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Sainz-Gil M, Merino Kolly N, Velasco-González V, Verde Rello Z, Fernandez-Araque AM, Sanz Fadrique R, Martín Arias LH. Hydroxychloroquine safety in Covid-19 vs non-Covid-19 patients: analysis of differences and potential interactions. Expert Opin Drug Saf 2023; 22:71-79. [PMID: 35574687 DOI: 10.1080/14740338.2022.2078303] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The use of hydroxychloroquine (HCQ) in the first COVID-19 epidemic wave raised safety concerns. RESEARCH DESIGN AND METHODS Adverse reactions (ADR) suspected to be induced by HCQ and submitted to the Spanish Pharmacovigilance Database were studied. A disproportionality analysis was performed to determine adverse effects reported in non-Covid and Covid patients. To explore potential drug-drug interactions, Omega (Ω) statistics was calculated. RESULTS More severe cases were reported when used in COVID-19. Main differences in frequency were observed in hepatobiliary, skin, gastrointestinal, eye, nervous system and heart ADRs. During the COVID-19 pandemic, high disproportionality in reports was found for Torsade de Pointes/QT prolongation with a ROR (-ROR) of 132.8 (76.7); severe hepatotoxicity, 18.7 (14.7); dyslipidaemias, 12.1 (6.1); shock, 9.5 (6.9) and ischemic colitis, 8.9 (2.6). Myopathies, hemolytic disorders and suicidal behavior increased their disproportionality during the pandemic. Disproportionality was observed for neoplasms, hematopoietic cytopaenias and interstitial lung disease in the pre-COVID-19 period. Potential interactions were showed between HCQ and azithromycin, ceftriaxone, lopinavir and tocilizumab. CONCLUSIONS The use of HCQ during the Covid-19 pandemic changed its ADRs reporting profile. Of particular concern during the pandemic were arrhythmias, hepatotoxicity, severe skin reactions and suicide, but not ocular disorders. Some signals identified would require more detailed analyses.
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Affiliation(s)
- María Sainz-Gil
- Centro de Estudios sobre la Seguridad de los Medicamentos (CESME). Departamento de Biología Celular, Histología, Farmacología y Genética. Facultad de Medicina. Universidad de Valladolid, Valladolid, Spain.,Grupo de Investigación Reconocido "Pharmacogenetics, Cancer Genetics, Genetic Polymorphisms and Pharmacoepidemiology", Universidad de Valladolid, Valladolid, Spain
| | - Nieves Merino Kolly
- Centro Andaluz de Farmacovigilancia. Dirección General de Salud Pública, Consejería de Salud y Familias, Junta de Andalucía. Avda, Sevillla, Spain
| | - Verónica Velasco-González
- Centro de Estudios sobre la Seguridad de los Medicamentos (CESME). Departamento de Biología Celular, Histología, Farmacología y Genética. Facultad de Medicina. Universidad de Valladolid, Valladolid, Spain.,Grupo de Investigación Reconocido "Pharmacogenetics, Cancer Genetics, Genetic Polymorphisms and Pharmacoepidemiology", Universidad de Valladolid, Valladolid, Spain.,Departamento de Enfermería, Universidad de Valladolid, Valladolid, Spain
| | - Zoraida Verde Rello
- Grupo de Investigación Reconocido "Pharmacogenetics, Cancer Genetics, Genetic Polymorphisms and Pharmacoepidemiology", Universidad de Valladolid, Valladolid, Spain.,Departamento de Bioquímica, Biología Molecular y Fisiología, Universidad de Valladolid, Campus Universitario Duques de Soria, Soria, Spain
| | - Ana M Fernandez-Araque
- Grupo de Investigación Reconocido "Pharmacogenetics, Cancer Genetics, Genetic Polymorphisms and Pharmacoepidemiology", Universidad de Valladolid, Valladolid, Spain.,Departamento de Enfermería, Universidad de Valladolid, Campus Universitario Duques de Soria, Soria, Spain
| | - Rosario Sanz Fadrique
- Centro de Estudios sobre la Seguridad de los Medicamentos (CESME). Departamento de Biología Celular, Histología, Farmacología y Genética. Facultad de Medicina. Universidad de Valladolid, Valladolid, Spain
| | - Luis H Martín Arias
- Centro de Estudios sobre la Seguridad de los Medicamentos (CESME). Departamento de Biología Celular, Histología, Farmacología y Genética. Facultad de Medicina. Universidad de Valladolid, Valladolid, Spain.,Grupo de Investigación Reconocido "Pharmacogenetics, Cancer Genetics, Genetic Polymorphisms and Pharmacoepidemiology", Universidad de Valladolid, Valladolid, Spain
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Sobreira da Silva MJ, Serpa Osorio-de-Castro CG, Paes RD, Negrete CL, Eugênio E, Moraes EL, Livinalli A. Potential interactions between antineoplastic agents and medicines used to treat Covid-19. J Oncol Pharm Pract 2022; 28:1737-1748. [PMID: 34637360 PMCID: PMC9619075 DOI: 10.1177/10781552211040494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Cancer patients with Covid-19 are exposed to treatment combinations that can potentially result in interactions that adversely affect patient outcomes. This study aimed to identify potential drug-drug interactions between antineoplastic agents and medicines used to treat Covid-19. METHODS We conducted a search for potential interactions between 201 antineoplastic agents and 26 medicines used to treat Covid-19 on the Lexicomp® and Micromedex® databases. The following data were extracted: interaction severity ("major" and "contraindicated") and interaction effects (pharmacokinetic and pharmacodynamic). We also sought to identify the therapeutic indication of the antineoplastic drugs involved in the potential drug-drug interactions. RESULTS A total of 388 "major" or "contraindicated" drug-drug interactions were detected. Eight drugs or combinations (baricitinib, lopinavir/ritonavir, atazanavir, darunavir, azithromycin, chloroquine, hydroxychloroquine, and sirolimus) accounted for 91.5% of these interactions. The class of antineoplastic agents with the greatest potential for interaction was tyrosine kinase inhibitors (accounting for 46.4% of all interactions). The findings show that atazanavir, baricitinib, and lopinavir/ritonavir can affect the treatment of all common types of cancer. The most common pharmacokinetic effect of the potential drug-drug interactions was increased plasma concentration of the antineoplastic medicine (39.4%). CONCLUSIONS Covid-19 is a recent disease and pharmacological interventions are undergoing constant modification. This study identified a considerable number of potential drug-drug interactions. In view of the vulnerability of patients with cancer, it is vital that health professionals carefully assess the risks and benefits of drug combinations.
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Affiliation(s)
- Mario Jorge Sobreira da Silva
- National Cancer Institute of
Brazil, Brazil,Mario Jorge Sobreira da Silva, Rua Marquês
de Pombal, 125, 3° andar – Centro, Rio de Janeiro, RJ 20230-240, Brazil.
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