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Godfrey H, Jedlowski P, Thiede R. Medication Associations With Severe Cutaneous Adverse Reactions: A Case/Non-Case Analysis Using the FDA Adverse Event Reporting System. J Cutan Med Surg 2024; 28:51-58. [PMID: 38189282 DOI: 10.1177/12034754231220931] [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] [Indexed: 01/09/2024]
Abstract
BACKGROUND Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP) are potentially life-threatening severe cutaneous adverse reactions (SCARs). Although the classical causal agents of SCARs (antibiotics, anticonvulsants, nonsteroidal anti-inflammatory drugs, and allopurinol) are well characterized, there has been little update to this list to account for newly marketed medications. OBJECTIVE To provide an updated and stratified list of medications with significant reporting odds ratios (RORs) of SCARs. METHODS A case/non-case analysis using the United States FDA Adverse Event Reporting System was performed. RESULTS As expected, the prototypical medication classes made up the majority of reported cases of SJS, TEN, AGEP, and DRESS (77%, 64%, 75%, and 72%, respectively). In addition, several infrequently or previously undescribed classes/medications implicated in SCARs were identified to have significant ROR signals, including acetylcysteine, anticoagulants, diuretics, immunotherapies, proton pump inhibitors, antivirals, and antifungals. Among these reported for SJS were acetylcysteine (ROR: 64.38) and fluconazole (ROR: 17.13). For TEN, we identified furosemide (ROR: 26.32), spironolactone (ROR: 14.45), fluconazole (ROR: 30.21), amphotericin B (39.06), and acetylcysteine (ROR: 93.12). For AGEP, we identified acyclovir (ROR: 61.72), valacyclovir (ROR: 30.76), and enoxaparin (ROR: 27.37). For DRESS, we identified vemurafenib (ROR: 17.35), acyclovir (ROR: 30.63), abacavir (ROR: 26.62), raltegravir (ROR: 23.27), and valacyclovir (ROR: 21.77) to have strong reporting odds. CONCLUSION Our analysis provides an updated tool for physicians to reference when identifying suspected SCARs and a basis for future studies to investigate atypical medication causality.
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Affiliation(s)
- Hannah Godfrey
- University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
| | - Patrick Jedlowski
- Division of Dermatology, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
| | - Rebecca Thiede
- Division of Dermatology, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
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Besag FMC, Vasey MJ, Sharma AN, Lam ICH. Efficacy and safety of lamotrigine in the treatment of bipolar disorder across the lifespan: a systematic review. Ther Adv Psychopharmacol 2021; 11:20451253211045870. [PMID: 34646439 PMCID: PMC8504232 DOI: 10.1177/20451253211045870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/25/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Bipolar disorder (BD) is a cyclic mood disorder characterised by alternating episodes of mania/hypomania and depression interspersed with euthymic periods. Lamotrigine (LTG) demonstrated some mood improvement in patients treated for epilepsy, leading to clinical studies in patients with BD and its eventual introduction as maintenance therapy for the prevention of depressive relapse in euthymic patients. Most current clinical guidelines include LTG as a recommended treatment option for the maintenance phase in adult BD, consistent with its global licencing status. AIMS To review the evidence for the efficacy and safety of LTG in the treatment of all phases of BD. METHODS PubMed was searched for double-blind, randomised, placebo-controlled trials using the keywords: LTG, Lamictal, 'bipolar disorder', 'bipolar affective disorder', 'bipolar I', 'bipolar II', cyclothymia, mania, manic, depression, depressive, 'randomised controlled trial', 'randomised trial', RCT and 'placebo-controlled' and corresponding MeSH terms. Eligible articles published in English were reviewed. RESULTS Thirteen studies were identified. The strongest evidence supports utility in the prevention of recurrence and relapse, particularly depressive relapse, in stabilised patients. Some evidence suggests efficacy in acute bipolar depression, but findings are inconsistent. There is little or no strong evidence in support of efficacy in acute mania, unipolar depression, or rapid-cycling BD. Few controlled trials have evaluated LTG in bipolar II or in paediatric patients. Indications for safety, tolerability and patient acceptability are relatively favourable, provided there is slow dose escalation to reduce the probability of skin rash. CONCLUSION On the balance of efficacy and tolerability, LTG might be considered a first-line drug for BD, except for acute manic episodes or where rapid symptom control is required. In terms of efficacy alone, however, the evidence favours other medications.
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Affiliation(s)
- Frank M C Besag
- East London NHS Foundation Trust, 9 Rush Court, Bedford MK40 3JT, UK
| | | | - Aditya N Sharma
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ivan C H Lam
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Buch D, Chabriat H. Lamotrigine in the Prevention of Migraine With Aura: A Narrative Review. Headache 2019; 59:1187-1197. [PMID: 31468532 DOI: 10.1111/head.13615] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Lamotrigine is not recommended in the prevention of migraine in general but some reports suggest that it might be effective for treating specifically migraine with aura (MA). This review aims to summarize the related data from the literature and to better understand this discrepancy. METHODS All reports from the literature related to the use of lamotrigine in migraine with or without aura published prior to February 2019 found using PUBMED and the 2 keywords "migraine" AND "lamotrigine" were reviewed. Original studies, published in full, systematic reviews, and all case reports were synthetized. We also examined the risk profile, pharmacokinetics, and mode of action of lamotrigine in view of the presumed mechanism of MA. RESULTS Lamotrigine was tested in different populations of migraineurs, but previous studies had small sample sizes (n < 35) and might not have been powered enough for detecting a potential benefit of lamotrigine in MA. Accumulating data suggest that the drug can reduce both the frequency and severity of aura symptoms in multiple conditions and is well tolerated. CONCLUSION Lamotrigine appears promising for treating attacks of MA and related clinical manifestations because of its high potential of efficacy, low-risk profile, and cost. Additional studies are needed for testing lamotrigine in patients with MA.
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Affiliation(s)
- Dan Buch
- Neurology Department, DHU Neuro-Vasc, Hopital Lariboisière, Paris, France
| | - Hugues Chabriat
- Neurology Department, DHU Neuro-Vasc, Hopital Lariboisière, Paris, France.,INSERM U1161, Université Denis Diderot, Paris, France
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Ingen-Housz-Oro S, Duong TA, Bensaid B, Bellon N, de Prost N, Lu D, Lebrun-Vignes B, Gueudry J, Bequignon E, Zaghbib K, Royer G, Colin A, Do-Pham G, Bodemer C, Ortonne N, Barbaud A, Fardet L, Chosidow O, Wolkenstein P. Epidermal necrolysis French national diagnosis and care protocol (PNDS; protocole national de diagnostic et de soins). Orphanet J Rare Dis 2018; 13:56. [PMID: 29636107 PMCID: PMC5894129 DOI: 10.1186/s13023-018-0793-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 03/22/2018] [Indexed: 12/18/2022] Open
Abstract
Epidermal necrolysis (EN) encompasses Stevens-Johnson syndrome (SJS, < 10% of the skin affected), Lyell syndrome (toxic epidermal necrolysis, TEN, with ≥30% of the skin affected) and an overlap syndrome (10 to 29% of the skin affected). These rare diseases are caused, in 85% of cases, by pharmacological treatments, with symptoms occurring 4 to 28 days after treatment initiation. Mortality is 20 to 25% during the acute phase, and almost all patients display disabling sequelae (mostly ocular impairment and psychological distress). The objective of this French national diagnosis and care protocol (protocole national de diagnostic et de soins; PNDS), based on a critical literature review and on a multidisciplinary expert consensus, is to provide health professionals with an explanation of the optimal management and care of patients with EN. This PNDS, written by the French National Reference Center for Toxic Bullous Dermatoses was updated in 2017 (https://www.has-sante.fr/portail/jcms/c_1012735/fr/necrolyse-epidermique-syndromes-de-stevens-johnson-et-de-lyell). The cornerstone of the management of these patients during the acute phase is an immediate withdrawal of the responsible drug, patient management in a dermatology department, intensive care or burn units used to dealing with this disease, supportive care and close monitoring, the prevention and treatment of infections, and a multidisciplinary approach to sequelae. Based on published data, it is not currently possible to recommend any specific immunomodulatory treatment. Only the culprit drug and chemically similar molecules must be lifelong contraindicated.
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Affiliation(s)
- Saskia Ingen-Housz-Oro
- Dermatology Department, AP-HP, Henri Mondor Hospital, 51 avenue du maréchal de Lattre de Tassigny, 94000, Créteil, France. .,French National Reference Center for Toxic Bullous Dermatoses, Créteil, France. .,EA7379 EpiDermE (Epidemiologie en Dermatologie et Evaluation des Thérapeutiques), Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France.
| | - Tu-Anh Duong
- Dermatology Department, AP-HP, Henri Mondor Hospital, 51 avenue du maréchal de Lattre de Tassigny, 94000, Créteil, France.,French National Reference Center for Toxic Bullous Dermatoses, Créteil, France
| | - Benoit Bensaid
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Dermatology Department, Edouard Herriot Hospital, Lyon, France
| | - Nathalia Bellon
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Dermatology Department, AP-HP, Necker Hospital, Paris, France
| | - Nicolas de Prost
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Intensive Care Unit, AP-HP, Henri Mondor Hospital, Créteil, France.,Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
| | - Dévy Lu
- Dermatology Department, AP-HP, Henri Mondor Hospital, 51 avenue du maréchal de Lattre de Tassigny, 94000, Créteil, France.,French National Reference Center for Toxic Bullous Dermatoses, Créteil, France
| | - Bénédicte Lebrun-Vignes
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Pharmacovigilance Department, AP-HP, La Pitié Salpêtrière Hospital, Paris, France
| | - Julie Gueudry
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Ophthalmology Department, Charles Nicolle Hospital, Rouen, France
| | - Emilie Bequignon
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Ear Nose and Throat Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Karim Zaghbib
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Psychiatry Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Gérard Royer
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Ophthalmology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Audrey Colin
- Dermatology Department, AP-HP, Henri Mondor Hospital, 51 avenue du maréchal de Lattre de Tassigny, 94000, Créteil, France.,French National Reference Center for Toxic Bullous Dermatoses, Créteil, France
| | - Giao Do-Pham
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Dermatology Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Christine Bodemer
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Dermatology Department, AP-HP, Necker Hospital, Paris, France
| | - Nicolas Ortonne
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Pathology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
| | - Annick Barbaud
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Dermatology Department, AP-HP, Tenon Hospital, Paris, France
| | - Laurence Fardet
- Dermatology Department, AP-HP, Henri Mondor Hospital, 51 avenue du maréchal de Lattre de Tassigny, 94000, Créteil, France.,French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,EA7379 EpiDermE (Epidemiologie en Dermatologie et Evaluation des Thérapeutiques), Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
| | - Olivier Chosidow
- Dermatology Department, AP-HP, Henri Mondor Hospital, 51 avenue du maréchal de Lattre de Tassigny, 94000, Créteil, France.,French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,EA7379 EpiDermE (Epidemiologie en Dermatologie et Evaluation des Thérapeutiques), Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France.,Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
| | - Pierre Wolkenstein
- Dermatology Department, AP-HP, Henri Mondor Hospital, 51 avenue du maréchal de Lattre de Tassigny, 94000, Créteil, France.,French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,EA7379 EpiDermE (Epidemiologie en Dermatologie et Evaluation des Thérapeutiques), Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France.,Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
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