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Verardi F, Maul LV, Borsky K, Steinmann S, Rosset N, Pons HO, Sorbe C, Yawalkar N, Micheroli R, Egeberg A, Thyssen JP, Heidemeyer K, Boehncke WH, Conrad C, Cozzio A, Pinter A, Kündig T, Navarini AA, Maul JT. Sex differences in adverse events from systemic treatments for psoriasis: A decade of insights from the Swiss Psoriasis Registry (SDNTT). J Eur Acad Dermatol Venereol 2024; 38:719-731. [PMID: 38084852 DOI: 10.1111/jdv.19730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/26/2023] [Indexed: 03/26/2024]
Abstract
BACKGROUND Psoriasis is a disease that often requires prolonged systemic treatment. It is important to determine the safety of available therapies. There is currently little insight into sex-specific differences in the safety of systemic psoriasis therapies. OBJECTIVES To examine the real-world, long-term safety of systemic psoriasis therapies with sex stratification in drug-related adverse events (ADRs). METHODS Ten-year data from adults with moderate-to-severe psoriasis requiring systemic treatment (conventional systemic therapies [CST], biologics) were obtained from the Swiss psoriasis registry (SDNTT). ADRs were categorized according to the international terminology Medical Dictionary for Regulatory Activities (MedDRA). Safety was assessed by calculating event rates per 100 patient-years (PY). We used descriptive statistics for patient and disease characteristics, and binomial and t-tests to compare treatment groups and sex. RESULTS In total, 791 patients (290 females) were included with a mean age of 46 years. 358 (45%) received CSTs and 433 (55%) biologics; both groups had similar baseline characteristics except for more joint involvement in patients using biologics (26.86% vs. 14.8%, p < 0.0001). CSTs were associated with a 2.2-fold higher ADR rate (40.43/100 PY vs. 18.22/100 PY, p < 0.0001) and an 8.0-fold higher drug-related discontinuation rate than biologics (0.16/PY vs. 0.02/PY, p < 0.0001). Trends showed non-significant higher serious adverse event rates per 100 PY for biologics (8.19, CI 6.87-9.68) compared to CSTs (7.08, CI 5.39-9.13) (p = 0.3922). Sex stratification revealed a significantly higher overall ADR rate for all treatments in females (1.8-fold for CSTs [57.30/100 PY vs. 31.69/100 PY] and 2.0-fold for biologics [27.36/100 PY vs. 13.9/100 PY], p < 0.0001), and drug-related discontinuation rates for most CSTs in females. CONCLUSION Females were associated with a significantly higher rate of ADRs and drug-related discontinuation rates. Sex stratification should be taken into consideration when designing studies in the patient-tailored management of psoriasis.
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Affiliation(s)
- Fabio Verardi
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Lara Valeska Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Kim Borsky
- Oxford School of Surgery, Oxford Business Park, Oxford, UK
| | - Simona Steinmann
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Nina Rosset
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Christina Sorbe
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Nikhil Yawalkar
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raphael Micheroli
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexander Egeberg
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob P Thyssen
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kristine Heidemeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Wolf-Henning Boehncke
- Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland
| | - Curdin Conrad
- Department of Dermatology, CHUV University Hospital and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Antonio Cozzio
- Clinic of Dermatology, Venereology and Allergology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Andreas Pinter
- Department of Dermatology, Venerology and Allergology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Thomas Kündig
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Vercoutere A, Zina MJ, Benoit K, Costa E, Derisbourg S, Boulvain M, Roelens K, Vandenberghe G, Daelemans C. Late miscarriage and stillbirth in asymptomatic and symptomatic hospitalised pregnant women in Belgium during the first and second waves of COVID-19: a prospective nationwide population-based study. BMC Pregnancy Childbirth 2023; 23:356. [PMID: 37193958 DOI: 10.1186/s12884-023-05624-3] [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: 11/25/2022] [Accepted: 04/18/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Stillbirth has been recognized as a possible complication of a SARS-CoV-2 infection during pregnancy, probably due to destructive placental lesions (SARS-CoV-2 placentitis). The aim of this work is to analyse stillbirth and late miscarriage cases in unvaccinated pregnant women infected with SARS-CoV-2 during the first two waves (wild-type period) in Belgium. METHODS Stillbirths and late miscarriages in our prospective observational nationwide registry of SARS-CoV-2 infected pregnant women (n = 982) were classified by three authors using a modified WHO-UMC classification system for standardized case causality assessment. RESULTS Our cohort included 982 hospitalised pregnant women infected with SARS-CoV-2, with 23 fetal demises (10 late miscarriages from 12 to 22 weeks of gestational age and 13 stillbirths). The stillbirth rate was 9.5‰ for singleton pregnancies and 83.3‰ for multiple pregnancies, which seems higher than for the background population (respectively 5.6‰ and 13.8‰). The agreement between assessors about the causal relationship with SARS-Cov-2 infection was fair (global weighted kappa value of 0.66). Among these demises, 17.4% (4/23) were "certainly" attributable to SARS-CoV-2 infection, 13.0% (3/23) "probably" and 30.4% (7/23) "possibly". Better agreement in the rating was noticed when pathological examination of the placenta and identification of the virus were available, underlining the importance of a thorough investigation in case of intra-uterine fetal demise. CONCLUSIONS SARS-CoV-2 causality assessment of late miscarriage and stillbirth cases in our Belgian nationwide case series has shown that half of the fetal losses could be attributable to SARS-CoV-2. We must consider in future epidemic emergencies to rigorously investigate cases of intra-uterine fetal demise and to store placental tissue and other material for future analyses.
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Affiliation(s)
- An Vercoutere
- Department of Obstetrics and Gynaecology, Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Anderlecht, Belgium
| | | | - Karolien Benoit
- Belgian Obstetrical Surveillance System, Ghent University Hospital, Ghent, Belgium
| | - Elena Costa
- Department of Obstetrics and Gynaecology, Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Anderlecht, Belgium
| | - Sara Derisbourg
- Department of Obstetrics and Gynaecology, Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Anderlecht, Belgium
| | - Michel Boulvain
- Department of Obstetrics and Gynaecology, Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Anderlecht, Belgium
| | - Kristien Roelens
- Belgian Obstetrical Surveillance System, Ghent University Hospital, Ghent, Belgium
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Griet Vandenberghe
- Belgian Obstetrical Surveillance System, Ghent University Hospital, Ghent, Belgium
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - Caroline Daelemans
- Belgian Obstetrical Surveillance System, Ghent University Hospital, Ghent, Belgium.
- Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland.
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Adverse drug reactions and associated patient characteristics in older community-dwelling adults: a 6-year prospective cohort study. Br J Gen Pract 2023; 73:e211-e219. [PMID: 36823047 PMCID: PMC9923764 DOI: 10.3399/bjgp.2022.0181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/23/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To date, research on adverse drug reactions (ADRs) has focused on secondary care, and there is a paucity of studies that have prospectively examined ADRs affecting older adults in general practice. AIM To examine the cumulative incidence and severity of ADRs and associated patient characteristics in a sample of community-dwelling older adults. DESIGN AND SETTING Prospective cohort study of older adults (aged ≥70 years, N = 592) recruited from 15 general practices in the Republic of Ireland. METHOD Manual review of the participant's general practice electronic medical record, linked to the national dispensed prescription medicine database, and a detailed, self-reported patient postal questionnaire. The primary outcomes were ADR occurrence and severity over a 6-year period (2010-2016). Unadjusted and adjusted logistic regression models examined potential associations between patient characteristics and ADR occurrence. RESULTS A total of 211 ADRs were recorded for 159 participants, resulting in a cumulative incidence of 26.9% over 6 years. The majority of ADRs detected were mild (89.1%), with the remainder classified as moderate (10.9%). Eight moderate ADRs, representing 34.8% of moderate ADRs and 3.8% of all ADRs, required an emergency hospital admission. ADRs were independently associated with female sex (adjusted odds ratio [OR] 1.83, 95% confidence interval [CI] = 1.17 to 2.85; P = 0.008), polypharmacy (5-9 drug classes) (adjusted OR 1.81, 95% CI = 1.17 to 2.82; P = 0.008), and major polypharmacy (≥10 drug classes) (adjusted OR = 3.33, 95% CI = 1.62 to 6.85; P = 0.001). CONCLUSION This prospective cohort study of ADRs in general practice shows that over one-quarter of older adults experienced an ADR over a 6-year period. Polypharmacy is independently associated with ADR risk in general practice and older adults on ≥10 drug classes should be prioritised for regular medication review.
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Oh S, Byeon SJ, Chung SJ. Characteristics of adverse reactions among antipsychotic drugs using the Korean Adverse Event Reporting System database from 2010 to 2019. J Psychopharmacol 2022; 36:1041-1050. [PMID: 35695641 DOI: 10.1177/02698811221104055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Retrospective studies using spontaneous reporting system databases have provided a great understanding of adverse drug reactions (ADRs) in the real world, complementing the data obtained from randomized controlled trials. However, there have been few reports on large-scale epidemiological studies on the adverse effects of antipsychotics in Asia. AIM This study aimed to investigate the characteristics of antipsychotic ADRs using a nationwide pharmacovigilance database. METHODS Data were collected from the Korea Adverse Event Reporting System database between 2010 and 2019. The study subjects were selected using the International Classification of Disease codes for diseases related to psychosis and Electronic Data Interchange codes for amisulpride, aripiprazole, clozapine, haloperidol, olanzapine, paliperidone, quetiapine, risperidone, and ziprasidone. The causality assessment of "possible," "probable," or "certain" by the World Health Organization-Uppsala Monitoring Center System causality category was selected. All data were descriptively analyzed. RESULTS In total, 5067 adverse events associated with antipsychotic drugs were reported. The antipsychotics that commonly resulted in ADRs were quetiapine (47.7%), olanzapine (11.3%), and clozapine (10.7%). Serious ADRs were most commonly observed with clozapine. Gastrointestinal and central nervous system problems occurred within a month when ADRs were classified according to the time of onset. In contrast, metabolic and bone marrow-related symptoms occurred after long-term use. Sedation and nausea were the most common ADRs in children and adolescents, whereas constipation and dizziness were common in adults and the elderly. CONCLUSIONS This study extends our knowledge of antipsychotic ADRs in the Asian population.
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Affiliation(s)
- Sanghoon Oh
- Department of Psychiatry, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, South Korea
| | - Sun-Ju Byeon
- Department of Pathology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Soo Jie Chung
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
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Chung SJ, Byeon SJ, Choi JH. Analysis of Adverse Drug Reactions to First-Line Anti-Tuberculosis Drugs Using the Korea Adverse Event Reporting System. J Korean Med Sci 2022; 37:e128. [PMID: 35470602 PMCID: PMC9039191 DOI: 10.3346/jkms.2022.37.e128] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/23/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Adverse drug reactions (ADRs) to first-line anti-tuberculosis (TB) drugs are common; however, there have been few reports of nationwide epidemiologic studies on ADRs to anti-TB drugs in Korea. This study aimed to investigate the clinical characteristics of various ADRs to first-line anti-TB drugs using a nationwide database of ADRs. METHODS We used the Korea Adverse Event Reporting System (KAERS) database (2009-2018). The study subjects were selected using the Korean Standard Classification of Diseases codes for pulmonary and extrapulmonary TB and electronic data interchange codes for isoniazid (INH), rifampicin (RIF), ethambutol (ETB), and pyrazinamide (PZA). The causality assessment of "possible," "probable," or "certain" by World Health Organization-Uppsala Monitoring Center System causality category was selected. RESULTS A total of 1,562,024 ADRs were reported in the KIDS-KAERS database from 2009 to 2018, where ADRs to first-line anti-TB drugs were 17,843 cases (1.14%). The most common causative drugs were RIF (28.7%), INH (24.0%), ETB (23.4%), and PZA (23.9%) in that order. 48.5% of cases were reported in the older patients (≥ 60 years). According to organ system, gastro-intestinal system disorder was most common (32.0%), followed by skin and appendage (25.9%), liver and biliary system (14.2%). Nausea was the most common ADR (14.6%), followed by hepatic enzyme elevation (14.2%), rash (11.7%), pruritus (9.1%), vomiting (8.9%), and urticaria (4.2%). Most ADRs appeared within 1 month, but ADRs such as neuropathy, paresthesia, hematologic abnormalities, renal function abnormalities and liver enzyme abnormality were also often reported after 2 months. CONCLUSION Our data are clinically informative for recognizing and coping with ADRs of anti-TB drugs.
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Affiliation(s)
- Soo Jie Chung
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
- Allergy and Clinical Immunology Research Center, Hallym University College of Medicine, Chuncheon, Korea
| | - Sun-Ju Byeon
- Department of Pathology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jeong-Hee Choi
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
- Allergy and Clinical Immunology Research Center, Hallym University College of Medicine, Chuncheon, Korea.
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[Vitamin A and false fibromyalgia syndrome]. Aten Primaria 2021; 53:102076. [PMID: 33892225 PMCID: PMC8090993 DOI: 10.1016/j.aprim.2021.102076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 11/21/2022] Open
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Garcia Del Campo C, Murcia Soler M, Martinez-Mir I, Palop Larrea V. [Adequacy of the safety of metamizole and agranulocytosis]. Aten Primaria 2021; 53:102047. [PMID: 33823317 PMCID: PMC8047160 DOI: 10.1016/j.aprim.2021.102047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/03/2021] [Accepted: 01/04/2021] [Indexed: 11/30/2022] Open
Abstract
Objetivo Analizar si la nota informativa de la Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), de 30 de octubre del 2018, sobre agranulocitosis y metamizol contiene la información precisa y necesaria para proteger a los pacientes de la aparición de esta reacción adversa (RA) y si la documentación oficial de los medicamentos con metamizol para médicos, farmacéuticos y población general está adaptada a las directrices de la AEMPS para disminuir el riesgo. Emplazamiento y participantes Nota informativa, búsqueda bibliográfica, información sobre los medicamentos con metamizol comercializados en España en la Agencia Europea del Medicamento, fichas técnicas, prospectos, base de datos de información sanitaria Bot PLUS y Catálogo de Especialidades Farmacéuticas. Notificación de 4 casos de agranulocitosis por metamizol posteriores a la fecha de la nota informativa. Intervenciones y mediciones principales Comparación de los puntos clave de la nota informativa y de los documentos oficiales sobre metamizol con la bibliografía. Descripción de 4 casos de agranulocitosis por metamizol y aplicación del algoritmo de causalidad y gravedad. Resultados La nota informativa presenta ausencias y dudas respecto a la bibliografía y al uso de metamizol en la práctica asistencial. Los documentos oficiales presentan faltas de actualización, indicaciones no aprobadas y dosis superiores a las recomendadas. La nota informativa no ha frenado la presentación de casos de agranulocitosis por metamizol. Conclusiones La nota informativa de la AEMPS es mejorable y es necesario actualizar los documentos oficiales de información sobre el metamizol para profesionales sanitarios y pacientes para disminuir el riesgo de agranulocitosis.
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Affiliation(s)
- Cristina Garcia Del Campo
- Traductora médica y jurídica, presidenta de la Asociación de Afectados por Fármacos (ADAF), Jávea, Alicante, España
| | - Miguel Murcia Soler
- Farmacéutico de Atención Primaria, Departamento de Salud de La Ribera, Conselleria de Sanitat Universal i Salut Pública, Valencia, España
| | - Inocencia Martinez-Mir
- Técnica superior de Investigación, Dirección Gerencia Consorcio Hospital General Universitario de Valencia, Fundación IHGU, Valencia, España
| | - Vicente Palop Larrea
- Médico especialista en Medicina Familiar y Comunitaria, consulta de Fibromialgia, Unidad de Aparato Locomotor, Hospital de Denia, Alicante. Grupo de Fármacos de semFYC, Grupo de Investigación en Humanidades Histex, España.
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[Severe hyponatremia and oxcarbazepina hidden use]. Aten Primaria 2020; 52:665-666. [PMID: 32505481 PMCID: PMC7713087 DOI: 10.1016/j.aprim.2020.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/24/2020] [Accepted: 03/05/2020] [Indexed: 11/30/2022] Open
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Cortellini G, Carli G, Franceschini L, Lippolis D, Farsi A, Romano A. Evaluating nonimmediate cutaneous reactions to non-vitamin K antagonist oral anticoagulants via patch testing. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:3190-3193. [PMID: 32376484 DOI: 10.1016/j.jaip.2020.04.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Affiliation(s)
| | - Giulia Carli
- Allergy Unit, Ospedale Santo Stefano, Prato, Italy
| | | | | | | | - Antonino Romano
- Allergy Unit, IRCCS Oasi Maria S.S., Troina, Italy; Allergy Unit, Fondazione Mediterranea G.B. Morgagni, Catania, Italy.
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Faccio AA, Mattos CHPDS, Santos EASD, Neto NRM, Moreira RP, Luciara Tonelo Batella, Santos HD, Celes APM. Oral Nutritional Supplementation in Cancer Patients Who Were Receiving Chemo/Chemoradiation Therapy: A Multicenter, Randomized Phase II Study. Nutr Cancer 2020; 73:442-449. [PMID: 32363940 DOI: 10.1080/01635581.2020.1758170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Introduction: Oral nutritional supplementation (ONS) in cancer patients is justified by the low food intake caused by several factors. However, ONS can be affected by adverse events (AEs) correlated to treatment. This study aimed to compare the safety and efficacy of ONS (whey protein isolated, leucin, zinc-IMMAX®) during oncologic treatment.Methods: Patients in chemo/chemoradiotherapy were randomly assigned to receive IMMAX®+nutritional counseling (NC) according to daily requirements (S arm) or NC alone (C arm) for 4 weeks. Body weight (BW), %fat-free mass (%FFM) and nutrition intake were assessed before and after. In S arm, calories from IMMAX met the energy requirements. AEs were classified according to CTC-AE-NCI.Results: Eighty-five patients were included (51 females). After 4 weeks, the median of caloric intake, BW and %FFM were not statistically different in C arm. In S arm, median ONS intake was 81 g/332 kcal/day, protein intake was higher (pre: 66.75 ± 31.57 g; post: 88.57 ± 35.11 g; p < 0.01) and calories as well (pre: 1,549 ± 596 kcal; post: 1,756 ± 614 kcal; p = 0.02). The most common treatment related AEs were anemia, nausea/vomiting, not different between the arms. AEs supplement related were constipation and diarrhea (2 patients/4.6% each).Conclusion: IMMAX was safe, well tolerated, it did not interfere with oncologic treatment and provided significant amount of protein intake in this patient population, with few related AEs.
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Affiliation(s)
- Adilson Aparecido Faccio
- Department of Oncology, IRPCC - Instituto Ribeiraopretano de Combate ao Cancer, Ribeirao Preto, Brazil
| | | | | | | | - Raquel Pedro Moreira
- Department of Oncology, Santa Casa De Misericordia de Araraquara, Araraquara, Brazil
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Moore N, Berdaï D, Blin P, Droz C. Pharmacovigilance - The next chapter. Therapie 2019; 74:557-567. [PMID: 31623850 DOI: 10.1016/j.therap.2019.09.004] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/24/2019] [Indexed: 12/11/2022]
Abstract
The discovery and quantification of adverse drug reactions has long relied on the careful analysis of spontaneously reported cases. Causality assessment (imputation) was a fundamental feature of individual case report analysis. This was complemented by analysis of aggregated cases, and of disproportionality analyses in spontaneous reports databases. In the absence of more specific information sources, these have resulted in the discovery of many new adverse reactions, altering drug information. It has led to the withdrawal from the market of many drugs, but its use for risk quantification remains fraught with uncertainty. The recent access to population-wide claims or electronic health records databases have confirmed for spontaneous reporting a predominant role in hypothesis generation for serious adverse drug reactions, notably those that result in hospital admission or death. In these cases, the events are identifiable at the population level, and can be quantified precisely using the tools of modern pharmacoepidemiology, to generate specific benefit-risk analyses. Spontaneous reporting remains irreplaceable in signal and alert generation in drug safety, despite its inherent limitations. For signal strengthening and assessment, more systematic and quantitative methods should be sought, such as claims databases for reactions resulting in hospital admissions.
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Affiliation(s)
- Nicholas Moore
- Inserm CIC1401, Bordeaux PharmacoEpi, université de Bordeaux, 33076 Bordeaux, France.
| | | | - Patrick Blin
- Inserm CIC1401, Bordeaux PharmacoEpi, université de Bordeaux, 33076 Bordeaux, France
| | - Cécile Droz
- Inserm CIC1401, Bordeaux PharmacoEpi, université de Bordeaux, 33076 Bordeaux, France
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Hoban CL, Byard RW, Musgrave IF. Analysis of spontaneous adverse drug reactions to echinacea, valerian, black cohosh and ginkgo in Australia from 2000 to 2015. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2019; 17:338-343. [PMID: 31113761 DOI: 10.1016/j.joim.2019.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/29/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Assessing adverse drug reactions (ADRs) is a proven method to estimate the safety of medicines. The ADRs to herbal medicines in Australia (and by inference, the safety of herbal medicines in Australia) remain unknown. This study examines spontaneous ADR cases to four of the most popular herbs in Australia from 2000 to 2015: echinacea (Echinacea purpurea), valerian (Valeriana officinalis), black cohosh (Actaea racemosa) and ginkgo (Ginkgo biloba). METHODS ADRs of echinacea, valerian, black cohosh and ginkgo reported to the Australian Therapeutic Goods Administration (TGA) between 2000 and 2015 were obtained from the TGA database. Data were collated and analysed according to age, sex, severity, type of ADR and body system affected. Statistics were calculated using GraphPad Prism software. RESULTS Most ADRs were mild or moderate. However, every herbal medicine was associated with life-threatening ADRs. In each life-threatening case, the herbal medicine was taken concomitantly with prescription medications. Black cohosh was associated with a significant number of severe ADRs (30.3% of the total), with 39.4% of these ADRs being associated with abnormal hepatic function, hepatitis or hepatotoxicity. CONCLUSION This study highlights the lack of public awareness with regard to herb-drug interactions, since most of the severe ADRs involved a herb-drug interaction.
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Affiliation(s)
- Claire L Hoban
- Discipline of Pharmacology, The University of Adelaide, Adelaide, SA 5005, Australia.
| | - Roger W Byard
- Discipline of Anatomy and Pathology, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Ian F Musgrave
- Discipline of Pharmacology, The University of Adelaide, Adelaide, SA 5005, Australia
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Liver Allograft Failure After Nivolumab Treatment-A Case Report With Systematic Literature Research. Transplant Direct 2018; 4:e376. [PMID: 30255136 PMCID: PMC6092180 DOI: 10.1097/txd.0000000000000814] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 02/06/2023] Open
Abstract
Background Orthotopic liver transplantation (OLT) is a potential curative treatment in patients with hepatocellular carcinoma (HCC); however, treatment options for recurrent HCC after OLT are limited. Immune checkpoint inhibitors, such as nivolumab, an inhibitor of programmed cell death protein 1, have been successfully used for metastatic HCC but data on safety of nivolumab following solid organ transplantation are limited. Methods We report a 53-year-old woman with HCC who was treated with OLT. After 2 years, HCC recurred. Initial treatment with sorafenib was discontinued due to side effects and disease progression. Progressive HCC in the lung and lymph nodes was subsequently treated with nivolumab. One week after the first nivolumab dose, rapid progressive liver dysfunction was noted. Liver biopsy revealed severe cellular graft rejection prompting treatment with intravenous steroids and tacrolimus. Liver function continued to decline, leading to severe coagulopathy. The patient succumbed to intracranial hemorrhage. Results A systematic PubMed search revealed 29 cases treated with a checkpoint inhibitor following solid organ transplantation. Loss of graft was described in 4 (36%) of 11 cases with OLT and in 7 (54%) of 13 cases after kidney transplantation. However, cases with favorable outcome were also described. Eighteen cases with adverse events were identified upon searching the World Health Organization database VigiBase, including 2 cases with fatal outcome in liver transplant recipients due to graft loss. Conclusion Experience with checkpoint inhibitors in solid organ transplant recipients is limited. Published cases so far suggest severe risks for graft loss as high as 36% to 54%.
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Abstract
With the rapid pace of immunologic research, it is more important than ever for readers to understand rational immunodiagnosis, immunoprophylaxis, and immunotherapy. This column is intended to help you carry out proper immuno-logic drug use in your practice.
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Montané E, Barriocanal AM, Arellano AL, Valderrama A, Sanz Y, Perez-Alvarez N, Cardona P, Vilaplana C, Cardona PJ. Pilot, double-blind, randomized, placebo-controlled clinical trial of the supplement food Nyaditum resae® in adults with or without latent TB infection: Safety and immunogenicity. PLoS One 2017; 12:e0171294. [PMID: 28182700 PMCID: PMC5300153 DOI: 10.1371/journal.pone.0171294] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 01/14/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Nyaditum resae® (NR) is a galenic preparation of heat-killed Mycobacterium manresensis, a new species of the fortuitum complex, that is found in drinkable water, and that has demonstrated to protect against the development of active TB in a murine experimental model that develop human-like lesions. METHODS Double-blind, randomized, placebo-controlled Clinical Trial (51 volunteers included). Two different doses of NR and a placebo were tested, the randomization was stratified by Latent Tuberculosis Infection (LTBI)-positive (n = 21) and LTBI-negative subjects (n = 30). Each subject received 14 drinkable daily doses for 2 weeks. RESULTS All patients completed the study. The 46.3% of the overall reported adverse events (AE) were considered related to the investigational treatment. None of them were severe (94% were mild and 6% moderate). No statistical differences were found when comparing the median number of AE between the placebo group and both treatment groups. The most common AE reported were gastrointestinal events, most frequently mild abdominal pain and increase in stool frequency. Regarding the immunogenic response, both LTBI-negative and LTBI-positive volunteers treated with NR experienced a global increase on the Treg response, showed both in the population of CD25+CD39-, mainly effector Treg cells, or CD25+CD39+ memory PPD-specific Treg cells. CONCLUSION This clinical trial demonstrates an excellent tolerability profile of NR linked to a significant increase in the population of specific effector and memory Tregs in the groups treated with NR in both LTBI-positive and negative subjects. NR shows a promising profile to be used to reduce the risk of active TB.
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Affiliation(s)
- Eva Montané
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Ana Maria Barriocanal
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Catalonia, Spain
- Fundació Institut Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Ana Lucía Arellano
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Angelica Valderrama
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Yolanda Sanz
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Nuria Perez-Alvarez
- Lluita Contra la Sida Foundation, Badalona, Catalonia, Spain
- Statistics and Operations Research Department, Universitat Politècnica de Catalunya- BarcelonaTech, Barcelona, Catalonia, Spain
| | - Paula Cardona
- Unitat de Tuberculosi Experimental, Universitat Autònoma de Barcelona, CIBERES, Fundació Institut Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Cristina Vilaplana
- Unitat de Tuberculosi Experimental, Universitat Autònoma de Barcelona, CIBERES, Fundació Institut Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Pere-Joan Cardona
- Unitat de Tuberculosi Experimental, Universitat Autònoma de Barcelona, CIBERES, Fundació Institut Germans Trias i Pujol, Badalona, Catalonia, Spain
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Rullán M, Bulilete O, Leiva A, Soler A, Roca A, González-Bals MJ, Lorente P, Llobera J. Efficacy of gabapentin for prevention of postherpetic neuralgia: study protocol for a randomized controlled clinical trial. Trials 2017; 18:24. [PMID: 28088231 PMCID: PMC5237496 DOI: 10.1186/s13063-016-1729-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 11/25/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Postherpetic neuralgia (PHN) is a chronic neuropathic pain that results from alterations of the peripheral nervous system in areas affected by the herpes zoster virus. The symptoms include pain, paresthesia, dysesthesia, hyperalgesia, and allodynia. Despite the availability of pharmacological treatments to control these symptoms, no treatments are available to control the underlying pathophysiology responsible for this disabling condition. METHODS/DESIGN Patients with herpes zoster who are at least 50 years old and have a pain score of 4 or higher on a visual analogue scale (VAS) will be recruited. The aim is to recruit 134 patients from the practices of general physicians. Participants will be randomized to receive gabapentin to a maximum of 1800 mg/day for 5 weeks or placebo. Both arms will receive 1000-mg caplets of valacyclovir three times daily for 7 days (initiated within 72 h of the onset of symptoms) and analgesics as needed. The primary outcome measure is the percentage of patients with a VAS pain score of 0 at 12 weeks from rash onset. The secondary outcomes measures are changes in quality of life (measured by the SF-12 questionnaire), sleep disturbance (measured by the Medical Outcomes Study Sleep Scale), and percentage of patients with neuropathic pain (measured by the Douleur Neuropathique in 4 Questions). DISCUSSION Gabapentin is an anticonvulsant type of analgesic that could prevent the onset of PHN by its antihypersensitivity action in dorsal horn neurons. TRIAL REGISTRATION ISRCTN Registry identifier: ISRCTN79871784 . Registered on 2 May 2013.
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Affiliation(s)
- Manuel Rullán
- Pollença Health Care Centre, Baleares Health Services (IB-Salut), 07460, Pollença, Spain
| | - Oana Bulilete
- Son Espases Hospital, Baleares Health Services (IB-Salut), 07010, Palma, Spain
| | - Alfonso Leiva
- Primary Care Research Unit of Mallorca, Baleares Health Services (IB-Salut), 07005, Palma, Spain. .,Instituto de Investigación Sanitaria de Palma (IdISPa), 07010, Palma, Spain.
| | - Aina Soler
- Primary Care Research Unit of Mallorca, Baleares Health Services (IB-Salut), 07005, Palma, Spain.,Instituto de Investigación Sanitaria de Palma (IdISPa), 07010, Palma, Spain
| | - Antonia Roca
- Son Serra-La Vileta Health Care Centre, Baleares Health Services (IB-Salut), 07013, Palma, Spain
| | | | - Patricia Lorente
- Calvià Health Care Centre, Baleares Health Services (IB-Salut), 07184, Calvià, Spain
| | - Joan Llobera
- Primary Care Research Unit of Mallorca, Baleares Health Services (IB-Salut), 07005, Palma, Spain.,Instituto de Investigación Sanitaria de Palma (IdISPa), 07010, Palma, Spain
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Pandey K, Ravidas V, Siddiqui NA, Sinha SK, Verma RB, Singh TP, Dhariwal AC, Das Gupta RK, Das P. Pharmacovigilance of Miltefosine in Treatment of Visceral Leishmaniasis in Endemic Areas of Bihar, India. Am J Trop Med Hyg 2016; 95:1100-1105. [PMID: 27645786 DOI: 10.4269/ajtmh.16-0242] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 08/04/2016] [Indexed: 01/27/2023] Open
Abstract
Miltefosine, the only oral drug for visceral leishmaniasis (VL), is being used as the first-line drug under the VL elimination program in the Indian subcontinent. Miltefosine is an oral drug which was used as a topical application for skin metastasis of breast cancer. It was found to be effective against Leishmania donovani The main adverse events (AE) reported previously with miltefosine use includes diarrhea, vomiting, and dehydration. Other AEs include, raised serum alanine transaminase/aspartate aminotransferase and renal parameters such as creatinine. In this study, we report AEs in a large patient cohort of VL treated with miltefosine. The purpose of this pharmacovigilance study was to assess adverse drug reactions (ADRs)/AE of miltefosine treatment under unrestricted condition in the field setup. Patients were followed up to 6 months for therapeutic effectiveness. Outcomes of a larger data set of patients treated with this regimen from April 2012 to March 2015 were recorded. In the present study, 646 patients of VL were given miltefosine. Majority of the study subjects (58%) were male. Relapse occurred in 7% during follow-up period. Main causes of death were VL-pulmonary tuberculosis coinfection, extreme diarrhea, and acute pancreatitis which were reported in 1.7% subjects. Of 553 (85.6%) patients completing full course of treatment, 463 (83.7%) showed ADR with miltefosine during the study period. About 2.3% were suffering severe ADR, 51% from moderate, and the rest had mild ADR. The initial and final cure rate was 97.4% and 85.6%, respectively.
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Affiliation(s)
- Krishna Pandey
- Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Patna, India
| | - Vidyanand Ravidas
- Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Patna, India
| | - Niyamat A Siddiqui
- Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Patna, India
| | - Sanjay K Sinha
- Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Patna, India
| | - Rakesh B Verma
- Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Patna, India
| | | | - A C Dhariwal
- Directorate of National Vector Borne Disease Control Programme (NVBDCP), Delhi, India
| | - R K Das Gupta
- Directorate of National Vector Borne Disease Control Programme (NVBDCP), Delhi, India
| | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Patna, India.
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Bénichou C, Danan G. Causality Assessment in the European Pharmaceutical Industry: Presentation of the Preliminary Results of a New Method. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/009286159202600418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Gaby Danan
- Drug Monitoring Department, Roussel UCLAF, Paris, France
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Affiliation(s)
- K. K. Jain
- Drug Safety Department, Hoffmann La Roche, Basel, Switzerland
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Bénichou C, Danan G. EEC Pharmacovigilance and the Pharmaceutical Industry: Common Market, Common Rules? ACTA ACUST UNITED AC 2016. [DOI: 10.1177/009286159202600402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Gaby Danan
- Drug Monitoring Department, Roussel UCLAF, Paris, France
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A Case of Dasatinib-Induced Hemorrhagic Colitis Diagnosed by the Lymphocyte Transformation Test in a Chronic Myeloid Leukemia Patient. Indian J Hematol Blood Transfus 2016; 32:96-99. [PMID: 27408366 DOI: 10.1007/s12288-015-0528-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/07/2015] [Indexed: 10/23/2022] Open
Abstract
Dasatinib is an effective treatment option for patients diagnosed with Philadelphia chromosome positive chronic myeloid leukemia and who are non-responsive or intolerant to imatinib treatment. Dasatinib, however, is associated with various adverse effects and on rare occasions, may cause hemorrhagic colitis. We report the case of a 68-year-old male patient with dasatinib-induced hemorrhagic colitis, the first such case in Korea. Endoscopic biopsy of the transverse colon demonstrated non-specific inflammatory changes only. Cessation of dasatinib led to the resolution of symptoms, while reintroduction of the therapy led to the recurrence of his bloody diarrhea. To clarify the association between dasatinib and hemorrhagic colitis, the lymphocyte transformation test (LTT) was performed. The LTT result sustained a relatively high proliferation activity in the affected patient compared with almost no proliferation activity in normal control.
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Causality assessment in pharmacovigilance: The French method and its successive updates. Therapie 2016; 71:179-86. [PMID: 27080836 DOI: 10.1016/j.therap.2016.02.010] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 11/21/2015] [Indexed: 11/21/2022]
Abstract
The methods for causality assessment of adverse drug reactions were developed in the 1970s and 1980s, alongside the development of pharmacovigilance. The French method is one of the earlier of these, following on from the pioneering works by Irey and Karch and Lasagna. Initially published in 1978, it was updated in 1985, and again in 2011. The main alterations to the original method are presented in tables annexed to this paper. The successive versions improved the presentation, provided more formalised definitions of the criteria for assessing causality, while at the same time ensuring the method remained easy to use. Causality assessment enables the causal link between a drug and the occurrence of an adverse reaction to be formalised and explained. It contributes to diagnosis, and to determining the action to be taken in case of an adverse drug reaction. It can contribute to the quality and the relevance of the data stored in pharmacovigilance databases.
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Pedrós C, Formiga F, Corbella X, Arnau JM. Adverse drug reactions leading to urgent hospital admission in an elderly population: prevalence and main features. Eur J Clin Pharmacol 2015; 72:219-26. [DOI: 10.1007/s00228-015-1974-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/29/2015] [Indexed: 12/19/2022]
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Iavecchia L, Cereza García G, Sabaté Gallego M, Vidal Guitart X, Ramos Terrades N, de la Torre J, Segarra Medrano A, Agustí Escasany A. Drug-related acute renal failure in hospitalised patients. Nefrologia 2015; 35:523-32. [PMID: 26474529 DOI: 10.1016/j.nefro.2015.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/13/2015] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION The information available on the incidence and the characteristics of patients with acute renal failure (ARF) related to drugs is scarce. OBJECTIVES To estimate the incidence of drug-related ARF in hospitalised patients and to compare their characteristics with those of patients with ARF due to other causes. MATERIAL AND METHODS We selected a prospective cohort of patients with ARF during hospital admission (July 2010-July 2011). Information on patients' demographics, medical antecedents, ARF risk factors, ARF severity according to the RIFLE classification and hospital drug administration was collected. We analysed the relationship of drugs with the ARF episodes using Spanish Pharmacovigilance System methods and algorithm. RESULTS A total of 194 cases had an episode of hospital-acquired ARF. The median age of patients was 72 years [IQR 20]; 60% were men. The ARF incidence during hospitalization was 9.6 per 1,000 admissions. According to the RIFLE classification, a risk of kidney damage or kidney injury was present in 77.8% of cases. In 105 (54.1%) cases, ARF was drug-related; the drugs most frequently involved were diuretics, agents acting on the renin-angiotensin system, immunosuppressants, β-blocking agents, calcium channel blockers, contrast media and non-steroid anti-inflammatory drugs. Patients with drug-related ARF had more multi-morbidity, fewer ARF risk factors and lower mortality. CONCLUSIONS Half of ARF episodes during hospitalisation were drug related. Patients with drug-related ARF had higher cardiovascular morbidity than those with ARF related to other causes, but they had a lower frequency of ARF risk factors and mortality.
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Affiliation(s)
- Lujan Iavecchia
- Servicio de Farmacología Clínica, Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Gloria Cereza García
- Servicio de Farmacología Clínica, Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Mònica Sabaté Gallego
- Servicio de Farmacología Clínica, Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Xavier Vidal Guitart
- Servicio de Farmacología Clínica, Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | | | - Judith de la Torre
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | | | - Antònia Agustí Escasany
- Servicio de Farmacología Clínica, Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
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Roth Damas P, Sempere Manuel M, Vivas Maiques C, Palop Larrea V. Respuesta de los autores. Aten Primaria 2015; 47:472-3. [PMID: 25962571 PMCID: PMC6983602 DOI: 10.1016/j.aprim.2014.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 11/03/2014] [Indexed: 11/15/2022] Open
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Michalopoulou Alevras T, Guerrero Gual M, Villabona Artero C, Pérez-Maraver M. [Autoimmune hypoglycemia syndrome associated with α lipoic acid consumption]. Med Clin (Barc) 2015; 144:93-4. [PMID: 24703419 DOI: 10.1016/j.medcli.2014.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 02/20/2014] [Accepted: 02/27/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Theodora Michalopoulou Alevras
- Servicio de Endocrinología y Nutrición, Hospital Universitari de Bellvitge-IDIBELL, ĹHospitalet de Llobregat, Barcelona, España.
| | - Mireia Guerrero Gual
- Servicio de Endocrinología y Nutrición, Hospital Universitari de Bellvitge-IDIBELL, ĹHospitalet de Llobregat, Barcelona, España
| | - Carles Villabona Artero
- Servicio de Endocrinología y Nutrición, Hospital Universitari de Bellvitge-IDIBELL, ĹHospitalet de Llobregat, Barcelona, España
| | - Manuel Pérez-Maraver
- Servicio de Endocrinología y Nutrición, Hospital Universitari de Bellvitge-IDIBELL, ĹHospitalet de Llobregat, Barcelona, España
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Kebed KY, Bishu K, Al Adham RI, Baddour LM, Connolly HM, Sohail MR, Steckelberg JM, Wilson WR, Murad MH, Anavekar NS. Pregnancy and postpartum infective endocarditis: a systematic review. Mayo Clin Proc 2014; 89:1143-52. [PMID: 24997091 DOI: 10.1016/j.mayocp.2014.04.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 03/31/2014] [Accepted: 04/04/2014] [Indexed: 10/25/2022]
Abstract
The objective of this review was to describe the clinical characteristics, risk factors, and outcomes of infective endocarditis (IE) in pregnancy and the postpartum period. We conducted a systematic review of Ovid MEDLINE, Ovid Embase, Web of Science, and Scopus from January 1, 1988, through October 31, 2012. Included studies reported on women who met the modified Duke criteria for the diagnosis of IE and were pregnant or postpartum. We included 72 studies that described 90 cases of peripartum IE, mostly affecting native valves (92%). Risk factors associated with IE included intravenous drug use (14%), congenital heart disease (12%), and rheumatic heart disease (12%). The most common pathogens were streptococcal (43%) and staphylococcal (26%) species. Septic pulmonary, central, and other systemic emboli were common complications. Of the 51 pregnancies, there were 41 (80%) deliveries with survival to discharge, 7 (14%) fetal deaths, 1 (2%) medical termination of pregnancy, and 2 (4%) with unknown status. Maternal mortality was 11%. Infective endocarditis is a rare, life-threatening infection in pregnancy. Risk factors are changing with a marked decrease in rheumatic heart disease and an increase in intravenous drug use. The cases reported in the literature were commonly due to streptococcal organisms, involved the right-sided valves, and were associated with intravenous drug use.
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MESH Headings
- Adult
- Endocarditis, Bacterial/etiology
- Endocarditis, Bacterial/microbiology
- Endocarditis, Bacterial/mortality
- Female
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/microbiology
- Humans
- Infant Mortality
- Infant, Newborn
- Maternal Mortality
- Peripartum Period
- Pregnancy
- Pregnancy Complications, Cardiovascular/etiology
- Pregnancy Complications, Cardiovascular/microbiology
- Pregnancy Complications, Cardiovascular/mortality
- Pregnancy Complications, Infectious/etiology
- Pregnancy Complications, Infectious/microbiology
- Pregnancy Complications, Infectious/mortality
- Pregnancy Outcome
- Rheumatic Heart Disease/complications
- Rheumatic Heart Disease/microbiology
- Risk Factors
- Substance Abuse, Intravenous/complications
- Substance Abuse, Intravenous/microbiology
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Affiliation(s)
- Kalie Y Kebed
- Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Kalkidan Bishu
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Raed I Al Adham
- Department of Internal Medicine, St. Joseph's Hospital, Phoenix, AZ
| | - Larry M Baddour
- Department of Infectious Diseases, Mayo Clinic, Rochester, MN
| | - Heidi M Connolly
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | | | - Walter R Wilson
- Department of Infectious Diseases, Mayo Clinic, Rochester, MN
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Development and validation of providers’ and patients’ measurement instruments to evaluate adverse events after spinal manipulation therapy. Eur J Integr Med 2014. [DOI: 10.1016/j.eujim.2014.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Pharmacovigilance and moroccan tuberculosis public program: current situation. Tuberc Res Treat 2014; 2014:626797. [PMID: 25013729 PMCID: PMC4074959 DOI: 10.1155/2014/626797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 05/25/2014] [Indexed: 12/01/2022] Open
Abstract
The objective of this work is to demonstrate the interest of integration of pharmacovigilance in Moroccan Tuberculosis Control Program (MTCP). Design and Data Collection. The integration of pharmacovigilance in MTCP was conducted in October 2012 with the Global Fund support. We compared the reports notified before and after this integration (period 1: January 2010–October 2012; period 2: October 2012–December 2013). The detection of signals was based on the Information Component available in VigiMine. We used the SPSS version 10.0 and MedCalc version 7.3 for data analysis. Results. The average number of spontaneous reports increased from 3.6 to 37.4 cases/month (P < 10−3). The average age was 40.7 ± 17.5 years; the sex ratio was 0.8. Hepatic reactions (32.7%) predominated during the first period, while skin reactions (24.1%) were in the second period (P = 10−4), and 40.9% of cases in the first period were serious against 15.8% in second period (P = 0.003). Nine signals were generated (hepatic enzyme increase, cholestasis, jaundice, arthralgia, acne, lower limb edema, pruritus, skin rashes, and vomiting). Conclusion. The integration of pharmacovigilance in Moroccan Tuberculosis Control Program improved the management of ADRs and detected new signals of antituberculosis drugs.
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Smyth RL, Peak M, Turner MA, Nunn AJ, Williamson PR, Young B, Arnott J, Bellis JR, Bird KA, Bracken LE, Conroy EJ, Cresswell L, Duncan JC, Gallagher RM, Gargon E, Hesselgreaves H, Kirkham JJ, Mannix H, Smyth RMD, Thiesen S, Pirmohamed M. ADRIC: Adverse Drug Reactions In Children – a programme of research using mixed methods. PROGRAMME GRANTS FOR APPLIED RESEARCH 2014. [DOI: 10.3310/pgfar02030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AimsTo comprehensively investigate the incidence, nature and risk factors of adverse drug reactions (ADRs) in a hospital-based population of children, with rigorous assessment of causality, severity and avoidability, and to assess the consequent impact on children and families. We aimed to improve the assessment of ADRs by development of new tools to assess causality and avoidability, and to minimise the impact on families by developing better strategies for communication.Review methodsTwo prospective observational studies, each over 1 year, were conducted to assess ADRs in children associated with admission to hospital, and those occurring in children who were in hospital for longer than 48 hours. We conducted a comprehensive systematic review of ADRs in children. We used the findings from these studies to develop and validate tools to assess causality and avoidability of ADRs, and conducted interviews with parents and children who had experienced ADRs, using these findings to develop a leaflet for parents to inform a communication strategy about ADRs.ResultsThe estimated incidence of ADRs detected in children on admission to hospital was 2.9% [95% confidence interval (CI) 2.5% to 3.3%]. Of the reactions, 22.1% (95% CI 17% to 28%) were either definitely or possibly avoidable. Prescriptions originating in the community accounted for 44 out of 249 (17.7%) of ADRs, the remainder originating from hospital. A total of 120 out of 249 (48.2%) reactions resulted from treatment for malignancies. Off-label and/or unlicensed (OLUL) medicines were more likely to be implicated in an ADR than authorised medicines [relative risk (RR) 1.67, 95% CI 1.38 to 2.02;p < 0.001]. When medicines used for the treatment of oncology patients were excluded, OLUL medicines were not more likely to be implicated in an ADR than authorised medicines (RR 1.03, 95% CI 0.72 to 1.48;p = 0.830). For children who had been in hospital for > 48 hours, the overall incidence of definite and probable ADRs based on all admissions was 15.9% (95% CI 15.0 to 16.8). Opiate analgesic drugs and drugs used in general anaesthesia (GA) accounted for > 50% of all drugs implicated in ADRs. The odds ratio of an OLUL drug being implicated in an ADR compared with an authorised drug was 2.25 (95% CI 1.95 to 2.59;p < 0.001). Risk factors identified were exposure to a GA, age, oncology treatment and number of medicines. The systematic review estimated that the incidence rates for ADRs causing hospital admission ranged from 0.4% to 10.3% of all children [pooled estimate of 2.9% (95% CI 2.6% to 3.1%)] and from 0.6% to 16.8% of all children exposed to a drug during hospital stay. New tools to assess causality and avoidability of ADRs have been developed and validated. Many parents described being dissatisfied with clinician communication about ADRs, whereas parents of children with cancer emphasised confidence in clinician management of ADRs and the way clinicians communicated about medicines. The accounts of children and young people largely reflected parents’ accounts. Clinicians described using all of the features of communication that parents wanted to see, but made active decisions about when and what to communicate to families about suspected ADRs, which meant that communication may not always match families’ needs and expectations. We developed a leaflet to assist clinicians in communicating ADRs to parents.ConclusionThe Adverse Drug Reactions In Children (ADRIC) programme has provided the most comprehensive assessment, to date, of the size and nature of ADRs in children presenting to, and cared for in, hospital, and the outputs that have resulted will improve the management and understanding of ADRs in children and adults within the NHS. Recommendations for future research: assess the values that parents and children place on the use of different medicines and the risks that they will find acceptable within these contexts; focusing on high-risk drugs identified in ADRIC, determine the optimum drug dose for children through the development of a gold standard practice for the extrapolation of adult drug doses, alongside targeted pharmacokinetic/pharmacodynamic studies; assess the research and clinical applications of the Liverpool Causality Assessment Tool and the Liverpool Avoidability Assessment Tool; evaluate, in more detail, morbidities associated with anaesthesia and surgery in children, including follow-up in the community and in the home setting and an assessment of the most appropriate treatment regimens to prevent pain, vomiting and other postoperative complications; further evaluate strategies for communication with families, children and young people about ADRs; and quantify ADRs in other settings, for example critical care and neonatology.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Rosalind L Smyth
- Institute of Child Health, University of Liverpool, Liverpool, UK
- Institute of Child Health, University College London, London, UK
| | - Matthew Peak
- Alder Hey Children’s National Health Service Foundation Trust, Liverpool, UK
| | - Mark A Turner
- Institute of Translational Medicine, Liverpool Women’s National Health Service Foundation Trust and University of Liverpool, Liverpool, UK
| | - Anthony J Nunn
- National Institute for Health Research Medicines for Children Research Network, University of Liverpool, Liverpool, UK
| | | | - Bridget Young
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Janine Arnott
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Jennifer R Bellis
- Alder Hey Children’s National Health Service Foundation Trust, Liverpool, UK
| | - Kim A Bird
- Alder Hey Children’s National Health Service Foundation Trust, Liverpool, UK
| | - Louise E Bracken
- Alder Hey Children’s National Health Service Foundation Trust, Liverpool, UK
| | | | - Lynne Cresswell
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Jennifer C Duncan
- Alder Hey Children’s National Health Service Foundation Trust, Liverpool, UK
| | | | - Elizabeth Gargon
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Hannah Hesselgreaves
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Jamie J Kirkham
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Helena Mannix
- Alder Hey Children’s National Health Service Foundation Trust, Liverpool, UK
| | - Rebecca MD Smyth
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Signe Thiesen
- Institute of Child Health, University of Liverpool, Liverpool, UK
| | - Munir Pirmohamed
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
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Pedrós C, Quintana B, Rebolledo M, Porta N, Vallano A, Arnau JM. Prevalence, risk factors and main features of adverse drug reactions leading to hospital admission. Eur J Clin Pharmacol 2013; 70:361-7. [PMID: 24362489 DOI: 10.1007/s00228-013-1630-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 12/08/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the prevalence of hospital admission related to adverse drug reactions (ADRs) in a third-level hospital, to analyse the associated factors, and to describe the reactions and the drugs involved. METHODS A cross-sectional study was conducted for a 120-day period. Patients that were urgently hospitalized entered the study. The primary endpoint was the ADR-related urgent admission. A descriptive analysis of demographic, clinical, and drug-related variables was performed. The association between the likelihood of urgent admission due to ADRs and age, gender, and number of drugs used was analysed. A descriptive analysis of the suspected drugs and the reactions in ADR-related admissions was performed. RESULTS Overall, 186 out of 4,403 hospital admissions were due to ADRs (prevalence: 4.2 % [95 % CI 3.7-4.8 %]). Age (≥65 years: OR 1.59 [95 % CI 1.10-2.29]) and number of drugs used at the time of admission (3-5 drugs: OR 5.07 [95 % CI 2.71-9.59]; 6-9 drugs: OR 5.90 [95 % CI 3.16-11.0]; ≥10 drugs: OR 8.94 [95 % CI 4.73-16.89]), but not gender, were identified as independent factors associated with ADR-related hospitalization. The overall in-hospital stay for patients admitted with ADRs amounted to 1,785 days. The ADRs were mainly type A reactions (92 %). Acute renal failure related to renin-angiotensin system inhibitors, haemorrhage due to anticoagulants, and upper gastrointestinal bleeding related to antiplatelet drugs and/or non-steroidal anti-inflammatory drugs were the most frequent. CONCLUSION Over 4 % of urgent hospitalizations are caused by ADRs, which are dose-related and predictable in more than 90 % of cases. The main risk factors are advanced age and polypharmacy.
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Affiliation(s)
- Consuelo Pedrós
- Clinical Pharmacology Service, Bellvitge University Hospital, c/Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain,
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[Hypersensitivity to prune aroma as an excipient]. Aten Primaria 2013; 46:50-1. [PMID: 24183658 PMCID: PMC6983567 DOI: 10.1016/j.aprim.2013.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 04/23/2013] [Indexed: 11/20/2022] Open
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Abstract
Purpose-The purpose of this paper is to demonstrate the pro-active nature of the New Zealand Intensive Medicines Monitoring Programme (IMMP) and make an assessment of its effectiveness in postmarketing drug safety evaluation.Methods-The IMMP undertakes prospective observational cohort studies of selected new drugs. Patient cohorts are established from prescription data received from dispensing pharmacists nationwide. Adverse events are reported by doctors on prescription follow-up questionnaires or as spontaneous reports. The method of signal generation is reviewed with particular emphasis on the review of individual event reports and their relationship to the medicine. Signals reported over the last 10 years are assessed for timeliness in advising the regulatory authority.Results-Mean cohort size is 10,964 patients and the mean study period for each drug was 58 months. A total of 153 signals were recorded from 11 drugs with 132 (86%) being notified to the regulatory authority prior to any publication in the literature. The use of 'incidents' in controlling for reporting bias is illustrated and examples are given of data on safety in pregnancy and lactation, the assessment of deaths, reassurance with drug scares, risk comparison and signal validation studies.Conclusion-PEM type methodology is effective and cost-efficient in pro-active safety surveillance even with limited resources. Copyright (c) 2000 John Wiley & Sons, Ltd.
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Affiliation(s)
- D M Coulter
- Centre for Adverse Reactions Monitoring, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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García Llopis P, Vicente Valor MI, Martínez Cristóbal A. Alopecia areata universal por ranelato de estroncio. Med Clin (Barc) 2012; 138:229. [DOI: 10.1016/j.medcli.2011.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 08/23/2011] [Accepted: 08/27/2011] [Indexed: 11/29/2022]
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Gautier P, Ravan R, Najjar M, Belhakem A, Ferrier N, Marcaggi X, Colamarino R, Amat G. [Tako-Tsubo syndrome during normal human immunoglobolin perfusion]. Ann Cardiol Angeiol (Paris) 2011; 60:290-5. [PMID: 21924700 DOI: 10.1016/j.ancard.2011.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 08/04/2011] [Indexed: 10/17/2022]
Abstract
This is a case of an 82 year old female patient with myasthenia gravis, who following treatment with Human Normal Immunoglobulin (Tegeline(®)), developed dyspnoea, chest pain without cardiac insufficiency, inverted T wave on ECG with slight increase in Troponine T 0.43ng/mL (<0.2ng/mL normal value in our hospital) and marked increase in Pro-BNP 4900 (Nl≤450pg/mL for an age greater than 65 years old). Her coronary angiogram showed hypokinesia of apical area but was otherwise normal. Also, MRI ruled out inflammatory and ischemic cardiac diseases. The most likely diagnosis for us was Tako-Tsubo syndrome in relation with injection of Human Normal Immunoglobulin (Tegeline(®)) according to the Mayo clinic criteria.
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Affiliation(s)
- P Gautier
- Unité de réanimation polyvalente et soins intensifs cardiaques, médecine interne et cardiologie, centre hospitalier Jacques-Lacarin, Vichy, France
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Vicens C, Socias I, Mateu C, Leiva A, Bejarano F, Sempere E, Basora J, Palop V, Mengual M, Beltran JL, Aragonès E, Lera G, Folch S, Piñol JL, Esteva M, Roca M, Arenas A, Del Mar Sureda M, Campoamor F, Fiol F. Comparative efficacy of two primary care interventions to assist withdrawal from long term benzodiazepine use: a protocol for a clustered, randomized clinical trial. BMC FAMILY PRACTICE 2011; 12:23. [PMID: 21507257 PMCID: PMC3105938 DOI: 10.1186/1471-2296-12-23] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 04/20/2011] [Indexed: 11/21/2022]
Abstract
Background Although benzodiazepines are effective, long-term use is not recommended because of potential adverse effects; the risks of tolerance and dependence; and an increased risk of hip fractures, motor vehicle accidents, and memory impairment. The estimated prevalence of long-term benzodiazepine use in the general population is about 2,2 to 2,6%, is higher in women and increases steadily with age. Interventions performed by General Practitioners may help patients to discontinue long-term benzodiazepine use. We have designed a trial to evaluate the effectiveness and safety of two brief general practitioner-provided interventions, based on gradual dose reduction, and will compare the effectiveness of these interventions with that of routine clinical practice. Methods/Design In a three-arm cluster randomized controlled trial, general practitioners will be randomly allocated to: a) a group in which the first patient visit will feature a structured interview, followed by visits every 2-3 weeks to the end of dose reduction; b) a group in which the first patient visit will feature a structured interview plus delivery of written instructions to self-reduce benzodiazepine dose, or c) routine care. Using a computerized pharmaceutical prescription database, 495 patients, aged 18-80 years, taking benzodiazepine for at least 6 months, will be recruited in primary care health districts of three regions of Spain (the Balearic Islands, Catalonia, and Valencia). The primary outcome will be benzodiazepine use at 12 months. The secondary outcomes will include measurements of anxiety and depression symptoms, benzodiazepine dependence, quality of sleep, and alcohol consumption. Discussion Although some interventions have been shown to be effective in reducing benzodiazepine consumption by long-term users, the clinical relevance of such interventions is limited by their complexity. This randomized trial will compare the effectiveness and safety of two complex stepped care interventions with that of routine care in a study with sufficient statistical power to detect clinically relevant differences. Trial Registration Current Controlled Trials: ISRCTN13024375
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Affiliation(s)
- Caterina Vicens
- Son Serra- La Vileta Health Care Centre, Balearic Mental Health Research Group, Balearic Health service-IbSalut, Mallorca, Spain.
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Rodriguez-Pecci MS, Fuente-Aguado JDL, Montero-Tinnirello J, Fernandez-Fernandez FJ. [Mirtazapine-associated hepatotoxicity]. Med Clin (Barc) 2010; 135:625-6. [PMID: 19822332 DOI: 10.1016/j.medcli.2009.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 07/15/2009] [Accepted: 08/06/2009] [Indexed: 10/20/2022]
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García Llopis P, González D’huicque A, Palop Larrea V. Edema facial por gemfibrozilo. Med Clin (Barc) 2010; 135:384. [DOI: 10.1016/j.medcli.2009.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 06/18/2009] [Accepted: 06/23/2009] [Indexed: 10/20/2022]
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A qualitative study evaluating causality attribution for serious adverse events during early phase oncology clinical trials. Invest New Drugs 2010; 29:1013-20. [PMID: 20512397 DOI: 10.1007/s10637-010-9456-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Accepted: 05/12/2010] [Indexed: 01/22/2023]
Abstract
BACKGROUND In early phase oncology trials, novel targeted therapies are increasingly being tested in combination with traditional agents creating greater potential for enhanced and new toxicities. When a patient experiences a serious adverse event (SAE), investigators must determine whether the event is attributable to the investigational drug or not. This study seeks to understand the clinical reasoning, tools used and challenges faced by the researchers who assign causality to SAE's. METHODS Thirty-two semi-structured interviews were conducted with medical oncologists and trial coordinators at six Canadian academic cancer centres. Interviews were recorded and transcribed verbatim. Individual interview content analysis was followed by thematic analysis across the interview set. FINDINGS Our study found that causality assessment tends to be a rather complex process, often without complete clinical and investigational data at hand. Researchers described using a common processing strategy whereby they gather pertinent information, eliminate alternative explanations, and consider whether or not the study drug resulted in the SAE. Many of the interviewed participants voiced concern that causality assessments are often conducted quickly and tend to be highly subjective. Many participants were unable to identify any useful tools to help in assigning causality and welcomed more objectivity in the overall process. INTERPRETATION Attributing causality to SAE's is a complex process. Clinical trial researchers apply a logical system of reasoning, but feel that the current method of assigning causality could be improved. Based on these findings, future research involving the development of a new causality assessment tool specifically for use in early phase oncology clinical trials may be useful.
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Glina S, Fonseca GN, Bertero EB, Damião R, Rocha LC, Jardim CR, Cairoli CE, Teloken C, Torres LO, Faria GE, Da Silva MB, Pagani E. ORIGINAL RESEARCH—ED PHARMACOTHERAPY: Efficacy and Tolerability of Lodenafil Carbonate for Oral Therapy of Erectile Dysfunction: A Phase III Clinical Trial. J Sex Med 2010; 7:1928-36. [DOI: 10.1111/j.1743-6109.2010.01711.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vilaplana C, Montané E, Pinto S, Barriocanal AM, Domenech G, Torres F, Cardona PJ, Costa J. Double-blind, randomized, placebo-controlled Phase I Clinical Trial of the therapeutical antituberculous vaccine RUTI. Vaccine 2009; 28:1106-16. [PMID: 19853680 DOI: 10.1016/j.vaccine.2009.09.134] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 09/17/2009] [Accepted: 09/30/2009] [Indexed: 11/30/2022]
Abstract
A Phase I interventional Clinical Trial was performed with a potential tuberculosis vaccine, based on detoxified cellular fragments of M. tuberculosis, named RUTI. The objective was to evaluate the safety profile and T-cell immune responses over a 6-month period following subcutaneous inoculation. The double-blind, randomized and placebo-controlled trial was conducted in healthy volunteers, all recruited at one site. RUTI, at each of the four tested doses, starting from 5microg and going up to 200microg, and placebo were inoculated to groups of 4 and 2 volunteers respectively, consecutively. RUTI appeared to be well tolerated as judged by local and systemic clinical evaluation, though vaccine dose dependent local adverse reactions were recorded. T-cell responses of blood lymphocytes to PPD and a number of antigen subunits were elevated, when compared with controls subjects. These results support the feasibility of future evaluation, to be targeted at subjects with latent tuberculosis infection (LTBI).
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Affiliation(s)
- C Vilaplana
- Experimental Tuberculosis Unit, Germans Trias i Pujol Health Science Research Institute Foundation, Autonomous University of Barcelona, Crtra del Canyet s/n, Edifici Recerca, Catalonia, Spain.
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Eritema fijo medicamentoso y bisoprolol. Aten Primaria 2009; 41:351. [DOI: 10.1016/j.aprim.2008.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Accepted: 10/21/2008] [Indexed: 11/22/2022] Open
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Pedrós C, Vallano A, Cereza G, Mendoza-Aran G, Agustí A, Aguilera C, Danés I, Vidal X, Arnau JM. An intervention to improve spontaneous adverse drug reaction reporting by hospital physicians: a time series analysis in Spain. Drug Saf 2009; 32:77-83. [PMID: 19132807 DOI: 10.2165/00002018-200932010-00007] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Spontaneous reporting of adverse drug reactions (ADRs) in hospitals is scarce and several obstacles to such reporting have been identified previously. OBJECTIVE To assess the effectiveness of a multifaceted intervention based on healthcare management agreements for improving spontaneous reporting of ADRs by physicians in a hospital setting. METHODS In 2003, the spontaneous reporting of ADRs was included as one of the objectives of hospital physicians at the Vall d'Hebron Hospital, Barcelona, Spain, within the context of management agreements between clinical services and hospital managers. A continuous intervention related to these management agreements, including periodic educational meetings and economic incentives, was then initiated. We carried out an ecological time series analysis and assessed the change in the total number of spontaneous reports of ADRs, and the number of serious ADRs, unexpected ADRs, and ADRs associated with new drugs between a period previous to the intervention (from 1998 to 2002) and the period during the intervention (from 2003 to 2005). A time series analysis with ARIMA (Auto-Regressive Integrated Moving Average) models was performed. RESULTS The median number of reported ADRs per year increased from 40 (range 23-55) in the first period to 224 (range 98-248) in the second period. In the first period, the monthly number of reported ADRs was stable (3.47 per month; 95% CI 1.90, 5.03), but in the second period the number increased progressively (increase of 0.74 per month; 95% CI 0.62, 0.86). In the second period, the proportion of reported serious ADRs increased nearly 2-fold (63.1% vs 32.5% in the first period). The absolute number of previously unknown or poorly known ADRs increased 4-fold in the second period (54 vs 13 in the first period). There was also an increase in the absolute number of suspected pharmacological exposures to new drugs (97 vs 28) and in the number of different new drugs suspected of causing ADRs (50 vs 19). CONCLUSION A continuous intervention based on healthcare management agreements with economic incentives and educational activities is associated with a quantitative and qualitative improvement of spontaneous reporting of ADRs by hospital physicians.
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Steiner TJ, Voelker M. Gastrointestinal tolerability of aspirin and the choice of over-the-counter analgesia for short-lasting acute pain. J Clin Pharm Ther 2009; 34:177-86. [DOI: 10.1111/j.1365-2710.2008.00989.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Papay JI, Clines D, Rafi R, Yuen N, Britt SD, Walsh JS, Hunt CM. Drug-induced liver injury following positive drug rechallenge. Regul Toxicol Pharmacol 2009; 54:84-90. [PMID: 19303041 DOI: 10.1016/j.yrtph.2009.03.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 03/04/2009] [Accepted: 03/05/2009] [Indexed: 02/06/2023]
Abstract
Drug rechallenge (or reinitiation), following an event of drug-induced liver injury, can lead to serious or fatal liver injury. A retrospective review of a large pharmaceutical safety database was conducted to assess clinical outcomes of positive drug rechallenge following possible drug-induced liver injury. Positive rechallenge with suspect drug was reported in 770 of 36,795 hepatic adverse events. A total of 88 cases met inclusion criteria for analysis. Mean age was 44 years (range 0.5-83) and 56% were male. A broad spectrum of suspect drugs were identified. Many patients exhibited hepatitis symptoms or jaundice on the initial and rechallenge liver event. Twelve patients (14%) exhibited clinically worrisome severe hepatocellular injury and jaundice on either initial or rechallenge event and two died, reflecting a 2.3% fatality rate in those with positive rechallenge. The two fatalities developed severe hepatocellular injury with jaundice only upon rechallenge. Liver injury recurred in most rechallenges. Improved identification and communication of possible drug-induced liver injury is needed to avoid potentially serious and/or fatal drug rechallenges. Clinicians should generally avoid such rechallenges.
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Affiliation(s)
- Julie I Papay
- Global Clinical Safety and Pharmacovigilance, GlaxoSmithKline, RTP, NC 27709, USA.
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47
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Glina S, Toscano I, Gomatzky C, De Góes PM, Júnior AN, Claro JFDA, Pagani E. Efficacy and Tolerability of Lodenafil Carbonate for Oral Therapy in Erectile Dysfunction: A Phase II Clinical Trial. J Sex Med 2009; 6:553-7. [DOI: 10.1111/j.1743-6109.2008.01079.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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De Backer TL, Vander Stichele RH, Van Bortel LM. Bias in Benefit-Risk Appraisal in Older Products. Drug Saf 2009; 32:283-91. [DOI: 10.2165/00002018-200932040-00003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Palop Larrea V, Martínez-Mir I. Cefalea, retinosis pigmentaria y vitamina A. Aten Primaria 2008; 40:532-3. [DOI: 10.1157/13127238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Paterson H, Clifton J, Miller D, Ashton J, Harrison-Woolrych M. Hair loss with use of the levonorgestrel intrauterine device. Contraception 2007; 76:306-9. [PMID: 17900442 DOI: 10.1016/j.contraception.2007.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 04/27/2007] [Accepted: 06/25/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND The levonorgestrel intrauterine device (IUD) has associated systemic side effects. However, there is little published information about the risk of alopecia. STUDY DESIGN Review of both the New Zealand Intensive Medicines Monitoring Programme (IMMP) data on alopecia associated with levonorgestrel IUD and the international evidence. METHODS The IMMP uses Prescription Event Monitoring to study the safety of medicines during the postmarketing period. All reported cases of alopecia with levonorgestrel IUD use were identified in the IMMP databases and assessed for causality. World Health Organization (WHO) spontaneous reporting data were also obtained. RESULTS Five reports of alopecia associated with the levonorgestrel IUD were identified in the IMMP database. From the cohort of insertions during 2000-2001, the estimated cumulative incidence of alopecia was 0.33% (95% CI 0.07-0.95) in the responder population. The WHO database contained a further 68 reports. CONCLUSIONS Counselling prior to insertion of the levonorgestrel IUD should include information on systemic effects, including the possibility of alopecia.
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Affiliation(s)
- Helen Paterson
- Department of Women's and Child Health, University of Otago, Dunedin 9054, New Zealand.
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