Pub Date : 2024-10-22DOI: 10.1080/14740338.2024.2419547
Chiara Guarini, Anna Natalizia Santoro, Assunta Melaccio, Laura Lanotte, Gennaro Gadaleta-Caldarola, Francesco Giuliani, Antonello Pinto, Palma Fedele
Introduction: Breast cancer (BC) remains a prevalent and challenging malignancy among women, with significant advancements in treatment strategies over the past decades. Traditional chemotherapy has been progressively supplemented by newer modalities, including Antibody-Drug Conjugates (ADCs), Immunotherapy (IO), and Targeted Therapies (TT). Despite these advancements, there remains a critical need for strategies that maintain efficacy while minimizing toxicity.
Areas covered: This review delves into metronomic chemotherapy (MC), a novel approach involving the frequent administration of low-dose chemotherapy without prolonged breaks. We explore MC's impact across various breast cancer subtypes, such as Estrogen Receptor-Positive (ER+), HER2-Positive, and Triple-Negative Breast Cancer (TNBC). The literature reviewed highlights MC's mechanisms, including its anti-angiogenic, immunomodulatory, and antiproliferative effects, and its potential to improve treatment tolerability and address drug resistance.
Expert opinion: MC represents a promising adjunct to existing therapies, particularly in advanced or resistant cases. Its unique dosing schedule could offer sustained antitumor activity with reduced toxicity, making it a viable option for long-term management. However, further research is warranted to establish optimal dosing regimens, identify predictive biomarkers, and delineate its role within combination treatment strategies. Clarifying these aspects could refine MC's application, potentially reshaping treatment paradigms and enhancing patient outcomes in breast cancer management.
导言:乳腺癌(BC)仍然是女性中普遍存在且极具挑战性的恶性肿瘤,在过去几十年中,治疗策略取得了重大进展。传统化疗逐渐得到了抗体药物共轭物(ADC)、免疫疗法(IO)和靶向疗法(TT)等新方法的补充。尽管取得了这些进展,但仍然迫切需要既能保持疗效又能最大限度降低毒性的策略:本综述深入探讨了节律化疗(MC),这是一种涉及频繁施用低剂量化疗而不延长化疗间歇期的新方法。我们探讨了MC对各种乳腺癌亚型的影响,如雌激素受体阳性(ER+)、HER2阳性和三阴性乳腺癌(TNBC)。综述的文献强调了MC的作用机制,包括其抗血管生成、免疫调节和抗增生作用,以及其改善治疗耐受性和解决耐药性问题的潜力:MC是现有疗法的一种很有前景的辅助疗法,尤其是在晚期或耐药病例中。其独特的给药方式可在降低毒性的同时提供持续的抗肿瘤活性,使其成为长期治疗的可行选择。不过,还需要进一步研究,以确定最佳给药方案、确定预测性生物标志物,并明确其在联合治疗策略中的作用。明确这些方面可以完善 MC 的应用,从而有可能重塑治疗范式,提高乳腺癌患者的治疗效果。
{"title":"Metronomic chemotherapy and breast cancer: a critical evaluation of its role in the new landscape of therapeutics.","authors":"Chiara Guarini, Anna Natalizia Santoro, Assunta Melaccio, Laura Lanotte, Gennaro Gadaleta-Caldarola, Francesco Giuliani, Antonello Pinto, Palma Fedele","doi":"10.1080/14740338.2024.2419547","DOIUrl":"10.1080/14740338.2024.2419547","url":null,"abstract":"<p><strong>Introduction: </strong>Breast cancer (BC) remains a prevalent and challenging malignancy among women, with significant advancements in treatment strategies over the past decades. Traditional chemotherapy has been progressively supplemented by newer modalities, including Antibody-Drug Conjugates (ADCs), Immunotherapy (IO), and Targeted Therapies (TT). Despite these advancements, there remains a critical need for strategies that maintain efficacy while minimizing toxicity.</p><p><strong>Areas covered: </strong>This review delves into metronomic chemotherapy (MC), a novel approach involving the frequent administration of low-dose chemotherapy without prolonged breaks. We explore MC's impact across various breast cancer subtypes, such as Estrogen Receptor-Positive (ER+), HER2-Positive, and Triple-Negative Breast Cancer (TNBC). The literature reviewed highlights MC's mechanisms, including its anti-angiogenic, immunomodulatory, and antiproliferative effects, and its potential to improve treatment tolerability and address drug resistance.</p><p><strong>Expert opinion: </strong>MC represents a promising adjunct to existing therapies, particularly in advanced or resistant cases. Its unique dosing schedule could offer sustained antitumor activity with reduced toxicity, making it a viable option for long-term management. However, further research is warranted to establish optimal dosing regimens, identify predictive biomarkers, and delineate its role within combination treatment strategies. Clarifying these aspects could refine MC's application, potentially reshaping treatment paradigms and enhancing patient outcomes in breast cancer management.</p>","PeriodicalId":12232,"journal":{"name":"Expert Opinion on Drug Safety","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-19DOI: 10.1080/14740338.2024.2416916
George Tsey Sabblah, Katja Taxis, Mahama Duwiejua, Seth Kwaku Seaneke, Eugène van Puijenbroek, Florence van Hunsel
Introduction: Patient engagement in pharmacovigilance (PEP) has been shown to improve information on adverse drug reactions (ADRs), which may not be found in reports from healthcare professionals. This review shows that there is paucity of information on PEP in lower-middle-income countries (LMICs), particularly Africa. It provides insights into PEP in high-income countries (HICs) compared with Africa to help identify the disparities and system challenges in Africa.
Areas covered: We discussed the impact of PEP in HICs in comparison with Africa and incorporated two case studies: PEP in Ghana and medication error reporting in Africa using a scoping review. Recommendations were made to improve medication safety in Africa based on the identified disparities and system challenges.
Expert opinion: PEP is at an early stage in LMICs, particularly in Africa, with limited information available regarding patients' contributions to the safety of medicines. There should be further research into patients' roles in pharmacovigilance accompanied by advocacy efforts with policymakers, the development of sustainable funding strategies, benchmarking against experienced pharmacovigilance centers, and the use of technology to improve patient reporting.
简介:事实证明,患者参与药物警戒 (PEP) 可以改善药物不良反应 (ADR) 的信息,而这些信息可能无法在医疗保健专业人员的报告中找到。本综述显示,在中低收入国家(LMIC),尤其是非洲,有关药物警戒的信息很少。与非洲相比,本综述对高收入国家(HICs)的 PEP 进行了深入探讨,以帮助确定非洲的差异和系统挑战:我们讨论了与非洲相比,PEP 在高收入国家/地区的影响,并纳入了两个案例研究:我们讨论了高收入国家与非洲的 PEP 影响,并纳入了两个案例研究:加纳的 PEP 和非洲的用药错误报告。根据已确定的差异和系统挑战,提出了改善非洲用药安全的建议:专家意见:PEP 在低收入与中等收入国家(尤其是非洲)尚处于早期阶段,有关患者对用药安全的贡献的信息十分有限。应进一步研究患者在药物警戒中的作用,同时向政策制定者进行宣传,制定可持续的资助战略,以经验丰富的药物警戒中心为基准,并利用技术改善患者的报告情况。
{"title":"Achieving patient engagement in pharmacovigilance: from high-income countries to lower and -middle-income countries with focus on Africa.","authors":"George Tsey Sabblah, Katja Taxis, Mahama Duwiejua, Seth Kwaku Seaneke, Eugène van Puijenbroek, Florence van Hunsel","doi":"10.1080/14740338.2024.2416916","DOIUrl":"https://doi.org/10.1080/14740338.2024.2416916","url":null,"abstract":"<p><strong>Introduction: </strong>Patient engagement in pharmacovigilance (PEP) has been shown to improve information on adverse drug reactions (ADRs), which may not be found in reports from healthcare professionals. This review shows that there is paucity of information on PEP in lower-middle-income countries (LMICs), particularly Africa. It provides insights into PEP in high-income countries (HICs) compared with Africa to help identify the disparities and system challenges in Africa.</p><p><strong>Areas covered: </strong>We discussed the impact of PEP in HICs in comparison with Africa and incorporated two case studies: PEP in Ghana and medication error reporting in Africa using a scoping review. Recommendations were made to improve medication safety in Africa based on the identified disparities and system challenges.</p><p><strong>Expert opinion: </strong>PEP is at an early stage in LMICs, particularly in Africa, with limited information available regarding patients' contributions to the safety of medicines. There should be further research into patients' roles in pharmacovigilance accompanied by advocacy efforts with policymakers, the development of sustainable funding strategies, benchmarking against experienced pharmacovigilance centers, and the use of technology to improve patient reporting.</p>","PeriodicalId":12232,"journal":{"name":"Expert Opinion on Drug Safety","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Tafasitamab is the first anti-CD19 monoclonal antibody approved for relapsed/refractory diffuse large B-cell lymphoma patients ineligible for autologous stem cell transplantation. The study was designed to evaluate tafasitamab-associated adverse events (AEs) by data mining the United States Food and Drug Administration Adverse Event Reporting System (FAERS).
Research design and methods: A disproportionality analysis was performed to assess the safety profile of tafasitamab based on the reports from the FAERS database between 2020Q3 and 2023Q3. Proportional reporting ratio (PRR) and empirical Bayesian geometric mean (EBGM) were used to identify the signals of AEs in patients receiving tafasitamab.
Results: A total of 529 reports with tafasitamab as the primary suspect drug were collected, including 1,262 AEs. Of these, 28 repeated AEs were identified using two algorithms. After excluding events unrelated to drug therapy, the top five repeated AEs by intensity ranking were cytopenia, immunosuppression, neutropenic sepsis, blood lactate dehydrogenase increased, and hematotoxicity. Unexpected significant AEs included polyneuropathy, splenomegaly, hemophagocytic lymphohistiocytosis, hypercalcemia, and ascites.
Conclusions: This study provides additional evidence for risk identification of tafasitamab in the real world, which could help clinicians and pharmacists increase vigilance and improve the safety of tafasitamab in clinical practice.
{"title":"A real-world pharmacovigilance study of tafasitamab: data mining of the US food and drug administration adverse event reporting system.","authors":"Zhongliang Xu, Shimei Feng, Dan Huang, Hongli Wang, Jiating Liu, Zhengze Shen","doi":"10.1080/14740338.2024.2416914","DOIUrl":"https://doi.org/10.1080/14740338.2024.2416914","url":null,"abstract":"<p><strong>Background: </strong>Tafasitamab is the first anti-CD19 monoclonal antibody approved for relapsed/refractory diffuse large B-cell lymphoma patients ineligible for autologous stem cell transplantation. The study was designed to evaluate tafasitamab-associated adverse events (AEs) by data mining the United States Food and Drug Administration Adverse Event Reporting System (FAERS).</p><p><strong>Research design and methods: </strong>A disproportionality analysis was performed to assess the safety profile of tafasitamab based on the reports from the FAERS database between 2020Q3 and 2023Q3. Proportional reporting ratio (PRR) and empirical Bayesian geometric mean (EBGM) were used to identify the signals of AEs in patients receiving tafasitamab.</p><p><strong>Results: </strong>A total of 529 reports with tafasitamab as the primary suspect drug were collected, including 1,262 AEs. Of these, 28 repeated AEs were identified using two algorithms. After excluding events unrelated to drug therapy, the top five repeated AEs by intensity ranking were cytopenia, immunosuppression, neutropenic sepsis, blood lactate dehydrogenase increased, and hematotoxicity. Unexpected significant AEs included polyneuropathy, splenomegaly, hemophagocytic lymphohistiocytosis, hypercalcemia, and ascites.</p><p><strong>Conclusions: </strong>This study provides additional evidence for risk identification of tafasitamab in the real world, which could help clinicians and pharmacists increase vigilance and improve the safety of tafasitamab in clinical practice.</p>","PeriodicalId":12232,"journal":{"name":"Expert Opinion on Drug Safety","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1080/14740338.2024.2418320
Libo Wang, Xi Chen, Shijian Wang, Jing Wei, Jiabing Wang
Background and aims: Data related to clinical characteristics and potential mechanisms of proton pump inhibitors (PPIs)-related liver injury are sparse, thus the purpose of this study is to summarize the clinical features and molecular mechanisms of PPIs-induced liver injury.
Methods: We collected case report on liver injury induced by PPIs in English and Chinese for retrospective analysis. Clinical and pathological data and outcomes were obtained and analyzed. Network pharmacology and molecular docking techniques were employed to examine the mechanism.
Result: Twenty-three patients with PPIs-induced liver injury were enrolled. PPIs-induced liver injury is a rare adverse reaction, ranging from asymptomatic elevated transaminases to fulminant liver failure. Omeprazole was the drug with the highest number of associated reports. The most common symptom was fatigue. The most common liver injury pattern was hepatocellular injury. A total of 13 intersection targets of PPIs and liver injury were screened, and the top 10 targets were included, and the PI3K-Akt signaling pathway was significantly enriched. The results of molecular docking implied that the PPIs could combine well with key targets.
Conclusion: Patients receiving long-term treatment with PPIs should consider monitoring liver function. PPIs exhibit considerable capacity in liver injury via especially the PI3K-Akt signaling pathway.
{"title":"Exploration of the clinical characteristics and potential mechanisms of liver injury induced by proton pump inhibitors.","authors":"Libo Wang, Xi Chen, Shijian Wang, Jing Wei, Jiabing Wang","doi":"10.1080/14740338.2024.2418320","DOIUrl":"https://doi.org/10.1080/14740338.2024.2418320","url":null,"abstract":"<p><strong>Background and aims: </strong>Data related to clinical characteristics and potential mechanisms of proton pump inhibitors (PPIs)-related liver injury are sparse, thus the purpose of this study is to summarize the clinical features and molecular mechanisms of PPIs-induced liver injury.</p><p><strong>Methods: </strong>We collected case report on liver injury induced by PPIs in English and Chinese for retrospective analysis. Clinical and pathological data and outcomes were obtained and analyzed. Network pharmacology and molecular docking techniques were employed to examine the mechanism.</p><p><strong>Result: </strong>Twenty-three patients with PPIs-induced liver injury were enrolled. PPIs-induced liver injury is a rare adverse reaction, ranging from asymptomatic elevated transaminases to fulminant liver failure. Omeprazole was the drug with the highest number of associated reports. The most common symptom was fatigue. The most common liver injury pattern was hepatocellular injury. A total of 13 intersection targets of PPIs and liver injury were screened, and the top 10 targets were included, and the PI3K-Akt signaling pathway was significantly enriched. The results of molecular docking implied that the PPIs could combine well with key targets.</p><p><strong>Conclusion: </strong>Patients receiving long-term treatment with PPIs should consider monitoring liver function. PPIs exhibit considerable capacity in liver injury via especially the PI3K-Akt signaling pathway.</p>","PeriodicalId":12232,"journal":{"name":"Expert Opinion on Drug Safety","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1080/14740338.2024.2418325
Bin Deng, Shijun Li, Ruxu You, Zhiwen Fu
Background: The increasing prevalence of statin use for cardiovascular disease management has raised concerns regarding their safety profile, particularly regarding the potential risk of diabetes. Our study aims to analyze diabetic adverse event reports related to statins using a large pharmacovigilance database to provide timely insights into this significant issue.
Methods: We analyzed data from the FDA Adverse Event Reporting System (FAERS) database from 2004 to 2023. Disproportionality analyses were performed to detect signals of diabetic adverse events associated with the three most commonly prescribed statins: atorvastatin, rosuvastatin, and simvastatin.
Results: We identified 11,364 cases of statin-related diabetic adverse events across the three statins. Disproportionality analyses revealed a significant association between these statins and four specific diabetic adverse events: type 2 diabetes mellitus, impaired glucose tolerance, diabetic neuropathy, and diabetic retinal edema. Notable sex differences emerged, with females exhibiting an overall significantly higher propensity for diabetes-related adverse events.
Conclusions: Our study is timely and relevant as it addresses growing concerns about the safety of widely prescribed statins and their association with diabetes. By highlighting these critical issues, the study seeks to contribute valuable insights to practitioners, ultimately guiding better clinical practices and enhancing pharmacovigilance efforts.
{"title":"Diabetic adverse events associated with three commonly used statins: a disproportionality analysis based on the FDA adverse event reporting system database.","authors":"Bin Deng, Shijun Li, Ruxu You, Zhiwen Fu","doi":"10.1080/14740338.2024.2418325","DOIUrl":"https://doi.org/10.1080/14740338.2024.2418325","url":null,"abstract":"<p><strong>Background: </strong>The increasing prevalence of statin use for cardiovascular disease management has raised concerns regarding their safety profile, particularly regarding the potential risk of diabetes. Our study aims to analyze diabetic adverse event reports related to statins using a large pharmacovigilance database to provide timely insights into this significant issue.</p><p><strong>Methods: </strong>We analyzed data from the FDA Adverse Event Reporting System (FAERS) database from 2004 to 2023. Disproportionality analyses were performed to detect signals of diabetic adverse events associated with the three most commonly prescribed statins: atorvastatin, rosuvastatin, and simvastatin.</p><p><strong>Results: </strong>We identified 11,364 cases of statin-related diabetic adverse events across the three statins. Disproportionality analyses revealed a significant association between these statins and four specific diabetic adverse events: type 2 diabetes mellitus, impaired glucose tolerance, diabetic neuropathy, and diabetic retinal edema. Notable sex differences emerged, with females exhibiting an overall significantly higher propensity for diabetes-related adverse events.</p><p><strong>Conclusions: </strong>Our study is timely and relevant as it addresses growing concerns about the safety of widely prescribed statins and their association with diabetes. By highlighting these critical issues, the study seeks to contribute valuable insights to practitioners, ultimately guiding better clinical practices and enhancing pharmacovigilance efforts.</p>","PeriodicalId":12232,"journal":{"name":"Expert Opinion on Drug Safety","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-17DOI: 10.1080/14740338.2024.2416933
Yunxiang Zhong, Zhiping Li, Jinyi Tao, Jiao Yuan, Zhiwen Fu
Background: Myocarditis is a rare but potentially life-threatening inflammation of the heart muscle that can be caused by various drugs. This study aimed to comprehensively evaluate the risk of drug-induced myocarditis using data from the FDA Adverse Event Reporting System (FAERS) database.
Methods: We queried the FAERS database for reports of myocarditis from Q1 2004 to Q4 2023. The reporting odds ratio (ROR) and proportional reporting ratio (PRR) were calculated to detect disproportionality signals for drugs associated with myocarditis.
Results: A total of 8,212 myocarditis-related reports were identified in the FAERS database. The most frequently reported drugs were clozapine (N = 1269), followed by nivolumab (N = 621), pembrolizumab (N = 358), mesalazine (252), and olanzapine (N = 191). Disproportionality analysis revealed strong signals for the top 50 drugs, including mesalazine (ROR 48.01, 95% CI 42.29-54.49), cemiplimab (ROR 38.84, 95% CI 26.71-56.47), clozapine (ROR 35.21, 95% CI 33.13-37.39), nivolumab (ROR 23.21, 95% CI 21.38-25.2), atezolizumab (ROR 20.75, 95% CI 17.91-24.05) and pembrolizumab (ROR 19.90, 95% CI 17.89-22.13).
Conclusions: Our findings suggest a potential risk of drug-induced myocarditis associated with various medications. Close monitoring for signs and symptoms of myocarditis is crucial, especially in patients with risk factors or those receiving these drugs. Further investigations are warranted to establish causality and identify risk factors.
背景:心肌炎是一种罕见但可能危及生命的心肌炎症,可由多种药物引起。本研究旨在利用美国食品药品管理局不良事件报告系统(FAERS)数据库中的数据,全面评估药物诱发心肌炎的风险:我们在 FAERS 数据库中查询了 2004 年第一季度至 2023 年第四季度的心肌炎报告。计算报告几率比(ROR)和报告比例比(PRR),以检测与心肌炎相关药物的比例失调信号:结果:FAERS 数据库中共发现 8,212 例心肌炎相关报告。最常报告的药物是氯氮平(1269 例),其次是尼韦鲁单抗(621 例)、彭布利珠单抗(358 例)、美沙拉秦(252 例)和奥氮平(191 例)。比例失调分析显示,前 50 种药物存在强烈信号,包括美沙拉秦(ROR 48.01,95% CI 42.29-54.49)、赛美普利单抗(ROR 38.84,95% CI 26.71-56.47)、氯氮平(ROR 35.21,95% CI 33.13-37.39)、nivolumab(ROR 23.21,95% CI 21.38-25.2)、atezolizumab(ROR 20.75,95% CI 17.91-24.05)和pembrolizumab(ROR 19.90,95% CI 17.89-22.13):我们的研究结果表明,各种药物都有诱发心肌炎的潜在风险。密切监测心肌炎的体征和症状至关重要,尤其是对有风险因素或正在接受这些药物治疗的患者。为确定因果关系和风险因素,有必要进行进一步调查。
{"title":"Drug-induced myocarditis: a real-world pharmacovigilance study using the FDA adverse event reporting system database.","authors":"Yunxiang Zhong, Zhiping Li, Jinyi Tao, Jiao Yuan, Zhiwen Fu","doi":"10.1080/14740338.2024.2416933","DOIUrl":"https://doi.org/10.1080/14740338.2024.2416933","url":null,"abstract":"<p><strong>Background: </strong>Myocarditis is a rare but potentially life-threatening inflammation of the heart muscle that can be caused by various drugs. This study aimed to comprehensively evaluate the risk of drug-induced myocarditis using data from the FDA Adverse Event Reporting System (FAERS) database.</p><p><strong>Methods: </strong>We queried the FAERS database for reports of myocarditis from Q1 2004 to Q4 2023. The reporting odds ratio (ROR) and proportional reporting ratio (PRR) were calculated to detect disproportionality signals for drugs associated with myocarditis.</p><p><strong>Results: </strong>A total of 8,212 myocarditis-related reports were identified in the FAERS database. The most frequently reported drugs were clozapine (<i>N</i> = 1269), followed by nivolumab (<i>N</i> = 621), pembrolizumab (<i>N</i> = 358), mesalazine (252), and olanzapine (<i>N</i> = 191). Disproportionality analysis revealed strong signals for the top 50 drugs, including mesalazine (ROR 48.01, 95% CI 42.29-54.49), cemiplimab (ROR 38.84, 95% CI 26.71-56.47), clozapine (ROR 35.21, 95% CI 33.13-37.39), nivolumab (ROR 23.21, 95% CI 21.38-25.2), atezolizumab (ROR 20.75, 95% CI 17.91-24.05) and pembrolizumab (ROR 19.90, 95% CI 17.89-22.13).</p><p><strong>Conclusions: </strong>Our findings suggest a potential risk of drug-induced myocarditis associated with various medications. Close monitoring for signs and symptoms of myocarditis is crucial, especially in patients with risk factors or those receiving these drugs. Further investigations are warranted to establish causality and identify risk factors.</p>","PeriodicalId":12232,"journal":{"name":"Expert Opinion on Drug Safety","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Thrombopoietin receptor agonists (TPO-RAs) are currently approved for the treatment of thrombocytopenia in different conditions. The relationship between TPO-RAs and thromboembolic events (TEEs) remains controversial.
Research design and methods: We extracted TPO-RAs adverse reaction reports after their marketing until now, using the FDA adverse event reporting system (FAERS). Positive signals were detected by reporting odds ratios (RORs). And the Weibull shape parameter test was utilized to analyze the time-to-onset profiles.
Result: Thromboembolic events accounted for 8.97% among TPO-RAs reports. Increased reporting of TEEs was related to TPO-RAs treatment compared with the entire FAERS database [ROR = 2.65 (2.56, 2.73)]. In addition, venous thrombotic events [ROR = 4.13 (3.92, 4.35)] were reported more frequently than arterial events ROR = 1.81 (1.7, 1.93)]. Age over 60 years [odds ratio (OR) = 1.10 (1.01, 1.20), p = 0.029] and weight over 80 kg [OR = 1.36 (1.17, 1.58), p < 0.001] of patients might have higher risk of TEEs during TPO-RAs therapy.
Conclusion: Evidence from the real world suggested that TPO-RAs were associated with higher incidence of TEEs, particularly venous thrombosis. The risk of TPO-RAs-associated TEEs mostly happened in the early stages of treatment and decreased over time.
{"title":"Thromboembolism adverse event profiles of thrombopoietin receptor agonists: a real-world, pharmacovigilance study.","authors":"Xintian Xu, Lingxiao Zhang, Xiaoyu Zhang, Wanjing Huang, Longgui Xie, Mao Ouyang","doi":"10.1080/14740338.2024.2416540","DOIUrl":"https://doi.org/10.1080/14740338.2024.2416540","url":null,"abstract":"<p><strong>Background: </strong>Thrombopoietin receptor agonists (TPO-RAs) are currently approved for the treatment of thrombocytopenia in different conditions. The relationship between TPO-RAs and thromboembolic events (TEEs) remains controversial.</p><p><strong>Research design and methods: </strong>We extracted TPO-RAs adverse reaction reports after their marketing until now, using the FDA adverse event reporting system (FAERS). Positive signals were detected by reporting odds ratios (RORs). And the Weibull shape parameter test was utilized to analyze the time-to-onset profiles.</p><p><strong>Result: </strong>Thromboembolic events accounted for 8.97% among TPO-RAs reports. Increased reporting of TEEs was related to TPO-RAs treatment compared with the entire FAERS database [ROR = 2.65 (2.56, 2.73)]. In addition, venous thrombotic events [ROR = 4.13 (3.92, 4.35)] were reported more frequently than arterial events ROR = 1.81 (1.7, 1.93)]. Age over 60 years [odds ratio (OR) = 1.10 (1.01, 1.20), <i>p</i> = 0.029] and weight over 80 kg [OR = 1.36 (1.17, 1.58), <i>p</i> < 0.001] of patients might have higher risk of TEEs during TPO-RAs therapy.</p><p><strong>Conclusion: </strong>Evidence from the real world suggested that TPO-RAs were associated with higher incidence of TEEs, particularly venous thrombosis. The risk of TPO-RAs-associated TEEs mostly happened in the early stages of treatment and decreased over time.</p>","PeriodicalId":12232,"journal":{"name":"Expert Opinion on Drug Safety","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1080/14740338.2024.2416918
Kun Ma, Linna Ma, Tianjiao Huang, Yue Wang, Guanlan Zhong, Cong Gao, Zhiyu Zhou, Jie Luo
Objective: To assess the efficacy and safety of aripiprazole, bromocriptine, and cabergoline in the treatment of hyperprolactinemia (HPRL) using network meta-analysis.
Method: We searched PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, and China Biology Medicine disc (CBMdisc) for randomized controlled trials (RCTs). The quality of the included studies was assessed using the Cochrane risk-of-bias tool, and data were analyzed using RevMan 5.4, R 4.3.3, and Stata 17.
Results: 44 RCTs involving a total of 3886 patients were finally included. The results showed that at 12 week of treatment, cabergoline plus conventional therapy had optimal efficacy in reducing prolactin (PRL) levels. Cabergoline plus conventional therapy was most effective in reducing PRL levels in patients with non-drug-induced HPRL. Aripiprazole plus conventional therapy had optimal efficacy in reducing PRL levels in patients with antipsychotics-induced or antidepressant-induced HPRL. Bromocriptine was the most efficacious intervention in improving estrogen (E2) levels.
Conclusion: Three dopamine receptor agonists (DAs) have different advantages in improving serum PRL and E2 levels in HPRL patients.
Prospero id: CRD42024510695.
目的采用网络荟萃分析评估阿立哌唑、溴隐亭和卡麦角林治疗高泌乳素血症(HPRL)的疗效和安全性:我们检索了 PubMed、Cochrane Library、Embase、Web of Science、中国国家知识基础设施(CNKI)、万方数据库、VIP 和中国生物医学文献数据库(CBMdisc)中的随机对照试验(RCT)。使用 Cochrane 偏倚风险工具对纳入研究的质量进行评估,并使用 RevMan 5.4、R 4.3.3 和 Stata 17 对数据进行分析:最终纳入了 44 项研究,共涉及 3886 名患者。结果显示,在治疗 12 周时,卡贝戈林联合常规疗法在降低催乳素(PRL)水平方面具有最佳疗效。卡麦角林加常规疗法对降低非药物诱发的 HPRL 患者的 PRL 水平最为有效。阿立哌唑联合常规疗法对降低抗精神病药物诱发或抗抑郁药物诱发的HPRL患者的PRL水平具有最佳疗效。在改善雌激素(E2)水平方面,溴隐亭是最有效的干预措施:结论:三种多巴胺受体激动剂(DAs)在改善 HPRL 患者血清 PRL 和 E2 水平方面具有不同的优势:crd42024510695.
{"title":"The effectiveness and safety of aripiprazole, bromocriptine, and cabergoline in the treatment of hyperprolactinemia: a systematic review and network meta-analysis.","authors":"Kun Ma, Linna Ma, Tianjiao Huang, Yue Wang, Guanlan Zhong, Cong Gao, Zhiyu Zhou, Jie Luo","doi":"10.1080/14740338.2024.2416918","DOIUrl":"https://doi.org/10.1080/14740338.2024.2416918","url":null,"abstract":"<p><strong>Objective: </strong>To assess the efficacy and safety of aripiprazole, bromocriptine, and cabergoline in the treatment of hyperprolactinemia (HPRL) using network meta-analysis.</p><p><strong>Method: </strong>We searched PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, and China Biology Medicine disc (CBMdisc) for randomized controlled trials (RCTs). The quality of the included studies was assessed using the Cochrane risk-of-bias tool, and data were analyzed using RevMan 5.4, R 4.3.3, and Stata 17.</p><p><strong>Results: </strong>44 RCTs involving a total of 3886 patients were finally included. The results showed that at 12 week of treatment, cabergoline plus conventional therapy had optimal efficacy in reducing prolactin (PRL) levels. Cabergoline plus conventional therapy was most effective in reducing PRL levels in patients with non-drug-induced HPRL. Aripiprazole plus conventional therapy had optimal efficacy in reducing PRL levels in patients with antipsychotics-induced or antidepressant-induced HPRL. Bromocriptine was the most efficacious intervention in improving estrogen (E<sub>2</sub>) levels.</p><p><strong>Conclusion: </strong>Three dopamine receptor agonists (DAs) have different advantages in improving serum PRL and E<sub>2</sub> levels in HPRL patients.</p><p><strong>Prospero id: </strong>CRD42024510695.</p>","PeriodicalId":12232,"journal":{"name":"Expert Opinion on Drug Safety","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1080/14740338.2024.2416537
Jianglin Wang, Cuifang Wu, Zhenzhen Deng
Introduction: Vanishing bile duct syndrome (VBDS) is a potentially fatal adverse reaction triggered by certain medications. The association between nonsteroidal anti-inflammatory drugs (NSAIDs) and VBDS is based on case reports. We explored the reporting prevalence and evaluated the clinical features of NSAID-related VBDS.
Research design and methods: Adverse event reports of VBDS associated with NSAIDs from 2004 to 2023 in the FAERS database were retrieved, and disproportionality analyses were conducted to detect risk signals. Case reports from 2000 to 2023 on NSAID-induced VBDS were retrieved for retrospective analysis.
Results: We obtained 87 VBDS reports from the FAERS database. Ibuprofen had the greatest proportion of VBDS (63.2%), while loxoprofen had the highest positive signal value. Sixteen case reports showed evidence of VBDS, with 37.5% of children. The median age was 29 years; typical initial symptoms included rash (60.0%), jaundice (53.3%), fatigue/asthenia (33.3%), and SJS/TEN (53.3%). The median onset time of VBDS was 4 weeks. All cases had abnormal liver function tests, with the median level of TBIL being 20.0 mg/dl. The overall prognosis is poor, with 50% of patients achieving clinical remission.
Conclusion: Four NSAID agents had significant reporting associations with VBDS. Prescribers should be more aware of this risk and identify signs/symptoms earlier.
{"title":"Nonsteroidal anti-inflammatory drugs-associated vanishing bile duct syndrome: a real-world retrospective and disproportionality analysis.","authors":"Jianglin Wang, Cuifang Wu, Zhenzhen Deng","doi":"10.1080/14740338.2024.2416537","DOIUrl":"10.1080/14740338.2024.2416537","url":null,"abstract":"<p><strong>Introduction: </strong>Vanishing bile duct syndrome (VBDS) is a potentially fatal adverse reaction triggered by certain medications. The association between nonsteroidal anti-inflammatory drugs (NSAIDs) and VBDS is based on case reports. We explored the reporting prevalence and evaluated the clinical features of NSAID-related VBDS.</p><p><strong>Research design and methods: </strong>Adverse event reports of VBDS associated with NSAIDs from 2004 to 2023 in the FAERS database were retrieved, and disproportionality analyses were conducted to detect risk signals. Case reports from 2000 to 2023 on NSAID-induced VBDS were retrieved for retrospective analysis.</p><p><strong>Results: </strong>We obtained 87 VBDS reports from the FAERS database. Ibuprofen had the greatest proportion of VBDS (63.2%), while loxoprofen had the highest positive signal value. Sixteen case reports showed evidence of VBDS, with 37.5% of children. The median age was 29 years; typical initial symptoms included rash (60.0%), jaundice (53.3%), fatigue/asthenia (33.3%), and SJS/TEN (53.3%). The median onset time of VBDS was 4 weeks. All cases had abnormal liver function tests, with the median level of TBIL being 20.0 mg/dl. The overall prognosis is poor, with 50% of patients achieving clinical remission.</p><p><strong>Conclusion: </strong>Four NSAID agents had significant reporting associations with VBDS. Prescribers should be more aware of this risk and identify signs/symptoms earlier.</p>","PeriodicalId":12232,"journal":{"name":"Expert Opinion on Drug Safety","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1080/14740338.2024.2416542
Yinghong Zhai, Lei Yuan, Shihua Fang, Shenglian Liu, Xiaofei Ye, Wentao Shi, Yang Cao, Jia He, Fangyuan Hu, Feng Xu
Background: CAR-T-associated neurotoxicity is extremely frequent with highly variable clinical presentation.
Research design and methods: Disproportionality analysis was conducted leveraging the FDA Adverse Event Reporting System (FAERS), covering the period from 1 January 2017, through 31 March 2023. The reporting odds ratio (ROR) and the information component (IC) were utilized to assess the adverse signals in total/individual CAR-T product. The lower limit of the ROR and IC 95% confidence interval (ROR025 and IC025) both exceeding threshold value (1 and 0, respectively) was considered a significant signal.
Results: Of the 60, 730 records associated with CAR-T, 11, 037 (18.17%) pertained to neurological events. Tisagenlecleucel exhibited the highest percentage of death (38.02%) and life-threatening (12.90%) outcomes. Notably, it also displayed the broadest distribution of neurotoxicity. Additionally, distinct adverse signals unique to individual CAR-T products were identified. For instance, paraparesis, cerebral hemorrhage, impaired pupillary reflex, Guillain-Barre syndrome, brain death following tisagenlecleucel; dysarthria, orthostatic hypotension, and spinal cord edema after axicabtagene; parkinsonism, Bell's palsy, and cranial nerve paralysis post ciltacabtagene.
Conclusions: Axicabtagene ciloleucel, tisagenlecleucel, brexucabtagene autoleucel, lisocabtagene maraleucel, idecabtagene vicleucel, and ciltacabtagene autoleucel exhibited increased odds of neurotoxicity, with some discrepancies in their characteristics, profiles, and severity.
{"title":"Neurotoxicity associated with chimeric antigen receptor T-cell therapy: a real-world study leveraging the FDA Adverse Event Reporting System.","authors":"Yinghong Zhai, Lei Yuan, Shihua Fang, Shenglian Liu, Xiaofei Ye, Wentao Shi, Yang Cao, Jia He, Fangyuan Hu, Feng Xu","doi":"10.1080/14740338.2024.2416542","DOIUrl":"https://doi.org/10.1080/14740338.2024.2416542","url":null,"abstract":"<p><strong>Background: </strong>CAR-T-associated neurotoxicity is extremely frequent with highly variable clinical presentation.</p><p><strong>Research design and methods: </strong>Disproportionality analysis was conducted leveraging the FDA Adverse Event Reporting System (FAERS), covering the period from 1 January 2017, through 31 March 2023. The reporting odds ratio (ROR) and the information component (IC) were utilized to assess the adverse signals in total/individual CAR-T product. The lower limit of the ROR and IC 95% confidence interval (ROR<sub>025</sub> and IC<sub>025</sub>) both exceeding threshold value (1 and 0, respectively) was considered a significant signal.</p><p><strong>Results: </strong>Of the 60, 730 records associated with CAR-T, 11, 037 (18.17%) pertained to neurological events. Tisagenlecleucel exhibited the highest percentage of death (38.02%) and life-threatening (12.90%) outcomes. Notably, it also displayed the broadest distribution of neurotoxicity. Additionally, distinct adverse signals unique to individual CAR-T products were identified. For instance, paraparesis, cerebral hemorrhage, impaired pupillary reflex, Guillain-Barre syndrome, brain death following tisagenlecleucel; dysarthria, orthostatic hypotension, and spinal cord edema after axicabtagene; parkinsonism, Bell's palsy, and cranial nerve paralysis post ciltacabtagene.</p><p><strong>Conclusions: </strong>Axicabtagene ciloleucel, tisagenlecleucel, brexucabtagene autoleucel, lisocabtagene maraleucel, idecabtagene vicleucel, and ciltacabtagene autoleucel exhibited increased odds of neurotoxicity, with some discrepancies in their characteristics, profiles, and severity.</p>","PeriodicalId":12232,"journal":{"name":"Expert Opinion on Drug Safety","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}