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Wang FT, Xue F, Ding Y, Ng E, Critchlow CW, Dore DD. Predictive values of diagnostic codes for identifying serious hypocalcemia and dermatologic adverse events among women with postmenopausal osteoporosis in a commercial health plan database. BMC Health Serv Res 2018; 18:263. [PMID: 29631582 PMCID: PMC5891890 DOI: 10.1186/s12913-018-3016-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 03/15/2018] [Indexed: 11/12/2022] Open
Abstract
Background Post-marketing safety studies of medicines often rely on administrative claims databases to identify adverse outcomes following drug exposure. Valid ascertainment of outcomes is essential for accurate results. We aim to quantify the validity of diagnostic codes for serious hypocalcemia and dermatologic adverse events from insurance claims data among women with postmenopausal osteoporosis (PMO). Methods We identified potential cases of serious hypocalcemia and dermatologic events through ICD-9 diagnosis codes among women with PMO within claims from a large US healthcare insurer (June 2005-May 2010). A physician adjudicated potential hypocalcemic and dermatologic events identified from the primary position on emergency department (ED) or inpatient claims through medical record review. Positive predictive values (PPVs) and 95% confidence intervals (CIs) quantified the fraction of potential cases that were confirmed. Results Among 165,729 patients with PMO, medical charts were obtained for 40 of 55 (73%) potential hypocalcemia cases; 16 were confirmed (PPV 40%, 95% CI 25–57%). The PPV was higher for ED than inpatient claims (82 vs. 24%). Among 265 potential dermatologic events (primarily urticaria or rash), we obtained 184 (69%) charts and confirmed 128 (PPV 70%, 95% CI 62–76%). The PPV was higher for ED than inpatient claims (77 vs. 39%). Conclusion Diagnostic codes for hypocalcemia and dermatologic events may be sufficient to identify events giving rise to emergency care, but are less accurate for identifying events within hospitalizations. Electronic supplementary material The online version of this article (10.1186/s12913-018-3016-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Florence T Wang
- Optum Epidemiology, 1325 Boylston Street, Suite 1000, Boston, MA, 02215, USA.
| | - Fei Xue
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | - Yan Ding
- Optum Epidemiology, 1325 Boylston Street, Suite 1000, Boston, MA, 02215, USA
| | - Eva Ng
- Optum Epidemiology, 1325 Boylston Street, Suite 1000, Boston, MA, 02215, USA
| | | | - David D Dore
- Optum Epidemiology, 1325 Boylston Street, Suite 1000, Boston, MA, 02215, USA.,Brown University School of Public Health, Providence, RI, 02912, USA
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Marker BA, Barber LG, Clifford CA, Correa SS, Thalhofer PL, LaDue TA, Mullin CM, Sauerbrey ML, Wood CC. Extravasation reactions associated with the administration of pamidronate: 11 cases (2008-2013). Vet Comp Oncol 2016; 15:470-480. [PMID: 27174040 DOI: 10.1111/vco.12191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 10/09/2015] [Accepted: 10/11/2015] [Indexed: 11/30/2022]
Abstract
Pamidronate is a bisphosphonate drug widely utilized in veterinary oncologic practice for the palliation of malignant osteolysis. Pamidronate has not been previously reported to cause tissue injury upon extravasation in dogs. The medical records of 11 client-owned dogs undergoing palliative treatment for primary bone tumors with known or suspected pamidronate extravasation reactions were reviewed. The majority of adverse events were low grade in nature, however in some cases, the reactions were severe and led to euthanasia in one instance. Time to complete resolution of lesions ranged from within several days to greater than one and a half months. Aside from the dog that was euthanized, no long-term sequelae of extravasation were identified. Treatments employed to address the reactions varied widely. Pamidronate extravasation reaction appears to be an uncommon, but potentially serious complication of intravenous administration.
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Affiliation(s)
- B A Marker
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, 01536, USA
| | - L G Barber
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, 01536, USA
| | - C A Clifford
- Red Bank Veterinary Hospital, Tinton Falls, NJ, 07724, USA
| | - S S Correa
- Animal Cancer Care Clinic, Ft. Lauderdale, FL, 33304, USA
| | - P L Thalhofer
- Metropolitan Veterinary Hospital, Akron, OH, 44321, USA
| | - T A LaDue
- Southeast Veterinary Oncology, Orange Park, FL, 32073, USA
| | - C M Mullin
- Red Bank Veterinary Hospital, Tinton Falls, NJ, 07724, USA
| | - M L Sauerbrey
- Oakland Veterinary Referral Services, Bloomfield Hills, MI, 48302, USA
| | - C C Wood
- Veterinary Referral and Emergency Center of Westbury, Westbury, NY, USA
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Minciullo PL, Allegra A, D’Angelo A, Musolino C, Gangemi S. Challenge test to bisphosphonates in patients with hypersensitivity reactions to drugs. Allergol Immunopathol (Madr) 2015; 43:127-30. [PMID: 24411095 DOI: 10.1016/j.aller.2013.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 09/20/2013] [Accepted: 09/23/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Bisphosphonates are a commonly used class of drugs with known efficacy in the prevention and treatment of postmenopausal and steroid-induced osteoporosis, Paget's disease of bone, hypercaelcemia of malignancy, osteolytic lesions of multiple myeloma, and bone metastases. Nitrogen-containing bisphosphonates have a favourable tolerability and safety profile, cutaneous reactions have been reported. METHODS This is a retrospective case series study, based on the analysis of data from 1429 patients admitted to the Allergy and Clinical Immunology Division of the University of Messina between January 2011 and December 2012. Most patients had previous adverse drug reactions (ADRs) and referred to us for a challenge test with an alternative drug. RESULTS We observed six patients with a past history of adverse drug reaction who needed to be tested for bisphosphonates: three patients for risedronate, two for clodronate and one for alendronate. In two years only two patients were referred to us for an adverse reaction to bisphosphonates: one to alendronate and one to risedronate. Another patient presented a previous reaction to strontium ranelate. The other three patients reported previous hypersensitivity reactions to at least two different classes of drugs. All the patients experienced no reaction using the tested drugs. CONCLUSIONS In our experience drug challenge tests for bisphosphonates are safe and reliable.
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Barrantes-González M, Espona-Quer M, Salas E, Giménez-Arnau AM. Bisphosphonate-Induced Cutaneous Adverse Events: The Difficulty of Assessing Imputability through Patch Testing. Dermatology 2014; 229:163-8. [DOI: 10.1159/000363382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 05/02/2014] [Indexed: 11/19/2022] Open
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Tan KW, Wang YS, Tay YK. Stevens-Johnson Syndrome Due to Strontium Ranelate. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2011. [DOI: 10.47102/annals-acadmedsg.v40n11p510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Abstract
Use of bisphosphonates has been growing steadily in the last decade. This follows the introduction of simpler dosing regimes, the availability of lower-priced generics, and concerns about the safety of hormone-replacement therapy. Bisphosphonates have a relatively good safety record and are tolerated by the majority of patients, but serious adverse events have been recorded in some cases. Only the most common of adverse effects are robustly observable in clinical trials. In general, studies were not powered to detect effects that were lower in incidence than fractures. This review of adverse events in bisphosphonate-treated patients was based on published information from case reports, case series, claims databases, national databases, surveys, adverse event reporting databases, and single or pooled clinical trials. The most common acute adverse events with bisphosphonates for osteoporosis are gastrointestinal discomfort and acute influenza-like illness. Renal complications are very rare with oral bisphosphonates and rare with i.v. bisphosphonates when used appropriately. Based on our current knowledge, skeletal events in the form of osteonecrosis of the jaw and atypical fragility fractures are rare compared with the risk of osteoporotic fractures, at least in patients with the same risk of fractures as those in the phase III trials. It is biologically plausible that atypical fragility fractures could follow from suppression of bone remodeling, but high-quality studies proving causality are lacking. Physicians are advised to critically reassess BMD and risk profile after 3-5 years of therapy to avoid treatment in patients at low risk.
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Affiliation(s)
- Bo Abrahamsen
- Department of Internal Medicine and Endocrinology F, Copenhagen University Hospital Gentofte, Niels Andersensvej 65, Hellerup, Denmark.
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Isik A, Uras I, Uyar ME, Karakurt F, Kaftan O. Alendronate-induced asthma. Ann Pharmacother 2009; 43:547-8. [PMID: 19261958 DOI: 10.1345/aph.1l552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Brinkmeier T, Kügler K, Lepoittevin JP, Frosch PJ. Adverse cutaneous drug reaction to alendronate. Contact Dermatitis 2007; 57:123-5. [PMID: 17627657 DOI: 10.1111/j.1600-0536.2006.01071.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Thomas Brinkmeier
- Department of Dermatology, Klinikum Dortmund gGmbH, Dortmund, Beurhausstr. 40, D-44137 Germany.
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Tanvetyanon T, Stiff PJ. Management of the adverse effects associated with intravenous bisphosphonates. Ann Oncol 2006; 17:897-907. [PMID: 16547070 DOI: 10.1093/annonc/mdj105] [Citation(s) in RCA: 195] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Intravenous bisphosphonates are widely used to treat hypercalcemia and to reduce skeletal-related morbidity among cancer patients. However, serious complications, generally occurring in less than 2% of patients participated in phase III clinical trials, including acute systemic inflammatory reaction, ocular inflammation, renal failure, nephrotic syndrome, electrolyte imbalance, and osteonecrosis of the maxilla and mandible have all been increasingly reported. Yet, strategies to deal with these complications are becoming clear. Acute systemic inflammatory reaction is often self-limited and becomes less intense during subsequent treatments. For patients who develop ocular symptoms, prompt ophthalmologic evaluation is crucial to determine the safety of a subsequent bisphosphonate therapy. Patients who receive long-term pamidronate should be evaluated at intervals for early sign of nephritic syndrome as timely cessation of the agent may result in a full recovery. To reduce the risk of severe electrolyte abnormalities, particularly hypocalcemia, correcting any pre-treatment electrolyte abnormality and supplementing vitamin D and calcium may be helpful. Finally, to reduce the risk of osteonecrosis of the maxilla and mandible, obtaining a full dental evaluation before treatment and avoidance of invasive dental procedures is suggested. The three commonly used intravenous bisphosphonates (pamidronate, zoledronic acid, and ibandronate), are generally safe; ibandronate has to date been the least reported to be associated with renal side effects. As clinical indications of intravenous bisphosphonates continue to expand, prescribing clinicians should be familiar with these possible adverse effects and discuss them with patients before commencing or continuing on therapy.
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Affiliation(s)
- T Tanvetyanon
- H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa, 33613, USA.
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High WA, Cohen JB, Wetherington W, Cockerell CJ. Superficial gyrate erythema as a cutaneous reaction to alendronate for osteoporosis. J Am Acad Dermatol 2003; 48:945-6. [PMID: 12789190 DOI: 10.1067/mjd.2003.245] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Alendronate is a bisphosphonate compound used to treat diseases of pathologic bone resorption. Cutaneous reactions to this medication are rare. We report the case of a superficial gyrate erythema that occurred as a reaction to weekly alendronate therapy used in the treatment of postmenopausal osteoporosis.
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Affiliation(s)
- Whitney A High
- Department of Dermatology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9190, USA
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García Ortega P, Carrascal Martín M, Herrero Baladrón M, Pérez Martín R. [Toxicoderma associated with alendronate]. Aten Primaria 2002; 29:61-2. [PMID: 11820967 PMCID: PMC7684067 DOI: 10.1016/s0212-6567(02)70502-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- P García Ortega
- Médica de Familia. Centro de Salud Sur. Profesora Asociada de la Facultad de Medicina de Valladolid. Spain
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