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Ikoma T, Matsumoto T, Boku S, Motoki Y, Kinoshita H, Kosaka H, Kaibori M, Inoue K, Sekimoto M, Fujisawa T, Iwai H, Naganuma M, Tanizaki H, Hisamatsu Y, Okada H, Kurata T. Safety of immune checkpoint inhibitors in patients aged over 80 years: a retrospective cohort study. Cancer Immunol Immunother 2024; 73:126. [PMID: 38733406 PMCID: PMC11088591 DOI: 10.1007/s00262-024-03707-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Immuno-oncology (IO) drugs are essential for treating various cancer types; however, safety concerns persist in older patients. Although the incidence of immune-related adverse events (irAEs) is similar among age groups, higher rates of hospitalization or discontinuation of IO therapy have been reported in older patients. Limited research exists on IO drug safety and risk factors in older adults. Our investigation aimed to assess the incidence of irAEs and identify the potential risk factors associated with their development. METHODS This retrospective analysis reviewed the clinical data extracted from the medical records of patients aged > 80 years who underwent IO treatment at our institution. Univariate and multivariate analyses were performed to assess the incidence of irAEs. RESULTS Our study included 181 patients (median age: 82 years, range: 80-94), mostly men (73%), with a performance status of 0-1 in 87% of the cases; 64% received IO monotherapy. irAEs occurred in 35% of patients, contributing to IO therapy discontinuation in 19%. Our analysis highlighted increased body mass index, eosinophil counts, and albumin levels in patients with irAEs. Eosinophil count emerged as a significant risk factor for any grade irAEs, particularly Grade 3 or higher, with a cutoff of 118 (/μL). The group with eosinophil counts > 118 had a higher frequency of irAEs, and Grade 3 or higher events than the group with counts ≤ 118. CONCLUSION IO therapy is a safe treatment option for patients > 80 years old. Furthermore, patients with elevated eosinophil counts at treatment initiation should be cautiously managed.
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Affiliation(s)
- Tatsuki Ikoma
- Cancer Treatment Center, Kansai Medical University Hospital, 2-3-1, Shinmachi, Hirakata, Osaka-Prefecture, 573-1191, Japan
- Department of Thoracic Oncology, Kansai Medical University, 2-3-1, Shinmachi, Hirakata, Osaka-Prefecture, 573-1191, Japan
| | - Toshihiko Matsumoto
- Cancer Treatment Center, Kansai Medical University Hospital, 2-3-1, Shinmachi, Hirakata, Osaka-Prefecture, 573-1191, Japan
| | - Shogen Boku
- Cancer Treatment Center, Kansai Medical University Hospital, 2-3-1, Shinmachi, Hirakata, Osaka-Prefecture, 573-1191, Japan
| | - Yusuke Motoki
- Department of Urology and Andrology, Kansai Medical University, 2-3-1, Shinmachi, Hirakata, Osaka-Prefecture, 573-1191, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, 2-3-1, Shinmachi, Hirakata, Osaka-Prefecture, 573-1191, Japan
| | - Hisashi Kosaka
- Department of Surgery, Kansai Medical University, 2-3-1, Shinmachi, Hirakata, Osaka-Prefecture, 573-1191, Japan
| | - Masaki Kaibori
- Department of Surgery, Kansai Medical University, 2-3-1, Shinmachi, Hirakata, Osaka-Prefecture, 573-1191, Japan
| | - Kentaro Inoue
- Department of Surgery, Kansai Medical University, 2-3-1, Shinmachi, Hirakata, Osaka-Prefecture, 573-1191, Japan
| | - Mitsugu Sekimoto
- Department of Surgery, Kansai Medical University, 2-3-1, Shinmachi, Hirakata, Osaka-Prefecture, 573-1191, Japan
| | - Takuo Fujisawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Kansai Medical University, 2-3-1, Shinmachi, Hirakata, Osaka-Prefecture, 573-1191, Japan
| | - Hiroshi Iwai
- Department of Otorhinolaryngology, Head and Neck Surgery, Kansai Medical University, 2-3-1, Shinmachi, Hirakata, Osaka-Prefecture, 573-1191, Japan
| | - Makoto Naganuma
- Third Department of Internal Medicine, Kansai Medical University, 2-3-1, Shinmachi, Hirakata, Osaka-Prefecture, 573-1191, Japan
| | - Hideaki Tanizaki
- Department of Dermatology, Kansai Medical University, 2-3-1, Shinmachi, Hirakata, Osaka-Prefecture, 573-1191, Japan
| | - Yoji Hisamatsu
- Department of Obstetrics and Gynecology, Kansai Medical University, 2-3-1, Shinmachi, Hirakata, Osaka-Prefecture, 573-1191, Japan
| | - Hidetaka Okada
- Department of Obstetrics and Gynecology, Kansai Medical University, 2-3-1, Shinmachi, Hirakata, Osaka-Prefecture, 573-1191, Japan
| | - Takayasu Kurata
- Cancer Treatment Center, Kansai Medical University Hospital, 2-3-1, Shinmachi, Hirakata, Osaka-Prefecture, 573-1191, Japan.
- Department of Thoracic Oncology, Kansai Medical University, 2-3-1, Shinmachi, Hirakata, Osaka-Prefecture, 573-1191, Japan.
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Mendoza YG, Jusot V, Adou F, Ota M, Elenge DM, Begum T, Mdladla N, Menang O, Yavo JC, Kamagaté M. Enhancing Pharmacovigilance in Côte d'Ivoire: Impact of GSK's Training and Mentoring Pilot Project in the Abidjan Region. Drug Saf 2024; 47:147-159. [PMID: 37966696 PMCID: PMC10821828 DOI: 10.1007/s40264-023-01368-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/16/2023]
Abstract
INTRODUCTION Pharmacovigilance (PV) in sub-Saharan Africa relies on passive surveillance but underreporting of adverse events (AEs) by health care professionals (HCPs) is a major challenge. A PV enhancement project was implemented to address this in Côte d'Ivoire. OBJECTIVE To improve safety surveillance of medicines through PV training and mentoring of HCPs in selected health care facilities (HCFs). METHODS This collaborative project between national PV stakeholders, GSK, and PATH was implemented from September 2018 to February 2020 in Abidjan region, Côte d'Ivoire. Trained PV focal points provided training and regular mentoring of HCPs. Key performance indicator (KPI) categories for AE reporting were the volume of AE reports, efficiency of report transmission and data entry, quality of reports, and quality of the central (Vigilance Unit) response to AE reports. RESULTS Overall, 1427 HCPs at 91 HCFs were trained. In the 8 months before implementation, 33 AE reports were received versus 85 after 3 months and 361 after 18 months of implementation (71 [83.5%] and 278 [77.0%], respectively, from Abidjan). The KPIs with the highest proportions were: AE reports received centrally (100%), complete AE reports (69.0%), AE reports entered into the local PV database within 48 h (99.6%), and AE reports entered into the global database, VigiBase (86.7%). Report notification within 72 h, causality assessment, and serious AE reporting had proportions below 20%; feedback to reporters was provided for only 0.4% of reports. CONCLUSION Regular PV trainings and mentoring improved AE reporting in Côte d'Ivoire but further enhancement is required to improve passive safety surveillance.
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Affiliation(s)
| | | | - Félix Adou
- Autorité Ivoirienne de Régulation Pharmaceutique (AIRP), Abidjan, Ivory Coast
| | | | | | | | | | | | - Jean Claude Yavo
- Autorité Ivoirienne de Régulation Pharmaceutique (AIRP), Abidjan, Ivory Coast
| | - Mamadou Kamagaté
- Service de pharmacologie clinique, UFR-sciences médicales Bouaké, université Alassane-Ouattara, Abidjan, Ivory Coast
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Parzianello A, Fornasier G, Kiren V, Pigato F, Orzetti S, Zamagni G, Arbo A, Baldo P, Rossi P, Rabusin M, Mascarin M, Trojniak MP. Improving Drug Safety in Pediatric and Young Adult Patients with Hemato-Oncological Diseases: A Prospective Study of Active Pharmacovigilance. Pharmaceuticals (Basel) 2024; 17:106. [PMID: 38256939 PMCID: PMC10821342 DOI: 10.3390/ph17010106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/29/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
The acquisition of relevant pediatric clinical safety data is essential to ensure tolerable drug therapies. Comparing the real number of Adverse Drug Reaction (ADR) reports in clinical practice with the literature, the idea of ADR underreporting emerges. An active pharmacovigilance observational prospective study was conducted to assess the safety of oncology pharmacological prescriptions in patients aged 0-24 years at Institute for Maternal and Child Health IRCCS Burlo Garofolo in Trieste and IRCCS CRO National Cancer Institute in Aviano (Italy) between January 2021 and October 2023. Prescriptions and ADRs were evaluated by a multidisciplinary team. A total of 1218 prescriptions for 38 patients were analyzed, and 190 ADRs of grade 3-5 were collected. As compared to historical data, we registered a significant increase (p < 0.001) in the number of ADRs. The risk of ADR was 3.4 times higher in the case of off-label prescriptions compared to on-label ones (OR 3.4; [1.47; 7.89]; p-value = 0.004). The risks of error and near-miss were reported for 6.3% and 18.2% of total prescriptions, respectively. Of the total of 133 interactions, 47 (35.3%) resulted in ADRs. This study shows the importance of pro-active pharmacovigilance to efficiently highlight ADRs, and the fundamental role of multidisciplinary teams (oncologist, pharmacist, pharmacologist, pediatrician, nurse) in improving patients' safety during therapy.
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Affiliation(s)
- Anna Parzianello
- Department of Medicine, Surgery and Health Sciences, Postgraduate School of Clinical Pharmacology and Toxicology, University of Trieste, 34127 Trieste, Italy;
| | - Giulia Fornasier
- Regional Agency for Health Coordination of Friuli Venezia Giulia (ARCS), 33100 Udine, Italy;
| | - Valentina Kiren
- Pediatric Hemato-Oncology Unit, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, 34137 Trieste, Italy; (V.K.); (M.R.)
| | - Federico Pigato
- Pharmacy Unit, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, 34137 Trieste, Italy; (F.P.); (A.A.)
| | - Sabrina Orzetti
- Pharmacy Unit, IRCCS CRO National Cancer Institute, 33081 Aviano, Italy; (S.O.); (P.B.)
| | - Giulia Zamagni
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, 34137 Trieste, Italy;
| | - Anna Arbo
- Pharmacy Unit, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, 34137 Trieste, Italy; (F.P.); (A.A.)
| | - Paolo Baldo
- Pharmacy Unit, IRCCS CRO National Cancer Institute, 33081 Aviano, Italy; (S.O.); (P.B.)
| | - Paola Rossi
- Central Directorate for Health, Social Policies and Disability—Friuli Venezia Giulia Region, Regional Center for Pharmacovigilance, 34121 Trieste, Italy;
| | - Marco Rabusin
- Pediatric Hemato-Oncology Unit, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, 34137 Trieste, Italy; (V.K.); (M.R.)
| | - Maurizio Mascarin
- Integrated Oncology for Adolescents and Young Adults and Pediatric Radiotherapy Unit, IRCCS CRO National Cancer Institute, 33081 Aviano, Italy;
| | - Marta Paulina Trojniak
- Pharmacy Unit, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, 34137 Trieste, Italy; (F.P.); (A.A.)
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von Siebenthal HK, Gessler S, Vallelian F, Steinwendner J, Kuenzi UM, Moretti D, Zimmermann MB, Stoffel NU. Alternate day versus consecutive day oral iron supplementation in iron-depleted women: a randomized double-blind placebo-controlled study. EClinicalMedicine 2023; 65:102286. [PMID: 38021373 PMCID: PMC10659995 DOI: 10.1016/j.eclinm.2023.102286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023] Open
Abstract
Background Guidelines to treat iron deficiency recommend daily provision of oral iron, but this may decrease fractional iron absorption and increase side effects. Our objective was to compare consecutive-day versus alternate-day iron supplementation. Methods In a double-masked, randomized, placebo-controlled trial, young Swiss women (n = 150; serum ferritin ≤30 μg/L) were assigned to: daily 100 mg iron for 90 d, followed by daily placebo for another 90 d (consecutive-day group) or the same daily dose of iron and placebo on alternate days for 180 d (alternate-day group). The study period was 24/11/2021-10/8/2022. Co-primary outcomes, at equal total iron doses, were serum ferritin and gastrointestinal side effects; secondary outcomes were iron deficiency and serum hepcidin. Compliance and side effects were recorded daily using a mobile application. Data were analysed using mixed models and longitudinal prevalence ratios (LPR). The trial was registered at ClinicalTrials.gov (NCT05105438). Findings 75 women were assigned to each group and included in the intention-to-treat analysis. Capsule adherence and side effect reporting was >97% in both groups. At equal total iron doses, comparing consecutive-day and alternate-day groups, median serum ferritin was 43.8 μg/L (31.7-58.2) versus 44.8 μg/L (33.8-53.6) (P = 0.98), the LPR for gastrointestinal side effects on days of iron intake was 1.56 (95% CI: 1.38, 1.77; P < 0.0001), and median serum hepcidin was 3.0 nM (IQR 2.0-5.0) versus 1.9 nM (1.4-2.9) (P < 0.0001). Iron deficiency prevalence after 3 months was 5.5% versus 4.3% (P = 0.74) and after 6 months was 11.4% and 3.0% (P = 0.049). Interpretation At equal total iron doses, compared to consecutive day dosing of iron, alternate day dosing did not result in higher serum ferritin but reduced iron deficiency at 6 months and triggered fewer gastrointestinal side effects. Funding Swiss National Science Foundation, Bern, Switzerland.
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Affiliation(s)
- Hanna K. von Siebenthal
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Sara Gessler
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Florence Vallelian
- Division of Internal Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Joachim Steinwendner
- Laboratory of Web Science, Swiss Distance University of Applied Sciences, Zürich, Switzerland
| | - Urs-Martin Kuenzi
- Laboratory of Web Science, Swiss Distance University of Applied Sciences, Zürich, Switzerland
| | - Diego Moretti
- Nutrition Research, Department of Health, Swiss Distance University of Applied Sciences, Zürich, Switzerland
| | - Michael B. Zimmermann
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, Switzerland
- Medical Research Council Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Nicole U. Stoffel
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, Switzerland
- Medical Research Council Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Shuttleworth P, Baker J, Clark E. Under-reporting of gastrointestinal bleeding associated with anticoagulant use using the UK Yellow Card Scheme. Int J Clin Pharm 2023; 45:1014-1018. [PMID: 37269441 DOI: 10.1007/s11096-023-01601-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/25/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND The Yellow Card Scheme was created in 1964 to oversee new and existing medicines and medical devices, and act as an early warning system for unexpected adverse drug reactions (ADRs). Under-reporting within the system is a known issue, estimated to be as high as 94% in a 2006 systematic review. Anticoagulants are often prescribed in the UK to prevent stroke in patients with atrial fibrillation but can be associated with gastrointestinal bleeding as a common ADR. AIM The study aimed to investigate the incidence of suspected DOAC-related GI bleeds at a North-West England hospital and explore the volume of these incidents reported through the MHRA Yellow Card Scheme, over a 5-year period. METHOD Hospital coding data was used to identify patient records with GI bleeding and cross-referenced with electronic prescribing records for anticoagulant usage. Additionally, pharmacovigilance reporting activity for the Trust was obtained from the MHRA Yellow Card Scheme. RESULTS For the period investigated, the Trust recorded 12,013 GI bleed related emergency admissions. Of these admissions, 1058 patients were taking a DOAC. During the same time period, a total of 6 DOAC-related pharmacovigilance reports were made by the trust. CONCLUSION Utilisation of the Yellow Card System for reporting potential ADR is poor, leading to under-reporting of ADRs.
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Affiliation(s)
- Paul Shuttleworth
- Department of General Surgery, Stockport NHS Foundation Trust, Stockport, SK2 7JE, UK.
| | - James Baker
- Pharmacy Department, Stockport NHS Foundation Trust, Stockport, SK2 7JE, UK
| | - Edwin Clark
- Department of General Surgery, Stockport NHS Foundation Trust, Stockport, SK2 7JE, UK
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