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Schöckel L, Jost G, Seidensticker P, Lengsfeld P, Palkowitsch P, Pietsch H. Developments in X-Ray Contrast Media and the Potential Impact on Computed Tomography. Invest Radiol 2020; 55:592-597. [DOI: 10.1097/rli.0000000000000696] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rosenberg V, Michel A, Chodick G, Cheng Y, Palkowitsch P, Koren G, Shalev V. Hypothyroidism in Young Children Following Exposure to Iodinated Contrast Media: An Observational Study and a Review of the Literature. Pediatr Endocrinol Rev 2018; 16:256-265. [PMID: 30556658 DOI: 10.17458/per.vol16.2018.hypothyroidism] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
While it is well documented that exposure to iodinated contrast media (ICM) can interfere with thyroid function in adults, much less is known about the incidence and risk factors associated with ICM induced hypothyroidism in young children. Using a computerized database we identified 843 children who were exposed to ICM between 1998 and 2015. The incidence rate of ICM induced hypothyroidism per 1000 person-years was 9.66 (95% CI: 4.17-19.04). When compared to the rest of the cohort, children with hypothyroidism were more likely to be younger, weigh less and to have undergone cardio-angiography. These results are supported by findings described in the literature review. The risk of ICM- induced hypothyroidism needs to be considered especially in young children with low weight, undergoing cardio-angiography examinations. Systematic monitoring of thyroid function should be conducted in this focused patient population to avoid potential adverse consequences on child development.
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Affiliation(s)
- Vered Rosenberg
- Maccabi Healthcare Services, 4 Koifman st, Tel-Aviv, Israel, E-mail:
| | | | - Gabriel Chodick
- Maccabi Healthcare Services, Tel Aviv, Israel and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yingkai Cheng
- Bayer U.S. LLC, Whippany, NJ, USA, 5Bayer AG, Berlin, Germany
| | | | | | - Varda Shalev
- Maccabi Healthcare Services, Tel Aviv, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Prince MR, Lee HG, Lee CH, Youn SW, Lee IH, Yoon W, Yang B, Wang H, Wang J, Shih TTF, Huang GS, Lirng JF, Palkowitsch P. Safety of gadobutrol in over 23,000 patients: the GARDIAN study, a global multicentre, prospective, non-interventional study. Eur Radiol 2016; 27:286-295. [PMID: 26960538 PMCID: PMC5127858 DOI: 10.1007/s00330-016-4268-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 01/19/2016] [Accepted: 02/02/2016] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To investigate the safety and tolerability of gadobutrol at the recommended dose in patients requiring contrast-enhanced magnetic resonance imaging/angiography (MRI/MRA) in the routine setting. METHODS GARDIAN prospectively enrolled 23,708 patients undergoing routine gadobutrol-enhanced MRI/MRA for approved indications at 272 study centres in Europe, Asia, North America, and Africa and monitored for adverse events. RESULTS Median gadobutrol dose was 0.11 mmol/kg body weight. The overall incidence of adverse drug reactions (ADRs) was 0.7 % (n = 170 patients), with similar incidences in patients with renal impairment or cardiac disease, from different geographic regions and in different gadobutrol dose groups. Patients at risk for contrast media reaction had an ADR incidence of 2.5 %. Five patients (0.02 %) experienced serious adverse events, four were drug-related. One patient experienced a fatal anaphylactoid shock, assessed to be related to injection of gadobutrol. The contrast quality of gadobutrol-enhanced images was rated by treating physicians as good or excellent in 97 % cases, with similar ratings in all patient subgroups and indications. CONCLUSIONS The GARDIAN study shows that gadobutrol at the recommended dose is well tolerated across a large, diverse patient population. KEY POINTS • Gadobutrol at recommended dose shows low rates of adverse drug reactions • Gadobutrol demonstrates a uniform safety profile across diverse patient groups • Gadobutrol provides excellent contrast quality in routine practice.
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Affiliation(s)
- Martin R Prince
- Department of Radiology, Weill Cornell Medical College, 416 east 55th Street, New York, NY, 10022, USA. .,Department of Radiology, Columbia College of Physicians and Surgeons, New York, NY, 10021, USA.
| | - Hae Giu Lee
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, South Korea
| | - Chang-Hee Lee
- Department of Radiology, Korea University Guro Hospital, Seoul, South Korea
| | - Sung Won Youn
- Department of Radiology, Catholic University of Daegu Medical Center, Daegu, South Korea
| | - In Ho Lee
- Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Woong Yoon
- Department of Radiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Benqiang Yang
- Department of Radiology, General Hospital of Shenyang Military Region, Shenyang, China
| | - Haiping Wang
- Department of Radiology, Tangshan Worker's Hospital, Tangshan, China
| | - Jin Wang
- Department of Radiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Tiffany Ting-Fang Shih
- Department of Radiology and Medical Imaging, National Taiwan University, Medical College and Hospital, Taipei, Taiwan
| | - Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jiing-Feng Lirng
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Petra Palkowitsch
- Medical & Clinical Affairs Radiology, Bayer Pharmaceutical Division, Berlin, Germany
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Palkowitsch P, Lengsfeld P, Stauch K, Heinsohn C, Kwon ST, Zhang SX, Liang CH. Safety and diagnostic image quality of iopromide: results of a large non-interventional observational study of European and Asian patients (IMAGE). Acta Radiol 2012; 53:179-86. [PMID: 22184683 DOI: 10.1258/ar.2011.110359] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Iodine-based contrast agents such as iopromide play a central role in improving the diagnostic quality of imaging modalities using ionizing radiation. PURPOSE To investigate the safety and diagnostic image quality of iopromide in the routine clinical setting. MATERIAL AND METHODS This was an international, multicenter, prospective, single-arm, non-interventional study (NIS). The study was performed in out- and inpatients in 738 study centers in 21 countries in Europe and Asia. Iopromide was administered in a routine manner, in compliance with the local package insert. The use of premedication was at the discretion of the attending physician. Case report forms for 44,835 patients were analyzed (57.4% men). The median age of the patients was 55 years. RESULTS For the vast majority of patients (94.8%), the contrast quality was rated as 'good' (55.8%) or 'excellent' (39.0%). For 1265 (2.8%) patients, there were reports of adverse drug reactions (ADRs) excluding tolerance indicators (TIs) (i.e. injection site warmth, feeling hot, or injection site pain of mild intensity). At least one ADR including TIs was reported in 2415 (5.4%) patients. There were 11 (0.02%) patients with serious ADRs, and no drug-related deaths. Events of injection site warmth and/or feeling hot were reported by 3.5%, nausea and/or vomiting by 0.96%, and urticaria, erythema, and/or rash by 0.54% of patients. Patients at risk for an acute idiosyncratic reaction (i.e. patients with a history of bronchial asthma, allergies, and/or contrast media reaction) had a higher incidence of ADRs compared with the overall study population. At-risk patients who did not receive premedication reported distinctly more ADRs compared with those who received premedication (12.0% versus 5.9%). CONCLUSION Iopromide was shown to be a well-tolerated contrast agent whose usage resulted in high image quality. No unknown ADRs were observed. Premedication with antiallergy drugs should be considered in at-risk patients.
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Affiliation(s)
- Petra Palkowitsch
- Global Medical Affairs Diagnostic Imaging, Bayer HealthCare, Berlin, Germany
| | - Philipp Lengsfeld
- Global Medical Affairs Diagnostic Imaging, Bayer HealthCare, Berlin, Germany
| | - Kathrin Stauch
- Global Non-interventional Studies, Bayer HealthCare, Berlin, Germany
| | | | - Soon Tae Kwon
- Department of Radiology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Shui-xing Zhang
- Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chang-hong Liang
- Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
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Forsting M, Palkowitsch P. Prevalence of acute adverse reactions to gadobutrol--a highly concentrated macrocyclic gadolinium chelate: review of 14,299 patients from observational trials. Eur J Radiol 2009; 74:e186-92. [PMID: 19574008 DOI: 10.1016/j.ejrad.2009.06.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 05/22/2009] [Accepted: 06/04/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the safety and tolerability of gadobutrol in a large number of non-selected patients from routine clinical radiology practices. MATERIALS AND METHODS Six prospectively planned, observational surveillance studies were conducted at more than 300 institutions in Europe and Canada from 2000 to 2007. Demographic and medical status data, details of the diagnostic procedure, contrast agent administration and adverse drug reaction (ADR) data were collected using a standardized questionnaire. RESULTS A total of 14,299 patients were enrolled. The mean age of the patients was 53.7 years; 1.3% of the patients were <18 years old and 40.8% were 60 years or older. The body regions most frequently examined were head/neck/brain (54.3%), followed by spine (7.2%), pelvis/joints/limbs (6.7%) and multiple body regions (6.4%). Gadobutrol-enhanced magnetic resonance angiography (MRA) was performed in 14.7% of patients. Overall, the mean volume of gadobutrol administered for contrast-enhanced magnetic resonance imaging was 12 mL (0.16 mmol gadolinium [Gd]/kg body weight [BW]; mean BW: 75.5 kg), whereas for contrast-enhanced MRA the mean volume was 15.7 mL (0.21 mmol Gd/kg BW). Seventy-eight of the 14,299 patients (0.55%) reported at least one ADR. Two (0.01%) serious ADRs were reported. The most frequently reported ADR was nausea, which occurred in 36 patients (0.25%). CONCLUSION Gadobutrol 1.0M is very well tolerated and has a good safety profile. The occurrence of ADRs observed following the intravenous injection of gadobutrol is comparable with the published data of other Gd-based contrast agents.
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Affiliation(s)
- Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany.
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Kopp AF, Mortele KJ, Cho YD, Palkowitsch P, Bettmann MA, Claussen CD. Prevalence of acute reactions to iopromide: postmarketing surveillance study of 74,717 patients. Acta Radiol 2008; 49:902-11. [PMID: 18651252 DOI: 10.1080/02841850802282811] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Iodinated X-ray contrast media (CM) are recognized worldwide to be among the safest and most widely used injectable drugs. However, adverse drug reactions (ADRs) may still occur, ranging in severity from minor disturbances to severe and potentially fatal complications. PURPOSE To prospectively determine the incidence and characteristics of acute ADRs during clinical utilization of a single nonionic monomeric contrast agent, iopromide, in routine radiological practice in a large number of nonselected patients. MATERIAL AND METHODS 74,717 patients were enrolled in a prospective international postmarketing surveillance registry with iopromide (Ultravist; Bayer Schering Pharma AG, Berlin, Germany). A standardized questionnaire was used to collect the following patient information from 762 centers in 27 countries: baseline demographics, risk factors, premedication regimen, type of examination, route of injection, volume and selected concentration of iopromide, and overall tolerance to CM (utilizing specific criteria and descriptors). RESULTS The overall rate of ADRs, including tolerance indicators (TI) (i.e., heat sensation and pain at the injection site), was 2%; when TIs were excluded, the rate was 1.5%. Fourteen serious adverse reactions were reported (rate 0.02%), of which none were fatal. There was a higher incidence of ADRs among women and for the age group ranging between 18 and 30 years. Patients with established risk factors, such as a history of previous CM reaction or allergic diathesis (7.4% and 4.1%, respectively), were at an increased risk for developing an ADR when compared to patients without risk factors (1.2%). The incidence of ADRs was not altered by the use of premedication. CONCLUSION The safety of iopromide in routine clinical practice was shown to be comparable to the published safety profiles of other nonionic iodinated contrast agents. Adverse drug reaction rates were affected by age, gender, and risk factors (especially previous CM reactions or allergies), but not by premedication.
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Affiliation(s)
- A. F. Kopp
- Department of Diagnostic Radiology, Eberhard-Karls-University Tuebingen, Germany Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA Kosin University Gospel Hospital, Busan, South Korea Bayer Schering Pharma AG, Berlin, Germany; WFU School of Medicine-Radiology, Winston-Salem, North Carolina, USA
| | - K. J. Mortele
- Department of Diagnostic Radiology, Eberhard-Karls-University Tuebingen, Germany Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA Kosin University Gospel Hospital, Busan, South Korea Bayer Schering Pharma AG, Berlin, Germany; WFU School of Medicine-Radiology, Winston-Salem, North Carolina, USA
| | - Y. D. Cho
- Department of Diagnostic Radiology, Eberhard-Karls-University Tuebingen, Germany Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA Kosin University Gospel Hospital, Busan, South Korea Bayer Schering Pharma AG, Berlin, Germany; WFU School of Medicine-Radiology, Winston-Salem, North Carolina, USA
| | - P. Palkowitsch
- Department of Diagnostic Radiology, Eberhard-Karls-University Tuebingen, Germany Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA Kosin University Gospel Hospital, Busan, South Korea Bayer Schering Pharma AG, Berlin, Germany; WFU School of Medicine-Radiology, Winston-Salem, North Carolina, USA
| | - M. A. Bettmann
- Department of Diagnostic Radiology, Eberhard-Karls-University Tuebingen, Germany Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA Kosin University Gospel Hospital, Busan, South Korea Bayer Schering Pharma AG, Berlin, Germany; WFU School of Medicine-Radiology, Winston-Salem, North Carolina, USA
| | - C. D. Claussen
- Department of Diagnostic Radiology, Eberhard-Karls-University Tuebingen, Germany Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA Kosin University Gospel Hospital, Busan, South Korea Bayer Schering Pharma AG, Berlin, Germany; WFU School of Medicine-Radiology, Winston-Salem, North Carolina, USA
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Kopp AF, Palkowitsch P, Mortele K, Claussen CD. Sicherheit und Verträglichkeit von Iopromid bei 74.717 Patienten. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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