Comparison of Adverse Events Occurred During Administration of Dipeptidyl Peptidase-4 Inhibitor in Patients with Diabetes Using FDA Adverse Event Reporting System

Comparison of Adverse Events Among Angiotensin Receptor Blockers in Hypertension Using the United States Food and Drug Administration Adverse Event Reporting System

Background Angiotensin receptor blockers (ARBs) are pivotal in hypertension management. Despite sharing a common mechanism of blocking angiotensin II receptors, ARBs exhibit varying pharmacokinetic and pharmacodynamic properties that influence safety profiles. ARBs have been linked to adverse events (AEs) across multiple organ systems, including skin (e.g., angioedema), neurological (e.g., dizziness), and cardiovascular disorders (e.g., hypotension). Understanding these differences is essential for optimizing clinical decision-making. Objectives This study compared AE profiles of seven ARBs in patients with hypertension using data from the United States Food and Drug Administration Adverse Event Reporting System (FAERS). To enhance result reliability and control for confounding factors, only cases where ARBs were explicitly indicated for hypertension treatment were included. FAERS is a valuable post-marketing surveillance tool that captures spontaneous AE reports, although it has limitations such as reporting bias. The findings aim to generate hypotheses regarding ARB-associated AEs for future research using robust study designs. Methods A retrospective analysis of FAERS data between 2004 and 2024 was conducted. Patients prescribed ARBs for hypertension were included, while those with missing prescription indications or alternative uses were excluded. Reporting odds ratio (ROR) and adjusted ROR (aROR) were calculated to compare reporting proportions (RPs) among ARBs, with each ARB sequentially used as the reference in pairwise comparisons. The Bonferroni correction addressed multiple comparisons, with an adjusted significance level of 0.05/21=0.0024. For aROR calculations, cases with unknown values in adjustment variables were excluded. To enhance robustness, results were considered significant only when both ROR and aROR showed significance. Results Using losartan as the reference, valsartan, irbesartan, candesartan, telmisartan, and olmesartan demonstrated significantly lower RPs for skin disorders. For instance, the RP for skin disorders was 10.6 for losartan compared to 6.1 for valsartan (ROR: 0.545, p<0.0001; aROR: 0.648, p<0.0001) and 4.2 for olmesartan (ROR: 0.368, p<0.0001; aROR: 0.412, p<0.0001). Conversely, valsartan and olmesartan exhibited significantly higher RPs for cardiovascular disorders, with 23.7 for valsartan (ROR: 1.574, p<0.0001; aROR: 1.570, p<0.0001) and 19.0 for olmesartan (ROR: 1.186, p<0.0001; aROR: 1.278, p<0.0001) compared to 16.5 for losartan. Similar trends were observed when other ARBs were used as references, revealing a heterogeneous distribution of AE profiles among the seven ARBs. Conclusions This study reveals distinct AE patterns among ARBs in hypertension management. No single ARB exhibited universally favorable safety profiles across all AE categories, emphasizing the need for personalized prescribing. When selecting an ARB, prescribers should consider patient-specific risk factors and comorbidities. For instance, patients with a history of skin disorders may benefit from ARBs other than losartan. Conversely, patients with elevated cardiovascular risk may require closer monitoring when prescribed valsartan, including more frequent follow-up visits or additional cardiovascular diagnostics to detect early AEs. These findings enable healthcare providers to tailor ARB selection and monitoring strategies to optimize efficacy and safety in hypertension treatment.

Comparative Analysis of Adverse Event Profiles Among Seven Statins for Hypercholesterolemia Management Using the United States FDA Adverse Event Reporting System

Background Statins are fundamental in hypercholesterolemia management, with seven primary drugs available: atorvastatin, simvastatin, rosuvastatin, pravastatin, lovastatin, fluvastatin, and pitavastatin. While sharing a common mechanism of action, these statins exhibit variations in pharmacokinetic (what the body does to the drug) and pharmacodynamic (what the drug does to the body) properties (e.g., lipophilicity, cytochrome P450 metabolism), which may influence their safety profiles. Adverse events (AEs) such as myopathy and hepatotoxicity vary across agents, complicating clinical decision-making. The guidelines lack robust comparisons of all seven statins' AE profiles, presenting challenges for clinicians in balancing potency and tolerability. Objectives This study aimed to comprehensively compare the AE patterns and safety profiles of the seven statins in hypercholesterolemia management through a retrospective analysis of the United States Food and Drug Administration Adverse Event Reporting System (FAERS) database. By focusing solely on hypercholesterolemia, we aimed to control for potential confounding factors, providing a more focused comparison of statin safety profiles. Methods We conducted a retrospective analysis using data from the FAERS between 2004 and 2024. To control for confounding factors, this study included only patients prescribed statins with a clearly documented indication of hypercholesterolemia management. Patients prescribed statins for other indications or with missing data on the reason for prescription were excluded. Comparative evaluations employed the reporting odds ratio (ROR) and adjusted ROR (aROR), which were chosen for their efficiency in ease of interpretation, ability to adjust for confounding factors, and compatibility with statistical testing frameworks. This compatibility allowed for rigorous multiple comparison analysis, where each statin was sequentially set as a reference in 21 pairwise comparisons. To address the multiple comparisons problem, this study applied the Bonferroni correction, adjusting the significance level to 0.05 / 21 = 0.0024. Patient background variables were used as adjustment factors for the aROR. AEs were classified into 10 categories based on their characteristics. Results With atorvastatin as the reference, five statins (simvastatin, rosuvastatin, pravastatin, fluvastatin, and pitavastatin) demonstrated both significant ROR > 1 and aROR > 1 for gastrointestinal disorders. Conversely, five statins (simvastatin, rosuvastatin, pravastatin, lovastatin, and pitavastatin) demonstrated both significant ROR < 1 and aROR < 1 for metabolic disorders. When other statins were set as the reference, no consistent pattern of exclusively significant ROR > 1 and aROR > 1 or significant ROR < 1 and aROR < 1 was observed across all AE categories. Instead, a heterogeneous distribution of outcomes was evident. These results indicate that the patterns of AEs differ for each statin. Conclusions This study reveals distinct AE profiles among seven statins, providing critical insights to guide personalized treatment strategies. By aligning patient risk factors with specific statin AE profiles, clinicians can implement more targeted approaches to minimize AEs, potentially improving adherence and treatment efficacy. These findings directly inform clinical decision-making, enabling healthcare providers to optimize statin selection and management for individual patients.

Drug-induced skin ulcer: real-world pharmacovigilance analysis based on the FDA adverse event reporting system

BACKGROUND

Skin ulcer (SU) may increase the risk of systemic infections and have evolved into an important public health problem. However, there is a lack of research specifically on drug-induced SU.

RESEARCH DESIGN AND METHODS

We extracted data on adverse drug events (ADEs) associated with SU from the FDA Adverse Event Reporting System (FAERS) database. Disproportionality analysis was performed to calculate the risk signals for drugs that may induce SU. Logistic regression analysis was carried out to investigate the factors influencing the occurrence of SU.

RESULTS

21372 cases of SU were reported in FAERS database between 2005 and 2024. Based on the frequency of ADE reports, we compiled a list of the top 50 drugs associated with SU. Only 15 drugs had explicit mentions of SU in their instructions, while 32 drugs were recognized as positive signals for SU by reporting odds ratio model. Logistic regression revealed the duration of medication was the risk factor for tocilizumab, alendronate sodium, and erlotinib usage. Females were also identified as risk factor for erlotinib.

CONCLUSIONS

Our study identified 32 drugs potentially inducing SU, which provides valuable insights for targeted prevention and treatment strategies aimed at mitigating the risk of drug-induced SU.

Approach to Detecting Beneficial and Detrimental Drug-Drug Interactions in Complex Pharmacotherapy

Background The increasing prevalence of polypharmacy has raised concerns about drug-drug interactions (DDIs) and their impact on patient safety. Database-based DDI detection often suffers from insufficient patient background information and missing data, limiting the accuracy and applicability of DDI assessments. A novel model is needed to overcome these limitations and provide a more comprehensive evaluation of DDIs to enhance patient safety in the context of multiple medication use. Objectives This study aims to develop and validate a novel model for evaluating both the beneficial and detrimental effects of DDIs on patient safety. The model is designed to address challenges associated with insufficient patient background information and missing data in database studies while providing a comprehensive assessment of DDIs using statistical inference and hypothesis tests. Methods To address the challenges of insufficient patient background information and missing data often encountered in database studies, the proposed model incorporates an overlap parameter. This parameter represents the degree of commonality in patient profiles susceptible to adverse events from individual drug administrations. The magnitude of DDIs is presented in a 2×2 contingency table constructed by the occurrence or non-occurrence of specific adverse events in observed value and expected value estimated from the model. This tabular format facilitates the assessment of DDIs using statistical inference and hypothesis tests. Results Simulations under various settings confirmed that significance levels for statistical hypothesis tests were strictly observed. Furthermore, applications to real-world databases demonstrated that the proposed model effectively identifies both positive and negative DDIs. Conclusions This research provides healthcare professionals with a robust and practical tool for enhanced DDI detection and management. The presentation of findings in a familiar 2×2 contingency table format improves the accessibility of our results, facilitating straightforward interpretation. The proposed model has the potential to promote a safer healthcare environment for patients on multiple medications, ultimately enhancing patient safety and treatment efficacy.

Comparison of adverse events of poly adenosine diphosphate ribose polymerase inhibitors in patients with ovarian cancer using the United States Food and Drug Administration Adverse Event Reporting System

BACKGROUND

Olaparib, niraparib, and rucaparib are the three primary poly (adenosine diphosphate-ribose) polymerase (PARP) inhibitors that are currently available in the market. Previous studies indicate different incidences of adverse events based on the PARP inhibitor or country.

RESEARCH DESIGN AND METHODS

This study used data from the United States Food and Drug Administration Adverse Event Reporting System collected between January 2018 and December 2023. The data analyzed in this study involved patients receiving PARP inhibitors for treating ovarian cancer. A comparative analysis of the three PARP inhibitors was conducted using the reporting odds ratio (ROR) and the adjusted ROR (aROR) controlling for patient background differences.

RESULTS

The aROR for niraparib was significant at > 1.000, including platelet count decreased (p < 0.001) and thrombocytopenia (p < 0.001) when olaparib was set as the reference. Conversely, the aROR for niraparib was significant at < 1.000, including anemia (p < 0.001). Additionally, significant differences were observed in various adverse events for rucaparib. Moreover, significant differences were observed when comparing between countries.

CONCLUSIONS

This study indicates that the types of adverse events may vary by PARP inhibitor and by country. These results will be beneficial in clinical practice.

Prevalence and Predictors of Adverse Events Associated With Dipeptidyl Peptidase-4 (DPP-4) Inhibitors in Type 2 Diabetic Patients: A Cross-sectional Study

Background

Dipeptidyl peptidase-4 (DPP-4) inhibitors are oral hypoglycemic agents widely prescribed in India despite safety concerns. However, studies focused on their safety profile are scarce, especially in South India.

Objective

To evaluate the prevalence and predictors of adverse events (AEs) with DPP-4 inhibitors in patients with type 2 diabetes mellitus (T2DM).

Research design and methods

This retrospective cross-sectional study analyzed data from medical records of T2DM patients prescribed DPP-4 inhibitors admitted to the medicine department from 2019 to 2021 at a South Indian tertiary care hospital. The causality of AEs was assessed using the WHO-Uppsala Monitoring Centre (WHO-UMC) criteria and the Naranjo scale, and severity using the Modified Hartwig and Seigel scale. We applied a Generalized model with a binary response and logit-link function to understand the factors that best explain the AE. The best-fit models were chosen based on least Akaike's information criterion and highest PseudoR 2 and presented the odds ratio (OR) with a 95% confidence interval. The analyses were performed in R software version 4.2.1.

Results

Among the 796 patients included in the study, 26% experienced AEs. A total of 212 AEs were observed, and Saxagliptin-associated AEs were the most prevalent (66.6%). Hepatic AEs were predominant (37.7%), followed by gastrointestinal events (16.5%) and electrolyte imbalances (12.3%). Most AEs were possible based on WHO-UMC criteria (78.7%) and the Naranjo scale (86.7%), with 58% being of moderate severity and 42% mild. In the multivariate analysis, aspartate transaminase [OR: 1.013 (0.006-1.020)], alkaline phosphatase [OR: 1.004 (1.001-1.007)] and patients already on DPP-4 inhibitors [OR 1.191(1.012-1.366)] were significant predictors for AEs with DPP-4 inhibitors.

Conclusion

The study highlighted a high prevalence of AEs with DPP-4 inhibitors and identified significant predictors of these AEs. These findings underscore the necessity of vigilant monitoring and risk assessment while prescribing DPP-4 inhibitors to the Indian population.

Comparison of Adverse Events Following Immunosuppressant Administration for Pediatric Patients With Renal Transplants Categorized by Two-Year Age Increments Using the U.S. Food and Drug Administration Adverse Event Reporting System

Background Immunosuppressants are frequently administered to prevent transplant rejection in patients with renal transplants but cause various adverse events. The incidence of each adverse event may differ between pediatric and adult patients with renal transplants. Because the development of organs and bodies in pediatric patients varies greatly annually, the incidence of each adverse event following immunosuppressant administration may vary by age. Consequently, the age-specific incidence of each adverse event in pediatric patients represents invaluable information for clinical settings. To clarify trends in the occurrence of adverse events by age, a large sample size for each age is required. However, it is difficult to conduct clinical trials in pediatric patients with renal transplants with a large sample size for each age. One method to address this difficulty is to use a database.  Objectives This study aimed to investigate the trends in the occurrence of each adverse event following immunosuppressant administration in pediatric patients with renal transplants, categorized by two-year age increments. Methods We extracted data on pediatric patients aged 0-17 years who received immunosuppressants after renal transplant between January 2004 and March 2024 from the U.S. Food and Drug Administration Adverse Event Reporting System. Because adverse events were greatly affected by age, the patients were divided into groups by two-year age increments. We analyzed the relationship between the groups and the reporting proportion of each adverse event by using the reporting regression coefficient (RRC) from univariate regression analysis and the adjusted RRC (aRRC), which controlled for differences in patient background. Results Renal tubular necrosis, renal impairment, chronic allograft nephropathy, and headache were the adverse events that required more attention with increasing age because RRC and aRRC were significantly > 0. By contrast, Epstein-Barr virus infection was the adverse event that required attention, especially in younger pediatric patients, because RRC and aRRC were significantly < 0. Additionally, there were various trends among other adverse events, including those that required careful monitoring across all ages 0-17 years. Conclusions This study demonstrated that the types of adverse events requiring attention in pediatric patients with renal transplants differ by age. These findings can help enhance treatment and care in pediatric clinical settings.

Efficacy of Prednisone Avoidance in Patients With Liver Transplant Using the U.S. Food and Drug Administration Adverse Event Reporting System

Background Immunosuppressants are administered in various combinations to prevent immune-induced transplant rejection in patients with liver transplant, as each immunosuppressant acts on different cellular sites. However, the use of multiple immunosuppressants also increases the risk for adverse events. Therefore, it is desirable to reduce the types of immunosuppressants administered without increasing the incidence of transplant rejection. The effectiveness of prednisone avoidance has been suggested, although this was not based on statistical significance in many instances. To definitively establish the effectiveness of prednisone avoidance, a statistically significant difference from a prednisone-use group should be demonstrated. Additionally, the effectiveness of prednisone avoidance might vary depending on the combination of other immunosuppressants administered. It has therefore been considered necessary to investigate, for various immunosuppressant combinations, the administration patterns in which prednisone avoidance is effective. Objectives This study aimed to investigate the effectiveness of prednisone avoidance in patients with liver transplant and discuss the results based on statistically significant differences. Methods Data from the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) were obtained. In studying immunosuppressant combinations, it was essential to control for confounding. Thus, the immunosuppressant combinations, excluding prednisone, were kept the same in the two groups being compared (prednisone-use and prednisone-avoidance groups). The large sample from FAERS allowed for those various immunosuppressant combinations to be compared. Comparisons of transplant rejection in the prednisone-use and prednisone-avoidance groups used the reporting odds ratio (ROR) and the adjusted ROR (aROR), which controlled for differences in patient background. Results With the prednisone-use groups being set as the reference, ROR and aROR were calculated for the prednisone-avoidance groups. Various immunosuppressant combinations were evaluated, and in four patterns - (1) the combination of prednisone and tacrolimus, (2) the combination of prednisone, cyclosporine, and tacrolimus, (3) the combination of prednisone, tacrolimus, and basiliximab, and (4) the combination of prednisone and everolimus) - both the ROR and the aROR for transplant rejection in the prednisone-avoidance group were significantly <1.000. Conclusions This study identified effective immunosuppressant combinations for prednisone avoidance that were not associated with increased transplant rejection. The evidence supporting the effectiveness of prednisone avoidance is strengthened when combined with results from previous studies.

Analysis of Adverse Events Following Phenobarbital Administration for Pediatric Patients Categorized by One-Year Age Increments Using the U.S. Food and Drug Administration Adverse Event Reporting System

Background Organ and body development greatly varies in pediatric patients from year to year. Therefore, the incidence of each adverse event following phenobarbital (PB) administration would vary with age. However, in clinical trials, increasing the sample size of pediatric patients in each age group has been challenging. Therefore, previous studies were conducted by dividing pediatric patients into three or four age groups based on the development stage. Although these results were useful in clinical settings, information on adverse events that occurred at one-year age increments in pediatric patients could further enhance treatment and care. Objectives This study investigated in one-year age increments the occurrence tendency of each adverse event following PB administration in pediatric patients. Methods This study used data obtained from the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS). Two inclusion criteria were set: (1) treatment with PB between January 2004 and June 2023 and (2) age 0-15 years. Using the cutoff value obtained using the Wilcoxon-Mann-Whitney test by the minimum p-value approach, this study explored changes in the occurrence tendency of each adverse event in one-year age increments. At the minimum p-value of <0.05, the age corresponding to this p-value was determined as the cutoff value. Conversely, at the minimum p-value of ≥0.05, the cutoff value was considered nonexistent. Results This study investigated all types of adverse events and explored the cutoff value for each adverse event. We identified 34, 16, 15, nine, five, five, eight, three, and eight types of adverse events for the cutoff values of ≤3/>3, ≤4/>4, ≤5/>5, ≤6/>6, ≤7/>7, ≤8/>8, ≤9/>9, ≤10/>10, and ≤11/>11 years, respectively. Conclusions This study demonstrated that adverse events requiring attention in pediatric patients varied with age. The findings help in the improvement of treatment and care in the pediatric clinical settings.

Proteomic changes related to actin cytoskeleton function in the skin of vildagliptin-treated mice

BACKGROUND

Vildagliptin, a dipeptidyl peptidase-4 inhibitor (DPP-4i) is a widely used type 2 diabetes medication that is associated with an up-to 10-fold increased risk for the development of bullous pemphigoid (BP), an autoimmune skin disease. The mechanism by which vildagliptin promotes the development of BP remains unknown.

OBJECTIVE

To elucidate effects of vildagliptin treatment on the mouse cutaneous proteome.

METHODS

We analyzed the cutaneous proteome of nondiabetic mice treated for 12 weeks with vildagliptin using label-free shotgun mass spectrometry (MS), two-dimensional difference gel electrophoresis (2D-DIGE), immunohistochemistry, immunoblotting, and quantitative real-time polymerase chain reaction.

RESULTS

Although vildagliptin treatment did not cause any clinical signs or histological changes in the skin, separate MS and 2D-DIGE analyses revealed altered cutaneous expression of several proteins, many of which were related to actin cytoskeleton remodeling. Altogether 18 proteins were increased and 40 were decreased in the vildagliptin-treated mouse skin. Both methods revealed increased levels of beta-actin and C->U-editing enzyme APOBEC2 in vildagliptin-treated mice. However, elevated levels of a specific moesin variant in vildagliptin-treated animals were only detected with 2D-DIGE. Immunohistochemical staining showed altered cutaneous expression of DPP-4, moesin, and galectin-1. The changed proteins detected by MS and 2D-DIGE were linked to actin cytoskeleton remodeling, transport, cell movement and organelle assembly.

CONCLUSION

Vildagliptin treatment alters the cutaneous proteome of nondiabetic mice even without clinical signs in the skin. Cytoskeletal changes in the presence of other triggering factors may provoke a break of immune tolerance and further promote the development of BP.

Pharmacovigilance Study of Infigratinib: A Safety Analysis of the FDA Adverse Event Reporting System

BACKGROUND

Infigratinib is a fibroblast growth factor receptor (FGFR)-specifc tyrosine kinase inhibitor indicated for the treatment of patients with previously treated, unresectable, locally advanced or metastatic cholangiocarcinoma. However, few studies have been conducted to evaluated the safety of infigratinib in the real world. In this study, we conducted a pharmacovigilance study to evaluate the adverse events (AEs) of infigratinib by using the Food and Drug Administration Adverse Event Reporting System (FAERS) database.

METHODS

OpenVigil 2.1 was employed to extract the FAERS database. Descriptive analysis was used to describe the characteristics of infigratinib-associated AE reports. Disproportionality analysis was performed by calculating the proportional reporting ratio (PRR), reporting odds ratios (ROR), and Bayesian analysis confidence propagation neural network (BCPNN) to detect positive signals.

RESULTS

Our findings revealed 149 AE reports, among which 36 significant signals were identified. These significant AE signals were mainly observed in gastrointestinal disorders (N = 26, ROR = 26.03, PRR = 8.44, information component [IC] = 3.08) and skin and subcutaneous tissue disorders (N = 21, ROR = 92.13, PRR = 40.41, IC = 5.34). Notably, dehydration and skin exfoliation were unexpected AEs, but had relatively high signal intensities (ROR = 29.75, PRR = 26.64, IC = 4.74; ROR = 50.61, PRR = 45.24, IC = 5.50, respectively) despite not being listed on the drug label. Furthermore, our analysis showed that infigratinib dose differed statistically between severe and non-severe reports (113.82 ± 16.13 mg vs 125 ± 0.00 mg, t = - 4.28; p < 0.001). However, there were no significant differences in sex, age, and types of AEs between the two groups (p  = 0.06, p  = 0.86, and p = 0.93, respectively).

CONCLUSIONS

These findings suggest that gastrointestinal and skin toxicities are the most common adverse reactions for infigratinib. It is important to recognize skin exfoliation and dehydration in clinical practice, as they are unexpected AEs. Additionally, our study indicates that infigratinib dose may correlate with an increased risk of AE severity, highlighting the need for dose adjustment of infigratinib when exposure to the drug is increased due to internal or external factors.

Analysis of death avoidance by concomitant use of prednisone in patients with renal transplant using the Food and Drug Administration Adverse Event Reporting System

BACKGROUND

Patients with renal transplant are frequently administered immunosuppressants to prevent transplant-related adverse events. There are mainly nine immunosuppressants on the market, and multiple immunosuppressants are frequently administered for patients with renal transplant. Identifying which immunosuppressant was responsible when efficacy or safety was observed in patients taking multiple immunosuppressants is difficult. This study aimed to identify the immunosuppressant that was effective in reducing death in patients with renal transplant. A very large sample size was required to conduct prospective clinical trials of immunosuppressant combinations, which is impractical. We investigated cases wherein death occurred despite immunosuppressant administration in patients with renal transplant using Food and Drug Administration Adverse Event Reporting System (FAERS) data.

MATERIAL AND METHOD

We used FAERS data reported between January 2004 and December 2022 in patients with renal transplant who received one or more immunosuppressants. Groups were defined for each combination of immunosuppressants. Comparison between two identical groups except for the presence or absence of prednisone was performed using the reporting odds ratio (ROR) and the adjusted ROR (aROR) controlling for differences in patient background.

RESULTS

When the group without prednisone was set as the reference, the aROR for death was significantly <1.000 in several cases in the group to which prednisone was added.

CONCLUSIONS

The inclusion of prednisone in the immunosuppressant combinations was suggested to be effective in reducing death. We provided the sample code of software R that can reproduce the results.