Toxic medications in Charcot–Marie–Tooth patients: A systematic review

IF 3.9 3区 医学 Q1 CLINICAL NEUROLOGY Journal of the Peripheral Nervous System Pub Date : 2023-05-30 DOI:10.1111/jns.12566
Guido Cavaletti, Katherine Forsey, Paola Alberti
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引用次数: 1

Abstract

Background and Aims

Several widely used medications, with a relevant efficacy profile, are toxic to the peripheral nervous system and an even larger number of agents are suspected to be neurotoxic. There are concerns about the use of these drugs in patients with Charcot–Marie–Tooth disease (CMT), a hereditary motor and sensory neuropathy. This review provides evidence-based updated recommendations on this clinically relevant topic.

Methods

A systematic review of the available studies/reports written in English was performed from July to September 2022 including in the search string all reported putative neurotoxic drugs.

Results

The results of our systematic review provide evidence-based support for the statement that use of vincristine, and possibly paclitaxel, can occasionally induce an atypical, and more severe, course of drug-related peripheral neurotoxicity in CMT patients. It is therefore reasonable to recommend caution in the use of these compounds in CMT patients. However, no convincing evidence for a similar recommendation could be found for all other drugs.

Interpretation

It is important that patients with CMT are not denied effective treatments that may prolong life expectancy for cancer or improve their health status if affected by non-oncological diseases. Accurate monitoring of peripheral nerve function in CMT patients treated with any neurotoxic agent remains mandatory to detect the earliest signs of neuropathy worsening and atypical clinical courses. Neurologists monitoring CMT patients as part of their normal care package or for natural history studies should keep detailed records of exposures to neurotoxic medications and support reporting of accelerated neuropathy progression if observed.

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Charcot-Marie-Tooth患者的毒性药物:系统回顾
背景和目的一些广泛使用的药物,具有相关的疗效,对周围神经系统有毒性,甚至更多的药物被怀疑是神经毒性的。这些药物在患有腓骨肌萎缩症(CMT)(一种遗传性运动和感觉神经病变)患者中的应用令人担忧。本综述就这一临床相关主题提供了基于证据的最新建议。方法对2022年7月至9月已有的英文研究/报告进行系统回顾,检索字符串中包括所有报道的推定神经毒性药物。结果本系统综述的结果为以下观点提供了证据支持:长春新碱,可能还有紫杉醇,在CMT患者中偶尔会诱发非典型的、更严重的药物相关周围神经毒性病程。因此,建议在CMT患者中谨慎使用这些化合物是合理的。然而,没有令人信服的证据表明类似的建议适用于所有其他药物。重要的是,CMT患者不应被拒绝接受有效的治疗,这些治疗可能延长癌症的预期寿命,或改善非肿瘤疾病患者的健康状况。在接受任何神经毒性药物治疗的CMT患者中,准确监测周围神经功能仍然是必要的,以发现神经病变恶化的早期迹象和非典型临床病程。作为常规护理包或自然史研究的一部分,神经科医生监测CMT患者时,应详细记录神经毒性药物的暴露情况,并支持观察到的神经病变加速进展的报告。
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来源期刊
CiteScore
6.10
自引率
7.90%
发文量
45
审稿时长
>12 weeks
期刊介绍: The Journal of the Peripheral Nervous System is the official journal of the Peripheral Nerve Society. Founded in 1996, it is the scientific journal of choice for clinicians, clinical scientists and basic neuroscientists interested in all aspects of biology and clinical research of peripheral nervous system disorders. The Journal of the Peripheral Nervous System is a peer-reviewed journal that publishes high quality articles on cell and molecular biology, genomics, neuropathic pain, clinical research, trials, and unique case reports on inherited and acquired peripheral neuropathies. Original articles are organized according to the topic in one of four specific areas: Mechanisms of Disease, Genetics, Clinical Research, and Clinical Trials. The journal also publishes regular review papers on hot topics and Special Issues on basic, clinical, or assembled research in the field of peripheral nervous system disorders. Authors interested in contributing a review-type article or a Special Issue should contact the Editorial Office to discuss the scope of the proposed article with the Editor-in-Chief.
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