratings co-vary with HDRS-17 ratings. Data from all HDRS-17-rated, industry-sponsored pre- and post-marketing trials (n = 4647) comparing the serotonin and noradrenaline reuptake inhibitor, duloxetine, to placebo and/or to a selective serotonin reuptake inhibitor were pooled; three studies, which utilised sub-therapeutic doses, did not have symptom-level ratings available and could not be included. Severity was assessed for side effects related to sleep, somatic anxiety, gastrointestinal function, and sexual dysfunction. Analysis of covariance was used to assess the relation between these side effects and ratings of relevant HDRS-17-derived outcome parameters. Side effects related to sleep, somatic anxiety and sexual dysfunction significantly and exclusively associated with higher scores on HDRS-17 items measuring the corresponding domains. Side effects related to gastrointestinal function associated with higher HDRS-17 item scores on all assessed domains. Treatment outcome was significantly related to side effect severity when assessed using HDRS-17-sum (beta 0.32 (0.074), p < 0.001), but not when the HDRS-6-sum-score (beta 0.035 (0.043), p = 0.415) or the depressed mood item (beta 0.007 (0.012), p = .527) were used as effect parameters. That some HDRS-17 items co-vary with common antidepressant side effects suggests some of these adverse events are counted twice, potentially leading to an underestimation of antidepressant efficacy.
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Affiliation(s)
- Fredrik Hieronymus
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. .,Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark.
| | - Alexander Lisinski
- grid.8761.80000 0000 9919 9582Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elias Eriksson
- grid.8761.80000 0000 9919 9582Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Søren Dinesen Østergaard
- grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark ,grid.154185.c0000 0004 0512 597XDepartment of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
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Habarugira JMV, Figueras A. Pharmacovigilance network as an additional tool for the surveillance of antimicrobial resistance. Pharmacoepidemiol Drug Saf 2021; 30:1123-1131. [PMID: 33864401 DOI: 10.1002/pds.5249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/12/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND The WHO Programme for International Drug Monitoring (PIDM) is a large Pharmacovigilance network of countries sharing Adverse Drug Reaction (ADR) reports. Pharmacovigilance Experts have suggested that antimicrobial resistance (AMR) is an overlooked adverse event. We undertook this study to investigate the potential role of Pharmacovigilance databases in the surveillance of AMR. METHODS Using the AWaRe (Access, Watch and Reserve) list and the WHO Priority Pathogens List, we established a list of antimicrobials and carried out a VigiBase search via VigiAccess, looking for ADR reports with Preferred Terms (PTs) that contained AMR-relevant information. Identified Terms were matched with codes from the Medical Dictionary for Regulatory Activities (MedDRA Version 21.1). RESULTS Records on 86 drugs were retrieved with a total of 1 170 751 ADR reports submitted between 1968 and 2018. Seventeen PTs suggesting suspected resistance, ineffectiveness, inappropriate use, or medication error were used to code 15 250 reports. The most frequently used PTs were "Drug Ineffective" (45.6%), "Off label use" (9.5%) and "Pathogen Resistance" (8.9%). A group of six agents (Amoxicillin, Cefalotin, Ciprofloxacin, Clarithromycin, Levofloxacin and Daptomycin) accounted for 38% (n = 5806) of all 15 250 AMR-relevant ADR reports. The PTs most frequently used in 5806 reports were grouped in 4 categories: drug ineffectiveness (62.5%), resistance (19.2%), off-label use (12.1%) and prescription errors (6.2%). CONCLUSION Our findings suggest that Pharmacovigilance databases could serve as a tool in tracking antimicrobial use and resistance especially in settings where laboratory capacity is still in its development stages. National Pharmacovigilance centers could play a proactive role in stimulating the reporting of AMR-relevant ADRs which can serve as a basis for resistance suspicion alerts. Further studies focusing on the narrative and other clinical pharmacology details in ADR reports are required.
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Affiliation(s)
- Jean Marie Vianney Habarugira
- Calls and Grants, European & Developing Countries Clinical Trials Partnership (EDCTP), The Hague, The Netherlands.,Department de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Albert Figueras
- Department de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
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Xie J, Zi W, Li Z, He Y. Ontology-based Precision Vaccinology for Deep Mechanism Understanding and Precision Vaccine Development. Curr Pharm Des 2021; 27:900-910. [PMID: 33238868 DOI: 10.2174/1381612826666201125112131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/08/2020] [Indexed: 11/22/2022]
Abstract
Vaccination is one of the most important innovations in human history. It has also become a hot research area in a new application - the development of new vaccines against non-infectious diseases such as cancers. However, effective and safe vaccines still do not exist for many diseases, and where vaccines exist, their protective immune mechanisms are often unclear. Although licensed vaccines are generally safe, various adverse events, and sometimes severe adverse events, still exist for a small population. Precision medicine tailors medical intervention to the personal characteristics of individual patients or sub-populations of individuals with similar immunity-related characteristics. Precision vaccinology is a new strategy that applies precision medicine to the development, administration, and post-administration analysis of vaccines. Several conditions contribute to make this the right time to embark on the development of precision vaccinology. First, the increased level of research in vaccinology has generated voluminous "big data" repositories of vaccinology data. Secondly, new technologies such as multi-omics and immunoinformatics bring new methods for investigating vaccines and immunology. Finally, the advent of AI and machine learning software now makes possible the marriage of Big Data to the development of new vaccines in ways not possible before. However, something is missing in this marriage, and that is a common language that facilitates the correlation, analysis, and reporting nomenclature for the field of vaccinology. Solving this bioinformatics problem is the domain of applied biomedical ontology. Ontology in the informatics field is human- and machine-interpretable representation of entities and the relations among entities in a specific domain. The Vaccine Ontology (VO) and Ontology of Vaccine Adverse Events (OVAE) have been developed to support the standard representation of vaccines, vaccine components, vaccinations, host responses, and vaccine adverse events. Many other biomedical ontologies have also been developed and can be applied in vaccine research. Here, we review the current status of precision vaccinology and how ontological development will enhance this field, and propose an ontology-based precision vaccinology strategy to support precision vaccine research and development.
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Affiliation(s)
- Jiangan Xie
- Chongqing Engineering Research Center of Medical Electronics and Information Technology, School of Bioinformatics, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Wenrui Zi
- Chongqing engineering research center of medical electronics and information technology, School of Bioinformatics, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Zhangyong Li
- Chongqing engineering research center of medical electronics and information technology, School of Bioinformatics, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Yongqun He
- Unit of Laboratory Animal Medicine, Development of Microbiology and Immunology, Center of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan, United States
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207
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Unexpected beneficial effects of drugs: an analysis of cases in the Dutch spontaneous reporting system. Eur J Clin Pharmacol 2021; 77:1543-1551. [PMID: 33884456 DOI: 10.1007/s00228-021-03142-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 04/11/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Drug use is inherently related to both beneficial effects on health as well as the occurrence of risks. The beneficial effects may be related to efficacy, the treatment range of a product, or even to user-friendliness of a product. However, in addition to the occurrence of adverse drug reactions, a drug can also have an unexpected beneficial effect on a patient's health, not related to the indication for which the drug was used. The aim of this article is to characterize the reports of unexpected beneficial effects of drugs in the Dutch spontaneous reporting system. METHODS A descriptive analysis was used to gain insight in number of reports and drug classes responsible for unexpected beneficial effects of drugs. Grouping of positive side effects into classes was done by a conventional qualitative content analysis of the cases. RESULTS Four hundred nine reports which described unexpected beneficial effects of drugs were included, which mentioned 451 associations between suspected drugs and unexpected beneficial effects. There were 147 drug classes on the 4th ATC level involved. Content analysis of the reports gave rise to 22 categories of unexpected beneficial effects of drugs, including one "other category". DISCUSSION AND CONCLUSION: The analysis showed a diverse spectrum of reported reactions and drugs with some categories of unexpected beneficial effects of drugs mentioned multiple times for certain drug classes on the 4th ATC level. Most of these findings are consistent with the existing literature and knowledge on the pharmacological mechanism of the drugs in question. Coding harmonization would make it possible to study these effects in international databases.
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van Hunsel F, de Jong E, Gross-Martirosyan L, Hoekman J. Signals from the Dutch national spontaneous reporting system: Characteristics and regulatory actions. Pharmacoepidemiol Drug Saf 2021; 30:1115-1122. [PMID: 33840136 DOI: 10.1002/pds.5246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/12/2021] [Accepted: 04/07/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE The aim of the study is to characterise safety signals based on the Dutch spontaneous reporting system (SRS) and to investigate the association between signal characteristics and Product Information (PI) update stratified by approval type: centrally authorised products (CAPs) versus nationally and decentralised authorised products (NAPs). METHODS This study evaluates the full cohort of signals disseminated from the Dutch SRS in the period from 2008 to 2017. Each retrieved signal was characterised on a number of aspects. The signal management process from signal generation to a potential PI update was analysed in four steps: (1) signal characterisation; (2) proposed actions by the Dutch national competent authority (NCA) for the signals; (3) presence of PI update (yes/no) and association with signal characteristics; (4) timing from the moment the signal was issued to PI update. For step 1-3 we stratified products in CAPs and NAPs. RESULTS Of all signals, 88.7% led to a proposed regulatory action by the NCA. Signals from the Dutch SRS for CAPs versus NAPs more often concerned biologicals, important medical events, class effects and shorter periods since marketing authorization. We detected PI updates for 26.2% of CAP signals and 61.3% of NAP signals. CONCLUSIONS The Dutch SRSs remains an important source of signals. There are some notable differences in the characteristics of signals for CAPs versus NAPs. Signals for NAPs more frequently led to PI updates.
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Affiliation(s)
- Florence van Hunsel
- Netherlands Pharmacovigilance Centre Lareb, 's Hertogenbosch, The Netherlands
| | - Emma de Jong
- Netherlands Pharmacovigilance Centre Lareb, 's Hertogenbosch, The Netherlands.,Utrecht University, Utrecht, The Netherlands
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Taylor TRP, Galloway J, Davies R, Hyrich K, Dobson R. Demyelinating Events Following Initiation of Anti-TNFα Therapy in the British Society for Rheumatology Biologics Registry in Rheumatoid Arthritis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/3/e992. [PMID: 33863839 PMCID: PMC8105908 DOI: 10.1212/nxi.0000000000000992] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/22/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To establish the incidence of demyelination in patients who have received anti-tumor necrosis factor alpha (anti-TNFα) therapy, through analysis of adverse events reported in a prospective cohort of patients receiving biological therapies. METHODS A cohort study was performed on prospectively acquired data via the British Society for Rheumatology Biologics Register in Rheumatoid Arthritis. All potential demyelinating events during follow-up were extracted and classified as definite, probable, or possible blinded to treatment data. The point of starting an anti-TNF therapy in individuals with no prior reported demyelination was the time of exposure. Crude rates of demyelination and standardized incident rates (SIRs) compared with the general UK population were calculated. RESULTS Thirty-five individuals with demyelinating events were identified from a total pool of 13,489. The median age at study entry was 44 years, and the median disease duration was 8 years; 71% were female. Events occurred a median of 3 (interquartile range 1-5) years from the start of the first anti-TNF therapy. Twenty-six events occurred in individuals still taking anti-TNFα therapy; of the other 9, 6 were within 90 days of drug withdrawal. The raw incidence of demyelination was 19.7/100,000 patient-years (95% CI 13.7-27.3). The SIR in the whole population was 1.38 (95% CI 0.96-1.92) and 0.83 (0.51-1.26) limited to definite/probable cases. CONCLUSIONS Demyelination following anti-TNF therapy is uncommon. Patients receiving anti-TNFα therapy show a marginally increased SIR; this is lost in sensitivity analyses. Patients concerned about anti-TNFα-associated demyelination can be relatively reassured by these data.
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Affiliation(s)
- Thomas R P Taylor
- From the Preventive Neurology Unit (T.R.P.T., K.H., R. Dobson), Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Centre for Rheumatic Diseases (J.G.), King's College London; Centre for Epidemiology Versus Arthritis (R. Davies, K.H.), The University of Manchester, Manchester Academic Health Science Centre, Manchester; National Institute of Health Research Manchester Biomedical Research Centre (K.H.), Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester; and Department of Neurology (R. Dobson), Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - James Galloway
- From the Preventive Neurology Unit (T.R.P.T., K.H., R. Dobson), Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Centre for Rheumatic Diseases (J.G.), King's College London; Centre for Epidemiology Versus Arthritis (R. Davies, K.H.), The University of Manchester, Manchester Academic Health Science Centre, Manchester; National Institute of Health Research Manchester Biomedical Research Centre (K.H.), Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester; and Department of Neurology (R. Dobson), Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Rebecca Davies
- From the Preventive Neurology Unit (T.R.P.T., K.H., R. Dobson), Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Centre for Rheumatic Diseases (J.G.), King's College London; Centre for Epidemiology Versus Arthritis (R. Davies, K.H.), The University of Manchester, Manchester Academic Health Science Centre, Manchester; National Institute of Health Research Manchester Biomedical Research Centre (K.H.), Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester; and Department of Neurology (R. Dobson), Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Kimme Hyrich
- From the Preventive Neurology Unit (T.R.P.T., K.H., R. Dobson), Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Centre for Rheumatic Diseases (J.G.), King's College London; Centre for Epidemiology Versus Arthritis (R. Davies, K.H.), The University of Manchester, Manchester Academic Health Science Centre, Manchester; National Institute of Health Research Manchester Biomedical Research Centre (K.H.), Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester; and Department of Neurology (R. Dobson), Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Ruth Dobson
- From the Preventive Neurology Unit (T.R.P.T., K.H., R. Dobson), Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Centre for Rheumatic Diseases (J.G.), King's College London; Centre for Epidemiology Versus Arthritis (R. Davies, K.H.), The University of Manchester, Manchester Academic Health Science Centre, Manchester; National Institute of Health Research Manchester Biomedical Research Centre (K.H.), Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester; and Department of Neurology (R. Dobson), Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
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Montastruc JL, Lafaurie M, de Canecaude C, Durrieu G, Sommet A, Montastruc F, Bagheri H. Fatal adverse drug reactions: A worldwide perspective in the World Health Organization pharmacovigilance database. Br J Clin Pharmacol 2021; 87:4334-4340. [PMID: 33837554 DOI: 10.1111/bcp.14851] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS Adverse drug reactions (ADRs) are important causes of death. However, the main involved drugs are relatively unknown. The present study was performed to characterise death-related drugs recorded in a large pharmacovigilance database during the last 10 years. METHODS A retrospective analysis of VigiBase, the World Health Organization pharmacovigilance database, was performed investigating fatal ADRs registered between 1 January 2010 and 31 December 2019 in male and female patients aged ≥18 years and reported by physicians. Analyses were descriptive investigating age, sex and suspected drugs. Differences in reporting according to sex, age and continents were investigated using disproportionality analysis with calculation of reporting odds ratio and its 95% confidence interval. RESULTS Among the 23 millions ADRs recorded in VigiBase, 3 250 967 were included with 43 685 fatal. They were reported mainly in patients older than 75 years. The 3 most frequently involved drug classes were antineoplastic/immunomodulating drugs followed by nervous system and cardiac drugs. The top 3 individual drugs were denosumab, lenalidomide and thalidomide with marked differences according to age, sex, continents and countries. The risk of reporting fatal ADRs was higher in males, in the Americas and in patients ≥65 years. CONCLUSION Fatal ADRs registered in a large pharmacovigilance database during the last 10 years correspond to just over 1% of the total number of ADRs. They occurred more in males, after 65 years and with antineoplastic/immunomodulating drugs in general. Our study also highlighted, for the first time, important differences in fatal ADRs between continents and countries.
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Affiliation(s)
- Jean-Louis Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre de PharmacoVigilance de Pharmacoépidémiologie et d'Informations sur le Médicament, CIC INSERM, Centre Hospitalier Universitaire-Faculté de Médecine de Toulouse, 1436, France
| | - Margaux Lafaurie
- Service de Pharmacologie Médicale et Clinique, Centre de PharmacoVigilance de Pharmacoépidémiologie et d'Informations sur le Médicament, CIC INSERM, Centre Hospitalier Universitaire-Faculté de Médecine de Toulouse, 1436, France
| | - Claire de Canecaude
- Service de Pharmacologie Médicale et Clinique, Centre de PharmacoVigilance de Pharmacoépidémiologie et d'Informations sur le Médicament, CIC INSERM, Centre Hospitalier Universitaire-Faculté de Médecine de Toulouse, 1436, France
| | - Geneviève Durrieu
- Service de Pharmacologie Médicale et Clinique, Centre de PharmacoVigilance de Pharmacoépidémiologie et d'Informations sur le Médicament, CIC INSERM, Centre Hospitalier Universitaire-Faculté de Médecine de Toulouse, 1436, France
| | - Agnès Sommet
- Service de Pharmacologie Médicale et Clinique, Centre de PharmacoVigilance de Pharmacoépidémiologie et d'Informations sur le Médicament, CIC INSERM, Centre Hospitalier Universitaire-Faculté de Médecine de Toulouse, 1436, France
| | - François Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre de PharmacoVigilance de Pharmacoépidémiologie et d'Informations sur le Médicament, CIC INSERM, Centre Hospitalier Universitaire-Faculté de Médecine de Toulouse, 1436, France
| | - Haleh Bagheri
- Service de Pharmacologie Médicale et Clinique, Centre de PharmacoVigilance de Pharmacoépidémiologie et d'Informations sur le Médicament, CIC INSERM, Centre Hospitalier Universitaire-Faculté de Médecine de Toulouse, 1436, France
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211
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Campillo JT, Boussinesq M, Bertout S, Faillie JL, Chesnais CB. Serious adverse reactions associated with ivermectin: A systematic pharmacovigilance study in sub-Saharan Africa and in the rest of the World. PLoS Negl Trop Dis 2021; 15:e0009354. [PMID: 33878105 PMCID: PMC8087035 DOI: 10.1371/journal.pntd.0009354] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/30/2021] [Accepted: 04/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ivermectin is known to cause severe encephalopathies in subjects infected with loiasis, an endemic parasite in Sub-Saharan Africa (SSA). In addition, case reports have described ivermectin-related serious adverse drug reactions (sADRs) such as toxidermias, hepatic and renal disorders. The aim of this study was to identify suspected sADRs reported after ivermectin administration in VigiBase, the World Health Organization's global individual case safety reports database and analyze their frequency relative to the frequency of these events after other antinematodal drugs reported in SSA and other areas of the world (ROW). METHODS All antinematodal-related sADRs were extracted from VigiBase. Disproportionality analyses were conducted to investigate nervous, cutaneous, psychiatric, respiratory, renal, hepatic and cardiac suspected sADRs reported after ivermectin and benzimidazole drug administration across the world, in SSA and RoW. PRINCIPAL FINDINGS 2041 post-ivermectin or post-benzimidazole suspected sADRs were identified including 667 after ivermectin exposure (208 in SSA and 459 in the RoW). We found an increased reporting for toxidermias, encephalopathies, confusional disorders after ivermectin compared to benzimidazole drug administration. Encephalopathies were not only reported from SSA but also from the RoW (adjusted reporting odds ratios [aROR] 6.30, 95% confidence interval: 2.68-14.8), highlighting the fact these types of sADR occur outside loiasis endemic regions. CONCLUSION We described for the first time suspected sADRs associated with ivermectin exposure according to geographical origin. While our results do not put in question ivermectin's excellent safety profile, they show that as for all drugs, appropriate pharmacovigilance for adverse reactions is indicated.
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Affiliation(s)
- Jérémy T. Campillo
- TransVIHMI, Université Montpellier, Institut de Recherche pour le Développement (IRD), INSERM, Montpellier, France
- Department of medical pharmacology and toxicology, CHU Montpellier, Montpellier, France
| | - Michel Boussinesq
- TransVIHMI, Université Montpellier, Institut de Recherche pour le Développement (IRD), INSERM, Montpellier, France
| | - Sébastien Bertout
- TransVIHMI, Université Montpellier, Institut de Recherche pour le Développement (IRD), INSERM, Montpellier, France
- Laboratoire de Parasitologie et Mycologie Médicale, Université de Montpellier, Montpellier, France
| | - Jean-Luc Faillie
- Department of medical pharmacology and toxicology, CHU Montpellier, Montpellier, France
- EA 2415, IDESP, University of Montpellier, Montpellier, France
| | - Cédric B. Chesnais
- TransVIHMI, Université Montpellier, Institut de Recherche pour le Développement (IRD), INSERM, Montpellier, France
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Eugene AR, Eugene B, Masiak M, Masiak JS. Head-to-Head Comparison of Sedation and Somnolence Among 37 Antipsychotics in Schizophrenia, Bipolar Disorder, Major Depression, Autism Spectrum Disorders, Delirium, and Repurposed in COVID-19, Infectious Diseases, and Oncology From the FAERS, 2004-2020. Front Pharmacol 2021; 12:621691. [PMID: 33841149 PMCID: PMC8027114 DOI: 10.3389/fphar.2021.621691] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/02/2021] [Indexed: 11/21/2022] Open
Abstract
Objective: Antipsychotic compounds are known to induce sedation somnolence and have expanded clinical indications beyond schizophrenia to regulatory approval in bipolar disorder, treatment-resistant depression, and is being repurposed in infectious diseases and oncology. However, the medical sciences literature lacks a comprehensive association between sedation and somnolence among a wide-range of antipsychotic compounds. The objective of this study is to assess the disproportionality of sedation and somnolence among thirty-seven typical and atypical antipsychotics. Materials and Methods: Patient adverse drug reactions (ADR) cases were obtained from the United States Food and Drug Administration Adverse Events Reporting System (FAERS) between January 01, 2004 and September 30, 2020 for a wide-array of clinical indications and off-label use of antipsychotics. An assessment of disproportionality were based on cases of sedation and somnolence and calculated using the case/non-case methodology. Statistical analysis resulting in the reporting odds-ratio (ROR) with corresponding 95% confidence intervals (95% CI) were conducted using the R statistical programming language. Results: Throughout the reporting period, there were a total of 9,373,236 cases with 99,251 specific ADRs reporting sedation and somnolence. Zuclopenthixol (n = 224) ROR = 13.3 (95% CI, 11.6–15.3) was most strongly associated of sedation and somnolence and haloperidol decanoate long-acting injection (LAI) was not statistically associated sedation and somnolence. Further, among atypical antipsychotic compounds, tiapride and asenapine were the top two compounds most strongly associated with sedation and somnolence. Comprehensively, the typical antipsychotics ROR = 5.05 (95%CI, 4.97–5.12) had a stronger association with sedation and somnolence when compared to atypical antipsychotics ROR = 4.65 (95%CI, 4.47–4.84). Conclusion: We conducted a head-to-head comparison of thirty-seven antipsychotics and ranked the compounds based on the association of sedation and somnolence from ADR data collected throughout 16 years from the FAERS. The results are informative and with recent interests in repurposing phenothiazine antipsychotics in infectious disease and oncology provides an informative assessment of the compounds during repurposing and in psychopharmacology.
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Affiliation(s)
- Andy R Eugene
- Independent Neurophysiology Unit, Department of Psychiatry, Medical University of Lublin, Lublin, Poland
| | | | | | - Jolanta Sylwia Masiak
- Independent Neurophysiology Unit, Department of Psychiatry, Medical University of Lublin, Lublin, Poland.,Medical Center, Lublin, Poland.,II Department of Psychiatry and Psychiatric Rehabilitation, Medical University of Lublin, Lublin, Poland
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213
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Barbieri MA, Cutroneo PM, Baratelli C, Cicala G, Battaglia A, Santoro V, Andò G, Spina E. Adverse drug reactions with oral anticoagulants: data from sicilian spontaneous reporting system database. J Clin Pharm Ther 2021; 46:1027-1040. [PMID: 33646603 DOI: 10.1111/jcpt.13391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/07/2021] [Accepted: 02/09/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Direct oral anticoagulants (DOACs) were developed to avoid the limitations of vitamin K antagonists (VKAs). DOACs are associated with a greater incidence of gastrointestinal bleeding and a smaller number of intracranial haemorrhages than VKAs. Therefore, it is important to deepen our knowledge of their safety profiles. The aim of this study was thus to analyse adverse drug reaction (ADR) reports on DOACs and VKAs using the Sicilian Spontaneous Reporting System (SRS) database. METHODS All ADR reports with DOACs and VKAs as suspected drugs that were entered into the Sicilian SRS database during the period 2001-2019 were selected. In detail, all reports with the following single active substances were included: dabigatran etexilate, rivaroxaban, apixaban and edoxaban; acenocoumarol and warfarin were included as a comparator group. Descriptive statistical methodology was used to evaluate characteristics of the reported cases with a case-by-case assessment. RESULTS AND DISCUSSION Out of 521 reports related to anticoagulants, 444 (85.2%) and 77 (14.8%) involved DOACs and VKAs, respectively. DOAC-related reports were mainly of gastrointestinal disorders. In contrast, VKAs were mostly associated with blood and lymphatic system disorders, injury, investigations and vascular disorders. Many more cases of ADRs in the form of gastrointestinal disorders concerned dabigatran etexilate (n = 179, 73.7%) than the other DOACs, while ADRs in the form of blood disorders were mainly associated with acenocoumarol (n = 27, 57.4%). The most commonly reported Preferred Terms for DOACs were dyspepsia (n = 89, 17.1%), upper abdominal pain (n = 41, 9.2%) and pruritus (n = 26, 5.8%), whereas for VKAs, they were anaemia (n = 21, 27.3%) and hypocoagulable state (n = 18, 3.5%). Potentially interacting concomitant medications particularly included antithrombotic agents (n = 19, 4.3%) for DOACs and proton-pump inhibitors (PPIs) (n = 37, 48.1%) and antithrombotic agents (n = 13, 16.9%) for VKAs. CONCLUSION The ADRs most commonly associated with DOACs, especially dabigatran, were gastrointestinal disorders, particularly gastrointestinal bleeding. Our study also highlights the potential role of drug-drug interactions in the ADRs. The cases of gastrointestinal bleeding highlight the need for careful prescribing of DOACs and use of potentially interacting concomitant drugs.
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Affiliation(s)
| | - Paola Maria Cutroneo
- Sicilian Regional Pharmacovigilance Centre, University Hospital of Messina, Messina, Italy
| | - Chiara Baratelli
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Cicala
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alessandro Battaglia
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vincenza Santoro
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Andò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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214
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Du R, Wang X, Ma L, Larcher LM, Tang H, Zhou H, Chen C, Wang T. Adverse reactions of targeted therapy in cancer patients: a retrospective study of hospital medical data in China. BMC Cancer 2021; 21:206. [PMID: 33639888 PMCID: PMC7916285 DOI: 10.1186/s12885-021-07946-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/21/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The adverse reactions (ADRs) of targeted therapy were closely associated with treatment response, clinical outcome, quality of life (QoL) of patients with cancer. However, few studies presented the correlation between ADRs of targeted therapy and treatment effects among cancer patients. This study was to explore the characteristics of ADRs with targeted therapy and the prognosis of cancer patients based on the clinical data. METHODS A retrospective secondary data analysis was conducted within an ADR data set including 2703 patients with targeted therapy from three Henan medical centers of China between January 2018 and December 2019. The significance was evaluated with chi-square test between groups with or without ADRs. Univariate and multivariate logistic regression with backward stepwise method were applied to assess the difference of pathological characteristics in patients with cancer. Using the univariate Cox regression method, the actuarial probability of overall survival was performed to compare the clinical outcomes between these two groups. RESULTS A total of 485 patients were enrolled in this study. Of all patients, 61.0% (n = 296) occurred ADRs including skin damage, fatigue, mucosal damage, hypertension and gastrointestinal discomfort as the top 5 complications during the target therapy. And 62.1% of ADRs were mild to moderate, more than half of the ADRs occurred within one month, 68.6% ADRs lasted more than one month. Older patients (P = 0.022) and patients with lower education level (P = 0.036), more than 2 comorbidities (P = 0.021), longer medication time (P = 0.022), drug combination (P = 0.033) and intravenous administration (P = 0.019) were more likely to have ADRs. Those with ADRs were more likely to stop taking (P = 0.000), change (P = 0.000), adjust (P = 0.000), or not take the medicine on time (P = 0.000). The number of patients with recurrence (P = 0.000) and metastasis (P = 0.006) were statistically significant difference between ADRs and non-ADRs group. And the patients were significantly poor prognosis in ADRs groups compared with non-ADRs group. CONCLUSION The high incidence of ADRs would affect the treatment and prognosis of patients with cancer. We should pay more attention to these ADRs and develop effective management strategies.
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Affiliation(s)
- Ruofei Du
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001 China
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 China
- School of Medical Sciences, Zhengzhou University, Zhengzhou, 450001 China
| | - Xin Wang
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001 China
| | - Lixia Ma
- School of Statistics, Henan University of Economics and Law, Zhengzhou, 450046 China
| | - Leon M. Larcher
- Centre for Comparative Genomics, Murdoch University, Perth, WA 6150 Australia
| | - Han Tang
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001 China
| | - Huiyue Zhou
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001 China
| | - Changying Chen
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 China
| | - Tao Wang
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001 China
- Centre for Comparative Genomics, Murdoch University, Perth, WA 6150 Australia
- Hebi People’s Hospital, Hebi, 458030 China
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215
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Gras M, Gras-Champel V, Moragny J, Delaunay P, Laugier D, Masmoudi K, Liabeuf S. Impact of the COVID-19 outbreak on the reporting of adverse drug reactions associated with self-medication. ANNALES PHARMACEUTIQUES FRANÇAISES 2021; 79:522-529. [PMID: 33631179 PMCID: PMC7899020 DOI: 10.1016/j.pharma.2021.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/09/2021] [Accepted: 02/16/2021] [Indexed: 11/21/2022]
Abstract
Objectives The primary objective of the present study was to describe the characteristics of adverse drug reactions (ADRs) linked to self-medication that were notified to the French Pharmacovigilance Database (FPVD) during the COVID-19 outbreak in 2020 first wave. The secondary objective was to compare the characteristics of these ADRs in 2020 with those notified during the same calendar period a year previously. Material and methods We analyzed ADRs recorded in the FPVD between March 15th and May 31st, 2020 vs. the same dates in 2019. Only ADRs linked to self-medication were analyzed. Descriptive statistics were used to obtain an overview of the types and characteristics of these ADRs. Results Of 3114 ADRs notified to the FPVD during the COVID-19 period in 2020, 114 (3.7%) were linked to self-medication. The equivalent proportion in 2019 was 1.6% (113 out of 7097). Half of the ADRs notified in 2020 were “serious”. The median age of affected patients was 30.5, and 22% of the ADRs concerned children. Of the 114 ADRs linked to self-medication, 107 (66%) were for prescription-only drugs. The three mostly frequently suspected ATC classes were analgesics, psycholeptics, and antibacterials for systemic use. The most frequent ADRs were general disorders, gastrointestinal disorders, and nervous system disorders. The main difference between the non-COVID-19 period and the COVID-19 period was the higher proportion of medication errors during the latter. Conclusion The present study is the first to have reported on ADRs linked to self-medication and notified during a COVID-19 outbreak. Further studies of self-medication patterns and their consequences in a pandemic context are mandatory and effective information on medication use (including self-medication and its dangers) during a pandemic is essential.
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Affiliation(s)
- M Gras
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France
| | - V Gras-Champel
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France; MP3CV Laboratory, EA7517, Jules-Verne University of Picardie, Amiens, France
| | - J Moragny
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France
| | - P Delaunay
- Department of Clincal Pharmacology and Vigilances, Poitiers University Hospital, Poitiers, France
| | - D Laugier
- Regional Pharmacovigilance Centre Marseille - Provence - Corse, Sainte-Marguerite Hospital, AP-HM, Marseille, France
| | - K Masmoudi
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France
| | - S Liabeuf
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France; MP3CV Laboratory, EA7517, Jules-Verne University of Picardie, Amiens, France.
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216
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Safety profile of chimeric antigen receptor T-cell immunotherapies (CAR-T) in clinical practice. Eur J Clin Pharmacol 2021; 77:1225-1234. [PMID: 33608749 PMCID: PMC8275491 DOI: 10.1007/s00228-021-03106-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
Purpose Two chimeric antigen receptor T-cell (CAR-T) therapies have been approved in the United States (USA) in 2017 and Europe (EU) in 2018: axicabtagene ciloleucel and tisagenlecleucel. They contain the patient’s own T cells, which are extracted, genetically modified, and reinfused. Alongside the good efficacy results, the assessment of safety profile of these new therapies represents a great challenge. Our aim was to analyze the reports of the adverse drug reactions (ADR) after CAR-T administration as occurred in the real clinical setting. Methods We performed a retrospective observational study, collecting all the reports in EU (EudraVigilance, EV) and US (FAERS) databases of ADRs regarding axicabtagene ciloleucel and tisagenlecleucel. Both descriptive and statistical analyses were performed, the latter by using Reporting Odds Ratio (ROR). Results A total number of 1426 reports of suspected ADRs were retrieved in EudraVigilance and FAERS. Patients’ reported age reflected the age range for which the drugs are approved (18–64 years for axicabtagene ciloleucel and patients aged under 25 years for tisagenlecleucel). The most reported event was cytokine release syndrome (CRS), 185 events for tisagenlecleucel and 462 for axicabtagene ciloleucel in FAERS and 137 and 498, respectively, in EudraVigilance. A disproportionality was found comparing axicabtagene ciloleucel with tisagenlecleucel for the above-mentioned event: EV ROR 2.47, 95% CI 2.22–2.74, FAERS 1.89, 1.70–2.10. Conclusion CRS represents the major problem with the administration of CAR-T therapies. Our analysis has not revealed new ADRs; however, it supports the safety profile of CAR-T with new data from real clinical setting.
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217
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Liang S, Yu H. Revealing new therapeutic opportunities through drug target prediction: a class imbalance-tolerant machine learning approach. Bioinformatics 2021; 36:4490-4497. [PMID: 32399556 DOI: 10.1093/bioinformatics/btaa495] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/18/2020] [Accepted: 05/06/2020] [Indexed: 11/12/2022] Open
Abstract
MOTIVATION In silico drug target prediction provides valuable information for drug repurposing, understanding of side effects as well as expansion of the druggable genome. In particular, discovery of actionable drug targets is critical to developing targeted therapies for diseases. RESULTS Here, we develop a robust method for drug target prediction by leveraging a class imbalance-tolerant machine learning framework with a novel training scheme. We incorporate novel features, including drug-gene phenotype similarity and gene expression profile similarity that capture information orthogonal to other features. We show that our classifier achieves robust performance and is able to predict gene targets for new drugs as well as drugs that potentially target unexplored genes. By providing newly predicted drug-target associations, we uncover novel opportunities of drug repurposing that may benefit cancer treatment through action on either known drug targets or currently undrugged genes. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Siqi Liang
- Department of Computational Biology, Cornell University, Ithaca, NY 14853, USA.,Weill Institute for Cell and Molecular Biology, Cornell University, Ithaca, NY 14853, USA
| | - Haiyuan Yu
- Department of Computational Biology, Cornell University, Ithaca, NY 14853, USA.,Weill Institute for Cell and Molecular Biology, Cornell University, Ithaca, NY 14853, USA
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218
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Alsfouk BAA, Brodie MJ, Walters M, Kwan P, Chen Z. Tolerability of Antiseizure Medications in Individuals With Newly Diagnosed Epilepsy. JAMA Neurol 2021; 77:574-581. [PMID: 32091535 DOI: 10.1001/jamaneurol.2020.0032] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Tolerability is a key determinant of the effectiveness of epilepsy treatment. It is important to evaluate whether the overall tolerability has improved. Objective To identify factors associated with poor tolerability of antiseizure medications (ASMs) and examine temporal changes in tolerability. Design, Setting, and Participants This was a longitudinal cohort study at a specialist clinic in Glasgow, Scotland. Patients with newly diagnosed and treated epilepsy between July 1982 and October 2012 were included from 2282 eligible individuals. They were followed up until April 2016 or death. Data analysis was completed in August 2019. Exposures Antiseizure medications. Main Outcomes and Measures Univariable and multivariable survival analyses were performed to examine associations between potential risk factors and development of intolerable adverse effects (AEs). Intolerable AE rates of the ASMs as the initial monotherapy were compared between 3 epochs (July 1982-June 1992, July 1992-June 2002, and July 2002-April 2016). Results Of 1795 patients, 969 (54.0%) were male, and the median (interquartile range) age was 33 (21-50) years. A total of 3241 ASMs were prescribed during the period, of which 504 (15.6%) were discontinued within 6 months owing to intolerable AEs. Children younger than 18 years had lower intolerable AE rates than adults (vs aged 18-64 years: adjusted hazard ratio [aHR], 1.58; 95% CI, 1.07-2.32; vs aged ≥65 years: aHR, 1.90; 95% CI, 1.19-3.02) while female individuals (aHR, 1.60; 95% CI, 1.30-1.96) and those who had more than 5 pretreatment seizures (aHR, 1.24; 95% CI, 1.03-1.49) were associated with having higher risk. For each ASM trial, the risk of intolerable AEs increased with the number of previous drug withdrawals due to AEs (aHR, 1.18; 95% CI, 1.09-1.28) and the number of concomitant ASMs (aHR, 1.31; 95% CI, 1.04-1.64). The proportion of second-generation ASMs prescribed as the initial monotherapy increased from 22.3% (33 of 148) in the first epoch to 68.7% (645 of 939) in the last (P < .001). Although differences in intolerable AE rates and types of AEs were found between the ASMs, there was no difference in the overall intolerable AEs rates to the initial monotherapy across the 3 epochs (first: 10.1% [15 of 148]; second: 13.8% [98 of 708]; third: 14.0% [131 of 939]; P = .41). Conclusions and Relevance In this cohort study, the increased use of the second-generation ASMs had not improved overall treatment tolerability. Greater effort to improve tolerability in ASM development is needed.
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Affiliation(s)
- Bshra Ali A Alsfouk
- University of Glasgow, Glasgow, Scotland.,College of Pharmacy, Department of Pharmaceutical Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Martin J Brodie
- University of Glasgow, Glasgow, Scotland.,Epilepsy Unit, Scottish Epilepsy Initiative, Glasgow, Scotland
| | | | - Patrick Kwan
- Central Clinical School, Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Zhibin Chen
- Central Clinical School, Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.,School of Public Health and Preventive Medicine, Clinical Epidemiology, Monash University, Melbourne, Victoria, Australia
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Thiele F, Klein A, Windschall D, Hospach A, Foeldvari I, Minden K, Weller-Heinemann F, Horneff G. Comparative risk of infections among real-world users of biologics for juvenile idiopathic arthritis: data from the German BIKER registry. Rheumatol Int 2021; 41:751-762. [PMID: 33590331 PMCID: PMC7952348 DOI: 10.1007/s00296-020-04774-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/17/2020] [Indexed: 01/30/2023]
Abstract
To examine whether treatment with interleukin (IL)-1-, IL-6-, tumour necrosis factor α (TNFα)-inhibitors or Abatacept is associated with an increased risk of common infections, infections requiring hospitalization (SAE) or opportunistic infections among real-world juvenile idiopathic arthritis (JIA) patients. Furthermore, the influence of other patient-related covariates on the occurrence of infections was investigated. Patients diagnosed with JIA and treated with biologics were selected from the German BIKER registry. Incidence rates (IR) of infections per 100 person years were calculated and compared between the different cohorts. Using multivariate logistic regression, odds ratios with 95% confidence intervals (CI) were determined for the influence of patient-related covariates (age, diagnosis, laboratory data, concomitant medication, JIA activity, comorbidities, and premedication) on the occurrence of infections. 3258 patients entered the analysis. A total of 3654 treatment episodes were distributed among TNFα- (Etanercept, Adalimumab, Golimumab, Infliximab, n = 3044), IL-1- (Anakinra, Canakinumab, n = 105), IL-6- (Tocilizumab, n = 400) and T-cell activation inhibitors (Abatacept, n = 105). 813 (22.2%) patients had at least one infection, 103 (2.8%) patients suffered from an SAE infection. Both common and SAE infections were significantly more frequent in IL-1 (IR 17.3, 95% CI 12.5/24 and IR 4.3, 95% CI 2.3/8.3) and IL-6 cohort (IR 16.7, 95% CI 13.9/20 and IR 2.8, 95% CI 1.8/4.4) compared to TNFα-inhibitor cohort (IR 8.7, 95% CI 8.1/9.4 and IR 1, 95% CI 0.8/1.3). When comparing the influencing factors for various infectious diseases, the use of corticosteroids, younger age, cardiac comorbidities and higher JIA-activity are the most striking risk factors. Relative to TNFα inhibitors and Abatacept, IL-1 and IL-6 inhibitors were associated with an increased risk of common and SAE infections. The influencing covariates identified may be helpful for the choice of a suitable biologic to treat JIA.
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Affiliation(s)
- Franz Thiele
- Centre for Paediatric Rheumatology, Department of General Paediatrics, Asklepios Clinic Sankt Augustin, 53757, Sankt Augustin, Germany.
| | - Ariane Klein
- Centre for Paediatric Rheumatology, Department of General Paediatrics, Asklepios Clinic Sankt Augustin, 53757, Sankt Augustin, Germany.,Medical Faculty, University of Cologne, Cologne, Germany
| | - Daniel Windschall
- Clinic for Paediatric and Adolescent Rheumatology, St. Josef-Stift Sendenhorst, Northwest German Center for Rheumatology, Sendenhorst, Germany
| | - Anton Hospach
- Centre for Paediatric Rheumatology, Klinikum Stuttgart, Germany
| | - Ivan Foeldvari
- Hamburger Zentrum Für Kinder- Und Jugendrheumatologie, Hamburg, Germany
| | | | | | - Gerd Horneff
- Centre for Paediatric Rheumatology, Department of General Paediatrics, Asklepios Clinic Sankt Augustin, 53757, Sankt Augustin, Germany.,Medical Faculty, University of Cologne, Cologne, Germany
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Wang L, Shendre A, Chiang CW, Cao W, Ning X, Zhang P, Zhang P, Li L. A pharmacovigilance study of pharmacokinetic drug interactions using a translational informatics discovery approach. Br J Clin Pharmacol 2021; 88:1471-1481. [PMID: 33543792 DOI: 10.1111/bcp.14762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND While the pharmacokinetic (PK) mechanisms for many drug interactions (DDIs) have been established, pharmacovigilance studies related to these PK DDIs are limited. Using a large surveillance database, a translational informatics approach can systematically screen adverse drug events (ADEs) for many DDIs with known PK mechanisms. METHODS We collected a set of substrates and inhibitors related to the cytochrome P450 (CYP) isoforms, as recommended by the United States Food and Drug Administration (FDA) and Drug Interactions Flockhart table™. The FDA's Adverse Events Reporting System (FAERS) was used to obtain ADE reports from 2004 to 2018. The substrate and inhibitor information were used to form PK DDI pairs for each of the CYP isoforms and Medical Dictionary for Regulatory Activities (MedDRA) preferred terms used for ADEs in FAERS. A shrinkage observed-to-expected ratio (Ω) analysis was performed to screen for potential PK DDI and ADE associations. RESULTS We identified 149 CYP substrates and 62 CYP inhibitors from the FDA and Flockhart tables. Using FAERS data, only those DDI-ADE associations were considered that met the disproportionality threshold of Ω > 0 for a CYP substrate when paired with at least two inhibitors. In total, 590 ADEs were associated with 2085 PK DDI pairs and 38 individual substrates, with ADEs overlapping across different CYP substrates. More importantly, we were able to find clinical and experimental evidence for the paclitaxel-clopidogrel interaction associated with peripheral neuropathy in our study. CONCLUSION In this study, we utilized a translational informatics approach to discover potentially novel CYP-related substrate-inhibitor and ADE associations using FAERS. Future clinical, population-based and experimental studies are needed to confirm our findings.
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Affiliation(s)
- Lei Wang
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Aditi Shendre
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Chien-Wei Chiang
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Weidan Cao
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Xia Ning
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Ping Zhang
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Pengyue Zhang
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA.,Now at Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lang Li
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
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Chen C, Pan K, Wu B, Li X, Chen Z, Xu Q, Li X, Lv Q. Safety of hydroxychloroquine in COVID-19 and other diseases: a systematic review and meta-analysis of 53 randomized trials. Eur J Clin Pharmacol 2021; 77:13-24. [PMID: 32780229 PMCID: PMC7417776 DOI: 10.1007/s00228-020-02962-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/15/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Many concerns still exist regarding the safety of hydroxychloroquine (HCQ) in the treatment of Coronavirus Disease 2019 (COVID-19). OBJECTIVES The purpose of this study was to evaluate the safety of HCQ in the treatment of COVID-19 and other diseases by performing a systematic review and meta-analysis. METHODS Randomized controlled trials (RCTs) reporting the safety of HCQ in PubMed, Embase, and Cochrane Library were retrieved starting from the establishment of the database till June 5, 2020. Literature screening, data extraction, and assessment of risk bias were performed independently by two reviewers. RESULTS We identified 53 eligible studies involving 5496 patients. The meta-analysis indicated that the risk of adverse effects (AEs) in the HCQ group was significantly increased compared with that in the control group (RD 0.05, 95%CI, 0.02 to 0.07, P = 0.0002), and the difference was also statistically significant in the COVID-19 subgroup (RD 0.15, 95%CI, 0.07 to 0.23, P = 0.0002) as well as in the subgroup for other diseases (RD 0.03, 95%CI, 0.01 to 0.04, P = 0.003). CONCLUSIONS HCQ is associated with a high total risk of AEs compared with the placebo or no intervention in the overall population. Given the small number of COVID-19 participants included, we should be cautious regarding the conclusion stating that HCQ is linked with an increase incidence of AEs in patients with COVID-19, which we hope to confirm in the future through well-designed and larger sample size studies.
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Affiliation(s)
- Can Chen
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Kunming Pan
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Bingjie Wu
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Xiaoye Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Zhangzhang Chen
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Qing Xu
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Xiaoyu Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Qianzhou Lv
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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Kanza S, Graham Frey J. Semantic Technologies in Drug Discovery. SYSTEMS MEDICINE 2021. [DOI: 10.1016/b978-0-12-801238-3.11520-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Charan J, Kaur RJ, Bhardwaj P, Haque M, Sharma P, Misra S, Godman B. Rapid review of suspected adverse drug events due to remdesivir in the WHO database; findings and implications. Expert Rev Clin Pharmacol 2021; 14:95-103. [PMID: 33252992 PMCID: PMC7784780 DOI: 10.1080/17512433.2021.1856655] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/24/2020] [Indexed: 12/19/2022]
Abstract
Objectives: Remdesivir has shown promise in the management of patients with COVID-19 although recent studies have shown concerns with its effectiveness in practice. Despite this there is a need to document potential adverse drug events (ADEs) to guide future decisions as limited ADE data available before the COVID-19 pandemic. Methods: Interrogation of WHO VigiBase® from 2015 to 2020 coupled with published studies of ADEs in COVID-19 patients. The main outcome measures are the extent of ADEs broken down by factors including age, seriousness, region and organ. Results: A total 1086 ADEs were reported from the 439 individual case reports up to July 19, 2020, in the VigiBase®, reduced to 1004 once duplicates were excluded. Almost all ADEs concerned COVID-19 patients (92.5%), with an appreciable number from the Americas (67.7%). The majority of ADEs were from males > 45 years and were serious (82.5%). An increase in hepatic enzymes (32.1%), renal injury (14.4%), rise in creatinine levels (11.2%), and respiratory failure (6.4%) were the most frequently reported ADEs. Conclusions: Deterioration of liver and kidney function are frequently observed ADEs with remdesivir; consequently, patients should be monitored for these ADEs. The findings are in line with ADEs included in regulatory authority documents.
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Affiliation(s)
- Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Rimple Jeet Kaur
- Department of Pharmacology, S.N. Medical College, Jodhpur, India
| | - Pankaj Bhardwaj
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Sanjeev Misra
- Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, India
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
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Azzouz B, Laugier-Castellan D, Sanchez-Pena P, Rouault M, Kanagaratnam L, Morel A, Trenque T. Calcium channel blocker exposure and psoriasis risk: Pharmacovigilance investigation and literature data. Therapie 2021; 76:5-11. [DOI: 10.1016/j.therap.2020.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/29/2020] [Indexed: 01/06/2023]
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225
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Koller D, Almenara S, Mejía G, Saiz-Rodríguez M, Zubiaur P, Román M, Ochoa D, Wojnicz A, Martín S, Romero-Palacián D, Navares-Gómez M, Abad-Santos F. Safety and cardiovascular effects of multiple-dose administration of aripiprazole and olanzapine in a randomised clinical trial. Hum Psychopharmacol 2021; 36:1-12. [PMID: 32991788 DOI: 10.1002/hup.2761] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To assess adverse events (AEs) and safety of aripiprazole (ARI) and olanzapine (OLA) treatment. METHODS Twenty-four healthy volunteers receiving five daily oral doses of 10 mg ARI and 5 mg OLA in a crossover clinical trial were genotyped for 46 polymorphisms in 14 genes by qPCR. Drug plasma concentrations were measured by high-performance liquid chromatography tandem mass spectrometry. Blood pressure (BP) and 12-lead electrocardiogram were measured in supine position. AEs were also recorded. RESULTS ARI decreased diastolic BP on the first day and decreased QTc on the third and fifth day. OLA had a systolic and diastolic BP, heart rate and QTc lowering effect on the first day. Polymorphisms in ADRA2A, COMT, DRD3 and HTR2A genes were significantly associated to these changes. The most frequent adverse drug reactions (ADRs) to ARI were somnolence, headache, insomnia, dizziness, restlessness, palpitations, akathisia and nausea while were somnolence, dizziness, asthenia, constipation, dry mouth, headache and nausea to OLA. Additionally, HTR2A, HTR2C, DRD2, DRD3, OPRM1, UGT1A1 and CYP1A2 polymorphisms had a role in the development of ADRs. CONCLUSIONS OLA induced more cardiovascular changes; however, more ADRs were registered to ARI. In addition, some polymorphisms may explain the difference in the incidence of these effects among subjects.
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Affiliation(s)
- Dora Koller
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Susana Almenara
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Gina Mejía
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain.,UICEC Hospital Universitario de La Princesa, Platform SCReN (Spanish Clinical Research Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Miriam Saiz-Rodríguez
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain.,Research Unit, Fundación Burgos por la Investigación de la Salud, Hospital Universitario de Burgos, Burgos, Spain
| | - Pablo Zubiaur
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Manuel Román
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain.,UICEC Hospital Universitario de La Princesa, Platform SCReN (Spanish Clinical Research Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Dolores Ochoa
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain.,UICEC Hospital Universitario de La Princesa, Platform SCReN (Spanish Clinical Research Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Aneta Wojnicz
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Samuel Martín
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain.,UICEC Hospital Universitario de La Princesa, Platform SCReN (Spanish Clinical Research Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Daniel Romero-Palacián
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Marcos Navares-Gómez
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Francisco Abad-Santos
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain.,UICEC Hospital Universitario de La Princesa, Platform SCReN (Spanish Clinical Research Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
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Scailteux LM, Lacroix C, Bergeron S, Despas F, Sassier M, Triquet L, Picard S, Oger E, Polard E. [Adverse drug reactions profiles for abiraterone and enzalutamide: A pharmacovigilance descriptive analysis]. Therapie 2020; 76:455-465. [PMID: 33376005 DOI: 10.1016/j.therap.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to describe the profile of adverse drug reactions (ADRs) observed with abiraterone and enzalutamide, based on cases registered in the French regional pharmacovigilance centres to identify potential pharmacovigilance signals. METHODS We extracted from the French pharmacovigilance database all cases of ADRs or drug interactions involving abiraterone or enzalutamide from the time they market authorization date until December 31st, 2017. Signal detection results have been transmitted by the French Agency for Health Products (ANSM). The data were compared with those of the risk management plans for each drug and the literature. RESULTS Among the 233 observations analyzed, nearly 62% involved abiraterone as a suspect drug and 38% involved enzalutamide; only 1 case involved both drugs. The ADRs profile is different between the drugs. Abiraterone is mostly associated with expected cardiac diseases (heart failure, and QT prolongation), expected with the drug. Also described, several cases of hepatotoxicity have been reported, however some cases with fatal outcome suggest that despite a follow-up of the liver function tests, it is difficult to anticipate this risk. Signals concerning acute renal failure and ischemic stroke have arisen. Enzalutamide is more particularly associated with various neurological disorders (convulsions, hallucinations, fatigue, and memory impairment) expected with the drug. While ischemic heart disease is also expected, signals of heart failure and atrial fibrillation have arisen. A potential hepatotoxicity of the molecule is discussed because of cases of cholestatic hepatitis. CONCLUSION The analysis of the French pharmacovigilance database cases allows to confirm an expected and monitored risk profile in the risk management plan for both drugs. Several signals have arisen, some of which will be investigated through a pharmacoepidemiology study.
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Affiliation(s)
- Lucie-Marie Scailteux
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, CHU de Rennes, rue Henri Le Guilloux, 35000 Rennes, France; EA 7449 REPERES, université Rennes, 35000 Rennes, France.
| | - Clémence Lacroix
- Service de pharmacologie clinique, centre régional de pharmacovigilance, Inserm, institut de neuroscience des systèmes UMR 1106, Aix Marseille université, AP-HM, 13005 Marseille, France
| | - Sandrine Bergeron
- UMR-S1172, degenerative and vascular cognitive disorders, Lille neuroscience and cognition, Inserm, CHU de Lille, université Lille, 59000 Lille, France
| | - Fabien Despas
- Service de pharmacologie médicale et clinique, Inserm 1027, facultés de médecine, CHU, université Paul-Sabatier, 31000 Toulouse, France
| | - Marion Sassier
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, CHU de Caen, 14000 Caen, France
| | - Louise Triquet
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, CHU de Rennes, rue Henri Le Guilloux, 35000 Rennes, France
| | - Sylvie Picard
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, CHU de Rennes, rue Henri Le Guilloux, 35000 Rennes, France
| | - Emmanuel Oger
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, CHU de Rennes, rue Henri Le Guilloux, 35000 Rennes, France; EA 7449 REPERES, université Rennes, 35000 Rennes, France
| | - Elisabeth Polard
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, CHU de Rennes, rue Henri Le Guilloux, 35000 Rennes, France; EA 7449 REPERES, université Rennes, 35000 Rennes, France
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Liu YT, Chen GT, Huang YC, Ho JT, Lee CC, Tsai CC, Chang CN. Effectiveness of dose-escalated topiramate monotherapy and add-on therapy in neurosurgery-related epilepsy: A prospective study. Medicine (Baltimore) 2020; 99:e23771. [PMID: 33350762 PMCID: PMC7769361 DOI: 10.1097/md.0000000000023771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/16/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Lesional and symptomatic causes of epilepsy are the most common neurological disorders of the brain. Topiramate effectively controls newly diagnosed epilepsy and refractory focal seizures, but high-dose topiramate does not improve seizure control. This study aimed to evaluate the clinical efficacy and safety of dose-escalated topiramate as first-line monotherapy and add-on therapy in patients with neurosurgery-related epilepsy. MATERIAL AND METHODS A total of 55 neurosurgical patients with epilepsy were divided into monotherapy and add-on therapy groups and both groups received topiramate via the dose-escalation method. The primary efficacy outcomes were seizure-free rate and seizure response rate. Adverse events and seizure frequency were recorded. RESULTS The seizure response rate in the first month of monotherapy was significantly better than that of add-on therapy (89% vs 65%, P < .05), but no significant differences were found in seizure response rates between the 2 groups after 2 months of treatment. Both monotherapy and add-on therapy were effective in controlling seizures, with mean seizure frequency of 0.725 vs 0.536 and seizure-free rate of 88% vs 78.6%. Both treatments showed good improvement of seizure frequency in patients without tumor. The efficacy of monotherapy was better than that of add-on therapy (80% vs 29.2%) in patients with body mass index (BMI) ≤24. However, add-on therapy was better than monotherapy (76.7% vs 21.4%) in patients with BMI > 24. Dizziness (25.5%) and headache (16.4%) were the most common adverse events. No severe adverse event such as cognitive impairment was observed. CONCLUSIONS Dose-escalated topiramate monotherapy and add-on therapy demonstrate good efficacy and safety, with fewer adverse events in seizure control in neurosurgical patients.
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Affiliation(s)
- Yu-Tse Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch and school of medicine
| | - Guo-Tai Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi Branch and school of medicine, Chang Gung University, Taiwan
| | - Yin-Cheng Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch and school of medicine
| | - Jih-Tsun Ho
- Department of Neurosurgery, Chang Gung Memorial Hospital, Kaohsiung Branch and school of medicine
| | - Cheng-Chi Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch and school of medicine
| | - Cheng-Chia Tsai
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi Branch and school of medicine, Chang Gung University, Taiwan
| | - Chen-Nen Chang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi Branch and school of medicine, Chang Gung University, Taiwan
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Safety and efficacy of riluzole in patients undergoing decompressive surgery for degenerative cervical myelopathy (CSM-Protect): a multicentre, double-blind, placebo-controlled, randomised, phase 3 trial. Lancet Neurol 2020; 20:98-106. [PMID: 33357512 DOI: 10.1016/s1474-4422(20)30407-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Degenerative cervical myelopathy represents the most common form of non-traumatic spinal cord injury. This trial investigated whether riluzole enhances outcomes in patients undergoing decompression surgery for degenerative cervical myelopathy. METHODS This multicentre, double-blind, placebo-controlled, randomised, phase 3 trial was done at 16 university-affiliated centres in Canada and the USA. Patients with moderate-to-severe degenerative cervical myelopathy aged 18-80 years, who had a modified Japanese Orthopaedic Association (mJOA) score of 8-14, were eligible. Patients were randomly assigned (1:1) to receive either oral riluzole (50 mg twice a day for 14 days before surgery and then for 28 days after surgery) or placebo. Randomisation was done using permuted blocks stratified by study site. Patients, physicians, and outcome assessors remained masked to treatment group allocation. The primary endpoint was change in mJOA score from baseline to 6 months in the intention-to-treat (ITT) population, defined as all individuals who underwent randomisation and surgical decompression. Adverse events were analysed in the modified intention-to-treat (mITT) population, defined as all patients who underwent randomisation, including those who did not ultimately undergo surgical decompression. This study is registered with ClinicalTrials.gov, NCT01257828. FINDINGS From Jan 31, 2012, to May 16, 2017, 408 patients were screened. Of those screened, 300 were eligible (mITT population); 290 patients underwent decompression surgery (ITT population) and received either riluzole (n=141) or placebo (n=149). There was no difference between the riluzole and placebo groups in the primary endpoint of change in mJOA score at 6-month follow-up: 2·45 points (95% CI 2·08 to 2·82 points) versus 2·83 points (2·47 to 3·19), difference -0·38 points (-0·90 to 0·13; p=0·14). The most common adverse events were neck or arm or shoulder pain, arm paraesthesia, dysphagia, and worsening of myelopathy. There were 43 serious adverse events in 33 (22%) of 147 patients in the riluzole group and 34 serious adverse events in 29 (19%) of 153 patients in the placebo group. The most frequent severe adverse events were osteoarthrosis of non-spinal joints, worsening of myelopathy, and wound complications. INTERPRETATION In this trial, adjuvant treatment for 6 weeks perioperatively with riluzole did not improve functional recovery beyond decompressive surgery in patients with moderate-to-severe degenerative cervical myelopathy. Whether riluzole has other benefits in this patient population merits further study. FUNDING AOSpine North America.
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Allouchery M, Lombard T, Martin M, Rouby F, Sassier M, Bertin C, Atzenhoffer M, Miremont-Salame G, Perault-Pochat MC, Puyade M. Safety of immune checkpoint inhibitor rechallenge after discontinuation for grade ≥2 immune-related adverse events in patients with cancer. J Immunother Cancer 2020; 8:jitc-2020-001622. [PMID: 33428586 PMCID: PMC7768965 DOI: 10.1136/jitc-2020-001622] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2020] [Indexed: 12/27/2022] Open
Abstract
Background Safety of rechallenge of immune checkpoint inhibitor (ICI) after grade ≥2 immune-related adverse events (irAEs) leading to ICI discontinuation remains unclear. Methods All adverse drug reactions involving at least one ICI reported up to December 31, 2019 were extracted from the French pharmacovigilance database. Patients were included if they experienced at least one grade ≥2 irAE resulting in ICI discontinuation, with subsequent ICI rechallenge. The primary outcome was the recurrence of at least one grade ≥2 irAE in these patients after ICI rechallenge. Results We included 180 patients: 61.1% were men (median age of 66 years), 43.9% had melanoma and 78.9% were receiving anti-programmed cell death 1. First ICI discontinuation was related to 191 irAEs. After ICI rechallenge, 38.9% of the patients experienced at least one grade ≥2 irAE. Among them, 70.0% experienced the same irAE, 25.7% a distinct irAE, and 4.3% both the same and a distinct irAE. Lower recurrence rates of irAEs were associated with rechallenge with the same ICI treatment (p=0.02) or first endocrine irAEs (p=0.003). Gastrointestinal irAEs were more likely to recur (p=0.007). The median duration from ICI discontinuation to rechallenge and the severity of the initial irAE did not predict recurrent irAEs after ICI rechallenge (p=0.53 and p=0.40, respectively). Conclusions In this study, 61.1% of the patients who discontinued ICI treatment for grade ≥2 irAEs experienced no recurrent grade ≥2 irAEs after ICI rechallenge. Although ICI rechallenge appears to be safe under close monitoring, it should always be discussed balancing usefulness of rechallenge, patient comorbidities and risk of recurrence of first irAE(s). Due to inherent bias associated with pharmacovigilance studies, further prospective studies are needed to assess risk factors that may influence patient outcomes after ICI rechallenge.
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Affiliation(s)
- Marion Allouchery
- Pharmacologie clinique et Vigilances, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Thomas Lombard
- Pharmacie à usage intérieur, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Mickael Martin
- Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.,INSERM U1082, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Franck Rouby
- CRPV Marseille Provence Corse, service Hospitalo-Universitaire de Pharmacologie Clinique et Pharmacovigilance, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Marion Sassier
- Centre Régional de PharmacoVigilance, CHU de Caen, Caen, France.,Département de Pharmacologie, CHU de Caen, Caen, France
| | - Celia Bertin
- Département de Pharmacovigilance, Hôpital Henri Mondor, Creteil, France
| | - Marina Atzenhoffer
- Service Hospitalo-Universitaire de Pharmaco-Toxicologie, Hospices Civils de Lyon, Lyon, France
| | - Ghada Miremont-Salame
- INSERM, BPH, U1219Univ. Bordeaux, INSERM, BPH, U1219, F-33000 Bordeaux, France.,CHU de Bordeaux, Pole de Santé Publique, Pharmacologie Médicale, Centre de Pharmacovigilance de Bordeaux, Bordeaux, France
| | - Marie-Christine Perault-Pochat
- Pharmacologie clinique et Vigilances, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.,Laboratoire de Neurosciences Expérimentales et Cliniques, INSERM U1084, Université de Poitiers, Poitiers, France.,CIC-1402, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
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Kaur RJ, Charan J, Dutta S, Sharma P, Bhardwaj P, Sharma P, Lugova H, Krishnapillai A, Islam S, Haque M, Misra S. Favipiravir Use in COVID-19: Analysis of Suspected Adverse Drug Events Reported in the WHO Database. Infect Drug Resist 2020; 13:4427-4438. [PMID: 33364790 PMCID: PMC7751706 DOI: 10.2147/idr.s287934] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/20/2020] [Indexed: 12/13/2022] Open
Abstract
Background COVID-19 caused by SARS-CoV-2 virus emerged as an unprecedented challenge to discover effective drugs for its prevention and cure. Hyperinflammation-induced lung damage is one of the poor prognostic indicators causing a higher rate of morbidity and mortality of COVID-19 patients. Favipiravir, an antiviral drug, is being used for COVID-19 treatment, and we currently have limited information regarding its efficacy and safety. Thus, the present study was undertaken to evaluate the adverse drug events (ADEs) reported in the WHO pharmacovigilance database. Methods This study analyzed all suspected ADEs related to favipiravir reported from 2015. The reports were analyzed based on age, gender, and seriousness of ADEs at the System Organ Classification (SOC) level and the individual Preferred Term (PT) level. Results This study is based on 194 ADEs reported from 93 patients. Most frequent ADEs suspected to be caused by the favipiravir included increased hepatic enzymes, nausea and vomiting, tachycardia, and diarrhea. Severe and fatal ADEs occurred more frequently in men and those over the age of 64 years. Blood and lymphatic disorders, cardiac disorders, hepatobiliary disorders, injury poisoning, and procedural complications were more common manifestations of severe ADEs. Conclusion This study revealed that favipiravir appears to be a relatively safe drug. An undiscovered anti-inflammatory activity of favipiravir may explain the improvement in critically ill patients and reduce inflammatory markers. Currently, the data is based on very few patients. A more detailed assessment of the uncommon ADEs needs to be analyzed when more information will be available.
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Affiliation(s)
- Rimple Jeet Kaur
- Department of Pharmacology, Dr. S.N Medical College, Jodhpur, Rajasthan, India
| | - Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Siddhartha Dutta
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Paras Sharma
- Department of Pharmacognosy, BVM College of Pharmacy, Gwalior, India
| | - Pankaj Bhardwaj
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Halyna Lugova
- The Unit of Community Medicine, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur
| | - Ambigga Krishnapillai
- Family Medicine, Faculty of Medicine and Defence Health, National Defence University of Malaysia
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh
| | - Mainul Haque
- The Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan, Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Sanjeev Misra
- All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
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Munshi R, Lee-Son K, Hackbarth RM, Quigley R, Sutherland SM, Echeverri J, Goldstein SL. Clinical evaluation of the Prismaflex™ HF 20 set and Prismaflex™ system 7.10 for acute continuous kidney replacement therapy (CKRT) in children. Pediatr Nephrol 2020; 35:2345-2352. [PMID: 32607769 DOI: 10.1007/s00467-020-04664-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Continuous kidney replacement therapy (CKRT) is a common modality for treatment of severe acute kidney injury (AKI) in children. Adult technologies routinely utilized to provide this therapy have a large extracorporeal volume. The Prismaflex™ HF20 filter set has a relatively low extracorporeal blood volume of 60 mL, which provides technological benefit for smaller children compared with current filter sets available in the USA. METHODS We conducted a multicenter, open-label single group study to evaluate whether the Prismaflex™ HF20 filter set delivers efficacious and safe CKRT to support patients with AKI, fluid overload, or both in pediatric patients weighing ≥ 8 to 20 kg. RESULTS Twenty-three patients were enrolled between April 24, 2016 and April 8, 2018. The mean reduction in blood urea nitrogen from baseline to 24 h was 58.12 ± 20.08% (95% CI, - 68.45 and - 47.79 (p = 0.0008)). Median cumulative normalized effluent rate at 24 h was 60.8 mL/kg/h (25.9, 83.7). None of the patients participating in the study suffered a serious adverse event; thus, no obvious safety concerns were noted. CONCLUSIONS We suggest that the Prismaflex HF20™ filter set used in conjunction with the Prismaflex™ System Software Version 7.10 or 7.20 is a suitable alternative to larger filter sets for use in pediatric patients weighing less than 20 kg. Graphical abstract.
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Affiliation(s)
| | - Kathy Lee-Son
- University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | | | - Raymond Quigley
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Stuart L Goldstein
- University of Cincinnati College of Medicine and Cincinnati Children's Hospital, Cincinnati, OH, USA
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Dafniet B, Cerisier N, Audouze K, Taboureau O. Drug-target-ADR Network and Possible Implications of Structural Variants in Adverse Events. Mol Inform 2020; 39:e2000116. [PMID: 32725965 PMCID: PMC8047896 DOI: 10.1002/minf.202000116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022]
Abstract
Adverse drug reactions (ADRs) are of major concern in drug safety. However, due to the biological complexity of human systems, understanding the underlying mechanisms involved in development of ADRs remains a challenging task. Here, we applied network sciences to analyze a tripartite network between 1000 drugs, 1407 targets, and 6164 ADRs. It allowed us to suggest drug targets susceptible to be associated to ADRs and organs, based on the system organ class (SOC). Furthermore, a score was developed to determine the contribution of a set of proteins to ADRs. Finally, we identified proteins that might increase the susceptibility of genes to ADRs, on the basis of knowledge about genomic structural variation in genes encoding proteins targeted by drugs. Such analysis should pave the way to individualize drug therapy and precision medicine.
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Affiliation(s)
- Bryan Dafniet
- Université de ParisINSERM U1133, CNRS UMR 825175006ParisFrance
| | | | - Karine Audouze
- Université de ParisT3S, INSERM UMR S-112475006ParisFrance
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Zhang L, Mai W, Jiang W, Geng Q. Sintilimab: A Promising Anti-Tumor PD-1 Antibody. Front Oncol 2020; 10:594558. [PMID: 33324564 PMCID: PMC7726413 DOI: 10.3389/fonc.2020.594558] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022] Open
Abstract
Sintilimab (Tyvyt®) is a monoclonal antibody against programmed cell death protein 1 (PD-1). It could block the interaction between PD-1 and its ligands and help the anti-tumor effect of T-cells to recover. Sintilimab is developed by Innovent Biologics and Eli Lilly and Company and has been approved to treat relapsed or refractory classical Hodgkin lymphoma in patients who have undergone two or more lines of systemic chemotherapy by the National Medical Products Administration of China. Recently, sintilimab has been reported in plenty of literature and shows satisfying anti-tumor effect. Meanwhile, there are some reports showing its side effects. Overall, sintilimab has similar anti-tumor effects and a better safety profile compared to nivolumab and pembrolizumab in Hodgkin lymphoma, natural killer/T cell lymphoma and advanced non-small cell lung cancer. In this review, we aim to briefly describe the mechanisms, pharmacological characteristics, anti-tumor effects, predictive parameters of efficacy and side effects of sintilimab, providing valuable information of sintilimab for decision-making in the treatment of tumors in the future.
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Affiliation(s)
- Lin Zhang
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wuqian Mai
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Lab of Molecular Biological Targeted Therapies of the Ministry of Education, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenyang Jiang
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qing Geng
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
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Vrolijk MF, van de Koppel S, van Hunsel F. Red yeast rice (Monascus purpureus) supplements: Case series assessment of spontaneously reported cases to The Netherlands Pharmacovigilance Centre Lareb. Br J Clin Pharmacol 2020; 87:2146-2151. [PMID: 33085778 PMCID: PMC8056728 DOI: 10.1111/bcp.14599] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 01/14/2023] Open
Abstract
Serious concerns are expressed on the safe use of red yeast rice (RYR) supplements. The aim of the present study was to analyse cases received by Lareb on RYR‐related adverse health events. These cases were analysed for the number of reports, number of adverse drug reactions (ADRs), causality, seriousness of the reaction, latency‐period, age and sex of the patients, concomitant medication and type of reporter. A total of 94 individual reports were collected by Lareb, corresponding with 187 ADRs. The analysis showed most reported ADRs were labelled musculoskeletal and connective tissue disorders (n = 64), gastrointestinal disorders (n = 33) and general disorders and administration site conditions (n = 23). The use of RYR supplements should be considered as a significant safety concern. Exposure to monacolin K could lead to serious adverse effects. To fully assess the safety profile of RYR supplements, more research is necessary to compose a complete ADR profile of RYR supplements.
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Affiliation(s)
- Misha F Vrolijk
- Campus Venlo, Maastricht University, Maastricht, the Netherlands
| | - Sonja van de Koppel
- Netherlands Pharmacovigilance Centre Lareb, 5237 MH's-Hertogenbosch, The Netherlands
| | - Florence van Hunsel
- Netherlands Pharmacovigilance Centre Lareb, 5237 MH's-Hertogenbosch, The Netherlands
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Effect of desalted Salicornia europaea L. ethanol extract (PM-EE) on the subjects complaining memory dysfunction without dementia: a 12 week, randomized, double-blind, placebo-controlled clinical trial. Sci Rep 2020; 10:19914. [PMID: 33199752 PMCID: PMC7670404 DOI: 10.1038/s41598-020-76938-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 11/02/2020] [Indexed: 11/08/2022] Open
Abstract
Desalted Salicornia europaea L. (SE) inhibits acetylcholine esterase, attenuates oxidative stress and inflammatory cytokines, and activates neurotrophic pathway. We performed 12-week, randomized, double-blind, placebo-controlled study to evaluate the efficacy of PhytoMeal(a desalted SE)-ethanol extract (PM-EE), in improving the cognitive performance in patients with subjective memory impairment. 63 participants complaining memory dysfunction without dementia (Korean Mini-Mental State Examination [K-MMSE] score ≥ 23) were assigned to PM-EE 600 mg/day or placebo. The cognitive domain of the Alzheimer's disease assessment scale-Korean version (ADAS-K) was set as the primary outcome. After 12 weeks, there was no differences in the changes in the primary outcome or the frequency of adverse events between the groups. In the subgroup analysis for the 30 subjects with mild cognitive impairment (MCI, baseline K-MMSE scores ≤ 28), PM-EE significantly improved the color-reading score of the Korean color-word stroop test (8.2 ± 25.0 vs. - 4.7 ± 13.2, P = 0.018). Our findings suggest that PM-EE is safe but might not be effective in this setting of this study. However, PM-EE may improve the frontal executive function in the patients with MCI. Further large-sized studies with longer follow-up period is warranted (trial registration number KCT0003418).
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Borges FC, Ramos C, Ramos A, Mendes GP, Murteira R, Soares P, Furtado C, Miranda AC, Costa FA. Monitoring real-life utilization of pembrolizumab in advanced melanoma using the Portuguese National Cancer Registry. Pharmacoepidemiol Drug Saf 2020; 30:342-349. [PMID: 33103788 DOI: 10.1002/pds.5163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 09/24/2020] [Accepted: 10/21/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To evaluate the effectiveness and safety of pembrolizumab use in advanced melanoma in a real-life context; and to explore the existence of an efficacy-effectiveness gap, comparing registry data with the reference clinical trial. METHODS This study followed the guidelines for good pharmacoepidemology practice. An ambispective cohort was constituted, initiating the observation upon drug approval (17/07/2015) and following exposed patients until death or cut-off date (15/11/2019). The primary outcome was overall survival (OS); secondary outcomes comprised progression-free survival (PFS), overall response rate (ORR) and the occurrence of adverse events (AE). For all survival analyses, the Kaplan-Meier estimator was used, considering a 95% confidence interval (CI), aside with one-year survival rates. RESULTS A total of 125 patients constituted the cohort, originating from 16 hospitals in Portugal. Median OS was estimated to be 16.9 months (CI95% 11.3-25.5) and the probability of survival after 1 year was 57.5% (CI95% 48.4%-65.6%). Median PFS was estimated to be 4.8 months (CI95% 3.9-6.7) and the probability of remaining progression-free after 1 year was 32.8% (CI95% 24.8-41.1). ORR was 30.4% (CI95% 22.5%-39.3%). AEs were experienced by 82% of patients, and 27% experienced AE≥ grade 3. CONCLUSIONS Our data suggest lower effectiveness in a real-life context than the efficacy reported in the clinical trial. Safety data seems, however, quite comparable to KEYNOTE-006.
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Affiliation(s)
- Fábio C Borges
- Registo Oncológico Nacional (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Catarina Ramos
- Registo Oncológico Nacional (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Adriana Ramos
- Registo Oncológico Nacional (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Gonçalo P Mendes
- Registo Oncológico Nacional (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Rodrigo Murteira
- Registo Oncológico Nacional (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Patrícia Soares
- Registo Oncológico Nacional (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Claudia Furtado
- Health Technology Assessment, Pricing and Reimbursement Division (DATS), INFARMED, Autoridade Nacional do Medicamento e Produtos de Saúde, I.P., Lisboa, Portugal
| | - Ana C Miranda
- Registo Oncológico Nacional (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Filipa A Costa
- Registo Oncológico Nacional (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
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Moon J, Cohen Sedgh R, Jackevicius CA. Examining the Nocebo Effect of Statins Through Statin Adverse Events Reported in the Food and Drug Administration Adverse Event Reporting System. Circ Cardiovasc Qual Outcomes 2020; 14:e007480. [PMID: 33161769 DOI: 10.1161/circoutcomes.120.007480] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND This study aimed to evaluate whether the high frequency of reported statin adverse effects (AEs) may be associated with the nocebo effect. We compared nocebo-related subjective AEs with objective AEs and investigated factors potentially associated with the nocebo effect. METHODS A retrospective cohort study was conducted using the Food and Drug Administration Adverse Event Reporting System between January 2010 and December 2019 for statins, including, atorvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin. Subjective AEs included fatigue, subjective muscular, and nervous system AEs. Objective AEs were defined as hepatic and objective muscular AEs. We compared the number of subjective and objective AEs using the Mann-Whitney U test and examined trends in the frequency of subjective versus objective reports over time using linear regression with interaction terms. We evaluated the association between AEs and gender and country using linear regression. Quantitative detection of signals was estimated using proportional reporting ratio and reporting odds ratio for simvastatin. RESULTS Of 2 994 487 overall AE reports, more subjective than objective AEs were reported per quarter (mean±SD: 4777±1375.45 versus 999±276.95; P<0.0001), and over time during the study period (P<0.001). Women reported more subjective AEs than men per quarter (fatigue: 86.98 more per quarter, P=0.035; subjective muscular AE: 417.95, P<0.0001; nervous system AE: 273.60, P<0.0001), but fewer objective muscular AEs (-125.23 per quarter, P<0.0001). More subjective AEs and fewer objective AEs were reported per quarter in the United States relative to other countries. Simvastatin-associated reports showed signals for higher objective muscular AEs relative to all other statins (reporting odds ratio, 1.53 [95% CI, 1.49-1.58]). CONCLUSIONS This study found that significantly more subjective than objective AEs are reported for statins. Subjective statin AEs, potentially related to the nocebo effect are reported more often by women than by men, and in the United States than in other countries.
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Affiliation(s)
- Jungyeon Moon
- Western University of Health Sciences, Pomona, CA (J.M., R.C., C.A.J.)
| | | | - Cynthia A Jackevicius
- Western University of Health Sciences, Pomona, CA (J.M., R.C., C.A.J.).,VA Greater Los Angeles Healthcare System, CA (C.A.J.).,Institute for Clinical Evaluative Sciences, Toronto, Canada (C.A.J.).,Institute of Health Policy, Management and Evaluation, University of Toronto, Canada (C.A.J.)
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Said MA, Silva LSTE, de Oliveira Rocha AM, Alves GGB, Piotto DGP, Len CA, Terreri MT. Adverse drug reactions associated with treatment in patients with chronic rheumatic diseases in childhood: a retrospective real life review of a single center cohort. Adv Rheumatol 2020; 60:53. [PMID: 33153496 DOI: 10.1186/s42358-020-00154-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 10/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adverse drug reactions (ADRs) are the sixth leading causes of death worldwide; monitoring them is fundamental, especially in patients with disorders like chronic rheumatic diseases (CRDs). The study aimed to describe the ADRs investigating their severity and associated factors and resulting interventions in pediatric patients with CRDs. METHODS A retrospective, descriptive and analytical study was conducted on a cohort of children and adolescents with juvenile idiopathic arthritis (JIA), juvenile systemic lupus erythematosus (JSLE) and juvenile dermatomyositis (JDM). The study evaluated medical records of the patients to determine the causality and the management of ADRs. In order to investigate the risk factors that would increase the risk of ADRs, a logistic regression model was carried out on a group of patients treated with the main used drug. RESULTS We observed 949 ADRs in 547 patients studied. Methotrexate (MTX) was the most frequently used medication and also the cause of the most ADRs, which occurred in 63.3% of patients, followed by glucocorticoids (GCs). Comparing synthetic disease-modifying anti-rheumatic drugs (sDMARDs) vs biologic disease-modifying anti-rheumatic drugs (bDMARDs), the ADRs attributed to the former were by far higher than the latter. In general, the severity of ADRs was moderate and manageable. Drug withdrawal occurred in almost a quarter of the cases. In terms of risk factors, most patients who experienced ADRs due to MTX, were 16 years old or younger and received MTX in doses equal or higher than 0.6 mg/kg/week. Patients with JIA and JDM had a lower risk of ADRs than patients with JSLE. In the multiple regression model, the use of GCs for over 6 months led to an increase of 0.5% in the number of ADRs. CONCLUSIONS Although the ADRs highly likely affect a wide range of children and adolescents with CRDs they were considered moderate and manageable cases mostly. However, triggers of ADRs need further investigations.
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Affiliation(s)
- Manar Amanouil Said
- Division of Pediatric Rheumatology, Department of Pediatrics, Federal University Sao Paulo (Unifesp), Rua Borges Lagoa, 802, Sao Paulo, ZIP CODE: 04038-001, Brazil.
| | - Liana Soido Teixeira E Silva
- Division of Pediatric Rheumatology, Department of Pediatrics, Federal University Sao Paulo (Unifesp), Rua Borges Lagoa, 802, Sao Paulo, ZIP CODE: 04038-001, Brazil
| | - Aline Maria de Oliveira Rocha
- Division of Pediatric Rheumatology, Department of Pediatrics, Federal University Sao Paulo (Unifesp), Rua Borges Lagoa, 802, Sao Paulo, ZIP CODE: 04038-001, Brazil
| | - Gustavo Guimarães Barreto Alves
- Division of Pediatric Rheumatology, Department of Pediatrics, Federal University Sao Paulo (Unifesp), Rua Borges Lagoa, 802, Sao Paulo, ZIP CODE: 04038-001, Brazil
| | - Daniela Gerent Petry Piotto
- Division of Pediatric Rheumatology, Department of Pediatrics, Federal University Sao Paulo (Unifesp), Rua Borges Lagoa, 802, Sao Paulo, ZIP CODE: 04038-001, Brazil
| | - Claudio Arnaldo Len
- Division of Pediatric Rheumatology, Department of Pediatrics, Federal University Sao Paulo (Unifesp), Rua Borges Lagoa, 802, Sao Paulo, ZIP CODE: 04038-001, Brazil
| | - Maria Teresa Terreri
- Division of Pediatric Rheumatology, Department of Pediatrics, Federal University Sao Paulo (Unifesp), Rua Borges Lagoa, 802, Sao Paulo, ZIP CODE: 04038-001, Brazil
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Bonaldo G, Montanaro N, Vaccheri A, Motola D. Human papilloma virus vaccination in males: A pharmacovigilance study on the Vaccine Adverse Event Reporting System. Br J Clin Pharmacol 2020; 87:1912-1917. [PMID: 33145777 DOI: 10.1111/bcp.14584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/31/2020] [Accepted: 09/21/2020] [Indexed: 01/11/2023] Open
Abstract
AIMS Human papilloma virus (HPV) is 1 of the most common sexually transmitted infection responsible for different types of cancer: cervical, penile, vulvar, anal and oropharyngeal. It can affect both males and females. Our aim was to enrich the knowledge on the safety profiles of HPV vaccines in the male population. METHODS We reviewed all the reports of adverse events following immunization (AEFI) present in the US Vaccine Adverse Event Reporting System from 1 January 2006 to 30 September 2018. Statistical data mining was performed using the reporting odds ratio with 95% confidence interval in order to detect disproportionality in reporting. RESULTS A total of 5493 reports of AEFI were retrieved. The events most reported and that proportionally occurred more frequently with HPV vaccines than with others in males were: syncope (n = 701, reporting odds ratio = 2.85, 95% confidence interval [1.41-5.76p), loss of consciousness (n = 425, 2.79 [1.36-5.72]) and fall (n = 272, 3.54 [2.00-6.26]). CONCLUSION Most of the AEFIs were already reported in premarketing clinical trials and acknowledged for the corresponding vaccines. A disproportionate reporting was found for some of these events including syncope. The HPV vaccines are generally well tolerated in males, although limitations own of spontaneous reporting should be considered.
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Affiliation(s)
- Giulia Bonaldo
- Unit of Pharmacology, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Nicola Montanaro
- Former Professor of Pharmacology, University of Bologna, Bologna, Italy
| | - Alberto Vaccheri
- Unit of Pharmacology, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Domenico Motola
- Unit of Pharmacology, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Straumann A, Lucendo AJ, Miehlke S, Vieth M, Schlag C, Biedermann L, Vaquero CS, Ciriza de Los Rios C, Schmoecker C, Madisch A, Hruz P, Hayat J, von Arnim U, Bredenoord AJ, Schubert S, Mueller R, Greinwald R, Schoepfer A, Attwood S, Miehlke S, Bajbouj M, Brückner S, Fibbe C, Haag S, Schmöcker C, Hartmann D, Lammert F, Madisch A, Reinshagen M, Schubert S, von Arnim U, Börner N, Witzemann D, Caca K, Albert J, Zeuzem S, Wiedbrauck F, Messmann H, Bredenoord AJ, Verdonk R, Wolfhagen F, Villarin AL, Vaquero CS, de los Ríos CC, Juan AP, Martinez IP, Sanchez-Migallon JR, Andrés JB, Aisa Á, Straumann A, Hruz P, Schoepfer A, Biedermann L, Hayat J, Dhar A. Budesonide Orodispersible Tablets Maintain Remission in a Randomized, Placebo-Controlled Trial of Patients With Eosinophilic Esophagitis. Gastroenterology 2020; 159:1672-1685.e5. [PMID: 32721437 DOI: 10.1053/j.gastro.2020.07.039] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder. Swallowed topical-acting corticosteroids are effective in bringing active EoE into remission. However, it is not clear whether these drugs are effective for long-term maintenance of remission. METHODS We performed a double-blind trial to compare the efficacy and safety of 2 dosages of a budesonide orodispersible tablet (BOT) vs placebo in maintaining remission of EoE. Maintenance of remission was defined as absence of clinical and histologic relapse and no premature withdrawal for any reason. Two hundred and four adults with EoE in clinical and histologic remission, from 29 European study sites, were randomly assigned to groups given BOT 0.5 mg twice daily (n = 68), BOT 1.0 mg twice daily (n = 68), or placebo twice daily (n = 68) for up to 48 weeks. RESULTS At end of treatment, 73.5% of patients receiving BOT 0.5 mg twice daily and 75% receiving BOT 1.0 mg twice daily were in persistent remission compared with 4.4% of patients in the placebo group (P < .001 for both comparisons of BOT with placebo). Median time to relapse in the placebo group was 87 days. The frequency of adverse events was similar in the BOT and placebo groups. Morning serum levels of cortisol were in the normal range at baseline and did not significantly change during treatment. Four patients receiving BOT developed asymptomatic, low serum levels of cortisol. Clinically manifested candidiasis was suspected in 16.2% of patients in the BOT 0.5 mg group and in 11.8% of patients in the BOT 1.0 mg group; all infections resolved with treatment. CONCLUSIONS In a phase 3 trial, up to 48 weeks of treatment with BOT (0.5 mg or 1.0 mg twice daily) was superior to placebo in maintaining remission of EoE. Both dosages were equally effective and well tolerated. EudraCT number; 2014-001485-99; ClinicalTrials.gov number, NCT02434029.
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Affiliation(s)
- Alex Straumann
- Swiss Eosinophilic Esophagitis Research Group, Olten, Switzerland; Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain; Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, Spain; Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Stephan Miehlke
- Center for Digestive Diseases, Internal Medicine Center Eppendorf, Hamburg, Germany; Center for Esophageal Disorders, University Hospital Hamburg-Eppendorf, Germany
| | - Michael Vieth
- Institute for Pathology, Klinikum Bayreuth, Bayreuth, Germany
| | - Christoph Schlag
- II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Luc Biedermann
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Cecilio Santander Vaquero
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, Spain; Instituto de Investigación Sanitaria Princesa, Madrid, Spain; Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Madrid, Spain
| | | | | | - Ahmed Madisch
- Department of Gastroenterology, Clinical-Center Region Hannover Clinic Siloah, Hannover, Germany
| | - Petr Hruz
- Department of Gastroenterology, University Hospital Basel, Basel, Switzerland
| | - Jamal Hayat
- Department of Gastroenterology, Saint George's University Hospitals National Health Service Trust, London, UK
| | - Ulrike von Arnim
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Magdeburg, Germany
| | - Albert Jan Bredenoord
- Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | | | - Ralph Mueller
- Department of Clinical Research and Development, Dr Falk Pharma GmbH, Freiburg, Germany
| | - Roland Greinwald
- Department of Clinical Research and Development, Dr Falk Pharma GmbH, Freiburg, Germany
| | - Alain Schoepfer
- Department of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Stephen Attwood
- Department of Health Services Research, Durham University, Durham, UK
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NDDSA: A network- and domain-based method for predicting drug-side effect associations. Inf Process Manag 2020. [DOI: 10.1016/j.ipm.2020.102357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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242
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Thomas L, Le Beller C, Trenque T, Michot J, Zenut M, Letavernier E, Mongardon N, Vodovar D. Amoxicillin-induced crystal nephropathy: A nationwide French pharmacovigilance databases study. Br J Clin Pharmacol 2020; 86:2256-2265. [PMID: 32353167 PMCID: PMC7576614 DOI: 10.1111/bcp.14328] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 01/21/2023] Open
Abstract
AIMS Amoxicillin (AMX)-induced crystal nephropathy (AICN) is a rarely reported adverse drug reaction (ADR) but its increase has been recently reported in the Paris area. Our aim was to investigate the incidence, characteristics and outcome of AICN in France. METHODS Retrospective analysis of all AICN cases reported to the French National Pharmacovigilance Database and the Marketing Authorization Holders Pharmacovigilance Database. AICN notification rate was compared to intravenous AMX and AMX-clavulanate sales. RESULTS In total, 101 AICN cases were included. Intravenous AMX/AMX-clavulanate was prescribed as surgical prophylaxis (32 surgical patients) or to treat infection (69 medical patients). AKI KDIGO stage 3 was observed in 70 patients and 24/70 patients required renal replacement therapy and/or intensive care unit admission. The annual notification rate of AICN was increased by a factor of 13 since 2010 (6 [0;7] and 77 [24;111] cases per 100 000 patient-years of exposure, before and after 2010 respectively; P < .001). In surgical patients, the increase in AICN has been reported since 2010 and was mainly related to inadequate AMX administration. In medical patients, the increase in AICN was observed since 2014. After 2014, medical patients were older (67 [42;77] vs 74 years [64;84] respectively; P < .05) and were treated more frequently for endocarditis (0/20 vs 15/49 respectively; P < .01). A contributing factor was observed or suspected in 62 patients. CONCLUSION AICN is a severe ADR that dramatically increased in France since 2010. Assessment of AICN contributing factors and AMX drug monitoring in patients receiving high dose of AMX could reduce the risk of AICN.
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Affiliation(s)
- Laure Thomas
- Centre Régional de Pharmacovigilance, Assistance Publique‐Hôpitaux de Paris (AH‐HP), Hôpitaux Universitaires Henri MondorCréteilFrance
| | - Christine Le Beller
- Centre Régional de Pharmacovigilance, Assistance Publique‐Hôpitaux de Paris (AH‐HP), Hôpital Européen Georges Pompidou, F‐75014ParisFrance
| | - Thierry Trenque
- Centre Régional de Pharmacovigilance et de Pharmacoépidémiologie, Centre Hospitalier UniversitaireReimsFrance
| | - Joëlle Michot
- Centre Régional de Pharmacovigilance, Assistance Publique‐Hôpitaux de Paris (AH‐HP), Centre Hospitalier Universitaire Saint‐AntoineParisFrance
| | - Marie Zenut
- Centre Régional de Pharmacovigilance, Centre Hospitalier UniversitaireClermont‐FerrandFrance
| | - Emmanuel Letavernier
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche_S1155, Rare and Common Kidney Diseases, Matrix Remodeling and Tissue RepairParisFrance
- Sorbonne UniversitésUniversité Pierre et Marie Curie, Université Paris 6ParisFrance
- Explorations fonctionnelles multidisciplinaires, Hôpital Tenon, Assistance Publique ‐ Hôpitaux de Paris (AH‐HP)ParisFrance
| | - Nicolas Mongardon
- Service d'anesthésie‐réanimation chirurgicale, DMU CARE, Assistance Publique‐Hôpitaux de Paris (AP‐HP), Hôpitaux Universitaires Henri MondorCréteilFrance
- Université Paris Est Créteil, Faculté de SantéCréteilFrance
- U955‐IMRB, Equipe 03 "Stratégies pharmacologiques et thérapeutiques expérimentales des insuffisances cardiaques et coronaires", Inserm, UPEC, Ecole Nationale Vétérinaire d'AlfortMaisons‐AlfortFrance
| | - Dominique Vodovar
- Centre Anti‐Poison et de Toxicovigilance de Paris ‐ Fédération de toxicologie, Assistance Publique des Hôpitaux de Paris, Hôpital Fernand‐WidalParisFrance
- UFR de médecine, Université Paris‐DiderotParisFrance
- UMRS 1144, Inserm, Faculté de PharmacieParisFrance
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Garcia P, Revet A, Yrondi A, Rousseau V, Degboe Y, Montastruc F. Psychiatric Disorders and Hydroxychloroquine for Coronavirus Disease 2019 (COVID-19): A VigiBase Study. Drug Saf 2020; 43:1315-1322. [PMID: 33078372 PMCID: PMC7571787 DOI: 10.1007/s40264-020-01013-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION In the stressful context of the coronavirus disease 2019 (COVID-19) pandemic, some reports have raised concerns regarding psychiatric disorders with the use of hydroxychloroquine. In this study, we reviewed all psychiatric adverse effects with hydroxychloroquine in COVID-19 patients, as well as in other indications, reported in VigiBase, the World Health Organization's (WHO) global database of individual case safety reports. METHODS First, we analyzed all psychiatric adverse effects, including suicide, of hydroxychloroquine in COVID-19 patients reported to 16 June 2020. We also performed disproportionality analysis to investigate the risk of reporting psychiatric disorders with hydroxychloroquine compared with remdesivir, tocilizumab, or lopinavir/ritonavir prescribed in COVID-19 patients. We used reporting odds ratios (RORs) and their 95% confidence intervals (CIs) to calculate disproportionality. Second, we sought to examine the psychiatric safety profile of hydroxychloroquine in other indications (before 2020). RESULTS Among the 1754 reports with hydroxychloroquine in COVID-19 patients, we found 56 psychiatric adverse effects. Half of these adverse effects were serious, including four completed suicides, three cases of intentional self-injury, and 12 cases of psychotic disorders with hallucinations. Compared with remdesivir, tocilizumab, or lopinavir/ritonavir, the use of hydroxychloroquine was associated with an increased risk of reporting psychiatric disorders (ROR 6.27, 95% CI 2.74-14.35). Before 2020, suicide was the main cause of death among all adverse drug reactions reported with hydroxychloroquine, followed by cardiac adverse effects (cardiomyopathy) and respiratory failure. CONCLUSIONS This pharmacovigilance analysis suggests that COVID-19 patients exposed to hydroxychloroquine experienced serious psychiatric disorders, and, among these patients, some committed suicide. Further real-world studies are needed to quantify the psychiatric risk associated with hydroxychloroquine during the COVID-19 pandemic.
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Affiliation(s)
- Philippe Garcia
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Faculty of Medicine, Toulouse University Hospital (CHU), 37 Allées Jules Guesde, 31000, Toulouse, France
| | - Alexis Revet
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Toulouse University Hospital (CHU), Toulouse, France
- UMR 1027 Pharmacoepidemiology, Assessment of Drug Utilization and Drug Safety, INSERM, CIC 1426, University Paul Sabatier Toulouse, Toulouse, France
| | - Antoine Yrondi
- Department of Medical Psychiatry, Toulouse University Hospital (CHU), Faculty of Medicine, Treatment Resistant Depression Expert Center, FondaMental, ToNIC Toulouse NeuroImaging Center, University Paul Sabatier Toulouse, INSERM, Toulouse, France
| | - Vanessa Rousseau
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Faculty of Medicine, Toulouse University Hospital (CHU), 37 Allées Jules Guesde, 31000, Toulouse, France
- UMR 1027 Pharmacoepidemiology, Assessment of Drug Utilization and Drug Safety, INSERM, CIC 1426, University Paul Sabatier Toulouse, Toulouse, France
| | - Yannick Degboe
- Department of Rheumatology, Faculty of Medicine, Toulouse University Hospital (CHU), Toulouse, France
| | - François Montastruc
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Faculty of Medicine, Toulouse University Hospital (CHU), 37 Allées Jules Guesde, 31000, Toulouse, France.
- UMR 1027 Pharmacoepidemiology, Assessment of Drug Utilization and Drug Safety, INSERM, CIC 1426, University Paul Sabatier Toulouse, Toulouse, France.
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Giraud EL, Jessurun NT, van Hunsel FPAM, van Puijenbroek EP, van Tubergen A, Ten Klooster PM, Vonkeman HE. Frequency of real-world reported adverse drug reactions in rheumatoid arthritis patients. Expert Opin Drug Saf 2020; 19:1617-1624. [PMID: 32990050 DOI: 10.1080/14740338.2020.1830058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To describe the cumulative incidences of adverse drug reactions (ADRs) associated with disease-modifying anti-rheumatic drugs (DMARDs) in rheumatoid arthritis (RA) patients from real-world data (RWD), using the DREAM-RA registry, and to compare these with incidence frequencies mentioned in the Summary of Product Characteristics (SmPC). METHODS All ADRs in patients with recorded use of adalimumab, etanercept, hydroxychloroquine, leflunomide, oral and subcutaneous methotrexate, and sulfasalazine from a single center participating in the DREAM-RA registry (n = 1,098 patients) that were directly sent to the Netherlands Pharmacovigilance Center Lareb were assessed. Cumulative incidences were calculated, described and compared to the most recently revised SmPCs. RESULTS In total, 14 ADRs (≥5 case reports) associated with the use of one of the included DMARDs were reported with a higher estimated cumulative incidence compared to the SmPC. For hydroxychloroquine and sulfasalazine, 5 ADRs (≥5 case reports) mentioned with an 'unknown' incidence in the SmPC were reported as 'common' in this study. CONCLUSIONS Although ADR data in the DREAM-RA registry were partly comparable with data in the SmPCs, RWD from this patient registry provided an added value to the currently available information on the incidences of ADRs associated with DMARDs in RA patients as described in SmPCs.
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Affiliation(s)
- Eline L Giraud
- Netherlands Pharmacovigilance Centre Lareb , 's-Hertogenbosch, The Netherlands
| | - Naomi T Jessurun
- Netherlands Pharmacovigilance Centre Lareb , 's-Hertogenbosch, The Netherlands
| | | | | | - Astrid van Tubergen
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands and Care and Public Health Research Institute (CAPHRI), Maastricht University , Maastricht, The Netherlands
| | - Peter M Ten Klooster
- Transparency in Healthcare B.v ., Hengelo, The Netherlands.,Department of Psychology, Health & Technology, University of Twente , Enschede, The Netherlands
| | - Harald E Vonkeman
- Department of Psychology, Health & Technology, University of Twente , Enschede, The Netherlands.,Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente , Enschede, The Netherlands
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Marcilly R, Douze L, Ferré S, Audeh B, Bobed C, Lillo-Le Louët A, Lamy JB, Bousquet C. How to interact with medical terminologies? Formative usability evaluations comparing three approaches for supporting the use of MedDRA by pharmacovigilance specialists. BMC Med Inform Decis Mak 2020; 20:261. [PMID: 33036603 PMCID: PMC7547416 DOI: 10.1186/s12911-020-01280-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medical terminologies are commonly used in medicine. For instance, to answer a pharmacovigilance question, pharmacovigilance specialists (PVS) search in a pharmacovigilance database for reports in relation to a given drug. To do that, they first need to identify all MedDRA terms that might have been used to code an adverse reaction in the database, but terms may be numerous and difficult to select as they may belong to different parts of the hierarchy. In previous studies, three tools have been developed to help PVS identify and group all relevant MedDRA terms using three different approaches: forms, structured query-builder, and icons. Yet, a poor usability of the tools may increase PVS' workload and reduce their performance. This study aims to evaluate, compare and improve the three tools during two rounds of formative usability evaluation. METHODS First, a cognitive walkthrough was performed. Based on the design recommendations obtained from this evaluation, designers made modifications to their tools to improve usability. Once this re-engineering phase completed, six PVS took part in a usability test: difficulties, errors and verbalizations during their interaction with the three tools were collected. Their satisfaction was measured through the System Usability Scale. The design recommendations issued from the tests were used to adapt the tools. RESULTS All tools had usability problems related to the lack of guidance in the graphical user interface (e.g., unintuitive labels). In two tools, the use of the SNOMED CT to find MedDRA terms hampered their use because French PVS were not used to it. For the most obvious and common terms, the icons-based interface would appear to be more useful. For the less frequently used MedDRA terms or those distributed in different parts of the hierarchy, the structured query-builder would be preferable thanks to its great power and flexibility. The form-based tool seems to be a compromise. CONCLUSION These evaluations made it possible to identify the strengths of each tool but also their weaknesses to address them before further evaluation. Next step is to assess the acceptability of tools and the expressiveness of their results to help identify and group MedDRA terms.
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Affiliation(s)
- Romaric Marcilly
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France. .,Inserm, CHU Lille, CIC-IT/Evalab 1403 - Centre d'Investigation Clinique, F-59000, Lille, France.
| | - Laura Douze
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France.,Inserm, CHU Lille, CIC-IT/Evalab 1403 - Centre d'Investigation Clinique, F-59000, Lille, France
| | - Sébastien Ferré
- SemLIS - Semantics, Logics, Information Systems for Data-User Interaction, Rennes, France
| | - Bissan Audeh
- Laboratoire d'informatique médicale et d'ingénierie des Connaissances en e-santé, LIMICS, Sorbonne Université, Inserm, Université Paris 13, 75006, Paris, France
| | - Carlos Bobed
- Everis / NTT Data, University of Zaragoza, Zaragoza, Spain
| | | | - Jean-Baptiste Lamy
- Université Sorbonne Paris Nord, LIMICS, INSERM, UMR 1142, F-93000, Bobigny, France
| | - Cédric Bousquet
- Laboratoire d'informatique médicale et d'ingénierie des Connaissances en e-santé, LIMICS, Sorbonne Université, Inserm, Université Paris 13, 75006, Paris, France.,SSPIM, Unit of Public Health and Medical Informatics, CHU University Hospital of Saint Etienne, Saint-Étienne, France
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246
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Bate A, Hobbiger SF. Artificial Intelligence, Real-World Automation and the Safety of Medicines. Drug Saf 2020; 44:125-132. [PMID: 33026641 DOI: 10.1007/s40264-020-01001-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 12/16/2022]
Abstract
Despite huge technological advances in the capabilities to capture, store, link and analyse data electronically, there has been some but limited impact on routine pharmacovigilance. We discuss emerging research in the use of artificial intelligence, machine learning and automation across the pharmacovigilance lifecycle including pre-licensure. Reasons are provided on why adoption is challenging and we also provide a perspective on changes needed to accelerate adoption, and thereby improve patient safety. Last, we make clear that while technologies could be superimposed on existing pharmacovigilance processes for incremental improvements, these great societal advances in data and technology also provide us with a timely opportunity to reconsider everything we do in pharmacovigilance operations to maximise the benefit of these advances.
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Affiliation(s)
- Andrew Bate
- Clinical Safety and Pharmacovigilance, GSK, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK.
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK.
| | - Steve F Hobbiger
- Clinical Safety and Pharmacovigilance, GSK, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
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Kis B, Lücke C, Abdel-Hamid M, Heßmann P, Graf E, Berger M, Matthies S, Borel P, Sobanski E, Alm B, Rösler M, Retz W, Jacob C, Colla M, Huss M, Jans T, van Elst LT, Müller HHO, Philipsen A. Safety Profile of Methylphenidate Under Long-Term Treatment in Adult ADHD Patients - Results of the COMPAS Study. PHARMACOPSYCHIATRY 2020; 53:263-271. [PMID: 33017854 DOI: 10.1055/a-1207-9851] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The Comparison of Methylphenidate and Psychotherapy in adult ADHD Study (COMPAS) was a prospective, randomized multicenter clinical trial, comparing methylphenidate (MPH) with placebo (PLAC) in combination with cognitive behavioral group psychotherapy (GPT) or individual clinical management (CM) over the period of 1 year. Here, we report results on treatment safety. METHODS MPH and PLAC were flexibly dosed. Among 433 randomized patients, adverse events (AEs) were documented and analyzed on an "as received" basis during week 0-52. Electrocardiogram data were recorded at baseline and week 24. RESULTS Comparing 205 patients who received ≥1 dose of MPH with 209 patients who received PLAC, AEs occurring significantly more frequently in the MPH group were decreased appetite (22 vs. 3.8%), dry mouth (15 vs. 4.8%), palpitations (13 vs. 3.3%), gastrointestinal infection (11 vs. 4.8%), agitation (11 vs. 3.3%), restlessness (10 vs. 2.9%), hyperhidrosis, tachycardia, weight decrease (all 6.3 vs. 1.9%), depressive symptom, influenza (both 4.9 vs. 1.0%), and acute tonsillitis (4.4 vs. 0.5%). Syncope occurred significantly more often in the PLAC group (2.4 vs. 0%). Clinically relevant ECG changes occurred very rarely in both groups. Serious AEs were rare and without a significant group difference. The comparison of 206 patients treated with GPT versus 209 patients who received CM revealed no major differences. Serious AE classified as psychiatric occurred in 5 cases in the CM group and in 1 case in the GPT group. CONCLUSION In this so far longest-running clinical trial, methylphenidate treatment was safe and well-tolerated.
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Affiliation(s)
- Bernhard Kis
- Department of Psychiatry, Psychotherapy and Psychosomatics, St. Elisabeth Hospital Niederwenigern, Contilia Group, Hattingen, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center, Göttingen, Germany.,LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Caroline Lücke
- Department of Psychiatry and Psychotherapy - University of Bonn, Bonn, Germany
| | - Mona Abdel-Hamid
- Department of Psychiatry and Psychotherapy, University Medical Center, Göttingen, Germany.,LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Philipp Heßmann
- Department of Psychiatry and Psychotherapy, University Medical Center, Göttingen, Germany
| | - Erika Graf
- Institute of Medical Biometry and Statistics, Clinical Trials Unit and Medical Faculty, University Medical Center - University of Freiburg, Freiburg, Germany
| | - Mathias Berger
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Medical Center - University of Freiburg, Freiburg, Germany
| | - Swantje Matthies
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Medical Center - University of Freiburg, Freiburg, Germany
| | - Patricia Borel
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Medical Center - University of Freiburg, Freiburg, Germany
| | - Esther Sobanski
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, University Medicine Mainz, Mainz, Germany
| | - Barbara Alm
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Rösler
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Wolfgang Retz
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Christian Jacob
- Clinic for Psychiatry and Psychotherapy, Medius Clinic, Kirchheim, Germany
| | - Michael Colla
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Michael Huss
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medicine Mainz, Mainz, Germany
| | - Thomas Jans
- University Hospital of Würzburg, Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Würzburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Medical Center - University of Freiburg, Freiburg, Germany
| | - Helge H O Müller
- Witten/Herdecke University, Faculty of Health/School of Medicine, Integrative Psychiatry and Psychotherapy, Witten, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy - University of Bonn, Bonn, Germany
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Cottin J, Pierre S, Pizzoglio V, Simon C, Durrieu G, Bleyzac N, Gouraud A, Dumortier J. Methylprednisolone-related liver injury: A descriptive study using the French pharmacovigilance database. Clin Res Hepatol Gastroenterol 2020; 44:662-673. [PMID: 31948782 DOI: 10.1016/j.clinre.2019.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 12/03/2019] [Accepted: 12/18/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Hepatotoxicity associated with methylprednisolone (MP) is rarely reported in the literature. The aim of the present study was to review the characteristics of acute liver injury associated with intravenous (IV) or oral MP registered in the French pharmacovigilance database (FPD). METHODS All cases with MP coded as suspected, concomitant, or interacting drug associated with liver injury as the adverse effect reported up to May 2016 were extracted from the FPD. Cases were identified using the "Drug related hepatic disorders" Standard Medical Query. RESULTS A total of 97 cases of liver injury associated with MP were analysed; 58.8% were women and the median age was 46 years (range: 1-91). MP was used for an autoimmune disease in 47.6% of cases including 26 cases of multiple sclerosis, and was IV in 79.4% of cases. Nearly three-quarters of patients (73,2%) had a hepatocellular type of injury, the severity of which was mainly mild (45%) or moderate (31%). Most patients (92%) spontaneously and fully recovered within a mean 38.4 days. A rechallenge using the IV route was performed in 13 patients and for 10 (76.9%) this was positive (the initial type of injury was hepatocellular for all these cases). Regarding IV route of administration (n=77), MP was coded as the only suspected drug in 22% of cases. DISCUSSION The results suggest that IV MP causality should be considered in case of acute liver injury while data for oral MP is insufficient; systematic liver monitoring for high-dose IV MP may be recommended.
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Affiliation(s)
- Judith Cottin
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Centre de Pharmacovigilance, Hospices Civils de Lyon, CHU-Lyon, 69003 Lyon, France.
| | - Sabrina Pierre
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Centre de Pharmacovigilance, Hospices Civils de Lyon, CHU-Lyon, 69003 Lyon, France
| | - Véronique Pizzoglio
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Centre de Pharmacovigilance, Hospices Civils de Lyon, CHU-Lyon, 69003 Lyon, France
| | - Corinne Simon
- Service de Pharmacosurveillance, Centre Régional de Pharmacovigilance, CHRU Tours, 37044 Tours, France
| | - Geneviève Durrieu
- Service de Pharmacologie Médicale et Clinique, Centre Régional de PharmacoVigilance, de Pharmaco-épidémiologie et d'Informations sur le Médicament, INSERM U 1027, Faculté de Médecine, Centre Hospitalier Universitaire, 31000 Toulouse, France
| | - Nathalie Bleyzac
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Centre de Pharmacovigilance, Hospices Civils de Lyon, CHU-Lyon, 69003 Lyon, France
| | - Aurore Gouraud
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Centre de Pharmacovigilance, Hospices Civils de Lyon, CHU-Lyon, 69003 Lyon, France
| | - Jérôme Dumortier
- Service d'Hépato-gastro-entérologie, Hôpital Edouard-Herriot, Hospices Civils de Lyon, 69003 Lyon, France
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249
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Luo YF, Henry S, Wang Y, Shen F, Uzuner O, Rumshisky A. The 2019 National Natural language processing (NLP) Clinical Challenges (n2c2)/Open Health NLP (OHNLP) shared task on clinical concept normalization for clinical records. J Am Med Inform Assoc 2020; 27:1529-1537. [PMID: 32968800 PMCID: PMC7647359 DOI: 10.1093/jamia/ocaa106] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/01/2020] [Accepted: 05/14/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE The 2019 National Natural language processing (NLP) Clinical Challenges (n2c2)/Open Health NLP (OHNLP) shared task track 3, focused on medical concept normalization (MCN) in clinical records. This track aimed to assess the state of the art in identifying and matching salient medical concepts to a controlled vocabulary. In this paper, we describe the task, describe the data set used, compare the participating systems, present results, identify the strengths and limitations of the current state of the art, and identify directions for future research. MATERIALS AND METHODS Participating teams were provided with narrative discharge summaries in which text spans corresponding to medical concepts were identified. This paper refers to these text spans as mentions. Teams were tasked with normalizing these mentions to concepts, represented by concept unique identifiers, within the Unified Medical Language System. Submitted systems represented 4 broad categories of approaches: cascading dictionary matching, cosine distance, deep learning, and retrieve-and-rank systems. Disambiguation modules were common across all approaches. RESULTS A total of 33 teams participated in the MCN task. The best-performing team achieved an accuracy of 0.8526. The median and mean performances among all teams were 0.7733 and 0.7426, respectively. CONCLUSIONS Overall performance among the top 10 teams was high. However, several mention types were challenging for all teams. These included mentions requiring disambiguation of misspelled words, acronyms, abbreviations, and mentions with more than 1 possible semantic type. Also challenging were complex mentions of long, multi-word terms that may require new ways of extracting and representing mention meaning, the use of domain knowledge, parse trees, or hand-crafted rules.
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Affiliation(s)
- Yen-Fu Luo
- Department of Computer Science, University of Massachusetts
Lowell, Lowell, Massachusetts, USA
| | - Sam Henry
- Department of Information Sciences and Technology, George Mason
University, Fairfax, Virginia, USA
| | - Yanshan Wang
- Department of Health Sciences Research, Mayo Clinic, Rochester,
New York, USA
| | - Feichen Shen
- Department of Health Sciences Research, Mayo Clinic, Rochester,
New York, USA
| | - Ozlem Uzuner
- Department of Information Sciences and Technology, George Mason
University, Fairfax, Virginia, USA
- Department of Biomedical Informatics, Harvard Medical School,
Boston, Massachusetts, USA
- Computer Science and Artificial Intelligence Laboratory, Massachusetts
Institute of Technology, Cambridge, Massachusetts, USA
| | - Anna Rumshisky
- Department of Computer Science, University of Massachusetts
Lowell, Lowell, Massachusetts, USA
- Computer Science and Artificial Intelligence Laboratory, Massachusetts
Institute of Technology, Cambridge, Massachusetts, USA
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250
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Taylor DC, Abel JL, Doshi JA, Martin C, Goolsby Hunter A, Essoi B, Korrer S, Reasner DS, Carson RT, Chey WD. The Impact of Stool Consistency on Bowel Movement Satisfaction in Patients With IBS-C or CIC Treated With Linaclotide or Other Medications: Real-World Evidence From the CONTOR Study. J Clin Gastroenterol 2020; 53:737-743. [PMID: 31361710 PMCID: PMC6791496 DOI: 10.1097/mcg.0000000000001245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 05/26/2019] [Indexed: 12/19/2022]
Abstract
GOALS This study aimed to characterize the impact of stool consistency on patient-reported bowel movement (BM) satisfaction in patients with irritable bowel syndrome with constipation (IBS-C) or chronic idiopathic constipation, with a focus on linaclotide. BACKGROUND As new medications for constipation become available, understanding patients' perceptions of treatment effects may help clinicians manage patient expectations and inform clinical decision-making. MATERIALS AND METHODS Data were derived from the Chronic Constipation and IBS-C Treatment and Outcomes Real-world Research Platform (CONTOR) study from 2 patient-reported 7-day daily BM diaries to create a dataset of 2922 diaries representing 26,524 BMs for 1806 participants. Binary variables were created for: medication(s) used in the past 24 hours and categorization of BMs as loose or watery stools (LoWS), hard or lumpy stools (HoLS), or intermediate (neither LoWS nor HoLS). The relationship between stool consistency, medication use, and BM satisfaction was analyzed using logistic regression with SEs corrected for repeated observations. RESULTS BMs characterized as intermediate stools and LoWS were satisfactory more often (61.2% and 51.2%, respectively) than HoLS (19.4%). Participants who reported taking linaclotide rated a similar proportion of BMs as satisfactory when described as LoWS (65.6%) or intermediate (64.1%). Linaclotide use was associated with higher odds of BMs being reported as satisfactory compared with nonlinaclotide use (odds ratio: 1.23, P<0.05). CONCLUSIONS Overall, CONTOR participants were more likely to report BMs classified as LoWS or intermediate as satisfactory, versus HoLS. Participants taking linaclotide were more likely to be satisfied, particularly those reporting LoWS, versus those not taking linaclotide.
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Affiliation(s)
| | | | - Jalpa A. Doshi
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | | | - William D. Chey
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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