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Undela K, Kalaiselvan V, Gudi SK, Viswam SK, Ali SK. Risk of serious skin and subcutaneous tissue disorders for nimesulide among the pediatric population: a jeopardy identified through the analysis of global individual case safety reports. Expert Opin Drug Saf 2023:1-6. [PMID: 37908194 DOI: 10.1080/14740338.2023.2274416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/15/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND The safety reports arising currently on nimesulide are divulging the jeopardy of skin and subcutaneous tissue disorders (SSTDs). RESEARCH DESIGN AND METHODS The global individual case safety reports on nimesulide-induced SSTDs available at VigiBase® were analyzed up to 31 March 2023. Disproportionality analyses viz. Proportional Reporting Ratio (PRR), Reporting Odds Ratio (ROR), and Information Component (IC) were performed to identify the quantitative signals. RESULTS Out of 33,983,649 de-duplicated cases available in the VigiBase®, 1,664,134 (4.9%) were in pediatrics below 12 years of age. Among these, cases attributed to nimesulide were 251, of which 126 (50.2%) were on SSTDs. Among all the SSTDs reported for nimesulide, the serious reactions like urticaria [PRR = 2.3; lower bound (LB) ROR = 1.7; IC025 = 0.6], Stevens-Johnson syndrome (SJS) [PRR = 28.3; LB ROR = 18.2; IC025 = 3.2], angioedema [PRR = 7.5; LB ROR = 4.5; IC025 = 1.7], and toxic epidermal necrolysis (TEN) [PRR = 27.4; LB ROR = 11.5; IC025 = 1.5] were identified as potential signals. In comparison with non-SSTDs, SSTDs reported for nimesulide were significantly higher among children (2-11 years, 90.5%), from India (38.9%), and by the physician (60.3%). CONCLUSIONS Identifying the giant quantitate association between nimesulide and serious & life-threatening reactions like SJS and TEN, precautionary measures need to be taken by the regulatory authorities to prevent nimesulide-induced SSTDs among the pediatric population.
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Affiliation(s)
- Krishna Undela
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER) Guwahati, Kamrup, Assam, India
| | - Vivekanandan Kalaiselvan
- Pharmacovigilance Programme of India (PvPI), National Coordination Centre, Indian Pharmacopoeia Commission, Ghaziabad, Uttar Pradesh, India
| | - Sai Krishna Gudi
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Subeesh K Viswam
- Independent Researcher, and formerly Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Syed Kashif Ali
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER) Guwahati, Kamrup, Assam, India
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Sanchez-Pena P, Milpied B, Darrigade AS, Miremont-Salamé G, Pariente A, Beylot Barry M. Bidisciplinary dermatology-pharmacovigilance consultations: Results of a two-year study. Ann Dermatol Venereol 2023; 150:217-218. [PMID: 36496263 DOI: 10.1016/j.annder.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/21/2022] [Accepted: 08/30/2022] [Indexed: 12/12/2022]
Affiliation(s)
- P Sanchez-Pena
- Pharmacovigilance center, University Hospital of Bordeaux, Bordeaux, France.
| | - B Milpied
- Dermatology Department, University Hospital of Bordeaux, Bordeaux, France
| | - A-S Darrigade
- Dermatology Department, University Hospital of Bordeaux, Bordeaux, France
| | - G Miremont-Salamé
- Pharmacovigilance center, University Hospital of Bordeaux, Bordeaux, France; Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Bordeaux, France
| | - A Pariente
- Pharmacovigilance center, University Hospital of Bordeaux, Bordeaux, France; Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Bordeaux, France
| | - M Beylot Barry
- Dermatology Department, University Hospital of Bordeaux, Bordeaux, France
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Del Pozzo-Magaña BR, Liy-Wong C. Drugs and the skin: A concise review of cutaneous adverse drug reactions. Br J Clin Pharmacol 2022. [PMID: 35974692 DOI: 10.1111/bcp.15490] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 01/19/2023] Open
Abstract
Drug-induced skin disease or cutaneous adverse drug reactions (CADRs) are terms that encompass the clinical manifestations of the skin, mucosae and adnexa induced by a drug or its metabolites. The skin is the organ most frequently affected by drug reactions, which may affect up to 10% of hospitalized patients and occur in 1-3% of multimedicated patients. Most CADRs are mild or self-resolving conditions; however, 2-6.7% of could develop into potentially life-threatening conditions. CADRs represent a heterogeneous field and can be diagnostically challenging as they may potentially mimic any dermatosis. Currently, there are between 29-35 different cutaneous drug-reaction patterns reported ranging from mild dermatitis to an extensively burnt patient. The most frequently reported are maculopapular rash, urticaria/angioedema, fixed drug eruption and erythema multiforme. Less common but more severe patterns include erythroderma, drug reaction with eosinophilia and systemic symptoms, and Stevens-Johnson syndrome/toxic epidermal necrolysis spectrum. Almost any drug can induce a CADR, but antibiotics, nonsteroidal anti-inflammatory drugs and antiepileptics are the most frequently involved. Different mechanisms are involved in the pathogenesis of CADRs, although in some cases, these remain still unknown. CADRs could be classified in different ways: (i) type A (augmented) or type B (bizarre); (ii) immediate or delayed; (iii) immune-mediated or nonimmune-mediated; (iv) nonsevere or life-threatening; and (v) by their phenotype, including exanthematous, urticarial, pustular and blistering morphology. Recognizing a specific CADR will mostly depend on the ability of the physician to perform a detailed clinical examination, the proper description of the morphology of the skin lesions and supporting laboratory and/or skin biopsy findings.
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Affiliation(s)
- Blanca R Del Pozzo-Magaña
- Department of Pediatrics, Division of Pediatric Clinical Pharmacology, Children's Hospital of Western Ontario, Western University, London, ON, Canada
| | - Carmen Liy-Wong
- Department of Pediatrics, Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
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Alfares I, Javaid MS, Chen Z, Anderson A, Antonic-Baker A, Kwan P. Sex Differences in the Risk of Cutaneous Adverse Drug Reactions Induced by Antiseizure Medications: A Systematic Review and Meta-analysis. CNS Drugs 2021; 35:161-176. [PMID: 33580477 DOI: 10.1007/s40263-021-00794-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cutaneous adverse drug reactions (cADRs) are one of the most common, severe, and life-threatening types of adverse reactions following treatment with antiseizure medications (ASMs). Some studies have reported a higher incidence of ASM-induced cADRs in females than in males. OBJECTIVE This study sought to perform a systematic review, meta-analysis, and meta-regression to compare the ASM cADR risks between females and males. METHODS We searched the literature using three databases (EMBASE, PubMed, and Web of Science) between October 1998 and November 2018, later updated to October 2019. Studies were included in the meta-analysis if they met the following criteria: (1) observational studies that estimated the incidence of cADRs related to ASMs; (2) provided the risk or odds ratio (OR) for cADRs among female and male patients exposed to ASMs; and (3) provided information on patients' characteristics. We assessed the impact of study characteristics, publication bias, and measures to reduce bias, and performed a DerSimonian and Laird random effects meta-analysis. RESULTS We included 28 studies in this review. Of these, seven studies were eligible for inclusion in the meta-analysis, involving a total of 223,209 patients. Overall, females were more likely to develop cADRs to ASMs than males (OR 1.76, 95% confidence interval [CI] 1.55-1.99). The largest differences were observed in patients prescribed lamotrigine (OR 2.17, 95% CI 1.53-3.08, p < 0.001) and carbamazepine (OR 1.63, 95% CI 1.02-2.60, p = 0.042). Also, the OR trended higher for phenytoin (OR 2.46, 95% CI 0.79-7.65, p = 0.12), followed by oxcarbazepine (OR 1.91, 95% CI 0.75-4.85, p = 0.18) and sodium valproate (OR 0.60, 95% CI 0.12-2.99, p = 0.53), but the difference did not reach statistical significance. In the remaining 21 studies, 13 reported numerically higher risk of cADRs among females compared to male patients, and in five of these, the difference was statistically significant. CONCLUSION Our findings confirmed that females are more susceptible to cADRs induced by ASMs than males. More research is needed to understand the pathophysiological mechanisms for this difference. PROTOCOL REGISTRATION PROSPERO (CRD42018111943).
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Affiliation(s)
- Israa Alfares
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Muhammad Shahid Javaid
- Department of Neuroscience, Central Clinical School, Monash University, Alfred Hospital, Melbourne, VIC, Australia
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Alfred Hospital, Melbourne, VIC, Australia
| | - Alison Anderson
- Department of Neuroscience, Central Clinical School, Monash University, Alfred Hospital, Melbourne, VIC, Australia
| | - Ana Antonic-Baker
- Department of Neuroscience, Central Clinical School, Monash University, Alfred Hospital, Melbourne, VIC, Australia
| | - Patrick Kwan
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia. .,Department of Neuroscience, Central Clinical School, Monash University, Alfred Hospital, Melbourne, VIC, Australia.
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Zheng ZQ, Jiang C, Yu RL, Zhou JQ, Wu ZJ, Luo JY. General characteristics, economic burden, causative drugs and medical errors associated with medical damage litigation involving severe cutaneous adverse drug reactions in China. J Clin Pharm Ther 2020; 45:1087-1097. [PMID: 32516456 DOI: 10.1111/jcpt.13174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/26/2020] [Accepted: 04/20/2020] [Indexed: 12/21/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE To investigate the general characteristics, economic burden, causative drugs and medical errors associated with litigation involving severe cutaneous adverse drug reactions (SCADRs) in China, with the aims of improving rational medication use and reducing the extent of damage from SCADRs. METHODS This study analysed 150 lawsuit judgements involving SCADRs from 2005 to 2019, collected from China Judgments Online. RESULTS AND DISCUSSION In total, 50% of lawsuits stemmed from SCADRs occurring in general hospitals. The average time elapsed from the date of occurrence of the SCADRs to the end of litigation procedures was 1055 days. Of the patients involved, 51% were female and more than two thirds (69%) were under 60 years old. The most common outcome of SCADRs was death (39%), followed by disabilities (30%). The average responsibility of the medical provider was 48 ± 29%. The average amount of compensation was $43 424. Of the cases studied, 51% of SCADRs were Stevens-Johnson syndrome or toxic epidermal necrolysis, which together accounted for 75% of cases with known clinical subtype. The overall average economic burden of SCADRs was $99 178, of which indirect costs made up the largest proportion (more than 60%). The most common causative drug groups were antimicrobial drugs (49%), Chinese patent medicine and Chinese herbal medicine (17%), and antipyretic analgesics (16%). Finally, 61% of medical errors were found to stem from violation of duty of care, 20% from violation of informed consent and 18% from violations related to the medical record writing and management system. WHAT IS NEW AND CONCLUSION Severe cutaneous adverse drug reactions not only severely affect patient survival and quality of life, but also impose a heavy economic burden in terms of health care and societal costs. Medical providers should be better educated on strategies to reduce risk to patients and establish mechanisms of risk sharing and management.
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Affiliation(s)
- Zao-Qian Zheng
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, Hangzhou, China.,Division of Medical Administration, Tongde Hospital of Zhejiang Province, Hangzhou, China.,Department of Medicine, Zhejiang Academy of Traditional Chinese Medicine, Hangzhou, China
| | - Cheng Jiang
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Rong-Liang Yu
- Division of Medical Administration, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Jia-Qi Zhou
- Division of Medical Administration, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Zheng-Jia Wu
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Jin-Yu Luo
- Hemopurification Center, Division of Nursing, Tongde Hospital of Zhejiang Province, Hangzhou, China
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