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

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.

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.