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Yang H, Ding Z, An Z. Urinary tract infection following the use of BTK inhibitors: a real-world analysis of post-marketing surveillance data. Expert Opin Drug Saf 2024; 23:333-338. [PMID: 37609933 DOI: 10.1080/14740338.2023.2251376] [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: 04/17/2023] [Revised: 07/27/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Emerging case reports have raised awareness of urinary tract infection (UTI) which maybe a potentially serious complication. The present study aimed to summarize the clinical characteristics of patients with BTK inhibitor-related UTI, and the association between BTK inhibitors and UTI events was also assessed by disproportionality analysis. RESEARCH DESIGN AND METHODS We conducted an observational, retrospective, and pharmacovigilance study using data from the Food and Drug Administration Adverse Event Reporting System (FAERS) database. Data were retrieved from Quarter 1, 2004 to Quarter 2, 2022. The clinical characteristics of cases were summarized using descriptive statistics. We used the χ2 or Fisher exact methods for the analysis of categorical variables and the Mann-Whitney test or Student's t-text for the comparisons of continuous variables between fatal and non-fatal cases. A p-value less than 0.05 is considered to be statistically significant. Information component (IC) and reporting odds ratio (ROR) were used to evaluate the association. RESULTS BTK inhibitors were identified as the suspected drug causing UTI in 539 cases. The age of those cases concentrated on 60-89 years (87.83%, data available in 263/539). UTI signals were detected during BTK inhibitors treatment (IC 0.95[0.83-1.08], ROR 1.96[1.80-2.13]). The association between BTK inhibitors and UTI events was shown among all groups but not in the group of age<60 years old. There were no significant differences in age and gender between fatal and non-fatal cases. However, a significant difference in reporting regions was found (p = 0.016), with the highest percentage of reported deaths occurring in Europe (26.15%, p = 0.000). CONCLUSIONS Our study suggested a safety signal for UTI and BTK inhibitors compared to all other drugs in the database, especially in the elder (age ≥60). Further studies are needed to clarify these results.
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Affiliation(s)
- Hui Yang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhexin Ding
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
| | - Zhuoling An
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Billig JI, Bicket MC, Yazdanfar M, Gunaseelan V, Sears ED, Brummett CM, Waljee JF. Cohort study of new off-label gabapentin prescribing in chronic opioid users. Reg Anesth Pain Med 2024; 49:88-93. [PMID: 37380198 DOI: 10.1136/rapm-2023-104613] [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: 04/19/2023] [Accepted: 06/14/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION Gabapentin is commonly prescribed as an off-label adjunct to opioids because of its safer risk profile. Recent evidence has shown an increased risk of mortality when coprescribed with opioids. Therefore, we aimed to evaluate whether the addition of off-label gabapentin in patients with chronic opioid use is associated with a reduction in opioid dosage. METHODS We performed a retrospective cohort study of patients with chronic opioid use with a new off-label gabapentin prescription (2010-2019). Our primary outcome of interest was a reduction in opioid dosage measured via oral morphine equivalents (OME) per day after the addition of a new off-label gabapentin prescription. RESULTS In our cohort of 172,607 patients, a new off-label gabapentin prescription was associated with a decrease in opioid dosage in 67,016 patients (38.8%) (median OME/day reduction:13.8), with no change in opioid dosage in 24,468 patients (14.2%), and an increase in opioid dosage in 81,123 patients (47.0%) (median OME/day increase: 14.3). A history of substance/alcohol use disorders was associated with a decrease in opioid dosage after the addition of a new off-label gabapentin (aOR 1.20, 95% CI 1.16 to 1.23). A history of pain disorders was associated with a decrease in opioid dosage after the initiation of a new gabapentin prescription including arthritis (aOR 1.12, 95% CI 1.09 to 1.15), back pain (aOR 1.10, 95% CI 1.07 to 1.12), and other pain conditions (aOR 1.08, 95% CI 1.06 to 1.10). CONCLUSIONS In this study of patients with chronic opioid use, an off-label gabapentin prescription did not reduce opioid dosage in the majority of patients. The coprescribing of these medications should be critically evaluated to ensure optimal patient safety.
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Affiliation(s)
- Jessica I Billig
- Orthopaedic Surgery, Washington University in St Louis, St Louis, Missouri, USA
| | - Mark C Bicket
- Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Maryam Yazdanfar
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Vidhya Gunaseelan
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Erika D Sears
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Chad M Brummett
- Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
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Zhang Y, Ran L, Liang Y, Zhang Y, An Z. Safety analysis of pemigatinib leveraging the US Food and Drug administration adverse event reporting system. Front Pharmacol 2023; 14:1194545. [PMID: 37554985 PMCID: PMC10405447 DOI: 10.3389/fphar.2023.1194545] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023] Open
Abstract
Background: Cholangiocarcinoma (CCA) is a highly lethal and aggressive epithelial tumor of the hepatobiliary system. A poor prognosis, propensity for relapse, low chance of cure and survival are some of its hallmarks. Pemigatinib, the first targeted treatment for CCA in the United States, has been demonstrated to have a significant response rate and encouraging survival data in early-phase trials. The adverse events (AEs) of pemigatinib must also be determined. Objective: To understand more deeply the safety of pemigatinib in the real world through data-mining of the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS). Methods: Disproportionality analysis was employed in a retrospective pharmacovigilance investigation to identify the AEs linked to pemigatinib use as signals. Data were collected between 1 January 2020 to 30 June 2022. Four data-mining methods (proportional reporting odds ratio; proportional reporting ratio; Bayesian confidence propagation neural networks of information components; empirical Bayes geometric means) were used to calculate disproportionality. Results: A total of 203 cases using pemigatinib as the prime-suspect medication were found in our search, which involved 99 preferred terms (PTs). Thirteen signals of pemigatinib-induced AEs in seven System Organ Classes were detected after confirming the four algorithms simultaneously. Nephrolithiasis was an unexpected significant AE not listed on the drug label found in our data-mining. Comparison of the differences between pemigatinib and platinum drugs in terms of 33 PTs revealed that 13 PTs also met the criteria of the four algorithms. Ten of these PTs were identical to those compared with all other drugs, in which (excluding a reduction in phosphorus in blood) other PT signal values were higher than those of all other drugs tested. However, comparison of the differences between pemigatinib and infigratinib in terms of the 33 PTs revealed no significant signals in each algorithm method. Conclusion: Some significant signals were detected between pemigatinib use and AEs. PTs with apparently strong signals and PTs not mentioned in the label should be taken seriously.
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Affiliation(s)
| | | | | | | | - Zhuoling An
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Covvey JR, Blakely ML, Singh R, Peckham AM, Evoy KE. Pharmacist, prescriber, and drug policy expert opinions on gabapentinoid misuse. Res Social Adm Pharm 2023; 19:599-609. [PMID: 36503683 DOI: 10.1016/j.sapharm.2022.12.001] [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: 08/23/2022] [Revised: 11/28/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gabapentinoids (gabapentin and pregabalin) are widely used in clinical practice, but recent evidence indicates that they carry an increased risk of misuse. As healthcare professionals (HCPs) and policymakers plan different strategies to promote harm reduction, it is important to understand different interested party viewpoints. OBJECTIVE To explore prescriber, pharmacist, and drug policy expert (DPE) awareness, opinions, and experiences regarding gabapentinoid misuse. METHODS A qualitative description study using individual semi-structured virtual interviews was conducted between February and April 2021. Participants included prescribers (physicians, physician assistants [PA], or nurse practitioners [NP]) and pharmacists practicing in outpatient, ambulatory, or community-based healthcare settings; individuals with relevant drug policy expertise were also included. Qualtrics (Provo, Utah) and Zoom (San Jose, California) were used to facilitate quantitative (for initial screening and participant characteristics) and qualitative (interview) data collection. Data were coded and organized into themes in NVivo (QSR International; Burlington, Massachusetts) using thematic analysis steps. RESULTS A total of 43 individuals participated in this study, including 16 (37.2%) pharmacists, 13 (30.2%) physicians, seven (16.3%) NPs, four (9.3%) DPEs, two (4.7%) pharmacist/DPEs, and one (2.3%) PA. Results were organized along four themes: (1) challenges/opportunities in gabapentinoid use; (2) gabapentinoid misuse awareness; (3) solutions to gabapentinoid misuse and (4) contributing barriers in pain management. Participants invoked different opinions in their consideration of gabapentinoid misuse, including the desire for harm reduction, the limitations of the current healthcare and insurance system, the lack of options for pain and substance use disorder treatment, and the influence of patient expectations. CONCLUSIONS Gabapentinoid misuse was commonly framed in comparative fashion to ongoing concerns with opioids, and proposed solutions often focused less on regulatory control and more toward patient and HCP education and an overhaul of the health system approach to substance use and healthcare overall.
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Affiliation(s)
- Jordan R Covvey
- Duquesne University School of Pharmacy, 600 Forbes Ave, Pittsburgh, PA, 15282, USA.
| | - Michelle L Blakely
- University of Wyoming School of Pharmacy, 1000 E University Ave, Laramie, WY, 82071, USA.
| | - Reshmi Singh
- University of Wyoming School of Pharmacy, 1000 E University Ave, Laramie, WY, 82071, USA.
| | - Alyssa M Peckham
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02115, USA.
| | - Kirk E Evoy
- The University of Texas at Austin College of Pharmacy, USA; UT Health San Antonio School of Medicine, 7703 Floyd Curl Drive - MC 6220; San Antonio, TX, 78229, USA.
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Ri K, Fukasawa T, Yoshida S, Takeuchi M, Kawakami K. Risk of parkinsonism and related movement disorders with gabapentinoids or tramadol: A case-crossover study. Pharmacotherapy 2023; 43:136-144. [PMID: 36633384 DOI: 10.1002/phar.2761] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/17/2022] [Accepted: 12/18/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION A safety signal concerning parkinsonism and related movement disorders with gabapentinoids (gabapentin and pregabalin) or tramadol was detected by reviewing individual case reports and data mining in spontaneous report databases. Well-designed pharmacoepidemiological studies are needed to assess the signal. OBJECTIVE This study aimed to investigate the association of exposure to gabapentinoids or tramadol with the risk of parkinsonism and related movement disorders. METHODS We conducted a case-crossover study using a Japanese electronic medical records database. Patients with newly diagnosed parkinsonism or related movement disorders between January 1, 2007, and April 14, 2019, were identified. The diagnosis date of outcomes was defined as the index date. We assessed the exposure of each patient to gabapentinoids or tramadol during a 90-day hazard period ending 1 day before the index date and in three 90-day reference periods. Multivariable conditional logistic regression models were employed to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). To confirm the robustness of the primary findings, we also performed sensitivity analyses using a case-case-time-control design, a different time window for hazard and reference periods, a different definition of outcome, and different number of reference periods. RESULTS A total of 28,972 eligible cases were included in the primary analysis. Exposure to gabapentinoids (aOR, 2.12; 95% CI, 1.73-2.61) and tramadol (aOR, 2.04; 95% CI, 1.57-2.64) was associated with increased risk. Results were consistent across sensitivity analyses. CONCLUSION Our findings serve as a caution to physicians who prescribe gabapentinoids or tramadol in routine clinical practice.
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Affiliation(s)
- Kairi Ri
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Toshiki Fukasawa
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Satomi Yoshida
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Pregabalin for chemotherapy-induced neuropathy: background and rationale for further study. Support Care Cancer 2022; 30:8845-8853. [PMID: 35953729 DOI: 10.1007/s00520-022-07317-7] [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: 01/20/2022] [Accepted: 08/02/2022] [Indexed: 01/05/2023]
Abstract
Chemotherapy-induced neuropathy is difficult to manage, and the pain associated with neuropathy is poorly responsive to gabapentin in a randomized trial. Duloxetine is the only drug that has been found to be effective in reducing pain from chemotherapy neuropathy. In this qualitative review, the use of pregabalin for chemotherapy-induced neuropathy is discussed including the rationale and pharmacological reasons why pregabalin should be considered in a large, randomized placebo-controlled trial.
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Soldatos TG, Kim S, Schmidt S, Lesko LJ, Jackson DB. Advancing drug safety science by integrating molecular knowledge with post-marketing adverse event reports. CPT Pharmacometrics Syst Pharmacol 2022; 11:540-555. [PMID: 35143713 PMCID: PMC9124355 DOI: 10.1002/psp4.12765] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/20/2021] [Accepted: 01/17/2022] [Indexed: 12/15/2022] Open
Abstract
Promising drug development efforts may frequently fail due to unintended adverse reactions. Several methods have been developed to analyze such data, aiming to improve pharmacovigilance and drug safety. In this work, we provide a brief review of key directions to quantitatively analyzing adverse events and explore the potential of augmenting these methods using additional molecular data descriptors. We argue that molecular expansion of adverse event data may provide a path to improving the insights gained through more traditional pharmacovigilance approaches. Examples include the ability to assess statistical relevance with respect to underlying biomolecular mechanisms, the ability to generate plausible causative hypotheses and/or confirmation where possible, the ability to computationally study potential clinical trial designs and/or results, as well as the further provision of advanced features incorporated in innovative methods, such as machine learning. In summary, molecular data expansion provides an elegant way to extend mechanistic modeling, systems pharmacology, and patient‐centered approaches for the assessment of drug safety. We anticipate that such advances in real‐world data informatics and outcome analytics will help to better inform public health, via the improved ability to prospectively understand and predict various types of drug‐induced molecular perturbations and adverse events.
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Affiliation(s)
| | - Sarah Kim
- Department of PharmaceuticsCenter for Pharmacometrics and Systems PharmacologyUniversity of FloridaOrlandoFloridaUSA
| | - Stephan Schmidt
- Department of PharmaceuticsCenter for Pharmacometrics and Systems PharmacologyUniversity of FloridaOrlandoFloridaUSA
| | - Lawrence J. Lesko
- Department of PharmaceuticsCenter for Pharmacometrics and Systems PharmacologyUniversity of FloridaOrlandoFloridaUSA
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Nonsurgical Treatment of Carpal Tunnel Syndrome: A Survey of Hand Surgeons. Plast Reconstr Surg Glob Open 2022; 10:e4189. [PMID: 35450266 PMCID: PMC9015205 DOI: 10.1097/gox.0000000000004189] [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: 10/15/2021] [Accepted: 01/14/2022] [Indexed: 11/26/2022]
Abstract
Background The nonsurgical treatment of carpal tunnel syndrome (CTS) consists of multiple modalities: splinting, corticosteroid injections, hand therapy, and oral medications. However, data supporting the effectiveness of these different modalities are varied, thus creating controversy regarding the optimal nonsurgical treatment. It is unknown how current hand surgeons utilize nonsurgical treatments for CTS. Methods An anonymous web-based survey was sent to 3289 members of the American Society for Surgery of the Hand to assess nonsurgical treatment patterns for CTS. We pretested the survey using expert survey and content review and cognitively tested the survey for readability and understandability. Results We analyzed surveys from 770 hand surgeons. Of the respondents, 41.2% of respondents recommend steroid injections for the treatment of CTS, 81.3% of respondents do not believe that oral steroids are beneficial for the treatment of CTS, and 3.6% of respondents typically prescribe gabapentinoids for the treatment of CTS. In total, 561 (72.9%) respondents always, usually, or sometimes encounter patients with more than two steroid injections for CTS before hand surgeon evaluation. Conclusions There is variation in the use of nonsurgical modalities for the treatment of CTS among American Society for Surgery of the Hand members. However, patients do not obtain long-term benefit from multiple steroid injections and gabapentinoids for the treatment of CTS, highlighting the importance of dissemination of evidence-based nonsurgical management of CTS. Collectively, these findings underscore the importance of providing clear guidelines as to which patients benefit most from nonsurgical treatments.
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Yang H, Yu X, An Z. Cutaneous Toxicity Associated With Enfortumab Vedotin: A Real-Word Study Leveraging U.S. Food and Drug Administration Adverse Event Reporting System. Front Oncol 2022; 11:801199. [PMID: 35127510 PMCID: PMC8807512 DOI: 10.3389/fonc.2021.801199] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/22/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Enfortumab vedotin (EV) has been demonstrated to have a significant response rate in early phase trials and is known for its tolerable side-effect profile. Emerging case reports have raised awareness of cutaneous toxicities, which may be a potentially fatal complication. Objective To assess the potential relevance between EV and cutaneous toxicities reports through data mining of the U.S. Food and Drug Administration (FDA) adverse event reporting system (FAERS). Methods Data from January 1, 2019, to November 4, 2021, in the FAERS database were retrieved. Information component (IC) and reporting odds ratio (ROR) were used to evaluate the association between EV and cutaneous toxicities events. Results EV was significantly associated with cutaneous toxicities in the database compared with both all other drugs (ROR 12.90 [10.62–15.66], IC 2.76 [2.52–3.01], middle signal) and platinum-based therapy (ROR 15.11 [12.43–18.37], IC 2.91 [2.66–3.15], middle signal) in the FAERS database. A significant association was detected between EV and all the cutaneous adverse effects (AEs) except erythema, palmar–plantar erythrodysesthesia syndrome, and dermatitis allergic. Both Stevens–Johnson syndrome and toxic epidermal necrolysis occurred 15 times as frequently for EV compared with all other drugs (ROR = 15.20; ROR = 15.52), while Stevens–Johnson syndrome occurred 18 times and toxic epidermal necrolysis occurred 7 times as frequently for EV compared with platinum-based therapy in the database (ROR = 18.74; ROR = 7.80). All groups that limited the gender and age showed a significant association between EV and cutaneous toxicities. Conclusions A significant signal was detected between EV use and cutaneous toxicities. It is worth noting that Stevens–Johnson syndrome and toxic epidermal necrolysis were significantly associated with EV use.
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