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Tada K, Maruo K, Gosho M. A Bayesian method to detect drug-drug interaction using external information for spontaneous reporting system. Stat Med 2024; 43:3353-3363. [PMID: 38840316 DOI: 10.1002/sim.10137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 03/22/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024]
Abstract
Due to the insufficiency of safety assessments of clinical trials for drugs, further assessments are required for post-marketed drugs. In addition to adverse drug reactions (ADRs) induced by one drug, drug-drug interaction (DDI)-induced ADR should also be investigated. The spontaneous reporting system (SRS) is a powerful tool for evaluating the safety of drugs continually. In this study, we propose a novel Bayesian method for detecting potential DDIs in a database collected by the SRS. By applying a power prior, the proposed method can borrow information from similar drugs for a drug assessed DDI to increase sensitivity of detection. The proposed method can also adjust the amount of the information borrowed by tuning the parameters in power prior. In the simulation study, we demonstrate the aforementioned increase in sensitivity. Depending on the scenarios, approximately 20 points of sensitivity of the proposed method increase from an existing method to a maximum. We also indicate the possibility of early detection of potential DDIs by the proposed method through analysis of the database shared by the Food and Drug Administration. In conclusion, the proposed method has a higher sensitivity and a novel criterion to detect potential DDIs early, provided similar drugs have similar observed-expected ratios to the drug under assessment.
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Affiliation(s)
- Keisuke Tada
- Biostatistics & Programming, Sanofi K.K, Shinjuku-ku, Tokyo, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Institute of Medicine, University of Tsukuba, Tsukuba-shi, Ibaraki, Japan
| | - Masahiko Gosho
- Department of Biostatistics, Institute of Medicine, University of Tsukuba, Tsukuba-shi, Ibaraki, Japan
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Yu M, Zhao S, Fan X, Lv Y, Xiang L, Li R. Sodium-glucose cotransporter-2 inhibitors and abnormal serum potassium: a real-world, pharmacovigilance study. J Cardiovasc Med (Hagerstown) 2024; 25:613-622. [PMID: 38949149 DOI: 10.2459/jcm.0000000000001646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
BACKGROUND New trials indicated a potential of sodium-glucose cotransporter-2 inhibitors (SGLT2i) to reduce hyperkalemia, which might have important clinical implications, but real-world data are limited. Therefore, we examined the effect of SGLT2i on hyper- and hypokalemia occurrence using the FDA adverse event reporting system (FAERS). METHODS The FAERS database was retrospectively queried from 2004q1 to 2021q3. Disproportionality analyses were performed based on the reporting odds ratio (ROR) and 95% confidence interval (CI). RESULTS There were 84 601 adverse event reports for SGLT2i and 1 321 186 reports for other glucose-lowering medications. The hyperkalemia reporting incidence was significantly lower with SGLT2i than with other glucose-lowering medications (ROR, 0.83; 95% CI, 0.79-0.86). Reductions in hyperkalemia reports did not change across a series of sensitivity analyses. Compared with that with renin-angiotensin-aldosterone system inhibitors (RAASi) alone (ROR, 4.40; 95% CI, 4.31-4.49), the hyperkalemia reporting incidence was disproportionally lower among individuals using RAASi with SGLT2i (ROR, 3.25; 95% CI, 3.06-3.45). Compared with that with mineralocorticoid receptor antagonists (MRAs) alone, the hyperkalemia reporting incidence was also slightly lower among individuals using MRAs with SGLT-2i. The reporting incidence of hypokalemia was lower with SGLT2i than with other antihyperglycemic agents (ROR, 0.79; 95% CI, 0.75-0.83). CONCLUSION In a real-world setting, hyperkalemia and hypokalemia were robustly and consistently reported less frequently with SGLT2i than with other diabetes medications. There were disproportionally fewer hyperkalemia reports among those using SGLT-2is with RAASi or MRAs than among those using RAASi or MRAs alone.
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Affiliation(s)
- Meng Yu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College, The First Batch of Key Disciplines on Public Health in Chongqing
| | - Subei Zhao
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoyun Fan
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College, The First Batch of Key Disciplines on Public Health in Chongqing
| | - Yuhuan Lv
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Linyu Xiang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rong Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Cocco M, Carnovale C, Clementi E, Barbieri MA, Battini V, Sessa M. Exploring the impact of co-exposure timing on drug-drug interactions in signal detection through spontaneous reporting system databases: a scoping review. Expert Rev Clin Pharmacol 2024; 17:441-453. [PMID: 38619027 DOI: 10.1080/17512433.2024.2343875] [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: 12/22/2023] [Accepted: 04/12/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Drug-drug interactions (DDIs) are defined as the pharmacological effects produced by the concomitant administration of two or more drugs. To minimize false positive signals and ensure their validity when analyzing Spontaneous Reporting System (SRS) databases, it has been suggested to incorporate key pharmacological principles, such as temporal plausibility. AREAS COVERED The scoping review of the literature was completed using MEDLINE from inception to March 2023. Included studies had to provide detailed methods for identifying DDIs in SRS databases. Any methodological approach and adverse event were accepted. Descriptive analyzes were excluded as we focused on automatic signal detection methods. The result is an overview of all the available methods for DDI signal detection in SRS databases, with a specific focus on the evaluation of the co-exposure time of the interacting drugs. It is worth noting that only a limited number of studies (n = 3) have attempted to address the issue of overlapping drug administration times. EXPERT OPINION Current guidelines for signal validation focus on factors like the number of reports and temporal association, but they lack guidance on addressing overlapping drug administration times, highlighting a need for further research and method development.
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Affiliation(s)
- Marianna Cocco
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- Department of Drug Sciences, University of Pavia, Pavia, Italy
| | - Carla Carnovale
- Pharmacovigilance & Clinical Research, International Centre for Pesticides and Health Risk Prevention, Department of Biomedical and Clinical Sciences (DIBIC), ASST Fatebenefratelli-Sacco University Hospital, Università Degli Studi di Milano, Milan, Italy
| | - Emilio Clementi
- Pharmacovigilance & Clinical Research, International Centre for Pesticides and Health Risk Prevention, Department of Biomedical and Clinical Sciences (DIBIC), ASST Fatebenefratelli-Sacco University Hospital, Università Degli Studi di Milano, Milan, Italy
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, LC, Italy
| | - Maria Antonietta Barbieri
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vera Battini
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Maurizio Sessa
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
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Wang Y, Liu X. Safety signals of albumin-bound paclitaxel: Data mining of the Food and Drug Administration adverse event reporting system. Indian J Pharmacol 2023; 55:167-173. [PMID: 37555411 PMCID: PMC10501543 DOI: 10.4103/ijp.ijp_640_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 06/30/2023] [Accepted: 07/13/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND With the extensive application of paclitaxel for injection (albumin-bound), its adverse reactions have also received increasing attention. AIM This study aims to provide a reference for the safe use of albumin-bound paclitaxel in clinical practice; adverse drug events signals of albumin-bound paclitaxel were reviewed and identified by data mining of the Food and Drug Administration (FDA) adverse event reporting system (FAERS). METHODS The reporting odds ratio method was used for the quantitative detection of signals from the data in the FDA public data program (OpenFDA) during 2004-2019 for the albumin-bound paclitaxel. RESULTS According to the OpenFDA, 1659 adverse events (AEs) were identified for albumin-bound paclitaxel. AEs were mostly observed in females rather than males, aged 45-64 years. AEs involved 17 system organ classes, mainly blood and lymphatic, gastrointestinal, hepatobiliary, respiratory, thoracic, and mediastinal systems, and general AEs. Safety signals were found in 20 unexpected adverse drug reactions which are not listed on drug labels, mainly including macular edema and lymphopenia. CONCLUSION Identifying and evaluating albumin-bound paclitaxel-associated AEs signals by mining FAERS may help evaluate the safety profiles of albumin-bound paclitaxel and reduce the risk of medical treatment. In the clinical application of albumin-bound paclitaxel in addition to the adverse reactions mentioned in the drug instructions, lymphocyte changes should be paid close attention to, and eye monitoring should be conducted regularly to avoid drug withdrawal or organ damage caused by adverse reactions.
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Affiliation(s)
- Yuwei Wang
- Radiation Oncology Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiao Liu
- Department of Gastrointestinal Surgery, The Fifth People's Hospital of Chongqing, Chongqing, China
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Noguchi Y. Comment on: "Drug-Drug Interaction of the Sodium Glucose Co-transporter 2 Inhibitors with Statins and Myopathy: A Disproportionality Analysis Using Adverse Events Reporting Data". Drug Saf 2022; 45:809-811. [PMID: 35713777 DOI: 10.1007/s40264-022-01191-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 12/19/2022]
Affiliation(s)
- Yoshihiro Noguchi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, 1-25-4, Daigakunishi, Gifu, 501-1196, Japan.
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Al-Ashwal FY, Sulaiman SAS, Sheikh Ghadzi SM, Kubas MA, Halboup A. Prevalence and predictors of clinically significant statin-drug interactions among Yemeni patients taking statins for primary and secondary prevention of cardiovascular disease. Curr Med Res Opin 2022; 38:889-899. [PMID: 35481428 DOI: 10.1080/03007995.2022.2072088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Statins are extensively used in clinical practice for the primary and secondary prevention of cardiovascular diseases. Statins are usually taken in combination with other medications. This may increase the risk of statin-drug interactions. The study aimed to evaluate the prevalence, patterns, and predictors of clinically significant statin-drug interactions among patients on statin therapy. MATERIAL AND METHODS A cross-sectional study was conducted at the cardiology, endocrine, and internal medicine outpatient clinics in four tertiary care hospitals in Sana'a, Yemen. Lexicomp Drug Interaction database was used to analyze the prescriptions for potential statin-drug interactions. Binary and multivariable logistic regression were utilized for analysis. RESULTS Of the total number of patients (634), 114 individuals (18%) had a total of 122 statin-drug interactions. According to Lexicomp risk classification, 102 (83.6%) DDIs were class C (monitor therapy), 19 (15.6%) were class D (therapy modification), and only one (0.8%) class X (avoid combination). Simvastatin use was significantly associated with the presence of category D and X DDIs (15.9% vs. 1.6%, p < .001). Polypharmacy (OR = 2.571, p < .001) and having ≥3 comorbidities (OR = 2.512, p < .001) were the only variables associated with the presence of statin-drug interactions (C, D, and/or X). CONCLUSION Patients with polypharmacy and those with three or more comorbidities had a higher risk for statin-drug interactions. Therefore, routine screening by physicians and pharmacists for potential interactions should occur before prescribing or dispensing any medication to avoid clinically significant statin-drug interactions.
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Affiliation(s)
- Fahmi Y Al-Ashwal
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Clinical Pharmacy Department, University of Science and Technology Hospital (USTH), Sana'a, Yemen
| | - Syed Azhar Syed Sulaiman
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | | | - Mohammed Abdullah Kubas
- Clinical Pharmacy Department, University of Science and Technology Hospital (USTH), Sana'a, Yemen
| | - Abdulsalam Halboup
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Science and Technology, Sana'a, Yemen
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Meng L, Huang J, Qiu F, Shan X, Chen L, Sun S, Wang Y, Yang J. Peripheral Neuropathy During Concomitant Administration of Proteasome Inhibitors and Factor Xa Inhibitors: Identifying the Likelihood of Drug-Drug Interactions. Front Pharmacol 2022; 13:757415. [PMID: 35359859 PMCID: PMC8963930 DOI: 10.3389/fphar.2022.757415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Backgrounds: Proteasome inhibitors (PI) cause toxic peripheral neuropathy (PN), which is one of the dose-limiting adverse events of these treatments. Recent preclinical studies find that factor Xa inhibitor (FXaI), rivaroxaban, promotes PN in animals receiving oxaliplatin. Cancer patients can receive combined therapy of PI and FXaI. This study aimed to identify and characterize the interaction signals for the concomitant use of PI and FXaI resulting in PN.Methods: Reports from the United States FDA Adverse Event Reporting System (FAERS) were extracted from the first quarter of 2004 to the first quarter of 2020 for analysis. The Standardized Medical Dictionary for Regulatory Activities (MedDRA) query was used to identify PN cases. We conducted an initial disproportionality investigation to detect PN adverse event signals associated with the combined use of PI and FXaI by estimating a reporting odds ratio (ROR) with a 95% confidence interval (CI). The adjusted RORs were then analyzed by logistic regression analysis (adjusting for age, gender, and reporting year), and additive/multiplicative models were performed to further confirm the findings. Additionally, subset data analysis was performed on the basis of a single drug of PI and FXaI.Results: A total of 159,317 adverse event reports (including 2,822 PN reports) were included. The combined use of PI and FXaI was associated with a higher reporting of PN (RORadj = 7.890, 95%CI, 5.321–11.698). The result remained significant based on additive/multiplicative methods. The observed association was consistent in the analysis restricted to all specific PI agents (bortezomib and ixazomib) and FXaI (rivaroxaban), except apixaban.Conclusion: Analysis of FAERS data identified reporting associations of PN in the combined use of PI and FXaI, suggesting the need for more robust preclinical and clinical studies to elucidate the relationship.
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Affiliation(s)
- Long Meng
- Key Laboratory of Biochemistry and Molecular Pharmacology, Department of Pharmacology, Chongqing Medical University, Chongqing, China
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Qiu
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuefeng Shan
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Chen
- Department of Pharmacy, Chongqing Health Center for Women and Children, Chongqing, China
| | - Shusen Sun
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Western New England University, Springfield, MA, United States
- Department of Pharmacy, Xiangya Hospital Central South University, Changsha, China
| | - Yuwei Wang
- Chongqing University Cancer Hospital, Chongqing, China
| | - Junqing Yang
- Key Laboratory of Biochemistry and Molecular Pharmacology, Department of Pharmacology, Chongqing Medical University, Chongqing, China
- *Correspondence: Junqing Yang,
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Alkabbani W, Pelletier R, Beazely MA, Labib Y, Quan B, Gamble JM. Drug-Drug Interaction of the Sodium Glucose Co-Transporter 2 Inhibitors with Statins and Myopathy: A Disproportionality Analysis Using Adverse Events Reporting Data. Drug Saf 2022; 45:287-295. [PMID: 35247195 DOI: 10.1007/s40264-022-01166-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION An increased risk of myopathy due to a potential interaction between sodium glucose co-transporter-2 inhibitors (SGLT-2i) and HMG-CoA reductase inhibitors (statins) has been suggested by case reports. OBJECTIVE We aimed to assess if the reporting of myopathy is disproportionally higher among people using both SGLT-2i and statins compared to using either SGLT-2i or statins alone. METHODS We conducted a disproportionality analysis using data from the US Food and Drug Administration Adverse Event Reporting System (FAERS). We included reports with at least one antihyperglycemic agent. We compared the proportion of myopathy cases to non-cases between those not using SGLT-2i or statins, using SGLT-2i only, statins only, or both. We calculated the reporting odds ratio and 95% confidence interval. We further stratified by individual SGLT-2i and selected statins (rosuvastatin or atorvastatin). RESULTS We included 688,388 reports with at least one antihyperglycemic agent recorded, of which 9.80% had at least one SGLT-2i agent. Among all included reports, there were a total of 2202 myopathy cases with the majority, 61.26%, occurring among those using statins alone and only 2.72% of myopathy cases were among those using both SGLT-2i and statins together. Reporting of myopathy was not disproportionally higher among those reporting the use of SGLT-2i with statins (reporting odds ratio 2.95, 95% confidence interval 2.27-3.85) compared to statins alone (reporting odds ratio 6.41, 95% confidence interval 5.86-7.02). CONCLUSIONS Reports of myopathy were not disproportionally higher among those using SGLT-2i with statins compared to SGLT-2i or statins alone at the class level. Further observational studies may be needed to better assess this interaction at the agent level.
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Affiliation(s)
- Wajd Alkabbani
- School of Pharmacy, Faculty of Science, University of Waterloo, 10A Victoria Street S, Kitchener, ON, N2G 1C5, Canada
| | - Ryan Pelletier
- School of Pharmacy, Faculty of Science, University of Waterloo, 10A Victoria Street S, Kitchener, ON, N2G 1C5, Canada
| | - Michael A Beazely
- School of Pharmacy, Faculty of Science, University of Waterloo, 10A Victoria Street S, Kitchener, ON, N2G 1C5, Canada
| | - Youssef Labib
- School of Pharmacy, Faculty of Science, University of Waterloo, 10A Victoria Street S, Kitchener, ON, N2G 1C5, Canada
| | - Breanna Quan
- School of Pharmacy, Faculty of Science, University of Waterloo, 10A Victoria Street S, Kitchener, ON, N2G 1C5, Canada
| | - John-Michael Gamble
- School of Pharmacy, Faculty of Science, University of Waterloo, 10A Victoria Street S, Kitchener, ON, N2G 1C5, Canada.
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Musculoskeletal Adverse Events Associated with PCSK9 Inhibitors: Disproportionality Analysis of the FDA Adverse Event Reporting System. Cardiovasc Ther 2022; 2022:9866486. [PMID: 35140810 PMCID: PMC8808238 DOI: 10.1155/2022/9866486] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/25/2021] [Accepted: 01/12/2022] [Indexed: 01/17/2023] Open
Abstract
Background. Some studies suggest that potential safety issues about PCSK9 inhibitors have not been sufficiently explored in clinical trials, including musculoskeletal adverse events (MAEs). Objective. To examine the association between use of PCSK9 inhibitors with and without concurrent statins and risk of MAEs. Patients and Methods. FDA Adverse Event Reporting System (FAERS) dataset of PCSK9 inhibitors and statins from October 2015 to June 2021 was queried. The reporting odds ratio (ROR) with relevant 95% confidence interval (95% CI) was calculated as the index of disproportionality. Outcome of MAEs of different PCSK9 inhibitors regimens was also investigated. Results. 3,185 cases of PCSK9 inhibitor-associated MAEs were recorded. PCSK9 inhibitor class alone demonstrated a strong link to MAEs (ROR 5.92; 95% CI 5.70-6.15), and evolocumab was associated with more reports of MAEs than alirocumab. Concomitant use with statins leaded to an increased occurrence of MAEs (ROR 32.15 (25.55-40.46)), and the risk differed among different statins. The PCSK9 inhibitors were safer than statins in terms of hospitalization rate and death rate (15.64% vs. 36.83%; 0.72% vs. 3.53%). Conclusions. This pharmacovigilance investigation suggests that PCSK9 inhibitors are associated with MAEs. The risk significantly increases when combined with statins. Increased laboratory and clinical monitoring are required to timely diagnose and manage MAEs.
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Noguchi Y, Yoshizawa S, Aoyama K, Kubo S, Tachi T, Teramachi H. Verification of the "Upward Variation in the Reporting Odds Ratio Scores" to Detect the Signals of Drug-Drug Interactions. Pharmaceutics 2021; 13:pharmaceutics13101531. [PMID: 34683823 PMCID: PMC8537362 DOI: 10.3390/pharmaceutics13101531] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 02/08/2023] Open
Abstract
The reporting odds ratio (ROR) is easy to calculate, and there have been several examples of its use because of its potential to speed up the detection of drug-drug interaction signals by using the "upward variation of ROR score". However, since the validity of the detection method is unknown, this study followed previous studies to investigate the detection trend. The statistics models (the Ω shrinkage measure and the "upward variation of ROR score") were compared using the verification dataset created from the Japanese Adverse Drug Event Report database (JADER). The drugs registered as "suspect drugs" in the verification dataset were considered as the drugs to be investigated, and the target adverse event in this study was Stevens-Johnson syndrome (SJS), as in previous studies. Of 3924 pairs that reported SJS, the number of positive signals detected by the Ω shrinkage measure and the "upward variation of ROR score" (Model 1, the Susuta Model, and Model 2) was 712, 2112, 1758, and 637, respectively. Furthermore, 1239 positive signals were detected when the Haldane-Anscombe 1/2 correction was applied to Model 2, the statistical model that showed the most conservative detection trend. This result indicated the instability of the positive signal detected in Model 2. The ROR scores based on the frequency-based statistics are easily inflated; thus, the use of the "upward variation of ROR scores" to search for drug-drug interaction signals increases the likelihood of false-positive signal detection. Consequently, the active use of the "upward variation of ROR scores" is not recommended, despite the existence of the Ω shrinkage measure, which shows a conservative detection trend.
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Affiliation(s)
- Yoshihiro Noguchi
- Correspondence: or (Y.N.); (H.T.); Tel.: +81-58-230-8100 (Y.N. & H.T.)
| | | | | | | | | | - Hitomi Teramachi
- Correspondence: or (Y.N.); (H.T.); Tel.: +81-58-230-8100 (Y.N. & H.T.)
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Pariente A, Labat V, Mansiaux Y, Salvo F, Bégaud B, Raschi E, Faillie JL, Létinier L, Bezin J. DPP-4 Inhibitors in Combination with Lipid-Lowering Agents and Risk of Serious Muscular Injury: A Nested Case-Control Study in a Nationwide Cohort of Patients with Type 2 Diabetes Mellitus. Drug Saf 2021; 43:767-774. [PMID: 32306223 DOI: 10.1007/s40264-020-00936-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION After a safety warning was issued for a risk of muscular injury associated with dipeptidyl peptidase-4 (DPP-4) inhibitor use, especially when co-prescribed with statins, spontaneous reporting analyses provided conflicting results. OBJECTIVE The aim of this study was to investigate the association between DPP-4 inhibitor use and the risk of muscular injury in individuals with type 2 diabetes mellitus using statins or fibrates. METHODS We conducted a nested case-control study amongst a cohort of individuals with type 2 diabetes using statins or fibrates, identified from a nationwide French health insurance database (2009-2014). Cases of serious muscular injury were defined as subjects hospitalized for rhabdomyolysis or myopathy, or for whom testing for myoglobin or creatine phosphokinase followed by a change in statin or fibrate prescription (dose decrease, treatment switch, or stop) was identified. Up to ten controls were matched to each case according to sex, age, and type of lipid-lowering agent. Associations between DPP-4 inhibitor use and serious muscular injury were estimated using a multivariate conditional logistic regression model, providing odds ratios (ORs) adjusted for alcoholism, chronic renal failure, hypothyroidism, and number of concomitant drugs. RESULTS Within the 35,117 individuals with type 2 diabetes mellitus constituting the source cohort, 437 statin-user cases were identified who were matched to 4358 statin-user controls. Similarly, 54 fibrate-user cases were identified who were matched to 540 fibrate-user controls. The adjusted OR for DPP-4 inhibitor use and serious muscular injury was estimated at 1.0 (95% confidence interval [CI] 0.7-1.2) in statin users and 0.8 (95% CI 0.4-1.9) in fibrate users. CONCLUSION In this study, DPP-4 inhibitor use was not associated with an increased risk of serious muscular injury among patients with type 2 diabetes mellitus using statins or fibrates.
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Affiliation(s)
- Antoine Pariente
- Team Pharmacoepidemiology, Bordeaux Population Health Research Center, Inserm U1219, Univ. Bordeaux, 33000, Bordeaux, France. .,Centre Régional de Pharmacovigilance et d'Information sur le Médicament de Bordeaux, Service de Pharmacologie Médicale, Pôle de Santé Publique, CHU Bordeaux, 33000, Bordeaux, France.
| | - Vanessa Labat
- Team Pharmacoepidemiology, Bordeaux Population Health Research Center, Inserm U1219, Univ. Bordeaux, 33000, Bordeaux, France
| | - Yohann Mansiaux
- Team Pharmacoepidemiology, Bordeaux Population Health Research Center, Inserm U1219, Univ. Bordeaux, 33000, Bordeaux, France
| | - Francesco Salvo
- Team Pharmacoepidemiology, Bordeaux Population Health Research Center, Inserm U1219, Univ. Bordeaux, 33000, Bordeaux, France.,Centre Régional de Pharmacovigilance et d'Information sur le Médicament de Bordeaux, Service de Pharmacologie Médicale, Pôle de Santé Publique, CHU Bordeaux, 33000, Bordeaux, France
| | - Bernard Bégaud
- Team Pharmacoepidemiology, Bordeaux Population Health Research Center, Inserm U1219, Univ. Bordeaux, 33000, Bordeaux, France.,Centre Régional de Pharmacovigilance et d'Information sur le Médicament de Bordeaux, Service de Pharmacologie Médicale, Pôle de Santé Publique, CHU Bordeaux, 33000, Bordeaux, France
| | - Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Irnerio, 48, 40126, Bologna, Italy
| | - Jean-Luc Faillie
- Department of Medical Pharmacology and Toxicology, Univ. Montpellier, CHU Montpellier, 34295, Montpellier, France
| | - Louis Létinier
- Team Pharmacoepidemiology, Bordeaux Population Health Research Center, Inserm U1219, Univ. Bordeaux, 33000, Bordeaux, France
| | - Julien Bezin
- Team Pharmacoepidemiology, Bordeaux Population Health Research Center, Inserm U1219, Univ. Bordeaux, 33000, Bordeaux, France
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Gatti M, Raschi E, Moretti U, Ardizzoni A, Poluzzi E, Diemberger I. Influenza Vaccination and Myo-Pericarditis in Patients Receiving Immune Checkpoint Inhibitors: Investigating the Likelihood of Interaction through the Vaccine Adverse Event Reporting System and VigiBase. Vaccines (Basel) 2021; 9:vaccines9010019. [PMID: 33406694 PMCID: PMC7823897 DOI: 10.3390/vaccines9010019] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 01/13/2023] Open
Abstract
Background: Evidence on whether the influenza vaccine could exacerbate immune-related adverse events, including myopericarditis (MP), in patients treated with immune checkpoint inhibitors (ICIs), is still conflicting. We explored this issue through a global real-world approach. Methods: We queried the Vaccine Adverse Event Reporting System (VAERS) and VigiBase to retrieve cases of MP in which the influenza vaccine and ICIs were recorded as suspect and were concomitantly reported. For the included cases, causality assessment and Drug Interaction Probability Scale (DIPS) algorithms were applied. Results: There were 191 and 399 reports of MP with the influenza vaccine that were retrieved (VAERS and VigiBase, respectively). No case of MP reporting the concomitant use of ICIs and the influenza vaccine was found in VAERS, while three cases of myocarditis were retrieved in VigiBase. All of the cases were unclassifiable for a causality assessment because of the lack of data concerning latency. According to the DIPS, one report was categorized as possible and two as doubtful. Conclusion: The paucity of cases coupled with the doubtful causality assessment make the potential interaction between influenza vaccines and ICIs in cancer patients negligible from clinical and epidemiological standpoints. These findings support the cardiovascular safety of the influenza vaccination, which remains strongly recommended in cancer patients, especially in the current COVID-19 era.
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Affiliation(s)
- Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy; (M.G.); (E.R.); (E.P.)
| | - Emanuel Raschi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy; (M.G.); (E.R.); (E.P.)
| | - Ugo Moretti
- Department of Public Health and Community Medicine, University of Verona, 37134 Verona, Italy;
| | - Andrea Ardizzoni
- Medical Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Policlinico S. Orsola-Malpighi, Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy;
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy; (M.G.); (E.R.); (E.P.)
| | - Igor Diemberger
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-051-2143-434; Fax: +39-0516-364-216
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Orime K, Terauchi Y. Efficacy and safety of saxagliptin for the treatment of type 2 diabetes mellitus. Expert Opin Pharmacother 2020; 21:2101-2114. [DOI: 10.1080/14656566.2020.1803280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Kazuki Orime
- Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama-City University, Yokohama, Japan
| | - Yasuo Terauchi
- Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama-City University, Yokohama, Japan
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Gatti M, Raschi E, De Ponti F. Serotonin syndrome by drug interactions with linezolid: clues from pharmacovigilance-pharmacokinetic/pharmacodynamic analysis. Eur J Clin Pharmacol 2020; 77:233-239. [PMID: 32901348 PMCID: PMC7803711 DOI: 10.1007/s00228-020-02990-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/01/2020] [Indexed: 12/30/2022]
Abstract
Purpose To characterize the post-marketing reporting of serotonin syndrome (SS) due to drug-drug interactions (DDIs) with linezolid and investigate the relationship with pharmacokinetic/pharmacodynamic (PK/PD) properties of serotonergic agents. Methods We queried the worldwide FDA Adverse Event Reporting System to extract SS records due to DDIs where linezolid was reported as suspect. For each serotonergic agent concomitantly reported, proportion of SS reports and mean number of DDIs were calculated and three different “SS reporting zones” were created. Relevant PK (peak concentration, area under plasma concentration curve, volume of distribution (VD), and lipophilicity) and PD (values of binding affinity (Ki) and IC50 for serotonin reuptake transporter (SERT) and 5-HT2A) parameters were extracted for each serotonergic agent, and relevant PK/PD indexes were calculated to assess correlation with mean number of DDIs (PV index). Results Six hundred sixty-nine reports of SS mentioning linezolid were found, being linezolid-citalopram (N = 69; 10.3%) the most frequently DDI reported. Citalopram and methadone showed respectively the highest proportion of SS reports (0.28%) and the lowest mean number of DDIs (1.41). Citalopram, escitalopram, and methadone emerged as red (i.e., alert)-zone medications: they exhibited high lipophilicity and large VD (proxies of excellent central nervous system penetration) coupled with high potency. Among PK/PD indexes, a significant correlation with PV index was found for VD/Ki SERT ratio (p = 0.05). Discussion Our integrated approach suggests that linezolid is more likely to cause SS when co-administered with citalopram, escitalopram, and methadone, as inferred from their pharmacological properties. Proper management of SS should be tailored on a case-by-case basis. Electronic supplementary material The online version of this article (10.1007/s00228-020-02990-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Milo Gatti
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Irnerio, 48, 40126, Bologna, Italy.
| | - Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Irnerio, 48, 40126, Bologna, Italy
| | - Fabrizio De Ponti
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Irnerio, 48, 40126, Bologna, Italy
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Antonazzo IC, Poluzzi E, Forcesi E, Salvo F, Pariente A, Marchesini G, De Ponti F, Raschi E. Signal of potentially protective drug-drug interactions from spontaneous reporting systems: proceed with caution. Acta Diabetol 2020; 57:115-116. [PMID: 31691870 DOI: 10.1007/s00592-019-01441-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Ippazio Cosimo Antonazzo
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Irnerio, 48, 40126, Bologna, Italy
| | - Elisabetta Poluzzi
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Irnerio, 48, 40126, Bologna, Italy
| | - Emanuele Forcesi
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Irnerio, 48, 40126, Bologna, Italy
| | - Francesco Salvo
- University of Bordeaux, U657, 33000, Bordeaux, France
- INSERM U657, 33000, Bordeaux, France
- CIC Bordeaux CICI1401, 33000, Bordeaux, France
| | - Antoine Pariente
- University of Bordeaux, U657, 33000, Bordeaux, France
- INSERM U657, 33000, Bordeaux, France
- CIC Bordeaux CICI1401, 33000, Bordeaux, France
| | - Giulio Marchesini
- Unit of Metabolic Diseases and Clinical Dietetics, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Fabrizio De Ponti
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Irnerio, 48, 40126, Bologna, Italy
| | - Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Irnerio, 48, 40126, Bologna, Italy.
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Kuss O, Rathmann W. A missed protective drug-drug interaction of DPP-4 inhibitors and statins on myopathy risk. Acta Diabetol 2020; 57:113-114. [PMID: 31691868 DOI: 10.1007/s00592-019-01440-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/21/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Oliver Kuss
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.
- Institute of Medical Statistics, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Munich, Germany
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Comparative Effectiveness and Safety of Direct Oral Anticoagulants: Overview of Systematic Reviews. Drug Saf 2019; 42:1409-1422. [DOI: 10.1007/s40264-019-00866-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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