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Yamashita M, Maezawa M, Wakabayashi W, Hirofuji S, Miyasaka K, Ichihara N, Nokura Y, Matsui K, Nakao S, Tanaka H, Nakamura M. Relationships between acute generalized eruptive pustulosis, age, sex, primary disease, and prescription medications: Further analysis of the Japanese Adverse Drug Event Report database. Heliyon 2024; 10:e27800. [PMID: 38560160 PMCID: PMC10979194 DOI: 10.1016/j.heliyon.2024.e27800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/08/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
Background Acute generalized eruptive pustulosis (AGEP) is a rare, but serious, drug-related adverse event. This study aimed to determine the relationships between AGEP and age, sex, primary disease, and prescription medications using a database of adverse drug events, namely, the Japanese Adverse Drug Event Report (JADER) database. Methods In this retrospective observational study, we analyzed AGEP reports extracted from the JADER database based on the preferred term for AGEP (code 10048799). We evaluated the effects of causative drugs, underlying diseases, age, and sex. The association between AGEP and prescription drugs was analyzed using the reporting odds ratio and adjusted for covariates using multiple logistic regression. Association rule mining was performed to evaluate the correlation between each combination of factors and AGEP. Results Between April 2004 and March 2023, 823,662 reports, including 869 reports on AGEP, were entered in the JADER database. The highest percentage of reports in each age group was in males aged <10 years, and clarithromycin was the most used drug in males aged <10 years. Nasopharyngitis was the most common reason for use, and Kawasaki disease was reported as a reason for use among males under 10 years of age, but not among females. Conclusions In boys aged <10 years, attention should be paid to the occurrence of AGEP when prescribing clarithromycin and treating Kawasaki disease.
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Affiliation(s)
- Moe Yamashita
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196, Japan
| | - Mika Maezawa
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196, Japan
| | - Wataru Wakabayashi
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196, Japan
| | - Sakiko Hirofuji
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196, Japan
| | - Koumi Miyasaka
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196, Japan
| | - Nanaka Ichihara
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196, Japan
| | - Yuka Nokura
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196, Japan
| | - Kensuke Matsui
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196, Japan
| | - Satoshi Nakao
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196, Japan
- Division of Pharmacy, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hiroyuki Tanaka
- Laboratory of Immunobiology, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196, Japan
| | - Mitsuhiro Nakamura
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196, Japan
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Sun Y, Xu T, Zhu S, Xu H. Characteristics of adverse drug reactions induced by flutamide and bicalutamide: a real-world pharmacovigilance study using FAERS. Expert Opin Drug Saf 2024; 23:305-311. [PMID: 37795911 DOI: 10.1080/14740338.2023.2267978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/15/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Flutamide and bicalutamide are indicated for the management of prostate metastatic carcinoma. The current study evaluated the adverse drug reactions related to flutamide and bicalutamide in a real-world setting. METHODS To quantify the signals of flutamide and bicalutamide associated adverse events (AEs), we used the US Food and Drug Administration Adverse Event Reporting System (FAERS) for this pharmacovigilance study using established pharmacovigilance methods. RESULTS A total of 2711 AEs of flutamide were investigated as the primary suspected; 522 AEs were related to prostate cancer. A total of 4459 AEs were investigated as the primary suspected for bicalutamide; 2251 AEs were related to prostate cancer. The analysis demonstrated 29 signals for flutamide and 84 for bicalutamide. Liver function test was the most common AEs for flutamide, and malignant neoplasm progression was the most common for bicalutamide. The signal strength of Dementia Alzheimer's type was 26.53 (17.89-39.35) and 26.33 (607.34), which had the highest strength for flutamide. Anti-androgen withdrawal syndrome exhibited the strongest signal for bicalutamide. Generating awareness of rare AEs that were not listed on the label is critical. CONCLUSIONS The analysis of the AE signals may provide support for prescribing flutamide and bicalutamide.
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Affiliation(s)
- Yu Sun
- Department of Pharmacy, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Tao Xu
- Department of Pharmacy, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Suyan Zhu
- Department of Pharmacy, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Hongbin Xu
- Department of Pharmacy, The First Affiliated Hospital of Ningbo University, Ningbo, China
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3
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Jiang C, Qian J, Jiang X, Zhang S, Zheng J, Wang H. Is pitolisant safe for clinical use? A retrospective pharmacovigilance study focus on the post-marketing safety. Pharmacol Res Perspect 2024; 12:e1161. [PMID: 38174838 PMCID: PMC10765455 DOI: 10.1002/prp2.1161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/27/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024] Open
Abstract
Pitolisant, a novel histamine H3-receptor antagonist, holds significant promise for treating narcolepsy. However, a petition, which highlighted that pitolisant was associated with deaths during clinical trials, has propelled it into the spotlight of widespread societal attention on April 3, 2023. Till now, the clinical safety of pitolisant remains a heatedly debated topic. This study aimed to offer a comprehensive assessment of the safety profile of pitolisant in real-world clinical settings. Adverse event reports where pitolisant was the primary suspect drug were extracted from the FDA Adverse Event Reporting System database. The clinical characteristics and concomitant drugs of the pitolisant-associated adverse events were analyzed. The potential adverse event signals of pitolisant were explored using four disproportionality analysis methods. Furthermore, the difference in pitolisant-associated adverse event signals was investigated concerning sex, age, weight, and dose. A total of 526 reports and 1695 adverse events with pitolisant as the primary suspected drug were identified. The most significant adverse event signals were generally mild and of short duration. The concomitant drugs of pitolisant were highly intricate, mainly included drugs for treating narcolepsy as well as antidepressants. Seven new significant adverse event signals emerged. The safety profile of pitolisant exhibited no significant differences across age and dose groups, although slight variations were observed in relation to sex and weight. The findings from reports of death and life-threatening outcomes underscore the importance of enhanced monitoring for cardiac and respiratory adverse reactions when utilizing pitolisant. This study provided a broader understanding of the safety profile of pitolisant.
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Affiliation(s)
- Cheng Jiang
- Zhejiang Academy of Traditional Chinese Medicine, Tongde Hospital of Zhejiang ProvinceHangzhouZhejiangChina
- Hangzhou Medical CollegeHangzhouZhejiangChina
| | - Jiancheng Qian
- Zhejiang Academy of Traditional Chinese Medicine, Tongde Hospital of Zhejiang ProvinceHangzhouZhejiangChina
| | - Xin Jiang
- Wenling Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical UniversityWenlingZhejiangChina
| | | | - Junxian Zheng
- Zhejiang Academy of Traditional Chinese Medicine, Tongde Hospital of Zhejiang ProvinceHangzhouZhejiangChina
| | - Hongwei Wang
- Zhejiang Academy of Traditional Chinese Medicine, Tongde Hospital of Zhejiang ProvinceHangzhouZhejiangChina
- Hangzhou Medical CollegeHangzhouZhejiangChina
- Department of Anesthesiology, Tongde Hospital of Zhejiang ProvinceHangzhouZhejiangChina
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Watanabe H, Hirai K, Nakazawa Y, Koike A, Tsuchiya H, Naito T. Effect of Enoxaparin and Daikenchuto Coadministration on Hepatic Disorder Markers in Gynecological Cancer Patients after Abdominal Surgery. Biol Pharm Bull 2024; 47:758-763. [PMID: 38569843 DOI: 10.1248/bpb.b24-00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Enoxaparin and daikenchuto are commonly administered to prevent venous thromboembolism and intestinal obstruction after gynecological malignancy surgery. However, the effects of their combined use on hepatic function are not well studied. This study aimed to clarify the effects of the coadministration of enoxaparin and daikenchuto on hepatic function. First, Japanese Adverse Drug Event Report (JADER) data were analyzed to identify signals of hepatic disorders. Second, a retrospective observational study of patients who underwent surgery for gynecological malignancies was conducted. This study defined hepatic disorders as an increase in aspartate aminotransferase (AST) or alanine aminotransaminase (ALT) levels above the reference values, using 1-h postoperative values as the baseline. The analysis of JADER data revealed an increased risk for hepatic disorders with the coadministration of enoxaparin and daikenchuto. An observational study also showed higher odds ratios (95% confidence intervals) for the occurrence of hepatic disorders in the coadministration group (4.27; 2.11-8.64) and enoxaparin alone group (2.48; 1.31-4.69) than in the daikenchuto alone group. The median increase in the ALT level was also higher in the coadministration group (34; 15-59) than in the enoxaparin alone (19; 6-38) and daikenchuto alone groups (8; 3-33). In conclusion, our study suggests that compared with the use of enoxaparin or daikenchuto alone, enoxaparin and daikenchuto coadministration increases the risk of hepatic disorders, with more significant increases in AST and ALT levels. Healthcare workers need to be aware of these potential side effects when combining these drugs after surgery for gynecological malignancies.
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Affiliation(s)
| | - Keita Hirai
- Department of Pharmacy, Shinshu University Hospital
- Department of Clinical Pharmacology and Therapeutics, Shinshu University Graduate School of Medicine
| | | | - Ayaka Koike
- Department of Pharmacy, Shinshu University Hospital
| | | | - Takafumi Naito
- Department of Pharmacy, Shinshu University Hospital
- Department of Clinical Pharmacology and Therapeutics, Shinshu University Graduate School of Medicine
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Chrétien B, Brazo P, Da Silva A, Sassier M, Dolladille C, Lelong-Boulouard V, Alexandre J, Fedrizzi S. Infections associated with clozapine: a pharmacovigilance study using VigiBase ®. Front Pharmacol 2023; 14:1260915. [PMID: 37849735 PMCID: PMC10577313 DOI: 10.3389/fphar.2023.1260915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/06/2023] [Indexed: 10/19/2023] Open
Abstract
Introduction: Clozapine is primarily reserved for treatment-resistant schizophrenia due to safety concerns associated with its use. Infections have been reported with clozapine, which may lead to elevated serum levels of the drug. However, the existing literature on this topic is limited. Therefore, we conducted a study using VigiBase® to investigate the potential over-reporting of infections associated with clozapine, to explore the presence of dose-dependency, and to investigate the underlying mechanism. Methods: Disproportionality analyses were performed using VigiBase to assess the association between clozapine and all types of infections, the association between clozapine-associated infections and neutropenia, the association between clozapine-associated infections and agranulocytosis, the dose-effect relationship between clozapine and infections, and the interaction between clozapine and the main strong CYP450 inhibitors using reports carried out until 11 April 2023. Results: A statistically significant signal of infections was observed with clozapine, as indicated by an information component of 0.43 [95% CI: (0.41-0.45)]. The most commonly reported infections were respiratory and gastrointestinal in nature. Neutropenia showed weaker association with clozapine-associated reports of infections compared to other clozapine-associated reports [X2 (1, N = 204,073) = 454; p < 0.005], while agranulocytosis demonstrated a stronger association with clozapine-associated reports of infections [X2 (1, N = 204,073) = 56; p < 0.005]. No evidence of dose-dependency was observed. Among the 17 tested CYP inhibitors, significant drug-drug interactions were found with clarithromycin, metronidazole, valproic acid, lansoprazole, omeprazole, amiodarone, and esomeprazole. Discussion: Our study revealed a significant safety signal between clozapine use and infections, predominantly respiratory and gastrointestinal infections. The co-administration of clozapine with valproic acid or proton pump inhibitors may potentially contribute to an increased risk of infection. Further vigilance is warranted in clinical practice, and consideration of therapeutic drug monitoring of clozapine in cases involving concomitant use of these drugs or in the presence of infections may be beneficial.
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Affiliation(s)
- Basile Chrétien
- Department of Pharmacology, Caen University Hospital, Caen, France
| | - Perrine Brazo
- Department of Psychiatry, Esquirol Center, Caen University Hospital, Caen, France
- Normandie Université, UNICAEN, EA7466, Imagerie et Stratégies Thérapeutiques de la Schizophrénie (ISTS), Caen, France
| | | | - Marion Sassier
- Department of Pharmacology, Caen University Hospital, Caen, France
| | - Charles Dolladille
- Department of Pharmacology, Caen University Hospital, Caen, France
- Normandy University, UNICAEN, Inserm U1086 Anticipe, Caen, France
| | - Véronique Lelong-Boulouard
- Department of Pharmacology, Caen University Hospital, Caen, France
- Normandy University, UNICAEN, UFR Santé, INSERM UMR 1075, COMETE-MOBILITES “Vieillissement, Pathologie, Santé”, Caen, France
| | - Joachim Alexandre
- Department of Pharmacology, Caen University Hospital, Caen, France
- Normandie Université, UNICAEN, EA7466, Imagerie et Stratégies Thérapeutiques de la Schizophrénie (ISTS), Caen, France
| | - Sophie Fedrizzi
- Department of Pharmacology, Caen University Hospital, Caen, France
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Chrétien B, Decros JB, Suard F, Dolladille C, Fischer MO, Alexandre J, Descamps R. Hypoxia Associated With Dihydropyridine Calcium Channel Inhibitors: A Pharmacovigilance Study in VigiBase. Clin Pharmacol Ther 2023; 114:686-692. [PMID: 37309986 DOI: 10.1002/cpt.2970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023]
Abstract
Due to their negative effects on hypoxic pulmonary vasoconstriction, dihydropyridine calcium channel inhibitors (DCCIs) can lead to hypoxia in patients with a pulmonary shunt. To date, only preclinical studies and case reports have focused on this potential adverse drug reaction. We aimed to assess the reporting association between DCCIs and hypoxia using the World Health Organization pharmacovigilance database (VigiBase). We performed a disproportionality analysis to evaluate the strength of the reporting association between i.v. clevidipine and nicardipine, thought to be a surrogate of patients in the intensive care unit, and hypoxia. The information component and the lower end of its 95% credibility interval were used to evaluate disproportionality. A description of the cases was made. Secondary outcomes included the association between all DCCIs and hypoxia compared with other treatments with similar indications, urapidil and labetalol, regardless of the route of administration. Association between oral nicardipine and hypoxia was also searched. A statistically significant signal of hypoxia was found for intravenous clevidipine and nicardipine. The time to onset was reported with a median of 2 days (interquartile range 1.5-4.5). Four dechallenges were performed with intravenous nicardipine, leading to the resolution of the symptoms. Regardless of the route of administration, a signal of hypoxia was also found for nimodipine but not for other drugs, including comparators. For nicardipine no signal of hypoxia was found with the oral route of administration. Our pharmacovigilance database analysis showed a significant association between the use of intravenous DCCIs and hypoxia.
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Affiliation(s)
- Basile Chrétien
- Department of Pharmacology, Caen University Hospital, Caen, France
| | - Jean Baptiste Decros
- Department of Anesthesiology and Critical Care, Caen University Hospital, Caen, France
| | - Florimond Suard
- Department of Anesthesiology and Critical Care, Caen University Hospital, Caen, France
| | | | | | - Joachim Alexandre
- Department of Pharmacology, Caen University Hospital, Caen, France
- Institut National de la Santé et de la Recherche Médicale U1086 ANTICIPE, UNICAEN, Service de Pharmacologie, Université de Caen-Normandie, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Richard Descamps
- Department of Anesthesiology and Critical Care, Caen University Hospital, Caen, France
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Xue X, Truong B, Qian J. Adverse event reporting of marketed biosimilar and biological monoclonal antibody cancer treatments in the United States. Expert Opin Biol Ther 2023; 23:841-849. [PMID: 36892184 DOI: 10.1080/14712598.2023.2189007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/06/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND By 8 September 2022, 10 biological monoclonal antibody (mAb) biosimilar products for cancer treatment had been approved and marketed in the United States (US). This study examined adverse event (AE) reporting patterns and disproportionate reporting signals for mAb biosimilars in the US compared to their originator biologics. RESEARCH DESIGN AND METHODS The US Food and Drug Adverse Event Reporting System database was used to identify AE reports for biological rituximab, bevacizumab, trastuzumab, and their marketed biosimilars. Proportions of patient age, sex and type of reporters of AEs were described for these reports. Reporting odds ratios (RORs) with 95% confidence intervals were calculated to compare reporting disproportionality in serious, death, and specific AEs between mAb biologics/biosimilars (index) and all other drugs. Breslow-Day statistic was used to determine homogeneity in RORs between each mAb biologic-biosimilar pair at p < 0.05. RESULTS We observed no risk signals of serious or death AE reporting for all three mAb biosimilars. A signal of disproportionate reporting of death was detected between biological and biosimilar bevacizumab (p < 0.05). CONCLUSIONS Our findings support the similarity in signals of disproportionate AE reporting between mAb originator biologics and biosimilars, except for death between biological and biosimilar bevacizumab.
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Affiliation(s)
- Xiangzhong Xue
- Department of Health Outcomes Research and Policy, Auburn University Harrison College of Pharmacy, Auburn, AL, USA
| | - Bang Truong
- Department of Health Outcomes Research and Policy, Auburn University Harrison College of Pharmacy, Auburn, AL, USA
| | - Jingjing Qian
- Department of Health Outcomes Research and Policy, Auburn University Harrison College of Pharmacy, Auburn, AL, USA
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8
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Detecting early safety signals of infliximab using machine learning algorithms in the Korea adverse event reporting system. Sci Rep 2022; 12:14869. [PMID: 36050484 PMCID: PMC9436954 DOI: 10.1038/s41598-022-18522-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/16/2022] [Indexed: 11/26/2022] Open
Abstract
There has been a growing attention on using machine learning (ML) in pharmacovigilance. This study aimed to investigate the utility of supervised ML algorithms on timely detection of safety signals in the Korea Adverse Event Reporting System (KAERS), using infliximab as a case drug, between 2009 and 2018. Input data set for ML training was constructed based on the drug label information and spontaneous reports in the KAERS. Gold standard dataset containing known AEs was randomly divided into the training and test sets. Two supervised ML algorithms (gradient boosting machine [GBM], random forest [RF]) were fitted with hyperparameters tuned on the training set by using a fivefold validation. Then, we stratified the KAERS data by calendar year to create 10 cumulative yearly datasets, in which ML algorithms were applied to detect five pre-specified AEs of infliximab identified during post-marketing surveillance. Four AEs were detected by both GBM and RF in the first year they appeared in the KAERS and earlier than they were updated in the drug label of infliximab. We further applied our models to data retrieved from the US Food and Drug Administration Adverse Event Reporting System repository and found that they outperformed existing disproportionality methods. Both GBM and RF demonstrated reliable performance in detecting early safety signals and showed promise for applying such approaches to pharmacovigilance.
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9
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De Wit LE, Wilting I, Souverein PC, van der Pol P, Egberts TCG. Impulse control disorders associated with dopaminergic drugs: A disproportionality analysis using vigibase. Eur Neuropsychopharmacol 2022; 58:30-38. [PMID: 35189453 DOI: 10.1016/j.euroneuro.2022.01.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Dopamine receptor agonist drugs, which are used, for example, to treat Parkinson's disease (PD), increase the risk for impulse control disorders (ICDs), potentially resulting in devastating psychosocial consequences. It is unknown whether other drugs with dopaminergic properties also increase the risk for ICDs. This study assesses the disproportionality of reporting ICDs between drugs with dopaminergic properties and selected non-dopaminergic drugs. METHODS A case/non-case disproportionality analysis was performed, using data from VigiBase (1968-2020). Reports on ICDs as suspected adverse drug reactions (ADRs) were cases (n=852), and those with ADRs other than ICDs were non-cases (n=281,720). Relative reporting frequencies were expressed as adjusted reporting odds ratios (aRORs). Within the dopamine receptor agonists, the relationship between reporting odds ratios and dopamine receptor occupancy was explored. RESULTS A high disproportionality was found for reporting ICDs for all dopaminergic drugs (aROR 20.4 [95% CI 17.4-24.1]) compared to non-dopaminergic drugs. In pharmacotherapeutic subgroups, a high disproportionality was found for primary dopaminergic agents used in PD (aROR 52.1 [95% CI 44.1-61.5]), and to a lesser extent for ADHD psychostimulants and antidepressants (aROR 5.8 [95% 4.1-8.3] and aROR 3.9 [95% CI 2.9-5.6], respectively). There was no difference in reporting by consumers and healthcare professionals. The highest disproportionality was found for the dopamine receptor agonists pramipexole and ropinirole. CONCLUSIONS A signal of disproportion in ICD occurrence was found among all investigated drugs with dopaminergic properties, highlighting the importance of counselling and monitoring for ICDs when prescribing dopaminergic drugs.
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Affiliation(s)
- Laura E De Wit
- Dept. of Psychiatry, University Medical Center Utrecht, the Netherlands; Dept. of Psychiatry, Sint Antonius Hospital, Utrecht, the Netherlands.
| | - Ingeborg Wilting
- Dept. of Clinical Pharmacy, University Medical Center Utrecht, the Netherlands
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Siences, Utrecht University, the Netherlands
| | | | - Toine C G Egberts
- Dept. of Clinical Pharmacy, University Medical Center Utrecht, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Siences, Utrecht University, the Netherlands
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10
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Wabont G, Ferret L, Houdre N, Lepied A, Bene J, Cousein E. Escitalopram-induced hepatitis: A case report. World J Clin Cases 2022; 10:2468-2473. [PMID: 35434055 PMCID: PMC8968601 DOI: 10.12998/wjcc.v10.i8.2468] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/23/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The antidepressant escitalopram is widely prescribed for the treatment of depression. It is generally well-tolerated, and cholestasis is not mentioned in its summary of product characteristics (SmPC). We present a case of cholestatic and cytolysis liver injury due to escitalopram and a VigiBase® study.
CASE SUMMARY A 68-year-old man was admitted to our emergency unit due to clinical jaundice associated with hepatitis, pruritus and dark urine. We tested the patient for the most common etiologies of jaundice, including hemolysis, viral hepatitis, cirrhosis, carcinoma, cholangitis, cholelithiasis and intrahepatic or extrahepatic obstruction. The etiological study was negative, and an adverse drug reaction was the sole possible explanation. The patient was receiving treatment with escitalopram. Two days after its withdrawal, pruritus was resolved. Ten days after withdrawal, clinical jaundice disappeared. It took a month and three weeks after withdrawal for the patient to have normalized liver function tests. To our knowledge, this is the first reported case of cholestasis where treatment with escitalopram was the only possible cause, with a highly probable causality. In addition, we determined whether escitalopram is associated with hepatotoxicity and cholestasis by performing a disproportionality analysis. All cases of hepatobiliary disorders induced by escitalopram and reported in the World Health Organization pharmacovigilance database (VigiBase®) were analyzed to characterize this toxicity. We found that patients treated with escitalopram had an increased risk of hepatitis [odds ratio (OR) = 1.938(1.186-3.166)] and cholestasis [OR = 1.866(1.279-2.724)] [OR (95% confidence interval)]. The median duration between the introduction of escitalopram and the occurrence of acute hepatitis and/or cholestasis was ten days +/- seven days.
CONCLUSION Although extremely rare, this case report, the review of the literature and the pharmacovigilance update confirm that escitalopram can cause drug-induced hepatotoxicity and cholestasis, generally within a week after initiation. Thus, escitalopram should be withdrawn immediately if an iatrogenic cause cannot be excluded. If its responsibility is ascertained, escitalopram should be consequently contraindicated. In addition, serotoninergic antidepressants in patients with non-severe depression are ineffective and harmful. Finally, the SmPC of escitalopram should be updated to alert for this risk and give clear clinical guidelines.
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Affiliation(s)
- Guillaume Wabont
- Department of Pharmacy, Valenciennes Hospital, Valenciennes 59300, France
| | - Laurie Ferret
- Department of Pharmacy, Valenciennes Hospital, Valenciennes 59300, France
| | - Nicolas Houdre
- Department of Emergency Medicine, Valenciennes Hospital, Valenciennes 59300, France
| | - Antoine Lepied
- Department of Psychiatry, Valenciennes Hospital, Valenciennes 59300, France
| | - Johana Bene
- Department of Pharmacology, Lille University Hospital, Lille 59000, France
| | - Etienne Cousein
- Department of Pharmacy, Valenciennes Hospital, Valenciennes 59300, France
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11
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Matsuo J, Yamaori S. Detecting drug-drug interactions that increase the incidence of long QT syndrome using a spontaneous reporting system. J Clin Pharm Ther 2021; 47:70-80. [PMID: 34664726 DOI: 10.1111/jcpt.13539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/07/2021] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Drug-induced long QT syndrome (diLQTS) is a rare but serious adverse drug reaction. Drug-drug interaction (DDI) is one of the risk factors for the development of diLQTS. However, the combinations of drugs that increase the risk of diLQTS have not been extensively investigated. This study was performed to analyse the potential DDIs that elevate the incidence of diLQTS using a spontaneous reporting system. METHODS The Japanese Adverse Drug Event Report database from April 2004 to January 2020 was used to assess adverse event reports. We calculated the reporting odds ratio and 95% confidence interval for signal detection. RESULTS AND DISCUSSION Signals for concomitant use risk were detected in 31 drug combinations. Combinations of antipsychotics and antidepressants were the most common (olanzapine & fluvoxamine, olanzapine & trazodone, quetiapine & paroxetine, sulpiride & fluvoxamine, sulpiride & trazodone). Sixteen, 17 and 21 combinations were designated as requiring precaution for concomitant use in at least one of the package inserts in Japan, the United States and the United Kingdom, respectively, although no such precautions were described for the remaining combinations. On the contrary, a combination of bepridil & clarithromycin was categorized as "X (avoid combination)" and two combinations (chlorpromazine & haloperidol, amiodarone & metildigoxin) were classified as "D (modify regimen)" in the Lexicomp® risk rating. WHAT IS NEW AND CONCLUSION This study identified 31 combinations of drugs that may elevate the risk of diLQTS. The use of these drug combinations should be monitored more carefully in future.
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Affiliation(s)
- Jun Matsuo
- Department of Pharmacy, Shinshu University Hospital, Matsumoto, Japan.,Department of Biochemical Pharmacology and Toxicology, Graduate School of Medicine, Shinshu University, Matsumoto, Japan
| | - Satoshi Yamaori
- Department of Pharmacy, Shinshu University Hospital, Matsumoto, Japan.,Department of Biochemical Pharmacology and Toxicology, Graduate School of Medicine, Shinshu University, Matsumoto, Japan
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Shin H, Kim N, Cha J, Kim GJ, Kim JH, Kim JY, Lee S. Geriatrics on beers criteria medications at risk of adverse drug events using real-world data. Int J Med Inform 2021; 154:104542. [PMID: 34411951 DOI: 10.1016/j.ijmedinf.2021.104542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/31/2021] [Accepted: 06/17/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The established Beers Criteria consider side effects and safety concerns when prescribing drugs to the elderly. As the criteria suggest that attention should be paid toward prescriptions rather than prescription prohibition lists, these Beers Criteria medications (BCMs) are used appropriately under unavoidable circumstances. METHODS Patients aged ≥ 65 years and with an experience of being prescribed inappropriate medications at Konyang University Hospital, South Korea, were selected. We analyzed data from the Korea Adverse Event Reporting System (KAERS) and the Food and Drug Administration Adverse Event Reporting System (FAERS) of the United States to identify medication-induced adverse drug events (ADEs). The actual incidence was predicted by multiplying the incidence and number of BCMs prescribed to the patients. The proportional reporting ratio (PRR) and reporting odds ratio (ROR) were calculated using KAERS and FAERS data. RESULTS We predicted that the incidence of ADEs would be higher for metoclopramide, chlorpheniramine, and amitriptyline in patients using medications for more than 1 day and metoclopramide, chlorpheniramine, and ketoprofen in patients using medications only for 1 day. Among the ADEs reported to KAERS and FAERS, significant ROR and PRR values were noted for clonazepam (drowsiness), nortriptyline (sleepiness), and zolpidem (amnesia, somnambulism, agitation, dependence, nightmare, and dysgeusia). CONCLUSION This study highlighted the actual status of BCM prescriptions in clinical institutions and predicted the incidence of ADEs. We concluded that greater care must be taken while prescribing BCMs to the elderly and indicators, such as PRR and ROR should be monitored regularly.
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Affiliation(s)
- Hyunah Shin
- Health Care Data Science Center, Konyang University Hospital, Daejeon, Republic of Korea
| | - Nanyeong Kim
- Departments of Biomedical Informatics, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Jaehun Cha
- Health Care Data Science Center, Konyang University Hospital, Daejeon, Republic of Korea
| | - Grace Juyun Kim
- Seoul National University Biomedical Informatics (SNUBI), Division of Biomedical Informatics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ju Han Kim
- Seoul National University Biomedical Informatics (SNUBI), Division of Biomedical Informatics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong-Yeup Kim
- Health Care Data Science Center, Konyang University Hospital, Daejeon, Republic of Korea; Departments of Biomedical Informatics, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Suehyun Lee
- Health Care Data Science Center, Konyang University Hospital, Daejeon, Republic of Korea; Departments of Biomedical Informatics, Konyang University College of Medicine, Daejeon, Republic of Korea.
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13
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[Antidepressive agents and hypertension: A case/no-case study in French pharmacovigilance database]. Encephale 2021; 48:404-408. [PMID: 34311965 DOI: 10.1016/j.encep.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 04/16/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Drug-induced hypertension was described with several pharmacological classes. The association between hypertension and antidepressant drugs (AD) is controversial. The objective of this study was to evaluate the link between hypertension and ADs. MATERIALS AND METHODS A retrospective disproportionality analysis from observations consecutively reported to the French pharmacovigilance database between 1985 and 2020 was performed. The relationship between the suspected ADs and the occurrence of hypertension was assessed by calculating the reporting odds ratio (ROR) in a case/non-case design. A negative (paracetamol) and a positive (celecoxib) control were used to validated this disproportionality method. RESULTS We compared 6725 cases (including 464 AD-related cases) to 789,483 non-cases (including 56,440 AD-related cases). The reporting of hypertension was significantly associated with serotonin/norepinephrine reuptake inhibitors (SNRI) (ROR 1.43, 95 % CI 1.26-1.64) and monoamine oxidase inhibitors (MAOI) (ROR 6.41, 95 % CI 4.25-9.67) but not with other ADs classes. Concerning ADs analyzed independently of their AD class, a significant signal was observed with many SNRIs (duloxetin, milnacipran and venlafaxin) and with all MAOIs (moclobemide, iproniazide) (ROR between 2.04 and 17.93) but not with others ADs. The ROR value of positive (celecoxib) and negative (paracetamol) controls were ROR=1.53; IC95 %=1.04-2.26 and ROR=0.72; IC95 %=0.65-0.80, respectively. CONCLUSION We found a significant association between development or worsening of hypertension and SNRIs and MAOIs but not with others ADs, in this study performed in real conditions of life. It is therefore advisable to remain cautious when prescribing ADs and to check systematically for hypertension.
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14
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Shukla S, Rastogi S, Abdi SAH, Dhamija P, Kumar V, Kalaiselvan V, Medhi B. Severe cutaneous adverse reactions in Asians: Trends observed in culprit anti-seizure medicines using VigiBase®. Seizure 2021; 91:332-338. [PMID: 34274893 DOI: 10.1016/j.seizure.2021.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Diverse ethnic genetic populations display variability in the risk regarding anti-seizure medicine (ASM)-induced severe cutaneous adverse reactions (SCARs). However, clinical and epidemiological data on ASM-induced SCARs in Asians is limited. METHODS We conducted a retrospective, post-market study until April 30, 2020 using VigiBase® for demographic characteristics, causative ASMs, complications and mortality. The study included adverse events as classified by Standardized Medical Dictionary for Regulatory Activities (MedDRA) queries of SCARs, mainly Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug rash with eosinophilia and systemic symptoms (DRESS), and SJS/TEN overlap reported for ASMs. RESULTS A total of 694,811 adverse events were reported across the world while using ASMs. Of this, skin and subcutaneous tissue adverse events were 122,885 (17.6%). Among ASM-induced skin and subcutaneous tissue adverse events, SJS, TEN, DRESS and SJS/TEN overlap represented 11,181 (9.1%), 3,645 (3.0%), 5,106 (4.1%) and 6 (0.004%) cases, respectively. Female SJS/TEN/DRESS patients were 54.1%, and 75% of them were adults (>18Y). Nearly 64% of the ASM-induced SCARs were serious and culminated in death (3.5%), life-threatening conditions (11.5%), and hospitalization/prolonged hospitalization (43.5%) of patients on ASM therapy. Carbamazepine (31.6%), phenytoin (29.6%), lamotrigine (24.3%), valproic acid (6.4%) and phenobarbital (5.7%) are the most commonly used ASMs linked with SCARs. ASMs associated with significantly higher risk of SCARs in Asians were carbamazepine [n = 3265, ROR 3.55 (95% CI 3.38-3.72, P < 0.0001)], lamotrigine [n = 1253, ROR 3.90 (95% CI 3.63-4.18, P < 0.0001)], gabapentin [n = 85, ROR 3.58 (95% CI 2.79-4.60, P < 0.0001)], pregabalin [n = 68, ROR 3.16 (95% CI 2.40-4.16, P < 0.0001)], clonazepam [n = 53, ROR 3.19 (95% CI 2.31-4.41, P < 0.0001)], lorazepam [n = 31, ROR 3.07 (95% CI 2.06-4.59, P < 0.0001)] and acetazolamide [n = 28, ROR 3.90 (95% CI 2.45-6.21, P < 0.0001)]. CONCLUSION Based on our study, carbamazepine, lamotrigine, gabapentin, pregabalin, clonazepam, lorazepam, and acetazolamide are the most common causative ASMs for SCARs in the Asian population.
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Affiliation(s)
- Shatrunajay Shukla
- Indian Pharmacopoeia Commission, Ministry of Health & Family Welfare, Government of India, Sector-23, Raj Nagar, Ghaziabad 201002, Uttar Pradesh, India
| | - Shruti Rastogi
- Indian Pharmacopoeia Commission, Ministry of Health & Family Welfare, Government of India, Sector-23, Raj Nagar, Ghaziabad 201002, Uttar Pradesh, India
| | | | - Puneet Dhamija
- All India Institute of Medical Science, Rishikesh 249203, Uttarakhand, India
| | - Vijay Kumar
- Kovai Medical Centre and Hospital, Coimbatore 641014, Tamilnadu, India
| | - Vivekanandan Kalaiselvan
- Indian Pharmacopoeia Commission, Ministry of Health & Family Welfare, Government of India, Sector-23, Raj Nagar, Ghaziabad 201002, Uttar Pradesh, India.
| | - Bikash Medhi
- Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
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15
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Chrétien B, Lelong-Boulouard V, Chantepie S, Sassier M, Bertho M, Brazo P, Humbert X, Alexandre J, Fedrizzi S, Dolladille C. Haematologic malignancies associated with clozapine v. all other antipsychotic agents: a pharmacovigilance study in VigiBase ®. Psychol Med 2021; 51:1459-1466. [PMID: 32036793 DOI: 10.1017/s0033291720000161] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Clozapine is mainly used in patients with treatment-resistant schizophrenia and may lead to potentially severe haematologic adverse events, such as agranulocytosis. Whether clozapine might be associated with haematologic malignancies is unknown. We aimed to assess the association between haematologic malignancies and clozapine using Vigibase®, the WHO pharmacovigilance database. METHODS We performed a disproportionality analysis to compute reporting odds-ratio adjusted for age, sex and concurrent reporting of antineoplastic/immunomodulating agents (aROR) for clozapine and structurally related drugs (loxapine, olanzapine and quetiapine) compared with other antipsychotic drugs. Cases were malignant lymphoma and leukaemia reports. Non-cases were all other reports including at least one antipsychotic report. RESULTS Of the 140 226 clozapine-associated reports, 493 were malignant lymphoma cases, and 275 were leukaemia cases. Clozapine was significantly associated with malignant lymphoma (aROR 9.14, 95% CI 7.75-10.77) and leukaemia (aROR 3.54, 95% CI 2.97-4.22). Patients suffering from those haematologic malignancies were significantly younger in the clozapine treatment group than patients treated with other medicines (p < 0.001). The median time to onset (available for 212 cases) was 5.1 years (IQR 2.2-9.9) for malignant lymphoma and 2.5 years (IQR 0.6-7.4) for leukaemia. The aROR by quartile of dose of clozapine in patients with haematologic malignancies suggested a dose-dependent association. CONCLUSIONS Clozapine was significantly associated with a pharmacovigilance signal of haematologic malignancies. The risk-benefit balance of clozapine should be carefully assessed in patients with risk factors of haematologic malignancies. Clozapine should be used at the lowest effective posology.
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Affiliation(s)
- Basile Chrétien
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France
- Pharmacovigilance Regional Center, Caen University Hospital, Caen, F-14000, France
| | - Véronique Lelong-Boulouard
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France
- Normandie Univ, UNICAEN, UFR Santé, INSERM UMR 1075, COMETE-MOBILITES "Vieillissement, Pathologie, Santé", 14000Caen, France
| | - Sylvain Chantepie
- Department of Clinical Haematology, Caen University Hospital, Caen, F-14000, France
| | - Marion Sassier
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France
- Pharmacovigilance Regional Center, Caen University Hospital, Caen, F-14000, France
| | - Mickael Bertho
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France
- Pharmacovigilance Regional Center, Caen University Hospital, Caen, F-14000, France
| | - Perrine Brazo
- Department of Psychiatry, Esquirol Center, Caen University Hospital, Caen, F-14000, France
- Normandie Univ, UNICAEN, EA7466, Imagerie et Stratégies Thérapeutiques de la Schizophrénie (ISTS), 14000Caen, France
| | - Xavier Humbert
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France
- Pharmacovigilance Regional Center, Caen University Hospital, Caen, F-14000, France
- General Practice Department, Normandie Univ, UNICAEN, 14000Caen, France
- Normandie Univ, UNICAEN, EA4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000Caen, France
| | - Joachim Alexandre
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France
- Pharmacovigilance Regional Center, Caen University Hospital, Caen, F-14000, France
- Normandie Univ, UNICAEN, EA4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000Caen, France
| | - Sophie Fedrizzi
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France
- Pharmacovigilance Regional Center, Caen University Hospital, Caen, F-14000, France
- Normandie Univ, UNICAEN, EA4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000Caen, France
| | - Charles Dolladille
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France
- Normandie Univ, UNICAEN, EA4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000Caen, France
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16
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Cardiovascular Safety Profile of Romosozumab: A Pharmacovigilance Analysis of the US Food and Drug Administration Adverse Event Reporting System (FAERS). J Clin Med 2021; 10:jcm10081660. [PMID: 33924496 PMCID: PMC8070537 DOI: 10.3390/jcm10081660] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/04/2021] [Accepted: 04/06/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Cardiovascular safety concerns for major cardiovascular events (MACE) were raised during the clinical trials of romosozumab. We aimed to evaluate the cardiovascular safety profile of romosozumab in a large pharmacovigilance database. Methods: All cases reported between January 2019 and December 2020 where romosozumab was reported were extracted from the Food and Drug Administration Adverse Event Reporting System (FAERS). The outcome of interest was MACE (myocardial infarction (MI), stroke, or cardiovascular death). A disproportionality analysis was conducted by estimating the reporting odds ratios (RORs) and 95% confidence intervals. Disproportionality analyses were stratified by sex and reporting region (US, Japan, other). Results: Of the 1995 eligible cases with romosozumab, the majority (N = 1188; 59.5%) originated from Japan. Overall, 206 suspected MACE reports were identified, of which the majority (n = 164; 13.8%) were from Japan, and 41 (5.2%) were from the United States (US). Among Japanese reports, patients were older and more frequently male than reports from the US. Similarly, cases with a reported MACE were older and had higher reports of cardioprotective drugs than those without cardiovascular events. Elevated reports for MACE (ROR 4.07, 95% CI: 2.39–6.93) was identified overall, which was primarily driven by the significant disproportionality measures in the Japanese reports. Conclusions: The current pharmacovigilance study identified a potential signal for elevated MACE, particularly in Japan. The results support the current safety warnings from the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) to avoid use in high-risk patients.
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17
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Petitpain N, D'Amico F, Yelehe-Okouma M, Jouzeau JY, Netter P, Peyrin-Biroulet L, Gillet P. IL-17 Inhibitors and Inflammatory Bowel Diseases: A Postmarketing Study in Vigibase. Clin Pharmacol Ther 2021; 110:159-168. [PMID: 33411953 DOI: 10.1002/cpt.2155] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/09/2020] [Indexed: 12/16/2022]
Abstract
Several gastrointestinal symptoms and chronic inflammatory bowel diseases (IBDs) have been reported after therapy with IL-17 inhibitors. To date, however, no study has shown a clear association between these drugs and IBD onset. We searched on Vigibase, the worldwide pharmacovigilance database, to investigate reporting prevalence, characteristics, and prognosis of all gastroenterological adverse events in patients treated with IL-17 inhibitors. In total, 1,129 gastrointestinal Individual Case Safety Reports (ICSRs) were identified, including 850 IBD (42.5% Crohn's disease, 31.9% ulcerative colitis, and 25.6% undifferentiated IBD) and 279 colitis (mainly undifferentiated colitis (79.2%), and microscopic colitis (10.4%)). ICSRs were associated with secukinumab (SEC, 83.6%) or ixekizumab (IXE, 16.3%), whereas only one colitis occurred with brodalumab (0.1%). Most IBD and colitis cases were detected within 6 months from therapy start in both the SEC (68.8% and 73.5%) and IXE groups (100% and 66.7%). Patients' outcomes were reported in 428 ICSRs (37.9%). Complete or ongoing recovery from symptoms was detected in about two-thirds of patients experiencing IBD (59.5%) or colitis (64.2%), whereas in the other cases, there was no recovery (33.9% and 29.5%) or there were sequelae (5.4% and 4.2%). Fatal events occurred in four patients (1.2%) in the IBD group (3 after SEC and on1e with IXE) and two SEC-treated subjects in the colitis group (2.1%). Treatment with IL-17 inhibitors is associated with a relevant number of exacerbations and new onset of IBD and colitis. Careful evaluation of gastrointestinal symptoms and the monitoring of intestinal inflammatory biomarkers should be recommended before prescribing these drugs.
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Affiliation(s)
- Nadine Petitpain
- Regional Centre of Pharmacovigilance, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Ferdinando D'Amico
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Melissa Yelehe-Okouma
- Regional Centre of Pharmacovigilance, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Jean-Yves Jouzeau
- Department of Clinical Pharmacology and Toxicology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France.,Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, University of Lorraine and University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Patrick Netter
- Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, University of Lorraine and University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Pierre Gillet
- Regional Centre of Pharmacovigilance, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France.,Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, University of Lorraine and University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
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18
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Gérard AO, Laurain A, Fresse A, Parassol N, Muzzone M, Rocher F, Esnault VLM, Drici MD. Remdesivir and Acute Renal Failure: A Potential Safety Signal From Disproportionality Analysis of the WHO Safety Database. Clin Pharmacol Ther 2021; 109:1021-1024. [PMID: 33340409 DOI: 10.1002/cpt.2145] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/15/2020] [Indexed: 12/21/2022]
Abstract
Remdesivir is approved for emergency use by the US Food and Drug Administration (FDA) and authorized conditionally by the European Medicines Agency (EMA) for patients with coronavirus disease 2019 (COVID-19). Its benefit-risk ratio is still being explored because data in the field are rather scant. A decrease of the creatinine clearance associated with remdesivir has been inconstantly reported in clinical trials with unclear relevance. Despite these uncertainties, we searched for a potential signal of acute renal failure (ARF) in pharmacovigilance postmarketing data. An analysis of the international pharmacovigilance postmarketing databases (VigiBase) of the World Health Organization (WHO) was performed, using two disproportionality methods. Reporting odds ratio (ROR) compared the number of ARF cases reported with remdesivir, with those reported with other drugs prescribed in comparable situations of COVID-19 (hydroxychloroquine, tocilizumab, and lopinavir/ritonavir). The combination of the terms "acute renal failure" and "remdesivir" yielded a statistically significant disproportionality signal with 138 observed cases instead of the 9 expected. ROR of ARF with remdesivir was 20-fold (20.3; confidence interval 0.95 [15.7-26.3], P < 0.0001]) that of comparative drugs. Based on ARF cases reported in VigiBase, and despite the caveats inherent to COVID-19 circumstances, we detected a statistically significant pharmacovigilance signal of nephrotoxicity associated with remdesivir, deserving a thorough qualitative assessment of all available data. Meanwhile, as recommended in its Summary of Product Characteristics, assessment of patients with COVID-19 renal function should prevail before and during treatment with remdesivir in COVID-19.
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Affiliation(s)
- Alexandre O Gérard
- Department of Nephrology-Dialysis-Transplantation, Centre Hospitalier Universitaire de Nice, Nice Cedex, France.,Department of Pharmacology and Pharmacovigilance, Centre Hospitalier Universitaire de Nice, Nice Cedex, France
| | - Audrey Laurain
- Department of Nephrology-Dialysis-Transplantation, Centre Hospitalier Universitaire de Nice, Nice Cedex, France
| | - Audrey Fresse
- Department of Pharmacology and Pharmacovigilance, Centre Hospitalier Universitaire de Nice, Nice Cedex, France
| | - Nadège Parassol
- Department of Pharmacology and Pharmacovigilance, Centre Hospitalier Universitaire de Nice, Nice Cedex, France
| | - Marine Muzzone
- Department of Pharmacology and Pharmacovigilance, Centre Hospitalier Universitaire de Nice, Nice Cedex, France
| | - Fanny Rocher
- Department of Pharmacology and Pharmacovigilance, Centre Hospitalier Universitaire de Nice, Nice Cedex, France
| | - Vincent L M Esnault
- Department of Nephrology-Dialysis-Transplantation, Centre Hospitalier Universitaire de Nice, Nice Cedex, France
| | - Milou-Daniel Drici
- Department of Pharmacology and Pharmacovigilance, Centre Hospitalier Universitaire de Nice, Nice Cedex, France
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19
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Tanni KA, Truong CB, Almahasis S, Qian J. Safety of Marketed Cancer Supportive Care Biosimilars in the US: A Disproportionality Analysis Using the Food and Drug Administration Adverse Event Reporting System (FAERS) Database. BioDrugs 2021; 35:239-254. [PMID: 33439472 DOI: 10.1007/s40259-020-00466-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Since the approval and availability of the first biosimilar in 2015 in the United States (US), evidence regarding the post-marketing safety of cancer supportive care biosimilars remains limited. OBJECTIVE The aim was to explore the adverse event (AE) reporting patterns and detect disproportionate reporting signals for cancer supportive care biosimilars in the US compared to their originator biologics. METHODS The US Food and Drug Administration Adverse Event Reporting System database (January 1, 2004-March 31, 2020) was used to identify AE reports for filgrastim, pegfilgrastim, and epoetin alpha by type of product (originator biologics vs. biosimilars) and report characteristics. Plots of AE reports against years were used to reveal the reporting patterns. Disproportionality analyses using reporting odds ratios (RORs) were conducted to detect differences in serious and specific AEs between studied drugs and all other drugs. Breslow-Day tests were used to determine homogeneity between the originator biologic-biosimilar pair RORs for the same AE. RESULTS Total numbers of AEs for all studied biosimilars increased after marketing. More AE reports were from female patients for all of the studied drugs. More AEs for originator biologics and filgrastim biosimilar were reported by health professionals, while the highest proportion of reports came from consumers for pegfilgrastim and epoetin alpha biosimilars (29% and 44.1%, respectively). Signals of disproportionate reporting in serious AEs were detected for a pegfilgrastim biosimilar (Fulphila®) compared to its originator biologic. CONCLUSION Our findings support the similarity in the signals of disproportionate reporting between cancer supportive care originator biologics and biosimilars, except for Fulphila®.
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Affiliation(s)
- Kaniz Afroz Tanni
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, AL, USA
| | - Cong Bang Truong
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, AL, USA
| | - Sura Almahasis
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, AL, USA
| | - Jingjing Qian
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, AL, USA.
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Chrétien B, Jourdan JP, Davis A, Fedrizzi S, Bureau R, Sassier M, Rochais C, Alexandre J, Lelong-Boulouard V, Dolladille C, Dallemagne P. Disproportionality analysis in VigiBase as a drug repositioning method for the discovery of potentially useful drugs in Alzheimer's disease. Br J Clin Pharmacol 2020; 87:2830-2837. [PMID: 33274491 DOI: 10.1111/bcp.14690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/09/2020] [Accepted: 11/28/2020] [Indexed: 12/12/2022] Open
Abstract
Drug repositioning aims to propose new indications for marketed drugs. Although several methods exist, the utility of pharmacovigilance databases for this purpose is unclear. We conducted a disproportionality analysis in the World Health Organization pharmacovigilance database VigiBase to identify potential anticholinesterase drug candidates for repositioning in Alzheimer's disease (AD). METHODS Disproportionality analysis is a validated method for detecting significant associations between drugs and adverse events (AEs) in pharmacovigilance databases. We applied this approach in VigiBase to establish the safety profile displayed by the anticholinesterase drugs used in AD and searched the database for drugs with similar safety profiles. The detected drugs with potential activity against acetylcholinesterase and butyrylcholinesterases (BuChEs) were then evaluated to confirm their anticholinesterase potential. RESULTS We identified 22 drugs with safety profiles similar to AD medicines. Among these drugs, 4 (clozapine, aripiprazole, sertraline and S-duloxetine) showed a human BuChE inhibition rate of over 70% at 10-5 M. Their human BuChE half maximal inhibitory concentration values were compatible with clinical anticholinesterase action in humans at their normal doses. The most active human BuChE inhibitor in our study was S-duloxetine, with a half maximal inhibitory concentration of 1.2 μM. Combined with its ability to inhibit serotonin (5-HT) reuptake, the use of this drug could represent a novel multitarget directed ligand therapeutic strategy for AD. CONCLUSION We identified 4 drugs with repositioning potential in AD using drug safety profiles derived from a pharmacovigilance database. This method could be useful for future drug repositioning efforts.
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Affiliation(s)
- Basile Chrétien
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France.,Pharmacovigilance Regional Center, Caen University Hospital, Caen, F-14000, France
| | - Jean-Pierre Jourdan
- Department of Pharmacy, Caen University Hospital, Caen, F-14000, France.,Centre d'Etudes et de Recherche sur le Médicament de Normandie (CERMN), Normandie Univ, UNICAEN, Caen, F-14000, France
| | - Audrey Davis
- Centre d'Etudes et de Recherche sur le Médicament de Normandie (CERMN), Normandie Univ, UNICAEN, Caen, F-14000, France
| | - Sophie Fedrizzi
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France.,Pharmacovigilance Regional Center, Caen University Hospital, Caen, F-14000, France
| | - Ronan Bureau
- Centre d'Etudes et de Recherche sur le Médicament de Normandie (CERMN), Normandie Univ, UNICAEN, Caen, F-14000, France
| | - Marion Sassier
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France.,Pharmacovigilance Regional Center, Caen University Hospital, Caen, F-14000, France
| | - Christophe Rochais
- Centre d'Etudes et de Recherche sur le Médicament de Normandie (CERMN), Normandie Univ, UNICAEN, Caen, F-14000, France
| | - Joachim Alexandre
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France.,Pharmacovigilance Regional Center, Caen University Hospital, Caen, F-14000, France.,EA4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Normandie Univ, UNICAEN, Caen, 14000, France
| | - Véronique Lelong-Boulouard
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France.,INSERM UMR 1075, COMETE-MOBILITES "Vieillissement, Pathologie, Santé", Normandie Univ, UNICAEN, Caen, 14000, France
| | - Charles Dolladille
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France.,EA4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Normandie Univ, UNICAEN, Caen, 14000, France
| | - Patrick Dallemagne
- Centre d'Etudes et de Recherche sur le Médicament de Normandie (CERMN), Normandie Univ, UNICAEN, Caen, F-14000, France
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Baek YH, Kim HJ, Bae JH, Lee H, Oh IS, Kim WJ, Shin JY. Benzodiazepine-Related Cognitive Impairment or Dementia: A Signal Detection Study Using a Case/Non-Case Approach. Psychiatry Investig 2020; 17:587-595. [PMID: 32450620 PMCID: PMC7324737 DOI: 10.30773/pi.2019.0275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/17/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The association between benzodiazepine use and the risk of cognitive impairment or dementia has been controversial. Our study aims to detect this association through a case/non-case method using the Korea Institute of Drug Safety & Risk Management-Korea adverse event reporting system database (KIDS-KD) between 2007 and 2016. METHODS Cases were adverse event (AE)-pairs with suspected cognitive impairment or dementia. 10 non-cases were matched to each case on age and sex. Exposure was defined as use of benzodiazepines, including long-, intermediate-, and short-acting benzodiazepine. We conducted multivariable logistic regression analyses to estimate reporting odds ratios (ROR) and 95% confidence intervals (CI). RESULTS Of the 1,086,584 AE-pairs, 887 cases were suspected AE-pairs of cognitive impairment or dementia, and 775,444 non-cases were selected. Benzodiazepine use was associated with increased AE-pairs of cognitive impairment or dementia when assessed using those with certain, probable, and/or possible in causality assessments (ROR=2.69, 95% CI=1.66-4.38). Higher ROR estimates were shown in female (2.33, 1.48-3.67) and in those with polypharmacy (2.20, 1.35-3.57). Dementia safety profiles were inconsistent across individual benzodiazepine components. CONCLUSION These results suggest the potentially increased association between benzodiazepine use and cognitive impairment or dementia in female and those with polypharmacy. Inconsistent safety profiles of benzodiazepine components should be further investigated.
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Affiliation(s)
- Yeon-Hee Baek
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Hye-Jun Kim
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Ji-Hwan Bae
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Hyesung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - In-Sun Oh
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Woo Jung Kim
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
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Averitt AJ, Slovis BH, Tariq AA, Vawdrey DK, Perotte AJ. Characterizing non-heroin opioid overdoses using electronic health records. JAMIA Open 2020; 3:77-86. [PMID: 32607490 PMCID: PMC7309230 DOI: 10.1093/jamiaopen/ooz063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/21/2019] [Accepted: 10/30/2019] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION The opioid epidemic is a modern public health emergency. Common interventions to alleviate the opioid epidemic aim to discourage excessive prescription of opioids. However, these methods often take place over large municipal areas (state-level) and may fail to address the diversity that exists within each opioid case (individual-level). An intervention to combat the opioid epidemic that takes place at the individual-level would be preferable. METHODS This research leverages computational tools and methods to characterize the opioid epidemic at the individual-level using the electronic health record data from a large, academic medical center. To better understand the characteristics of patients with opioid use disorder (OUD) we leveraged a self-controlled analysis to compare the healthcare encounters before and after an individual's first overdose event recorded within the data. We further contrast these patients with matched, non-OUD controls to demonstrate the unique qualities of the OUD cohort. RESULTS Our research confirms that the rate of opioid overdoses in our hospital significantly increased between 2006 and 2015 (P < 0.001), at an average rate of 9% per year. We further found that the period just prior to the first overdose is marked by conditions of pain or malignancy, which may suggest that overdose stems from pharmaceutical opioids prescribed for these conditions. CONCLUSIONS Informatics-based methodologies, like those presented here, may play a role in better understanding those individuals who suffer from opioid dependency and overdose, and may lead to future research and interventions that could successfully prevent morbidity and mortality associated with this epidemic.
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Affiliation(s)
- Amelia J Averitt
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Benjamin H Slovis
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Abdul A Tariq
- NewYork-Presbyterian Hospital, The Value Institute, New York, New York, USA
| | - David K Vawdrey
- Geisinger, Steele Institute for Health Innovation, Danville, Pennsylvania, USA
| | - Adler J Perotte
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
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23
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Rastogi S, Shukla S, Sharma AK, Sarwat M, Srivastava P, Katiyar T, Kalaiselvan V, Singh GN. Towards a comprehensive safety understanding of granulocyte-colony stimulating factor biosimilars in treating chemotherapy associated febrile neutropenia: Trends from decades of data. Toxicol Appl Pharmacol 2020; 395:114976. [PMID: 32222375 DOI: 10.1016/j.taap.2020.114976] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 01/05/2023]
Abstract
Filgrastim, a biopharmaceutical listed on WHO model list of essential medicines, was approved in USA in 1991 for patients with non-myeloid malignancies associated with severe neutropenia and fever. Several filgrastim biosimilars have now been approved in USA, Europe and elsewhere since 2008, based on the reference product which has lost patent exclusivity; however their immunogenicity and safety is controversial. We conducted a retrospective, post market study between 1991 and May 2018 using VigiBase®. The study included all adverse events with case reports ≥150. Overall, 11,183 adverse drugs reaction reports were identified during observation period; of which 5764; 51.5% reports concerned to Neupogen®, the originator, and rest consists of Leucostim® (N = 680), Zarzio® (N = 622), Grasin® (N = 545), Nivestim® (N = 359) and Tevagrastim® (N = 152) biosimilars. When compared with the originator, Grasin® was associated with higher reporting of pyrexia (11.5% vs 7.9%, ROR 1.52, IC025 1.12), myalgia (37% vs 2.2%, ROR 25.94, IC025 2.11) and back pain (11.3% vs 4%, ROR 3.09, IC025 2.32). Zarzio® was associated with increased reporting of arthralgia (4.5% vs 2.9%, ROR 1.59, IC025 1.25) and neutropenia (11.4% vs 4%, ROR 2.59, IC025 3.07). Bone pain was reported more often with Nivestim® (14.4% vs 8.3%, ROR 1.87, IC025 5.30). Drug ineffectiveness was reported in cases with Zarzio® (35.9%), Nivestim® (19.4%) and Tevagrastim® (42.2%). Authors observed significant differences among originator and biosimilars in particular to efficacy, adverse events reported and time to onset of occurrences. Large epidemiologic studies are needed to further confirm these finding and provide additional insights.
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Affiliation(s)
- Shruti Rastogi
- Indian Pharmacopoeia Commission, Ministry of Health & Family Welfare, Government of India, Sector-23, Raj Nagar, Ghaziabad 201002, Uttar Pradesh, India
| | - Shatrunajay Shukla
- Indian Pharmacopoeia Commission, Ministry of Health & Family Welfare, Government of India, Sector-23, Raj Nagar, Ghaziabad 201002, Uttar Pradesh, India.
| | - Arvind Kumar Sharma
- Indian Pharmacopoeia Commission, Ministry of Health & Family Welfare, Government of India, Sector-23, Raj Nagar, Ghaziabad 201002, Uttar Pradesh, India
| | - Maryam Sarwat
- Amity Institute of Pharmacy, Amity University, Noida 201313, Uttar Pradesh, India
| | - Pranay Srivastava
- UConn Health, University of Connecticut, Farmington, CT 06032, United States
| | - Tridiv Katiyar
- System Toxicology & Health Risk Assessment Group, CSIR-Indian Institute of Toxicology Research, Lucknow, Uttar Pradesh 226001, India
| | - Vivekanandan Kalaiselvan
- Indian Pharmacopoeia Commission, Ministry of Health & Family Welfare, Government of India, Sector-23, Raj Nagar, Ghaziabad 201002, Uttar Pradesh, India
| | - Gyanendra Nath Singh
- Indian Pharmacopoeia Commission, Ministry of Health & Family Welfare, Government of India, Sector-23, Raj Nagar, Ghaziabad 201002, Uttar Pradesh, India
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Eugene AR. Association of sleep among 30 antidepressants: a population-wide adverse drug reaction study, 2004-2019. PeerJ 2020; 8:e8748. [PMID: 32201646 PMCID: PMC7071824 DOI: 10.7717/peerj.8748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/14/2020] [Indexed: 01/08/2023] Open
Abstract
Background Sleep is one of the most essential processes required to maintain a healthy human life, and patients experiencing psychiatric illness often experience an inability to sleep. The aim of this study is to test the hypothesis that antidepressant compounds with strong binding affinities for the serotonin 5-HT2C receptor, histamine H1 receptors, or norepinephrine transporter (NET) will be associated with the highest odds of somnolence. Methods Post-marketing cases of patient adverse drug reactions were obtained from the United States Food and Drug Administration Adverse Events Reporting System (FAERS) during the reporting window of January 2004 to September 2019. Disproportionality analyses of antidepressants reporting somnolence were calculated using the case/non-case method. The reporting odds-ratios (ROR) and corresponding 95% confidence interval (95% CI) were computed and all computations and graphing conducted in R. Results There were a total of 69,196 reported cases of somnolence out of a total of 7,366,864 cases reported from January 2004 to September 2019. Among the 30 antidepressants assessed, amoxapine (n = 16) reporting odds-ratio (ROR) = 7.1 (95% confidence interval [CI] [4.3–11.7]), atomoxetine (n = 1,079) ROR = 6.6 (95% CI [6.2–7.1]), a compound generally approved for attention deficit hyperactivity disorder (ADHD), and maprotiline (n = 18) ROR = 6.3 (95% CI, 3.9–10.1) were the top three compounds ranked with the highest reporting odds of somnolence. In contrast, vortioxetine (n = 52) ROR = 1.3 (95% CI [1.0–1.8]), milnacipran (n = 58) ROR = 2.1 (95% CI [1.7–2.8]), and bupropion (n = 1,048) ROR = 2.2 (95% CI [2.1–2.4]) are least significantly associated with somnolence. Moreover, levomilnacipran (n = 1) ROR = 0.4 (95% CI [0.1–2.9]) was not associated with somnolence. Conclusion Among the thirty tested antidepressants, consistent with the original hypothesis, amoxepine has strongest 5-HT2C receptor binding affinity and has the highest reporting odds of somnolence. Atomoxetine, ranked second in reporting odds of somnolence overall, binds to the NET with with the strongest binding affinity among the thirty compounds. Mirtazapine, a tetracyclic antidepressant, was ranked 11th in reporting odds of somnolence and had the strongest H1 receptor binding affinity. This study provides an informative ranking of somnolence among thirty antidepressant compounds with an already wide array of clinical indications as well as provides insight into potential drug repurposing in psychopharmacology.
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Affiliation(s)
- Andy R Eugene
- Independent Researcher, Kansas, United States of America.,Independent Neurophysiology Unit, Department of Psychiatry, Medical University of Lublin, Lublin, Poland
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25
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Fluoxetine and Risk of Bleeding in Patients Aged 60 Years and Older Using the Korea Adverse Event Reporting System Database: A Case/Noncase Study. J Clin Psychopharmacol 2020; 39:362-366. [PMID: 31206390 DOI: 10.1097/jcp.0000000000001059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Depression, the leading cause of nonfatal disease burden, has a strong correlation with suicide and affects approximately 7% of the general elderly population. Adverse drug reactions in older patients are particularly important because of reduced drug metabolism, polypharmacy, drug-drug interactions, and drug-disease interactions. Fluoxetine is the first representative selective serotonin reuptake inhibitor but is associated with the possibility of hemorrhage based on its mechanism of action. Serious cases of gastrointestinal bleeding and cerebral hemorrhage have been reported, raising concerns about the safety of this drug. METHODS We detected signals of bleeding risk associated with fluoxetine in an elderly population using the Korea Adverse Event Reporting System database. Reporting odds ratios and 95% confidence intervals (CIs) were calculated. RESULTS A total of 16,517 adverse events related to antidepressants were reported. The reporting odds ratios for fluoxetine were 2.34 (95% CI, 1.03-5.34) for total bleeding, 4.41 (95% CI, 1.60-12.15) for major bleeding, 2.06 (95% CI, 0.28-15.03) for gastrointestinal bleeding, and 6.12 (95% CI, 2.14-22.60) for brain hemorrhage compared with those of all other antidepressants. CONCLUSIONS We detected safety signals with total bleeding, major bleeding, and brain hemorrhage related to fluoxetine. For patients with a high risk of bleeding, such as the elderly population, prescribing antidepressants other than fluoxetine can be considered. The results of this study provide preliminary evidence of a relationship between fluoxetine and hemorrhage but have wide 95% CIs. Further pharmacoepidemiological studies will be needed to confirm the risk of bleeding associated with fluoxetine.
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Reporting Patterns of Sialorrhea Comparing Users of Clozapine to Users of Other Antipsychotics: A Disproportionality Analysis Using VigiBase. J Clin Psychopharmacol 2020; 40:283-286. [PMID: 32332463 PMCID: PMC7188267 DOI: 10.1097/jcp.0000000000001198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Sialorrhea is a non-life-threatening, but potentially invalidating adverse drug reaction (ADR) in patients using clozapine. In light of the very serious ADRs (agranulocytosis and myocarditis), sialorrhea is at risk to be overlooked by health care professionals. In this study, the sialorrhea reporting patterns of clozapine compared with other antipsychotics were assessed by evaluating differences in relative reporting frequency and reporter type. METHODS A case/noncase disproportionality analysis using data from VigiBase (1968-2016) was performed. Reports of antipsychotics with "salivary hypersecretion" as ADR were considered as cases, and those with ADRs other than salivary hypersecretion were defined as noncases. Relative reporting frequencies were expressed as reporting odds ratios (RORs), and multivariate logistic regression was performed with the drug-ADR pair as unit of analysis to estimate RORs with 95% confidence intervals (CIs). RESULTS A total of 1,169,254 drug-ADR pairs from 425,304 unique Individual Case Safety Reports were identified. Sialorrhea was relatively more frequently reported in clozapine (n = 2732 [1.1%]) compared with other antipsychotics (n = 2911 [0.31%]; ROR, 3.60; 95% CI, 3.41-3.79) and was reported relatively more often by consumers (ROR, 19.8; 95% CI, 15.1-25.9) compared with health care professionals (ROR, 2.44; 95% CI, 2.27-2.63). CONCLUSIONS Sialorrhea was reported almost 4 times more often with clozapine use than with other antipsychotic use and was reported 8 times more often by patients than by health care professionals. This provides a signal of disproportion in sialorrhea occurrence among clozapine compared with other antipsychotics and in light of the disproportionality between reporter and an underreporting by health care professionals, underlining the importance to incorporate sialorrhea into the shared decision process when commencing clozapine therapy.
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Analysis of drug-induced hearing loss by using a spontaneous reporting system database. PLoS One 2019; 14:e0217951. [PMID: 31593579 PMCID: PMC6782099 DOI: 10.1371/journal.pone.0217951] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/20/2019] [Indexed: 12/11/2022] Open
Abstract
Many drugs can cause hearing loss, leading to sensorineural deafness. The aim of this study was to evaluate the risk of drug-induced hearing loss (DIHL) by using the Japanese Adverse Drug Event Report (JADER) database and to obtain profiles of DIHL onset in clinical settings. We relied on the Medical Dictionary for Regulatory Activities preferred terms and standardized queries, and calculated the reporting odds ratios (RORs). Furthermore, we applied multivariate logistic regression analysis, association rule mining, and time-to-onset analysis using Weibull proportional hazard models. Of 534688 reports recorded in the JADER database from April 2004 to June 2018, adverse event signals were detected for platinum compounds, sulfonamides (plain) (loop diuretics), interferons, ribavirin, other aminoglycosides, papillomavirus vaccines, drugs used in erectile dysfunction, vancomycin, erythromycin, and pancuronium by determining RORs. The RORs of other aminoglycosides, other quaternary ammonium compounds, drugs used in erectile dysfunction, and sulfonamides (plain) were 29.4 (22.4–38.6), 18.5 (11.2–30.6), 15.4 (10.6–22.5), and 12.6 (10.0–16.0), respectively. High lift score was observed for patients with congenital diaphragmatic hernia treated with pancuronium using association rule mining. The median durations (interquartile range) for DIHL due to platinum compounds, sulfonamides (plain), interferons, antivirals for treatment of hepatitis C virus (HCV) infections, other aminoglycosides, carboxamide derivatives, macrolides, and pneumococcal vaccines were 25.5 (7.5–111.3), 80.5 (4.5–143.0), 64.0 (14.0–132.0), 53.0 (9.0–121.0), 11.0 (3.0–26.8), 1.5 (0.3–11.5), 3.5 (1.3–6.8), and 2.0 (1.0–4.5), respectively. Our results demonstrated potential risks associated with several drugs based on their RORs. We recommend to closely monitor patients treated with aminoglycosides for DIHL for at least two weeks. Moreover, individuals receiving platinum compounds, sulfonamides (plain), interferons, and antivirals for HCV infection therapy should be carefully observed for DIHL for at least several months.
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Barbieri MA, Cicala G, Cutroneo PM, Mocciaro E, Sottosanti L, Freni F, Galletti F, Arcoraci V, Spina E. Ototoxic Adverse Drug Reactions: A Disproportionality Analysis Using the Italian Spontaneous Reporting Database. Front Pharmacol 2019; 10:1161. [PMID: 31649536 PMCID: PMC6791930 DOI: 10.3389/fphar.2019.01161] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/09/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction: The panorama of drug-induced ototoxicity has widened in the last decades; moreover, post-marketing data are necessary to gain a better insight on ototoxic adverse drug reactions (ADRs). The aim of this study was to perform an analysis of ADR reports describing drug-induced ototoxicity from the Italian spontaneous reporting system (SRS). Methods: As a measure of disproportionality, we calculated the reporting odds ratios (RORs) and 95% confidence intervals (CIs) with a case/non-case methodology. Cases were all suspected ADR reports regarding drug-induced ototoxicity collected into the Italian SRS from 2001 to 2017. Non-cases included all other ADRs reported in the same period. Results: Of 325,980 reports, 652 included at least one ototoxic ADR, compared with 325,328 non-cases. Statistically significant adjusted RORs were found for drugs for cardiovascular disorders, urologicals, teriparatide, amikacin, prulifloxacin, rifampicin and isoniazid, cisplatin, hormone antagonists, tacrolimus, pomalidomide, tramadol, and antidepressants. Significant adjusted RORs in relation to tinnitus were also observed for doxazosin (ROR 5.55, 95% CI 2.06–14.93), bisoprolol (4.28, 1.59–11.53), nebivolol (8.06, 3.32–19.56), ramipril (3.96, 2.17–7.23), irbesartan (19.60, 9.19–41.80), betamethasone (4.01, 1.28–12.52), moxifloxacin (4.56, 1.71–12.34), ethambutol (12.25, 3.89–38.57), efavirenz (16.82, 5.34–52.96), sofosbuvir/ledipasvir (5.95, 1.90–18.61), etoposide (7.09, 2.63–19.12), abatacept (6.51, 2.42–17.53), indometacin (6.30, 2.02–19.72), etoricoxib (5.00, 2.23–11.23), tapentadol (4.37, 1.09–17.62), and timolol combinations (23.29, 9.53–56.95). Moreover, significant adjusted RORs for hypoacusis regarded clarithromycin (3.95, 1.86–8.40), azithromycin (10.23, 5.03–20.79), vancomycin (6.72, 2.14–21.11), methotrexate (3.13, 1.00–9.81), pemetrexed (4.38, 1.40–13.76), vincristine (5.93, 1.88–18.70), vinorelbine (21.60, 8.83–52.82), paclitaxel (2.34, 1.03–5.30), rituximab (3.20, 1.19–8.63), interferon alfa-2b (17.44, 8.56–35.53), thalidomide (16.92, 6.92–41.38), and deferasirox (41.06, 20.07–84.01). Conclusions: This study is largely consistent with results from literature. Nevertheless, propafenone, antituberculars, hormone antagonists, teriparatide, tramadol, and pomalidomide are unknown for being ototoxic. Hypoacusis after the use of vinorelbine, methotrexate, and pemetrexed is unexpected, such as tinnitus related with etoposide, nebivolol, betamethasone, abatacept, sofosbuvir/ledipasvir, and tapentadol, but these considerations require further investigation to better define the risk due to the paucity of data. Moreover, physicians should be aware of the clinical significance of ototoxicity and be conscious about the importance of their contribution to spontaneous reporting.
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Affiliation(s)
| | - Giuseppe Cicala
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paola Maria Cutroneo
- Sicilian Regional Pharmacovigilance Centre, University Hospital of Messina, Messina, Italy
| | - Eleonora Mocciaro
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Francesco Freni
- Department of Adult and Developmental Human Pathology "Gaetano Barresi," University of Messina, Messina, Italy
| | - Francesco Galletti
- Department of Adult and Developmental Human Pathology "Gaetano Barresi," University of Messina, Messina, Italy
| | - Vincenzo Arcoraci
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Buxton EK, Vohra S, Guo Y, Fogleman A, Patel R. Pediatric population health analysis of southern and central Illinois region: A cross sectional retrospective study using association rule mining and multiple logistic regression. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 178:145-153. [PMID: 31416543 DOI: 10.1016/j.cmpb.2019.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 05/21/2019] [Accepted: 06/17/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Southern Illinois University School of Medicine (SIUSOM) collects large amounts of data every day. SIUSOM and other similar healthcare systems are always looking for better ways to use the data to understand and address population level problems. The purpose of this study is to analyze the administrative dataset for pediatric patients served by Southern Illinois University School of Medicine (SIUSOM) to uncover patterns that correlate specific demographic information to diagnoses of pediatric diseases. The study uses a cross-sectional database of medical billing information for all pediatric patients served by SIUSOM between June 2013 and December 2016. The dataset consists of about 980.9K clinical visits for 65.4K unique patients and includes patient demographic identifiers such as their sex, date of birth, race, anonymous zipcode and primary and secondary insurance plan as well as the related pediatric diagnosis codes. The goal is to find unknown correlations in this database. METHOD We proposed a two step methodology to derive unknown correlations in SIUSOM administrative database. First, Class association rule mining was used as a well-established data mining method to generate hypothesis and derive associations of the form D → M, where D is diagnosis code of a pediatric disease and M is a patient demographic identifier (age,sex, anonymous zipcode, insurance plan, or race). The resulting associations were pruned and filtered using measures such as lift, odds ratio, relative risk, and confidence. The final associations were selected by a pediatric doctor based on their clinical significance. Second,each association rule in the final set was further validated and adjusted odds ratios were obtained using multiple logistic regression. RESULTS Several associations were found correlating specific patients' residential zip codes with the diagnosis codes for viral hepatitis carrier, exposure to communicable diseases, screening for mental and developmental disorder in childhood, history allergy to medications, disturbance of emotions specific to childhood, and acute sinusitis. In addition, the results show that African American patients are more likely to be screened for mental and developmental disorders compared to White patients for SIUSOM pediatric population (Odds Ratio (OR):3.56, 95% Confidence Interval (CI):[3.29,3.85]). CONCLUSION Class association rule mining is an effective method for detecting signals in a large patient administrative database and generating hypotheses which correlate patients' demographics with diagnosis of pediatric diseases. A post processing of the hypotheses generated by this method is necessary to prune spurious associations and select a set of clinically relevant hypotheses.
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Affiliation(s)
| | - Sameer Vohra
- Office of Population Science and Policy, Southern Illinois University School of Medicine, United States.
| | - Yanhui Guo
- University of Illinois at Springfield, Department of Computer Science, United States.
| | - Amanda Fogleman
- Office of Population Science and Policy, Southern Illinois University School of Medicine, United States.
| | - Rushabh Patel
- Office of Population Science and Policy, Southern Illinois University School of Medicine, United States.
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Ha D, Choi SR, Kwon Y, Park HH, Shin JY. Pattern of adverse events induced by aflibercept and ranibizumab: A nationwide spontaneous adverse event reporting database, 2007-2016. Medicine (Baltimore) 2019; 98:e16785. [PMID: 31415382 PMCID: PMC6831246 DOI: 10.1097/md.0000000000016785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Data regarding the safety of anti-vascular endothelial growth factor (anti-VEGF) treatment is limited.To compare the adverse events (AEs) induced by aflibercept and ranibizumab using a spontaneous reporting system and determine the signals.We used data from the Korea Institute of Drug Safety & Risk Management-Korea Adverse Event Reporting System Database (KIDS-KD), collected between 2007 and 2016. Differences in patient demographics, report type, reporter, causality, and serious-AEs between aflibercept and ranibizumab were compared. Metrics including proportional reporting ratio (PRR), reporting odds ratio (ROR), and information component (IC), were used to compare signals with the AEs on the drug labels in the United States of America and Korea. Logistic regression analysis was performed to identify AEs that are more likely to occur with drug use.A total of 32 aflibercept and 103 ranibizumab cases of AEs were identified. The proportion of AEs that were reported voluntarily was higher with aflibercept (50.5%) use than ranibizumab (4.9%), whereas the AEs reported by post-marketing surveillance were higher with ranibizumab (46.6%) use than aflibercept (31.3%). The percentage of AEs in patients >60 years old, reports by consumers, and the ratio of SAEs to AEs associated with aflibercept (84. %, 9.4%, and 75.0%, respectively) were higher than those of ranibizumab (77.7%, 1.9%, and 19.4%, respectively). The number of newly detected AEs after aflibercept and ranibizumab treatment was 3 and 8, respectively. Among these, conjunctivitis and medicine ineffective were not included on the aflibercept and ranibizumab labels, respectively. Endophthalmitis (OR 6.96, 95% CI 2.74-17.73) was more likely to be reported in patients with aflibercept than in patients without aflibercept, whereas medicine ineffective (OR 18.49, 95% CI 2.39-143.29) and retinal disorder (OR 7.03, 95% CI 1.60-30.96) were more likely to be reported in patients with ranibizumab than in patients without ranibizumab.New signals have been identified for aflibercept and ranibizumab. Further research is necessary to evaluate the causality of AEs that were detected as signals in this study.
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Chrétien B, Dolladille C, Hamel-Sénécal L, Sassier M, Faillie JL, Miremont-Salamé G, Lelong-Boulouard V, Le Boisselier R, Fedrizzi S, Alexandre J, Humbert X. Comparative study of hypoglycaemia induced by opioids. Is it a class effect? Expert Opin Drug Saf 2019; 18:987-992. [PMID: 31317815 DOI: 10.1080/14740338.2019.1646246] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: Drug-induced hypoglycaemia has been described with the use of tramadol and methadone. The authors aimed to determine if drug-induced hypoglycaemia could be a class effect for opioids. Methods: The authors performed a disproportionality analysis in VigiBase®, the WHO global individual case safety report database with nine opioids (codeine, fentanyl, hydromorphone, methadone, morphine, oxycodone, tramadol, buprenorphine and nalbuphine) using the broad Standardised MedDRA Query for hypoglycaemia. The authors also carried out a descriptive study of opioid-induced hypoglycaemia in the French PharmacoVigilance DataBase (FPVDB) using the MedDRA Preferred Term 'hypoglycaemia'. Results: The global adjusted Reporting Odds Ratio (aROR) value for the 9 opioids was 1.53 (95% CI 1.52-1.54). The aROR ranged from 1.09 to 1.97 depending on the opioid, but all were statistically significant. A sex ratio of 0.74 was found for the reports of opioid-induced hypoglycaemia in Vigibase®. The authors also found 133 reports of hypoglycaemia in the FPVDB related to opioids. Among the reports, 55 were glycaemic imbalances in diabetics occurring shortly after the start of opioid treatment. Conclusion: This work highlighted a significant association between all opioids and hypoglycaemia, thereby indicating that opioid-induced hypoglycaemia is probably a class effect. Women and/or diabetics seem to be more at risk for developing opioid-induced hypoglycaemia.
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Affiliation(s)
- Basile Chrétien
- Department of Pharmacology, Caen University Hospital , Caen , France.,Pharmacovigilance Center, Caen University Hospital , Caen , France.,Addictovigilance Center, Caen University Hospital , Caen , France
| | | | - Léa Hamel-Sénécal
- Department of Pharmacology, Caen University Hospital , Caen , France.,Pharmacovigilance Center, Caen University Hospital , Caen , France.,Addictovigilance Center, Caen University Hospital , Caen , France
| | - Marion Sassier
- Department of Pharmacology, Caen University Hospital , Caen , France.,Pharmacovigilance Center, Caen University Hospital , Caen , France
| | - Jean Luc Faillie
- Pharmacovigilance Center, Montpellier University Hospital , Montpellier , France
| | | | - Véronique Lelong-Boulouard
- Department of Pharmacology, Caen University Hospital , Caen , France.,INSERM UMR 1075, COMETE-MOBILITES "Vieillissement, Pathologie, Santé", Normandie University, UNICAEN, UFR Santé , Caen , France
| | - Reynald Le Boisselier
- Department of Pharmacology, Caen University Hospital , Caen , France.,Addictovigilance Center, Caen University Hospital , Caen , France
| | - Sophie Fedrizzi
- Department of Pharmacology, Caen University Hospital , Caen , France.,Pharmacovigilance Center, Caen University Hospital , Caen , France
| | - Joachim Alexandre
- Department of Pharmacology, Caen University Hospital , Caen , France.,Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Normandie University, UNICAEN, Caen University Hospital , Caen , France
| | - Xavier Humbert
- General Practice Department, Normandie University, UNICAEN, EA4650 , Caen , France
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Batteux B, Llopis B, Muller C, Khouri C, Moragny J, Liabeuf S, Masmoudi K, Gras V. The drugs that mostly frequently induce gynecomastia: A national case - noncase study. Therapie 2019; 75:225-238. [PMID: 31471065 DOI: 10.1016/j.therap.2019.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/02/2019] [Accepted: 06/14/2019] [Indexed: 12/18/2022]
Abstract
AIMS Drug-induced gynecomastia accounts for up to 25% of cases of gynecomastia. The objective of the present study was to provide a comprehensive overview of drug-induced gynecomastia on the basis of spontaneously reported adverse drug reactions (ADRs) in the French national pharmacovigilance database (FPVD). METHODS We performed a case - noncase study of drug-induced gynecomastia. Cases corresponded to reports of gynecomastia recorded in the FPVD between 1 January 2008 and 31 December 2015. The noncases corresponded to all other spontaneously reported ADRs recorded in the FPVD during the same period. Data were expressed as the reporting odds ratio (ROR) and its 95% confidence interval. RESULTS Of the 255,354 ADRs recorded in the FPVD between 1 January 2008 and 31 December 2015, 327 (0.31%) of relevant cases of gynecomastia and 106,800 noncases were analyzed. The RORs were statistically significant for 54 active compounds mentioned 429 times in cases of gynecomastia. A single drug was involved in 59% of cases. The most frequently implicated drug classes were antiretrovirals (23.5%), diuretics (15.5%), proton pump inhibitors (11.9%), HMG-CoA reductase inhibitors (9.1%), neuroleptics and related drugs (6.5%), calcium channel blockers (6.3%), and 5-alpha reductase inhibitors (4%). CONCLUSIONS A comprehensive analysis of a national pharmacovigilance database highlighted the main drug classes suspected of inducing gynecomastia. A physiopathological mechanism (a hormone imbalance with elevated estrogen levels) is known or suspected for most of the drugs involved in gynecomastia. However, we noticed a lack of harmonization in the summary of product characteristics for original vs. generic medicines.
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Affiliation(s)
- Benjamin Batteux
- Centre régional de pharmacovigilance, CHU Amiens Sud, avenue René Laënnec, 80054 Amiens cedex 1, France.
| | - Benoît Llopis
- Centre régional de pharmacovigilance, CHU Amiens Sud, avenue René Laënnec, 80054 Amiens cedex 1, France
| | - Charlotte Muller
- Centre régional de pharmacovigilance, hôpital civil, 67091 Strasbourg, France
| | - Charles Khouri
- Centre régional de pharmacovigilance, CHU Grenoble, 38043 Grenoble, France
| | - Julien Moragny
- Centre régional de pharmacovigilance, CHU Amiens Sud, avenue René Laënnec, 80054 Amiens cedex 1, France
| | - Sophie Liabeuf
- Centre régional de pharmacovigilance, CHU Amiens Sud, avenue René Laënnec, 80054 Amiens cedex 1, France
| | - Kamel Masmoudi
- Centre régional de pharmacovigilance, CHU Amiens Sud, avenue René Laënnec, 80054 Amiens cedex 1, France
| | - Valérie Gras
- Centre régional de pharmacovigilance, CHU Amiens Sud, avenue René Laënnec, 80054 Amiens cedex 1, France
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Kwon J, Kim S, Yoo H, Lee E. Nimesulide-induced hepatotoxicity: A systematic review and meta-analysis. PLoS One 2019; 14:e0209264. [PMID: 30677025 PMCID: PMC6345488 DOI: 10.1371/journal.pone.0209264] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 12/03/2018] [Indexed: 01/10/2023] Open
Abstract
Objective This study aimed to evaluate the risk for hepatotoxicity with nimesulide, a non-steroidal anti-inflammatory drug (NSAID) available in Republic of Korea but withdrawn from the market in several countries. Methods A systematic review and meta-analysis were conducted of studies retrieved from PubMed, EMBASE, Cochrane, the Research Information Sharing Service and ClinicalTrials.gov up to September 2017. All studies reporting nimesulide-associated hepatotoxicity in patients as compared with the unexposed or the exposed to other NSAIDs were included. Studies using spontaneous reporting databases were included to estimate reporting odds ratio (ROR) of hepatotoxicity associated with nimesulide exposure. The association between nimesulide use and hepatotoxicity was estimated using relative risk (RR) and ROR with 95% confidence interval (CI). Results A total of 25 observational studies were eligible for review. In a meta-analysis of five observational studies, nimesulide was significantly associated with hepatotoxicity [RR 2.21, 95% CI 1.72–2.83]. From studies using spontaneous reporting databases (n = 6), rates of reported hepatotoxicity were significantly higher in patients using nimesulide, compared with those treated with other NSAIDs [pooled ROR 3.99, 95% CI 2.86–5.57]. Of a total of 33 patients from case studies and series, the majority (n = 28, 84.8%) were female, and the mean age (± standard deviation) was 56.8 (± 15.6) years. Almost half of the patients on nimesulide (45.5%) either required liver transplantation or died due to fulminant hepatic failure, of whom a third developed hepatotoxicity within less than 15 days of nimesulide administration. Conclusions Our study findings support previous reports of an increased risk for hepatotoxicity with nimesulide use and add to existing literature by providing risk estimates for nimesulide-associated hepatotoxicity. As the limited number of studies with primarily observational study designs were included in the analysis, more studies are needed to further describe the effects of dose and length of treatment on the risk for hepatotoxicity.
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Affiliation(s)
- Jeongyoon Kwon
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Seungyeon Kim
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Hyejin Yoo
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Euni Lee
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
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Humbert X, Fedrizzi S, Chrétien B, Sassier M, Bagheri H, Combret S, Drici M, Le Bas F, Puddu PE, Alexandre J. Hypertension induced by serotonin reuptake inhibitors: analysis of two pharmacovigilance databases. Fundam Clin Pharmacol 2019; 33:296-302. [DOI: 10.1111/fcp.12440] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 11/01/2018] [Accepted: 11/26/2018] [Indexed: 01/16/2023]
Affiliation(s)
- Xavier Humbert
- Département de médecine générale UNICAEN, EA4650 Normandie Université Caen 14000 France
| | - Sophie Fedrizzi
- Service de pharmacologie UNICAEN, EA4650 CHU Caen Normandie Normandie Université Caen 14000 France
| | - Basile Chrétien
- Service de pharmacologie UNICAEN CHU Caen Normandie Normandie Université Caen 14000 France
| | - Marion Sassier
- Service de pharmacologie UNICAEN CHU Caen Normandie Normandie Université Caen 14000 France
| | - Haleh Bagheri
- CHU Toulouse Centre régional de pharmacovigilance Toulouse 31000 France
| | - Sandrine Combret
- CHU Dijon Centre régional de pharmacovigilance Dijon 21000 France
| | | | - François Le Bas
- Département de médecine générale UNICAEN, EA4650 Normandie Université Caen 14000 France
| | - Paolo E. Puddu
- UNICAEN, EA4650 Normandie Université Caen 14000 France
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences Sapienza University of Rome Rome 00161 Italy
| | - Joachim Alexandre
- Service de pharmacologie UNICAEN, EA4650 CHU Caen Normandie Normandie Université Caen 14000 France
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Dolladille C, Humbert X, Faucon M, Tournilhac C, Sassier M, Fedrizzi S, Milliez P, Lelong-Boulouard V, Coquerel A, Puddu PE, Parienti JJ, Alexandre J. Association between venous thromboembolism events and fibrates: A comparative study. Therapie 2018; 74:421-430. [PMID: 30482666 DOI: 10.1016/j.therap.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/02/2018] [Accepted: 09/27/2018] [Indexed: 01/20/2023]
Abstract
AIM Previous studies highlighted a significant association between fibrates and venous thromboembolism (VTE) events in dyslipidemia diabetic patients. Studies in non-diabetic patients are divergent. The present study investigated the association between VTE events and fibrates in diabetic and non-diabetic patients. METHODS Two approaches were used: (1) a disproportionality analysis using the World health organization pharmacovigilance database VigiBase® was used to evaluate the reporting odds-ratio (ROR) of fibrates for VTE events. Clinical and demographic characterizations of patients with fibrates-related VTE reports are described; (2) a case control-study was performed using the Caen university hospital medical information database between January 2008 and December 2012. Cases were dyslipidemia patients who were hospitalized for VTE without an evident provoking factor. Up to four controls per case were selected in dyslipidemia patients hospitalized for a non-VTE event. Controls were matched to cases by age, gender, date of hospitalization, diabetes, chronic kidney disease and hospitalization department. A multivariate conditional logistic regression was performed. RESULTS Disproportionality analysis: a total of 946 notifications were identified in VigiBase® (32.9% of diabetic patients). Fibrates were significantly associated with an increased report of VTE (ROR 1.14, CI 1.07-1.22). Case-control study: a total of 163 cases (21.5% of diabetic patients) and 514 matched controls were recruited. Fibrates were significantly associated with a higher risk of VTE events that required hospitalization in multivariate analysis (odds-ratio (OR) 3.67, CI 1.82-7.37, P=0.0003). The association was only significant for fenofibrate in both approaches. CONCLUSION Fenofibrate was associated with a higher incidence of VTE events in diabetic and non-diabetic patients.
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Affiliation(s)
- Charles Dolladille
- Department of pharmacology, CHU de Caen, 14000 Caen, France; Department of cardiology, CHU de Caen, 14000 Caen, France.
| | - Xavier Humbert
- Department of pharmacology, CHU de Caen, 14000 Caen, France; Department of general medicine, université Caen Normandie, medical school, 14000 Caen, France; EA 4650, signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, université Caen Normandie, medical school, 14000 Caen, France
| | - Murielle Faucon
- Department of medical information, CHU de Caen, 14000 Caen, France
| | - Claire Tournilhac
- Department of general medicine, université Caen Normandie, medical school, 14000 Caen, France
| | - Marion Sassier
- Department of pharmacology, CHU de Caen, 14000 Caen, France
| | - Sophie Fedrizzi
- Department of pharmacology, CHU de Caen, 14000 Caen, France; EA 4650, signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, université Caen Normandie, medical school, 14000 Caen, France
| | - Paul Milliez
- Department of cardiology, CHU de Caen, 14000 Caen, France; EA 4650, signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, université Caen Normandie, medical school, 14000 Caen, France
| | | | | | - Paolo Emilio Puddu
- EA 4650, signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, université Caen Normandie, medical school, 14000 Caen, France; Department of cardiovascular, respiratory, nephrological, anesthesiological and geriatric sciences, Sapienza university of Rome, 000161 Rome, Italy
| | | | - Joachim Alexandre
- Department of pharmacology, CHU de Caen, 14000 Caen, France; EA 4650, signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, université Caen Normandie, medical school, 14000 Caen, France
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Rochoy M, Zakhem-Stachera C, Béné J, Berkhout C, Gautier S. Antidépresseurs et hyponatrémie : revue de littérature et analyse cas/non-cas dans la base nationale de pharmacovigilance française. Therapie 2018; 73:389-398. [DOI: 10.1016/j.therap.2018.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/24/2017] [Accepted: 02/26/2018] [Indexed: 12/13/2022]
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A data-driven method to detect adverse drug events from prescription data. J Biomed Inform 2018; 85:10-20. [PMID: 30016721 DOI: 10.1016/j.jbi.2018.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 06/19/2018] [Accepted: 07/13/2018] [Indexed: 12/17/2022]
Abstract
Drug safety issues such as Adverse Drug Events (ADEs) can cause serious consequences for the public. The clinical trials that are undertaken to assess medicine efficacy and safety prior to marketing, generally, may provide sufficient samples for discovering common ADEs. However, more samples are needed to detect infrequent and rare events. Additionally, clinical trials may not include all subgroups of patients. For these reasons, post-marketing surveillance of medicines is necessary for identifying drug safety issues. Most regulatory agencies use the Spontaneous Reporting Systems to identify associations between medicines and suspected ADEs. Data mining with effective analytical frameworks and large-scale medical data is potentially an alternative method to discover and monitor ADEs. In the present paper, we aim to detect potential ADEs from prescription data by discovering ADE associated prescription sequences. In an ADE associated prescription sequence 〈Dp→Ds〉, the prior medicine Dp leads to an ADE for which the succeeding medicine Ds is dispensed to treat. We propose a data-driven method which integrates (1) a constrained sequential pattern mining to uncover prescription sequences as potential signals of ADEs, (2) domain constraints to eliminate interference signals and (3) an adapted Self-Controlled Case Series model to evaluate the potential signals of ADEs. Despite ample prior works using Electronic Health Records (EHRs), our method utilises pure prescription data which does not contain additional information, e.g. symptoms or diagnoses as included in EHRs. To assess the performance of the proposed method, we apply it to a real-world dataset from the Pharmaceutical Benefits Scheme of Australia. The dataset contains over 50 million records covering approximately 2 million patients. The results demonstrate the effectiveness of our method in identifying both known ADEs and unknown yet suspicious ADEs with limited detection of false positive signals. Comparing to a recognised gold standard, our method successfully detects 67.4% of the positive adverse events while only 8.78% false positives exist.
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Bleeding events attributable to concurrent use of warfarin and other medications in high-risk elderly: meta-analysis and Italian population-based investigation. Eur J Clin Pharmacol 2018; 74:1061-1070. [DOI: 10.1007/s00228-018-2467-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/23/2018] [Indexed: 02/01/2023]
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Chan CL, Ang PS, Li SC. A Survey on Pharmacovigilance Activities in ASEAN and Selected Non-ASEAN Countries, and the Use of Quantitative Signal Detection Algorithms. Drug Saf 2018; 40:517-530. [PMID: 28247278 DOI: 10.1007/s40264-017-0510-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Most Countries have pharmacovigilance (PV) systems in place to monitor the safe use of health products. The process involves the detection and assessment of safety issues from various sources of information, communicating the risk to stakeholders and taking other relevant risk minimization measures. OBJECTIVES This study aimed to assess the PV status in Association of Southeast Asian Nation (ASEAN) countries, sources for postmarket safety monitoring, methods used for signal detection and the need for a quantitative signal detection algorithm (QSDA). Comparisons were conducted with centres outside ASEAN. METHODS A questionnaire was sent to all PV centres in ASEAN countries, as well as seven other countries, from November 2015 to June 2016. The questionnaire was designed to collect information on the status of PV, with a focus on the use of a QSDA. RESULTS Data were collected from nine ASEAN countries and seven other countries. PV activities were conducted in all these countries, which were at different stages of development. In terms of adverse drug reaction (ADR) reports, the average number received per year ranged from 3 to 50,000 reports for ASEAN countries and from 7000 to 1,103,200 for non-ASEAN countries. Thirty-three percent of ASEAN countries utilized statistical methods to help detect signals from ADR reports compared with 100% in the other non-ASEAN countries. Eighty percent agreed that the development of a QSDA would help in drug signal detection. The main limitation identified was the lack of knowledge and/or lack of resources. CONCLUSION Spontaneous ADR reports from healthcare professionals remains the most frequently used source for safety monitoring. The traditional method of case-by-case review of ADR reports prevailed for signal detection in ASEAN countries. As the reports continue to grow, the development of a QSDA would be useful in helping detect safety signals.
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Affiliation(s)
- Cheng Leng Chan
- Health Products Regulation Group, Health Sciences Authority, 11 Biopolis Way #11-01 Helios, Singapore, 138667, Singapore. .,School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia.
| | - Pei San Ang
- Health Products Regulation Group, Health Sciences Authority, 11 Biopolis Way #11-01 Helios, Singapore, 138667, Singapore
| | - Shu Chuen Li
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
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Methodological Considerations for Comparison of Brand Versus Generic Versus Authorized Generic Adverse Event Reports in the US Food and Drug Administration Adverse Event Reporting System (FAERS). Clin Drug Investig 2018; 37:1143-1152. [PMID: 28933038 DOI: 10.1007/s40261-017-0574-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The US Food and Drug Administration Adverse Event Reporting System (FAERS), a post-marketing safety database, can be used to differentiate brand versus generic safety signals. OBJECTIVE To explore the methods for identifying and analyzing brand versus generic adverse event (AE) reports. METHODS Public release FAERS data from January 2004 to March 2015 were analyzed using alendronate and carbamazepine as examples. Reports were classified as brand, generic, and authorized generic (AG). Disproportionality analyses compared reporting odds ratios (RORs) of selected known labeled serious adverse events stratifying by brand, generic, and AG. The homogeneity of these RORs was compared using the Breslow-Day test. The AG versus generic was the primary focus since the AG is identical to brand but marketed as a generic, therefore minimizing generic perception bias. Sensitivity analyses explored how methodological approach influenced results. RESULTS Based on 17,521 US event reports involving alendronate and 3733 US event reports involving carbamazepine (immediate and extended release), no consistently significant differences were observed across RORs for the AGs versus generics. Similar results were obtained when comparing reporting patterns over all time and just after generic entry. The most restrictive approach for classifying AE reports yielded smaller report counts but similar results. CONCLUSION Differentiation of FAERS reports as brand versus generic requires careful attention to risk of product misclassification, but the relative stability of findings across varying assumptions supports the utility of these approaches for potential signal detection.
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Analysis of polypharmacy effects in older patients using Japanese Adverse Drug Event Report database. PLoS One 2017; 12:e0190102. [PMID: 29267348 PMCID: PMC5739473 DOI: 10.1371/journal.pone.0190102] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/18/2017] [Indexed: 11/19/2022] Open
Abstract
Population aging is a global phenomenon, and choosing appropriate medical care for the elderly is critical. Polypharmacy is suspected to increase the risk of adverse events (AEs) in older patients. We examined the AE profiles associated with polypharmacy and aging using the Japanese Adverse Drug Event Report (JADER) database. We attempted to mitigate the effect of patient-related factors using a multiple-logistic regression technique and data subsetting. We selected case reports for AEs as specified in the Medical Dictionary for Regulatory Activities (MedDRA). The association between polypharmacy and "renal disorder" or "hepatic disorder" was evaluated using reporting odds ratio (ROR) and adjusted for covariates using multiple-logistic regression. For renal disorder, advanced polypharmacy showed higher adjusted RORs, because the value of administered drugs group [1.82 (1.76-1.88), ≥ 10] was higher than that of the number of administered drugs group [1.27 (1.24-1.31), 5-9]. The lower limit of the 95% confidence interval (CI) of adjusted ROR for age (≥ 60 years) was > 1 for renal disorder. For hepatic disorder, the adjusted RORs were as follows: 1.17 (1.14-1.20) for the number of administered drugs group (5-9) and 1.14 (1.11-1.18) for the number of administered drugs group (≥ 10). The adjusted RORs of hepatic disorder compared to those of renal disorder had lower adjusted RORs related to the increase in the number of administered drugs. Therefore, elderly individuals should be closely monitored for the occurrence of renal disorder when they are subjected to polypharmacy. This approach might apply to the simultaneous evaluation of the AE risk of polypharmacy and aging.
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Fibrates et risques thrombo-emboliques veineux : étude cas/non-cas dans la base nationale de pharmacovigilance. Therapie 2017; 72:677-682. [DOI: 10.1016/j.therap.2017.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 06/30/2017] [Accepted: 07/06/2017] [Indexed: 11/18/2022]
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Statins and diabetes: is there any difference between the different statins? Pharmacoepidemiol Drug Saf 2017; 26:1296-1297. [DOI: 10.1002/pds.4296] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/31/2017] [Indexed: 11/07/2022]
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Kim S, Park K, Kim MS, Yang BR, Choi HJ, Park BJ. Data-mining for detecting signals of adverse drug reactions of fluoxetine using the Korea Adverse Event Reporting System (KAERS) database. Psychiatry Res 2017. [PMID: 28646789 DOI: 10.1016/j.psychres.2017.06.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Selective serotonin reuptake inhibitors (SSRIs) have become one of the most broadly used medications in psychiatry. Fluoxetine is the first representative antidepressant SSRI drug approved by the Food and Drug Administration (FDA) in 1987. Safety information on fluoxetine use alone was less reported than its combined use with other drugs. There were no published papers on adverse drug reactions (ADRs) of fluoxetine analyzing spontaneous adverse events reports. We detected signals of the adverse drug reactions of fluoxetine by data mining using the Korea Adverse Events Reporting System (KAERS) database. We defined signals in this study by the reporting odds ratios (ROR), proportional reporting ratios (PRR), and information components (IC) indices. The KAERS database included 860,224 AE reports, among which 866 reports contained fluoxetine. We compared the labels of fluoxetine among the United States, UK, Germany, France, China, and Korea. Some of the signals, including emotional lability, myositis, spinal stenosis, paradoxical drug reaction, drug dependence, extrapyramidal disorder, adrenal insufficiency, and intracranial hemorrhage, were not labeled in the six countries. In conclusion, we identified new signals that were not known at the time of market approval. However, certain factors should be required for signal evaluation, such as clinical significance, preventability, and causality of the detected signals.
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Affiliation(s)
- Seonji Kim
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyounghoon Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Mi-Sook Kim
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Bo Ram Yang
- Medical Research Collaborating Center, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jin Choi
- Research Coordination Center for Rare Diseases, Seoul National University Hospital, Korea
| | - Byung-Joo Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Capogrosso Sansone A, Convertino I, Galiulo MT, Salvadori S, Pieroni S, Knezevic T, Mantarro S, Marino A, Hauben M, Blandizzi C, Tuccori M. Muscular Adverse Drug Reactions Associated with Proton Pump Inhibitors: A Disproportionality Analysis Using the Italian National Network of Pharmacovigilance Database. Drug Saf 2017; 40:895-909. [DOI: 10.1007/s40264-017-0564-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Rahman MM, Alatawi Y, Cheng N, Qian J, Plotkina AV, Peissig PL, Berg RL, Page D, Hansen RA. Comparison of brand versus generic antiepileptic drug adverse event reporting rates in the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS). Epilepsy Res 2017. [PMID: 28641219 DOI: 10.1016/j.eplepsyres.2017.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Despite the cost saving role of generic anti-epileptic drugs (AEDs), debate exists as to whether generic substitution of branded AEDs may lead to therapeutic failure and increased toxicity. This study compared adverse event (AE) reporting rates for brand vs. authorized generic (AG) vs. generic AEDs. Since AGs are pharmaceutically identical to brand but perceived as generics, the generic vs. AG comparison minimized potential bias against generics. METHODS Events reported to the U.S. Food and Drug Administration Adverse Event Reporting System between January 2004 to March 2015 with lamotrigine, carbamazepine, and oxcarbazepine listed as primary or secondary suspect were classified as brand, generic, or AG based on the manufacturer. Disproportionality analyses using the reporting odds ratio (ROR) assessed the relative rate of reporting of labeled AEs compared to reporting these events with all other drugs. The Breslow-Day statistic compared RORs across brand, AG, and other generics using a Bonferroni-corrected P<0.01. RESULTS A total of 27,150 events with lamotrigine, 13,950 events with carbamazepine, and 5077 events with oxcarbazepine were reported, with generics accounting for 27%, 41%, and 32% of reports, respectively. Although RORs for the majority of known AEs were different between brand and generics for all three drugs of interest (Breslow-Day P<0.001), RORs generally were similar for AG and generic comparisons. Generic lamotrigine and carbamazepine were more commonly involved in reports of suicide or suicidal ideation compared with the respective AGs based on a multiple comparison-adjusted P<0.01. SIGNIFICANCE Similar AED reporting rates were observed for the AG and generic comparisons for most outcomes and drugs, suggesting that brands and generics have similar reporting rates after accounting for generic perception biases. Disproportional suicide reporting was observed for generics compared with AGs and brand, although this finding needs further study.
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Affiliation(s)
- Md Motiur Rahman
- Auburn University, Harrison School of Pharmacy, Department of Health Outcomes Research and Policy, Auburn, AL, USA.
| | - Yasser Alatawi
- Auburn University, Harrison School of Pharmacy, Department of Health Outcomes Research and Policy, Auburn, AL, USA.
| | - Ning Cheng
- Auburn University, Harrison School of Pharmacy, Department of Health Outcomes Research and Policy, Auburn, AL, USA.
| | - Jingjing Qian
- Auburn University, Harrison School of Pharmacy, Department of Health Outcomes Research and Policy, Auburn, AL, USA.
| | - Annya V Plotkina
- Auburn University, Harrison School of Pharmacy, Department of Health Outcomes Research and Policy, Auburn, AL, USA.
| | - Peggy L Peissig
- Marshfield Clinic Research Foundation, Biomedical Informatics Research Center, Marshfield, WI, USA.
| | - Richard L Berg
- Marshfield Clinic Research Foundation, Biomedical Informatics Research Center, Marshfield, WI, USA.
| | - David Page
- University of Wisconsin, School of Medicine and Public Health, Department of Biostatistics and Medical Informatics, and Department of Computer Science, Madison, WI, USA.
| | - Richard A Hansen
- Auburn University, Harrison School of Pharmacy, Department of Health Outcomes Research and Policy, Auburn, AL, USA.
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Park K, Soukavong M, Kim J, Kwon KE, Jin XM, Lee J, Yang BR, Park BJ. Signal Detection of Imipenem Compared to Other Drugs from Korea Adverse Event Reporting System Database. Yonsei Med J 2017; 58:564-569. [PMID: 28332362 PMCID: PMC5368142 DOI: 10.3349/ymj.2017.58.3.564] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 10/29/2016] [Accepted: 11/29/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To detect signals of adverse drug events after imipenem treatment using the Korea Institute of Drug Safety & Risk Management-Korea adverse event reporting system database (KIDS-KD). MATERIALS AND METHODS We performed data mining using KIDS-KD, which was constructed using spontaneously reported adverse event (AE) reports between December 1988 and June 2014. We detected signals calculated the proportional reporting ratio, reporting odds ratio, and information component of imipenem. We defined a signal as any AE that satisfied all three indices. The signals were compared with drug labels of nine countries. RESULTS There were 807582 spontaneous AEs reports in the KIDS-KD. Among those, the number of antibiotics related AEs was 192510; 3382 reports were associated with imipenem. The most common imipenem-associated AE was the drug eruption; 353 times. We calculated the signal by comparing with all other antibiotics and drugs; 58 and 53 signals satisfied the three methods. We compared the drug labelling information of nine countries, including the USA, the UK, Japan, Italy, Switzerland, Germany, France, Canada, and South Korea, and discovered that the following signals were currently not included in drug labels: hypokalemia, cardiac arrest, cardiac failure, Parkinson's syndrome, myocardial infarction, and prostate enlargement. Hypokalemia was an additional signal compared with all other antibiotics, and the other signals were not different compared with all other antibiotics and all other drugs. CONCLUSION We detected new signals that were not listed on the drug labels of nine countries. However, further pharmacoepidemiologic research is needed to evaluate the causality of these signals.
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Affiliation(s)
- Kyounghoon Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Mick Soukavong
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jungmee Kim
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung Eun Kwon
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Xue Mei Jin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Joongyub Lee
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Bo Ram Yang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Byung Joo Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Detecting Signals of Disproportionate Reporting from Singapore's Spontaneous Adverse Event Reporting System: An Application of the Sequential Probability Ratio Test. Drug Saf 2017; 40:703-713. [PMID: 28455793 DOI: 10.1007/s40264-017-0531-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The ability to detect safety concerns from spontaneous adverse drug reaction reports in a timely and efficient manner remains important in public health. OBJECTIVE This paper explores the behaviour of the Sequential Probability Ratio Test (SPRT) and ability to detect signals of disproportionate reporting (SDRs) in the Singapore context. METHODS We used SPRT with a combination of two hypothesised relative risks (hRRs) of 2 and 4.1 to detect signals of both common and rare adverse events in our small database. We compared SPRT with other methods in terms of number of signals detected and whether labelled adverse drug reactions were detected or the reaction terms were considered serious. The other methods used were reporting odds ratio (ROR), Bayesian Confidence Propagation Neural Network (BCPNN) and Gamma Poisson Shrinker (GPS). RESULTS The SPRT produced 2187 signals in common with all methods, 268 unique signals, and 70 signals in common with at least one other method, and did not produce signals in 178 cases where two other methods detected them, and there were 403 signals unique to one of the other methods. In terms of sensitivity, ROR performed better than other methods, but the SPRT method found more new signals. The performances of the methods were similar for negative predictive value and specificity. CONCLUSIONS Using a combination of hRRs for SPRT could be a useful screening tool for regulatory agencies, and more detailed investigation of the medical utility of the system is merited.
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Pierson-Marchandise M, Gras V, Moragny J, Micallef J, Gaboriau L, Picard S, Choukroun G, Masmoudi K, Liabeuf S. The drugs that mostly frequently induce acute kidney injury: a case - noncase study of a pharmacovigilance database. Br J Clin Pharmacol 2017; 83:1341-1349. [PMID: 28002877 DOI: 10.1111/bcp.13216] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 11/30/2016] [Accepted: 12/13/2016] [Indexed: 12/29/2022] Open
Abstract
AIMS Acute kidney injury (AKI) is associated with a high hospitalization rate, accelerated long-term decline in kidney function and a high mortality rate. Adverse drug reactions (ADRs) constitute one of the most important modifiable factors in the context of AKI. Most studies of drug-induced AKI have focused on a sole drug class. The objective of the present study was to establish a comprehensive overview of drug-induced AKI on the basis of spontaneously reported ADRs in the French national pharmacovigilance database (FPVD). METHODS We performed a case-noncase study of drug-induced AKI. Cases corresponded to the reports of AKI recorded in the FPVD between 1 January 2015 and 31 December 2015. The noncases corresponded to all other spontaneously reported ADRs (excluding AKI) recorded in the FPVD during the same period. Data were expressed as the reporting odds ratio (ROR) and the 95% confidence interval. RESULTS Of the 38 782 ADRs recorded in the FPVD during the study period, 3.2% were classified as cases of AKI. A total of 1254 patients experienced AKI (males: 55%; mean age ± standard deviation: 68.7 ± 15.0 years). Overall, 15.2% of the patients required renal replacement therapy. Two or more concomitantly administered drugs were involved in 66% of the cases of AKI. The most frequently implicated drug classes were antibacterial agents for systemic use (29.5%), diuretics (18.5%), agents acting on the renin-angiotensin system (16.3%), antineoplastic agents (10.2%) and anti-inflammatory agents (5.4%). Gentamicin, eplerenone, spironolactone, candesartan, cisplatin and acyclovir had the highest RORs (>10). CONCLUSION A comprehensive study of a national pharmacovigilance database enabled us to identify the drug classes that most frequently induced AKI. Even though most of the identified drugs were already known to induce AKI, the present work should raise physicians' awareness of the compounds responsible for triggering this potentially life-threatening condition.
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Affiliation(s)
- Marion Pierson-Marchandise
- Regional Pharmacovigilance Centre, Division of Clinical Pharmacology, Amiens University Hospital, Amiens, France
| | - Valérie Gras
- Regional Pharmacovigilance Centre, Division of Clinical Pharmacology, Amiens University Hospital, Amiens, France
| | - Julien Moragny
- Regional Pharmacovigilance Centre, Division of Clinical Pharmacology, Amiens University Hospital, Amiens, France
| | - Joelle Micallef
- Centre Régional de Pharmacovigilance, Service de Pharmacologie clinique et pharmacovigilance Aix Marseille Université, Institut de Neurosciences Timone, CNRS 7289 - 264, rue Saint Pierre, 13385, Marseille, France
| | - Louise Gaboriau
- Regional Pharmacovigilance Centre, Lille University Hospital, Lille, France
| | - Sylvie Picard
- Regional Pharmacovigilance Centre, Rennes University Hospital, Rennes, France
| | - Gabriel Choukroun
- Nephrology Department, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France.,INSERM U1088, Jules Verne University of Picardy, Amiens, France
| | - Kamel Masmoudi
- Regional Pharmacovigilance Centre, Division of Clinical Pharmacology, Amiens University Hospital, Amiens, France
| | - Sophie Liabeuf
- Regional Pharmacovigilance Centre, Division of Clinical Pharmacology, Amiens University Hospital, Amiens, France.,INSERM U1088, Jules Verne University of Picardy, Amiens, France
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Montastruc J, Marque P, Moulis F, Bourg V, Lambert V, Durrieu G, Montastruc JL, Montastruc F. Adverse drug reactions of botulinum neurotoxin type A in children with cerebral palsy: a pharmaco-epidemiological study in VigiBase. Dev Med Child Neurol 2017; 59:329-334. [PMID: 27682175 DOI: 10.1111/dmcn.13286] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2016] [Indexed: 01/28/2023]
Abstract
AIM The aim of this study was to assess the risk of adverse drug reactions (ADRs) with botulinum neurotoxin type A (BoNT-A) in children with cerebral palsy (CP) using the World Health Organization global individual case safety report (ICSR) database, VigiBase. METHOD We extracted all children ICSRs for ADRs with BoNT-A used as anti-spastic drug in CP recorded between 1995 and 2015 in VigiBase. We also performed a case/non-case method (disproportionality analysis) to assess the link between exposure to BoNT-A and each ADR of interest in children and adults, calculating reporting odds ratios (RORs). RESULTS In VigiBase, 162 ICSRs were registered. They involved mainly males (n=95, 59%) and mean (SD) age was 7 years 11 months (4y 4mo). The most frequent ADR was dysphagia (27 ICSRs, 17%) followed by asthenia and muscular weakness (25 ICSRs each, 16%). Nineteen ICSRs (12%) were lethal. There was a significant association between BoNT-A and death in children (ROR=11.1 95%, confidence interval [CI] 7.0-17.7) but not in adults. INTERPRETATION In children with CP, most ADRs seem to be linked to a systemic spread of BoNT-A. Our study suggests a higher risk of ADRs with BoNT-A in children than in adults.
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Affiliation(s)
- Jeanne Montastruc
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire, Toulouse, France
| | - Philippe Marque
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire, Toulouse, France
| | - Florence Moulis
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'informations sur le Médicament, CIC INSERM 1436, INSERM U 1027, Faculté de Médecine et Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Véronique Bourg
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire, Toulouse, France
| | - Valérie Lambert
- Centre Paul Dottin ASEI, Soins de suite et de réadaptation pédiatriques spécialisés, Toulouse, France
| | - Geneviève Durrieu
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'informations sur le Médicament, CIC INSERM 1436, INSERM U 1027, Faculté de Médecine et Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jean-Louis Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'informations sur le Médicament, CIC INSERM 1436, INSERM U 1027, Faculté de Médecine et Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - François Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'informations sur le Médicament, CIC INSERM 1436, INSERM U 1027, Faculté de Médecine et Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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