1
|
Chen CB, Chen YE, Chu MT, Wang CW, Hui RCY, Lu CW, Hsiao YP, Chu CY, Chang MM, Cheung CMT, Cheng CY, Wang YW, Lin YJ, Chang CJ, Hung SI, Chung WH. The risk of anti-osteoporotic agent-induced severe cutaneous adverse drug reactions and their association with HLA. J Eur Acad Dermatol Venereol 2020; 35:712-720. [PMID: 32896010 DOI: 10.1111/jdv.16924] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 08/13/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is increasing use of anti-osteoporotic agents (AOA) worldwide for prevention or management of patients with osteoporosis. However, there have been reports of severe cutaneous adverse reactions (SCAR) induced by AOA. A recent study showed weak association between HLA and strontium ranelate (SR)-SCAR. OBJECTIVE To characterize patients with AOA-SCAR and investigate the HLA association and utility of in vitro diagnostic methods. METHODS We enrolled 16 cases with AOA-cutaneous adverse drug reactions (cADR), including SCAR (n = 10: 8 with Stevens-Johnson syndrome [SJS] and 2 with drug rash with eosinophilia and systemic symptoms [DRESS]) and maculopapular exanthema (MPE) (n = 6) from Taiwan and Hong Kong. We analysed the clinical characteristics, outcomes, HLA alleles and in vitro testing of AOA-SCAR, and tolerability to alternative drugs. We further performed literature review and meta-analysis on the HLA association of AOA-SCAR. RESULTS Our data showed strontium ranelate is the most common causality of AOA-SCAR in Asian populations. There was no cross-hypersensitivity of SR-SCAR with other AOA. HLA genotyping showed that SR-SJS was most significantly associated with HLA-A*33:03 (Pc = 5.17 × 10-3 , OR: 25.97, 95% CI: 3.08-219.33). Meta-analysis showed that HLA-A*33:03 was associated with SR-SJS (P = 5.01 × 10-5 ; sensitivity: 85.7%) in Asians. The sensitivity of lymphocyte activation test (LAT) for identifying the culprit drug of SR-SJS was 83.3%. CONCLUSIONS Strontium ranelate is identified as the most notorious AOA associated with SCAR. The HLA-A*33:03 genetic allele and LAT testing may add benefits to the diagnosis of SR-SCAR in patients whose reaction developed while taking multiple drugs.
Collapse
Affiliation(s)
- C-B Chen
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospitals, Linkou, Keelung, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan.,Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China.,Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan.,Cancer Vaccine & Immune Cell Therapy Core Lab, Department of Medical Research, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Y-E Chen
- Department of Surgical Pathology, Changhua Christian Hospital, Changhua, Taiwan
| | - M-T Chu
- Cancer Vaccine & Immune Cell Therapy Core Lab, Department of Medical Research, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - C-W Wang
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospitals, Linkou, Keelung, Taipei, Taiwan.,Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan.,Cancer Vaccine & Immune Cell Therapy Core Lab, Department of Medical Research, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - R C-Y Hui
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospitals, Linkou, Keelung, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - C-W Lu
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospitals, Linkou, Keelung, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Y-P Hsiao
- Department of Dermatology, Chung Shan Medical University Hospital and Chung Shan Medical University College of Medicine, Taichung, Taiwan
| | - C-Y Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - M M Chang
- Division of dermatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| | - C M-T Cheung
- Division of dermatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| | - C-Y Cheng
- Clinical Pharmacy Division, Department of Pharmacy, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Y-W Wang
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospitals, Linkou, Keelung, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Y-J Lin
- Biostatistical Center for Clinical Research, Chang Gung Memorial Hospital, Linkou, Taiwan.,Graduate Institute of Clinical Medical Science, Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - C-J Chang
- Biostatistical Center for Clinical Research, Chang Gung Memorial Hospital, Linkou, Taiwan.,Graduate Institute of Clinical Medical Science, Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - S-I Hung
- Cancer Vaccine & Immune Cell Therapy Core Lab, Department of Medical Research, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - W-H Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospitals, Linkou, Keelung, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan.,Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China.,Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan.,Cancer Vaccine & Immune Cell Therapy Core Lab, Department of Medical Research, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Dermatology, Beijing Tsinghua Chang Gung Hospital, School of Clinical Medicine, Tsinghua University, Beijingu, China.,Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan
| | | |
Collapse
|
2
|
Lin G, Zhou C, Lin M, Xu A, He F. Strontium‐incorporated titanium implant surface treated by hydrothermal reactions promotes early bone osseointegration in osteoporotic rabbits. Clin Oral Implants Res 2019; 30:777-790. [PMID: 31104360 DOI: 10.1111/clr.13460] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 04/27/2019] [Accepted: 05/07/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Guofen Lin
- Department of General Dentistry, The Affiliated Stomatology Hospital, School of Medicine Zhejiang University Hangzhou China
| | - Chuan Zhou
- Department of Prosthodontics, The Affiliated Stomatology Hospital, School of Medicine Zhejiang University Hangzhou China
| | - Mengna Lin
- Department of Prosthodontics, The Affiliated Stomatology Hospital, School of Medicine Zhejiang University Hangzhou China
| | - Antian Xu
- Department of Prosthodontics, The Affiliated Stomatology Hospital, School of Medicine Zhejiang University Hangzhou China
| | - Fuming He
- Department of Prosthodontics, The Affiliated Stomatology Hospital, School of Medicine Zhejiang University Hangzhou China
| |
Collapse
|
3
|
Zhang D, Du A, Wang X, Zhang L, Yang M, Ma J, Deng M, Liu H. Pharmacokinetics and bioequivalence of two strontium ranelate formulations after single oral administration in healthy Chinese subjects. Xenobiotica 2018; 49:457-462. [PMID: 29676197 DOI: 10.1080/00498254.2018.1465210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Dan Zhang
- Department of Clinical Pharmacology, Aerospace Center Hospital, Beijing, P.R. China
| | - Aihua Du
- Department of Clinical Pharmacology, Aerospace Center Hospital, Beijing, P.R. China
| | - Xiaolin Wang
- Department of Clinical Pharmacology, Aerospace Center Hospital, Beijing, P.R. China
| | - Lina Zhang
- Department of Clinical Pharmacology, Aerospace Center Hospital, Beijing, P.R. China
| | - Man Yang
- Department of Clinical Pharmacology, Aerospace Center Hospital, Beijing, P.R. China
| | - Jingyi Ma
- Department of Clinical Pharmacology, Aerospace Center Hospital, Beijing, P.R. China
| | - Ming Deng
- Department of Clinical Pharmacology, Aerospace Center Hospital, Beijing, P.R. China
| | - Huichen Liu
- Department of Clinical Pharmacology, Aerospace Center Hospital, Beijing, P.R. China
| |
Collapse
|
4
|
Abstract
While peripheral or tissue eosinophilia may certainly characterize drug eruptions, this feature is hardly pathognomonic for a medication-induced etiology. While delayed drug hypersensitivity reactions with prominent eosinophilic recruitment have been typically classified as type IVb reactions, their pathophysiology is now known to be more complex. Eosinophilic drug reactions have a diversity of presentations and may be benign and self-limited to severe and life-threatening. The extent of clinical involvement is also heterogeneous, ranging from isolated peripheral eosinophilia or single organ involvement (most often the skin and lung) to systemic disease affecting multiple organs, classically exemplified by drug-reaction with eosinophilia and systemic symptoms (DRESS). The spectrum of implicated medications in the causation of DRESS is ever expanding, and multiple factors including drug metabolites, specific HLA alleles, herpes viruses, and immune system activation have been implicated in pathogenesis. Due to this complex interplay of various factors, diagnostic workup in terms of skin and laboratory testing has not been validated. Similarly, the lack of controlled trials limits treatment options. This review also describes other localized as well as systemic manifestations of eosinophilic disease induced by various medication classes, including their individual pathophysiology, diagnosis, and management. Given the multitude of clinical patterns associated with eosinophilic drug allergy, the diagnosis can be challenging. Considerable deficits in our knowledge of these presentations remain, but the potential for severe reactions should be borne in mind in order to facilitate diagnosis and institute appropriate management.
Collapse
Affiliation(s)
- Merin Kuruvilla
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David A Khan
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| |
Collapse
|
5
|
Agier MS, Boivin N, Maruani A, Giraudeau B, Gouraud A, Haramburu F, Jean Pastor MJ, Machet L, Jonville-Bera AP. Risk assessment of drug-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: a disproportionality analysis using the French Pharmacovigilance Database. Br J Dermatol 2016; 175:1067-1069. [PMID: 27060861 DOI: 10.1111/bjd.14649] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M S Agier
- Department of Clinical Pharmacology, Regional Pharmacovigilance Center, CHRU Tours, 37044, Tours CEDEX 9, France
| | - N Boivin
- Department of Clinical Pharmacology, Regional Pharmacovigilance Center, CHRU Tours, 37044, Tours CEDEX 9, France
| | - A Maruani
- Department of Dermatology, CHRU Tours, 37044, Tours CEDEX 9, France.,University François Rabelais Tours, 37000, Tours, France.,INSERM U930, 37044, Tours CEDEX 9, France
| | - B Giraudeau
- University François Rabelais Tours, 37000, Tours, France.,Clinical Investigation Center - INSERM 1415, 37044, Tours CEDEX 9, France
| | - A Gouraud
- Regional Pharmacovigilance Center, Hospices Civils de Lyon, 69424, Lyon, France
| | - F Haramburu
- Department of Clinical Pharmacology, Regional Pharmacovigilance Center, Hôpital Pellegrin, 33076, Bordeaux, France
| | - M J Jean Pastor
- Regional Pharmacovigilance Center, Hôpital Salvator, Assistance Publique Hôpitaux de Marseille, 13274, Marseille, France
| | - L Machet
- Department of Dermatology, CHRU Tours, 37044, Tours CEDEX 9, France.,University François Rabelais Tours, 37000, Tours, France.,INSERM U930, 37044, Tours CEDEX 9, France
| | - A P Jonville-Bera
- Department of Clinical Pharmacology, Regional Pharmacovigilance Center, CHRU Tours, 37044, Tours CEDEX 9, France.
| |
Collapse
|
6
|
Cancellous bone response to strontium-doped hydroxyapatite in osteoporotic rats. J Appl Biomater Funct Mater 2015; 13:28-34. [PMID: 24744229 DOI: 10.5301/jabfm.5000168] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2013] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The objective of this study was to investigate cancellous bone response to strontium-doped hydroxyapatite (SrHA) in ovariectomized (OVX) rats. METHODS Hydroxyapatite (HA) and 10%SrHA (HA with 10 mol% calcium substituted by strontium) implants were prepared and characterized by scanning electronic microscopy (SEM), energy dispersive microanalysis (EDX) and X-ray diffraction (XRD). Twelve weeks after bilateral ovariectomy, 20 rats randomly received HA or 10%SrHA implants in the right distal femur, with 10 animals in each group. Eight weeks after implantation, specimens were harvested and analyzed by micro-computed tomography (micro-CT) and histology. RESULTS Compared with HA, 10%SrHA raised the percentage bone volume by 42.6%, bone-to-implant contact by 47.1%, mean trabecular number by 27.3%, mean trabecular thickness by 31.5% and mean connectivity density by 37.4%, while it decreased mean trabecular separation by 20.1% in micro-CT evaluation. 10%SrHA also increased the bone area density by 47.6% in histological analysis. CONCLUSIONS With the HA implants as controls, the 10%SrHA implants were shown to increase bone density and bone-to-implant contact, and improve trabecular architecture in the vicinity of implant surfaces.
Collapse
|
7
|
Luo X, Barbieri D, Zhang Y, Yan Y, Bruijn JD, Yuan H. Strontium-Containing Apatite/Poly Lactide Composites Favoring Osteogenic Differentiation and in Vivo Bone Formation. ACS Biomater Sci Eng 2015. [DOI: 10.1021/ab500005e] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Xiaoman Luo
- Xpand Biotechnology BV, Professor
Bronkhorstlaan 10, Bld 48, 3723MB Bilthoven, The Netherlands
- MIRA
Institute, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Davide Barbieri
- Xpand Biotechnology BV, Professor
Bronkhorstlaan 10, Bld 48, 3723MB Bilthoven, The Netherlands
| | - Yunfei Zhang
- Chongqing Academy of Metrology and Quality Inspection, Yangliu North Road No. 1, Yubei
District, 401123 Chongqing, China
| | - Yonggang Yan
- College
of Physical Science and Technology, Sichuan University, Wangjiang
Road 29, 610064 Chengdu, China
| | - Joost D. Bruijn
- Xpand Biotechnology BV, Professor
Bronkhorstlaan 10, Bld 48, 3723MB Bilthoven, The Netherlands
- MIRA
Institute, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
- School
of Engineering and Materials Science, Queen Mary University of London, Mile End Road, London E1 4NS, United Kingdom
| | - Huipin Yuan
- Xpand Biotechnology BV, Professor
Bronkhorstlaan 10, Bld 48, 3723MB Bilthoven, The Netherlands
- MIRA
Institute, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
- College
of Physical Science and Technology, Sichuan University, Wangjiang
Road 29, 610064 Chengdu, China
| |
Collapse
|
8
|
Li Y, Fu Q, Qi Y, Shen M, Niu Q, Hu K, Kong L. Effect of a hierarchical hybrid micro/nanorough strontium-loaded surface on osseointegration in osteoporosis. RSC Adv 2015. [DOI: 10.1039/c5ra04914h] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This study evaluated the effect of a hierarchical hybrid micro/nanorough titanium strontium-loaded (MNT-Sr) surface on osseointegration under osteoporotic conditions.
Collapse
Affiliation(s)
- Yongfeng Li
- State Key Laboratory of Military Stomatology
- Department of Oral and Maxillofacial Surgery
- School of Stomatology
- The Fourth Military Medical University
- Xi'an 710032
| | - Qian Fu
- State Key Laboratory of Military Stomatology
- Department of Oral and Maxillofacial Surgery
- School of Stomatology
- The Fourth Military Medical University
- Xi'an 710032
| | - Yaping Qi
- Department of Oral and Maxillofacial Surgery
- School of Stomatology
- The Second Hospital of Hebei Medical University
- Shijiazhuang 050000
- PR China
| | - Mingming Shen
- Department of Oral and Maxillofacial Surgery
- School of Stomatology
- The Second Hospital of Hebei Medical University
- Shijiazhuang 050000
- PR China
| | - Qiang Niu
- State Key Laboratory of Military Stomatology
- Department of Oral and Maxillofacial Surgery
- School of Stomatology
- The Fourth Military Medical University
- Xi'an 710032
| | - Kaijin Hu
- State Key Laboratory of Military Stomatology
- Department of Oral and Maxillofacial Surgery
- School of Stomatology
- The Fourth Military Medical University
- Xi'an 710032
| | - Liang Kong
- State Key Laboratory of Military Stomatology
- Department of Oral and Maxillofacial Surgery
- School of Stomatology
- The Fourth Military Medical University
- Xi'an 710032
| |
Collapse
|
9
|
Kirschneck C, Wolf M, Reicheneder C, Wahlmann U, Proff P, Roemer P. Strontium ranelate improved tooth anchorage and reduced root resorption in orthodontic treatment of rats. Eur J Pharmacol 2014; 744:67-75. [DOI: 10.1016/j.ejphar.2014.09.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 09/08/2014] [Accepted: 09/09/2014] [Indexed: 12/18/2022]
|
10
|
Pavlos R, Mallal S, Ostrov D, Pompeu Y, Phillips E. Fever, rash, and systemic symptoms: understanding the role of virus and HLA in severe cutaneous drug allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:21-33. [PMID: 24565765 DOI: 10.1016/j.jaip.2013.11.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/21/2013] [Accepted: 11/21/2013] [Indexed: 12/17/2022]
Abstract
Drug hypersensitivity syndromes such as abacavir hypersensitivity and the severe cutaneous adverse drug reactions have been associated with significant short- and long-term morbidity and mortality. More recently, these immunologically mediated and previously unpredictable diseases have been shown to be associated with primarily class I but also class II HLA alleles. The case of the association of HLA-B*57:01 and abacavir hypersensitivity has created a translational roadmap for how this knowledge can be used in the clinic to prevent severe reactions. Although many hurdles exist to the widespread translation of such HLA screening approaches, our understanding of how drugs interact with the major histocompatibility complex has contributed to the discovery of new models that have provided considerable insights into the immunopathogenesis of severe cutaneous adverse drug reactions and other T-cell-mediated drug hypersensitivity syndromes. Future translation of this knowledge will facilitate the development of preclinical toxicity screening to significantly improve efficacy and safety of drug development and design.
Collapse
Affiliation(s)
- Rebecca Pavlos
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia
| | - Simon Mallal
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia; Vanderbilt University School of Medicine, Nashville, Tenn
| | - David Ostrov
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, College of Medicine, Gainsville, Fla
| | - Yuri Pompeu
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, College of Medicine, Gainsville, Fla
| | - Elizabeth Phillips
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia; Vanderbilt University School of Medicine, Nashville, Tenn.
| |
Collapse
|
11
|
Hiligsmann M, Vanoverberghe M, Neuprez A, Bruyère O, Reginster JY. Cost–effectiveness of strontium ranelate for the prevention and treatment of osteoporosis. Expert Rev Pharmacoecon Outcomes Res 2014; 10:359-66. [DOI: 10.1586/erp.10.53] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
12
|
Cacoub P, Descamps V, Meyer O, Speirs C, Belissa-Mathiot P, Musette P. Drug rash with eosinophilia and systemic symptoms (DRESS) in patients receiving strontium ranelate. Osteoporos Int 2013; 24:1751-7. [PMID: 23361875 DOI: 10.1007/s00198-013-2265-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 01/03/2013] [Indexed: 10/27/2022]
Abstract
UNLABELLED We have reviewed 47 drug rash with eosinophilia and systemic symptoms (DRESS) cases associated to strontium ranelate reported up to March 2011 to the Marketing Holder. The main signs were skin rash, fever, face oedema hypereosinophilia and liver involvement. For ten patients, persistence of DRESS symptoms was reported at the latest news obtained, and DRESS was identified as the direct cause of death in one case. The maximum incidence of DRESS associated with strontium ranelate was 1/24,112 [95 % CI (1/14,859; 1/42,194)] newly treated patients in France. Because DRESS is a severe drug reaction, the occurrence of a rash in a patient treated with strontium ranelate should lead to prompt and permanent treatment discontinuation. INTRODUCTION This study aims to describe cases of DRESS reported to the Marketing Authorisation Holder worldwide for patients receiving strontium ranelate by practitioner or by regulatory authorities. METHODS Spontaneously reported hypersensitivity events from the strontium ranelate pharmacovigilance database since marketing authorisation (2004) to March 2011 were reviewed by an expert committee. Cases of DRESS were classified as established, probable, possible or no DRESS according to expert judgement. National incidences of DRESS were estimated in relation to the number of newly treated patients. RESULTS Up to March 2011, 325 cases of strontium ranelate-induced hypersensitivity events were assessed from which 47 DRESS cases were confirmed. Mean age was 68.7 years and besides skin rash, the main signs and symptoms were hypereosinophilia, liver involvement, fever and face oedema. Median time to skin reaction was 33.5 days after treatment start. Most patients (62 %) recovered at the time of reporting or were recovering. For ten patients, persistence of DRESS symptoms was reported at the latest news obtained. Relapses were observed in a single case. The mortality rate was 8.5 %. The maximum incidence of DRESS associated with strontium ranelate was 1/24,112 [95 % CI (1/14,859; 1/42,194)] newly treated patients in France. CONCLUSION DRESS is a well-identified and characterised adverse reaction to strontium ranelate. This risk should be integrated in the risk-benefit balance evaluation of patient treatment, and the occurrence of a rash should lead to prompt and permanent treatment discontinuation with careful follow-up.
Collapse
Affiliation(s)
- P Cacoub
- AP-HP, Department of Internal Medicine, Pitié-Salpêtrière Hospital, 83 Boulevard de l'hopital, 75013 Paris, France.
| | | | | | | | | | | |
Collapse
|
13
|
Pavlos R, Mallal S, Phillips E. HLA and pharmacogenetics of drug hypersensitivity. Pharmacogenomics 2013; 13:1285-306. [PMID: 22920398 DOI: 10.2217/pgs.12.108] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Immunologically mediated drug reactions have been traditionally classified as unpredictable based on the fact that they cannot be predicted strictly on the pharmacological action of the drug. Such adverse drug reactions are associated with considerable morbidity and include severe cutaneous adverse reactions such as Stevens-Johnson syndrome/toxic epidermal necrolysis and the drug hypersensitivity syndromes (drug reaction with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome). Over the last decade there have been many associations between these syndromes and Class I and II HLA alleles of the MHC, which have enriched and driven our knowledge of their immunopathogenesis. Significant translation has also occurred in the case of HLA-B*5701 screening being used to exclude at risk patients from abacavir and prevent abacavir hypersensitivity. The ultimate translation of the knowledge of how drugs interact with HLA would be applicable to preclinical drug screening programs to improve the safety and cost-effectiveness of drug design and development.
Collapse
Affiliation(s)
- Rebecca Pavlos
- The Institute for Immunology & Infectious Diseases, Murdoch University, Western Australia
| | | | | |
Collapse
|
14
|
Salgueiro ME, Manso G, Castells X, Jimeno FJ, Ordoñez L, González V, Rodríguez A, Capellà D. Trends in the pharmacological treatment of osteoporosis in Spain from 2000 to 2008. Maturitas 2012; 74:74-8. [PMID: 23121774 DOI: 10.1016/j.maturitas.2012.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 09/27/2012] [Accepted: 10/03/2012] [Indexed: 10/27/2022]
Abstract
AIM To analyze the time trends in anti-osteoporosis medications consumption in Spain between 2000 and 2008 and the influence on such consumption induced by the Information Sheets related to the safety of menopausal hormone therapy and strontium ranelate published by the Spanish Agency of Medicines and Health Products (AEMPS). METHODS Purchase data of anti-osteoporosis medications from 2000 to 2008 were obtained from the Spanish Ministry of Health. This information includes the pharmacy sales data of medicinal products reimbursed by the Spanish National Health Service. Anti-osteoporosis medications consumption data were expressed as defined daily dose per 1 000 inhabitants per day in women aged 50 or more. RESULTS During the study period, anti-osteoporosis medications consumption showed a continuous increase. The greatest increase was observed with bisphosphonates, particularly alendronate and risedronate in their weekly formulations. Strontium ranelate consumption was low but continuously increased and new information concerning its safety in 2007 had no effect on its consumption. The use of menopausal hormone therapy remained stable until 2003, and from then presented a continuous decrease until 2008. Raloxifene utilization increased from 2000 to 2004 and decreased thereafter. Calcitonin utilization decreased uninterruptedly and teriparatide was infrequently used. CONCLUSION This study reports a marked change in osteoporosis treatment in Spain, which includes an important increase in anti-osteoporosis medication use, particularly of bisphosphonates and a decrease in menopausal hormone therapy use secondary to the new information about their safety.
Collapse
Affiliation(s)
- M Esther Salgueiro
- Centro de Farmacovigilancia de Asturias, Facultad de Medicina, Universidad de Oviedo, Asturias, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Musette P, Kaufman JM, Rizzoli R, Cacoub P, Brandi ML, Reginster JY. Cutaneous side effects of antiosteoporosis treatments. Ther Adv Musculoskelet Dis 2012; 3:31-41. [PMID: 22870464 DOI: 10.1177/1759720x10387202] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Cutaneous adverse reactions are reported for many therapeutic agents and, in general, are observed in between 0% and 8% of treated patients depending on the drug. Antiosteoporotic agents are considered to be safe in terms of cutaneous effects, however there have been a number of case reports of cutaneous adverse reactions which warrant consideration. This was the subject of a working group meeting of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis in April 2009, which focused on the impact of cutaneous adverse reactions and drug-induced hypersensitivity in the management of postmenopausal osteoporosis. This position paper was drafted following these discussions and includes a flowchart for their recognition. Cutaneous adverse reactions observed with antiosteoporotic agents were reviewed and included information from case reports, regulatory documents and pharmacovigilance. These reactions ranged from benign effects including exanthematous or maculopapular eruption (drug rash), photosensitivity and urticaria, to the severe and potentially life-threatening reactions of angioedema, drug rash with eosinophilia and systemic symptoms (DRESS), Stevens Johnson syndrome and toxic epidermal necrolysis. A review of the available evidence demonstrates that cutaneous adverse reactions occur with all commonly used antiosteoporotic treatments. Notably, there are reports of Stevens Johnson syndrome and toxic epidermal necrolysis for bisphosphonates, and of DRESS and toxic epidermal necrolysis for strontium ranelate. These severe reactions remain very rare (<1 in 10,000 cases). In general, with proper management and early recognition, including immediate and permanent withdrawal of the culprit agent, accompanied by hospitalization, rehydration and systemic corticosteroids if necessary, the prognosis is positive.
Collapse
Affiliation(s)
- Philippe Musette
- Department of Internal Medicine, Gent University Hospital, B-9000 Gent, Belgium
| | | | | | | | | | | |
Collapse
|
16
|
Confavreux CB, Canoui-Poitrine F, Schott AM, Ambrosi V, Tainturier V, Chapurlat RD. Persistence at 1 year of oral antiosteoporotic drugs: a prospective study in a comprehensive health insurance database. Eur J Endocrinol 2012; 166:735-41. [PMID: 22258112 DOI: 10.1530/eje-11-0959] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Treatments against osteoporosis have demonstrated fracture risk reduction but persistence to therapy remains a major issue. Intermittent regimens have been developed to improve persistence. The aim of this 1-year prospective study was to compare, in the general population, the persistence of various oral regimens of antiosteoporotic treatment. METHODS We conducted this prospective study in the French comprehensive public health insurance database of the Rhône-Alpes region. Women aged 45 years or older who had a first reimbursement of an oral antiosteoporotic treatment during February 2007 composed the study cohort. Persistence was defined by the proportion of patients refilling a prescription in the pharmacist delivery register (ERASME). Using statistical analyses like Kaplan-Meier survival curves and log-rank tests, we compared the treatment persistence of strontium ranelate, raloxifene, and daily-, weekly-, and monthly bisphosphonates. RESULTS Two thousand four hundred and nineteen patients were included over a period of 1 month and followed up for 12 months. Two hundred and eighty-nine (11.9%) patients were treated with monthly bisphosphonates, 1298 (53.7%) with weekly bisphosphonates, and 832 (34.4%) with daily treatments (526 strontium ranelate (21.7%), 296 raloxifene (12.2%), and 10 bisphosphonates (0.4%)). At 1 year, overall persistence was 34%. Fifty percent of patients on monthly bisphosphonates were still persistent while only 37% of patients on weekly bisphosphonates, 34% on raloxifene, and 16% on strontium ranelate were persistent. Therapy monitoring with biochemical markers or bone mineral density was associated with improved persistence. CONCLUSION Overall persistence at 1 year was low, but intermittent regimens were associated with higher persistence rates, along with women who had therapy monitoring.
Collapse
Affiliation(s)
- Cyrille B Confavreux
- INSERM UMR 1033-Université de Lyon, Department of Rheumatology, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, Lyon, France.
| | | | | | | | | | | |
Collapse
|
17
|
Body JJ, Bergmann P, Boonen S, Devogelaer JP, Gielen E, Goemaere S, Kaufman JM, Rozenberg S, Reginster JY. Extraskeletal benefits and risks of calcium, vitamin D and anti-osteoporosis medications. Osteoporos Int 2012; 23 Suppl 1:S1-23. [PMID: 22311111 PMCID: PMC3273686 DOI: 10.1007/s00198-011-1891-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 12/19/2011] [Indexed: 12/11/2022]
Abstract
UNLABELLED Drugs used for the prevention and the treatment of osteoporosis exert various favourable and unfavourable extra-skeletal effects whose importance is increasingly recognized notably for treatment selection. INTRODUCTION The therapeutic armamentarium for the prevention and the treatment of osteoporosis is increasingly large, and possible extra-skeletal effects of available drugs could influence the choice of a particular compound. METHODS The present document is the result of a national consensus, based on a systematic and critical review of the literature. RESULTS Observational research has suggested an inverse relationship between calcium intake and cardiovascular diseases, notably through an effect on blood pressure, but recent data suggest a possible deleterious effect of calcium supplements on cardiovascular risk. Many diverse studies have implicated vitamin D in the pathogenesis of clinically important non-skeletal functions or diseases, especially muscle function, cardiovascular disease, autoimmune diseases and common cancers. The possible effects of oral or intravenous bisphosphonates are well-known. They have been associated with an increased risk of oesophageal cancer or atrial fibrillation, but large-scale studies have not found any association with bisphosphonate use. Selective oestrogen receptor modulators have demonstrated favourable or unfavourable extra-skeletal effects that vary between compounds. Strontium ranelate has a limited number of non-skeletal effects. A reported increase in the risk of venous thromboembolism is not found in observational studies, and very rare cases of cutaneous hypersensitivity reactions have been reported. Denosumab has been introduced recently, and its extra-skeletal effects still have to be assessed. CONCLUSION Several non-skeletal effects of bone drugs are well demonstrated and influence treatment choices.
Collapse
Affiliation(s)
- J.-J. Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - P. Bergmann
- Department of Radioisotopes, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - S. Boonen
- Center for Metabolic Bone Diseases, Katholieke University Leuven, Leuven, Belgium
| | - J.-P. Devogelaer
- Department of Rheumatology, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - E. Gielen
- Gerontology and Geriatrics Section, Department of Experimental Medicine, K.U.Leuven, Leuven, Belgium
| | - S. Goemaere
- Department of Rheumatology and Endocrinology, State University of Gent, Gent, Belgium
| | - J.-M. Kaufman
- Department of Endocrinology, State University of Gent, Gent, Belgium
| | - S. Rozenberg
- Department of Gynaecology–Obstetrics, Université Libre de Bruxelles, Brussels, Belgium
| | - J.-Y. Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Bone and Cartilage Metabolism Research Unit, CHU Centre-Ville, Policliniques L. BRULL, Quai Godefroid Kurth 45 (9ème étage), 4020 Liege, Belgium
| |
Collapse
|
18
|
2011 Up-Date of the Consensus Statement of the Spanish Society of Rheumatology on Osteoporosis. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.reumae.2011.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
19
|
[2011 Up-date of the consensus statement of the Spanish Society of Rheumatology on osteoporosis]. ACTA ACUST UNITED AC 2011; 7:357-79. [PMID: 22078694 DOI: 10.1016/j.reuma.2011.05.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 05/16/2011] [Accepted: 05/20/2011] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Due to increasing improvement in the diagnosis, evaluation and management of osteoporosis and the development of new tools and drugs, the Spanish Society of Rheumatology (SER) has promoted the development of recommendations based on the best evidence available. These recommendations should be a reference to rheumatologists and other health professionals involved in the treatment of patients with osteoporosis. METHODS Recommendations were developed following a nominal group methodology and based on a systematic review. The level of evidence and degree of recommendation were classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through Delphi technique. Evidence from previous consensus and available clinical guidelines was used. RESULTS We have produced recommendations on diagnosis, evaluation and management of osteoporosis. These recommendations include the glucocorticoid-induced osteoporosis, premenopausal and male osteoporosis. CONCLUSIONS We present the SER recommendations related to the biologic therapy risk management.
Collapse
|
20
|
Jonville-Bera AP, Autret-Leca E. [Adverse drug reactions of strontium ranelate(Protelos(®) in France]. Presse Med 2011; 40:e453-62. [PMID: 21885232 DOI: 10.1016/j.lpm.2011.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 07/19/2011] [Accepted: 07/22/2011] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Study of side effects (SE) associated with strontium ranelate required by the French Drug agency (Afssaps). METHOD SE associated with strontium ranelate and spontaneously reported until March 2009 to the manufacturer or to the French Regional Pharmacovigilance Centers and the periodic safety reports have been analyzed. Utilisation and sales data have been obtained from the manufacturer. RESULTS During the 3 years of the study, 844 SE have been reported in France in patients treated with strontium ranelate. The 199 severe SE are cardiovascular (52%), cutaneous (26%), hepatodigestive (6%), neurological (5%), haematological (3%), osteomuscular (3%) and various (3%). Venous thromboembolic events (VTEE) are the most frequent cardiovascular SE (93/104) with an incidence of 1/31,052 months of treatment. At least one VTEE risk factor is present in 26 (28%) patients. DRESS syndrome which median delay of advent is 35 days is the most frequent cutaneous SE (19/51 SE) with an incidence of 1/13,725 months of treatment. The 14 severe hepatodigestive SE are hepatitis (n=5), pancreatitis (n=2) and various others SE (n=7). The 10 severe neurological SE are confusion/amnesia (n=5), convulsions (n=4) and parenthesis (n=1). The seven severe haematological SE are pancytopenia (n=5), erythroblastopenia (n=1) and thrombocytopenic purpura (n=1). Among the seven deaths, only three (two pulmonary embolisms, one DRESS syndrome) are attributable to strontium ranelate. Apart from the severe SE, 685 SE have also been reported because strontium ranelate was the only drug with an imputability "suspect". DISCUSSION Anti-fractural effect of strontium ranelate is at least as equal as those of bisphosphonates. Its usual SE are benign but two severe risks of strontium ranelate i.e. VTEE and DRESS syndrome are confirmed. The profile of tolerability, different from the one of bisphosphonates makes strontium ranelate as an alternative when bisphosphonates are not recommended or contraindicated (renal insufficiency for example). CONCLUSION If DRESS syndrome is unpredictable, the one of VTEE could be reduced by a strontium ranelate contraindication for patients with a history of VTEE and by stopping the drug if a new VTEE risk situation happens.
Collapse
Affiliation(s)
- Annie-Pierre Jonville-Bera
- CHRU de Tours, service de pharmacologie clinique, centre régional de pharmacovigilance et d'information sur le médicament, 37044 Tours, France
| | | |
Collapse
|
21
|
Abstract
The Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) is a severe adverse drug-induced reaction. Diagnosing DRESS is challenging due to the diversity of cutaneous eruption and organs involved. We used the RegiSCAR scoring system that grades DRESS cases as "no," "possible," "probable," or "definite" to classify cases reported in the literature. We also analyzed the clinical course and treatments of the cases. A total of 44 drugs were associated with the 172 cases reported between January 1997 and May 2009 in PubMed and MEDLINE. The most frequently reported drug was carbamazepine, and the vast majority of cases were classified as "probable/definite" DRESS cases. Hypereosinophilia, liver involvement, fever, and lymphadenopathy were significantly associated with "probable/definite" DRESS cases, whereas skin rash was described in almost all of the cases, including "possible cases." Culprit drug withdrawal and corticosteroids constituted the mainstay of DRESS treatment. The outcome was death in 9 cases. However, no predictive factors for serious cases were found. This better knowledge of DRESS may contribute to improve the diagnosis and management of this syndrome in clinical practice.
Collapse
|
22
|
Bergmann JF. DRESS syndrome : à propos d’une revue de la littérature publiée dans Thérapie. Therapie 2011. [DOI: 10.2515/therapie/2011020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
23
|
Le Merlouette M, Adamski H, Dinulescu M, Le Gall F, Colin F, Grimaud H, Chevrant-Breton J. [Strontium ranelate-induced DRESS syndrome]. Ann Dermatol Venereol 2010; 138:124-8. [PMID: 21333824 DOI: 10.1016/j.annder.2010.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 10/25/2010] [Accepted: 11/17/2010] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe form of adverse drug reaction. Strontium ranelate has recently been authorised for postmenopausal osteoporosis. We report a case of strontium ranelate-induced DRESS complicated by linear Ig A dermatosis due to vancomycin. CASE REPORT A 77-year-old woman with osteoporosis had been treated by strontium ranelate for 4 weeks when she developed a febrile generalized skin rash. Blood tests showed eosinophilia (12.74 × 10(9)/L) and liver damage. A diagnosis of DRESS was made, leading to discontinuation of strontium ranelate and prescription of systemic corticosteroids. Two days later, methicillin-resistant Staphylococcus aureus bacteraemia occurred and treatment with vancomycin was started. The liver dysfunction resolved. After two weeks of antibiotherapy, bullous lesions were noted on the thighs. Skin biopsy results suggested a diagnosis of linear IgA bullous dermatosis. Vancomycin was stopped. Two weeks later, the eruption resolved. The eosinophil count gradually returned to normal after four months of corticosteroid therapy. DISCUSSION More than 15 cases of DRESS syndrome have been reported in Europe, including 2 deaths related to ranelate strontium, prompting European health authorities to publish a warning concerning the risk of strontium ranelate-induced DRESS. A particular feature of our patient was complication with linear IgA bullous dermatosis caused by vancomycin. In conclusion, it is essential to be aware of the risk of severe cutaneous reaction to strontium ranelate, a new drug used to treat osteoporosis.
Collapse
Affiliation(s)
- M Le Merlouette
- Service de dermatologie, CHU Pontchaillou, rue H.-Le-Guilloux, 35033 Rennes cedex, France
| | | | | | | | | | | | | |
Collapse
|
24
|
The effect of strontium-substituted hydroxyapatite coating on implant fixation in ovariectomized rats. Biomaterials 2010; 31:9006-14. [DOI: 10.1016/j.biomaterials.2010.07.112] [Citation(s) in RCA: 219] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 07/31/2010] [Indexed: 11/17/2022]
|
25
|
Musette P, Brandi ML, Cacoub P, Kaufman JM, Rizzoli R, Reginster JY. Treatment of osteoporosis: recognizing and managing cutaneous adverse reactions and drug-induced hypersensitivity. Osteoporos Int 2010; 21:723-32. [PMID: 19921087 DOI: 10.1007/s00198-009-1097-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 10/12/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED Cutaneous adverse reactions are reported for many treatments including antiosteoporotic agents. This position paper includes an algorithm for their recognition. With early recognition and proper management, including immediate and permanent withdrawal of the culprit agent, accompanied by hospitalization, rehydration, and systemic corticosteroids, if necessary, the prognosis is good. INTRODUCTION Cutaneous adverse reactions are reported for many therapeutic agents and observed in between 0% and 8% of treated patients depending on the drug. The antiosteoporotic agents are reputed to be safe in terms of cutaneous effects; however, there have been a number of case reports of cutaneous adverse reactions, which merit consideration. This was the subject of a Working Group meeting of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis in April 2009, to focus on the impact of cutaneous adverse reactions and drug-induced hypersensitivity in the management of postmenopausal osteoporosis. We prepared this position paper following these discussions, and include an algorithm for their recognition. METHODS We reviewed cutaneous adverse reactions observed with antiosteoporotic agents, including information from case reports, regulatory documents, and pharmacovigilance. RESULTS The cutaneous adverse reactions range from benign reactions including exanthematous or maculopapular eruption (drug rash), photosensitivity, and urticaria to the severe and potentially life-threatening reactions, angioedema, drug rash with eosinophilia and systemic symptoms (DRESS), Stevens Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). Review of available evidence shows that cutaneous adverse reactions occur with all commonly used antiosteoporotic agents. Notably, there are reports of SJS and TEN for bisphosphonates, and of DRESS and TEN for strontium ranelate. These severe reactions remain very rare (<1 in 10,000 cases). CONCLUSION With early recognition and proper management, including immediate and permanent withdrawal of the culprit agent, accompanied by hospitalization and rehydration and systemic corticosteroids if necessary, the prognosis is good.
Collapse
Affiliation(s)
- P Musette
- Department of Dermatology and INSERM Unit 905, Charles Nicolle University Hospital, Rouen, France
| | | | | | | | | | | |
Collapse
|
26
|
Smith EV, Shipley DRV. Severe exfoliative dermatitis caused by strontium ranelate: two cases of a new drug reaction. Age Ageing 2010; 39:401-3. [PMID: 20299323 DOI: 10.1093/ageing/afq026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Strontium ranelate is a relatively new drug used as a second-line treatment for osteoporosis, often targeted at older patients. It is known to cause skin rash and rarely drug reaction with eosinophilia and systemic symptoms, but there are no reports of exfoliative dermatitis as a reaction in the literature. We present the first two cases of this adverse effect of the drug, combined with eosinophilia but no systemic symptoms. We illustrate the significant morbidity involved and use of systemic steroid treatment required, highlighting the need for awareness of this reaction in medical and particularly in elderly care communities.
Collapse
Affiliation(s)
- Emma V Smith
- Dermatology, Singleton Hospital, Sketty Lane, Swansea SA2 8QA, UK.
| | | |
Collapse
|
27
|
Borgström F, Ström O, Coelho J, Johansson H, Oden A, McCloskey E, Kanis JA. The cost-effectiveness of strontium ranelate in the UK for the management of osteoporosis. Osteoporos Int 2010; 21:339-49. [PMID: 19513577 DOI: 10.1007/s00198-009-0971-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 04/17/2009] [Accepted: 04/21/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED The cost-effectiveness of strontium ranelate was compared to no treatment in UK women using the FRAX algorithm for fracture risk assessment. At a willingness-to-pay of pound 30,000 per quality-adjusted life-year (QALY), strontium ranelate was generally cost-effective in women with prior fracture at the threshold of osteoporosis from an age of 65 years. INTRODUCTION The objectives of the study were to estimate the cost-effectiveness of strontium ranelate in the UK for the treatment of osteoporosis and to establish intervention thresholds for treatment using the FRAX tool. METHODS The cost-effectiveness of strontium ranelate was compared to no treatment in postmenopausal women with clinical risk factors for fracture using a lifetime simulation model based on Markov cohort methodology that incorporated the features of FRAX. RESULTS At a threshold of pound 30,000 per QALY, strontium ranelate was generally cost-effective in women from an age of 65 years with prior fracture at the threshold of osteoporosis (i.e., a T-score of -2.5 SD) and in women with a prior fracture (and no information on bone mineral density) from the age of 65 years. At a threshold of pound 20,000, strontium ranelate became cost-effective at a 10-year fracture probability of 25.7% and at 16.9% with a threshold of pound 30,000 for a QALY. CONCLUSIONS Strontium ranelate is a cost-effective agent for the treatment of established osteoporosis in women over the age of 65 years. Cost-effective scenarios were also found for the prevention and treatment of fractures associated with osteoporosis, in younger women with additional clinical risk factors.
Collapse
Affiliation(s)
- F Borgström
- Medical Management Centre, Karolinska Institute, Stockholm, Sweden.
| | | | | | | | | | | | | |
Collapse
|
28
|
Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|