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Poluzzi E, Diemberger I, De Ridder M, Koci A, Clo M, Oteri A, Pecchioli S, Bezemer I, Schink T, Pilgaard Ulrichsen S, Boriani G, Sturkenboom MCJ, De Ponti F, Trifirò G. Use of antihistamines and risk of ventricular tachyarrhythmia: a nested case-control study in five European countries from the ARITMO project. Eur J Clin Pharmacol 2017; 73:1499-1510. [PMID: 28831527 DOI: 10.1007/s00228-017-2317-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 08/03/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE After regulatory restrictions for terfenadine and astemizole in '90s, only scarce evidence on proarrhythmic potential of antihistamines has been published. We evaluate the risk of ventricular tachyarrhythmia (VA) related to the use of individual antihistamines. METHODS A matched case-control study nested in a cohort of new users of antihistamines was conducted within the EU-funded ARITMO project. Data on 1997-2010 were retrieved from seven healthcare databases: AARHUS (Denmark), GEPARD (Germany), HSD and ERD (Italy), PHARMO and IPCI (Netherlands) and THIN (UK). Cases of VA were selected and up to 100 controls were matched to each case. The odds ratio (OR) of current use for individual antihistamines (AHs) was estimated using conditional logistic regression. RESULTS For agents largely used to prevent allergic symptoms, such as cetirizine, levocetirizine, loratadine, desloratadine and fexofenadine, we found no VA risk. A statistically significant, increased risk of VA was found only for current use of cyclizine in the pooled analysis (ORadj, 5.3; 3.6-7.6) and in THIN (ORadj, 5.3; 95% CI, 3.7-7.6), for dimetindene in GEPARD (ORadj, 3.9; 1.1-14.7) and for ebastine in GEPARD (ORadj, 3.3; 1.1-10.8) and PHARMO (ORadj, 4.6; 1.3-16.2). CONCLUSIONS The risk of VA associated with a few specific antihistamines could be ascribable to heterogeneity in pattern of use or in receptor binding profile.
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Affiliation(s)
- Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - I Diemberger
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - M De Ridder
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - A Koci
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - M Clo
- Regione Emilia Romagna Health Authority, Bologna, Italy
| | - A Oteri
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - S Pecchioli
- Health Search, Italian College of General Practitioners, Florence, Italy.,Regional Agency for Healthcare Services of Tuscany, Florence, Italy
| | - I Bezemer
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | - T Schink
- Leibniz Institute for Epidemiology and Prevention Research - BIPS, Bremen, Germany
| | - S Pilgaard Ulrichsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - G Boriani
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.,Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - M C J Sturkenboom
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - F De Ponti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - G Trifirò
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
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Täubel J, Ferber G, Fernandes S, Santamaría E, Izquierdo I. Cardiac Safety of Rupatadine in a Single-Ascending-Dose and Multiple-Ascending-Dose Study in Healthy Japanese Subjects, Using Intensive Electrocardiogram Assessments-Comparison With the Previous White Caucasian Thorough QT Study. Clin Pharmacol Drug Dev 2017; 7:67-76. [DOI: 10.1002/cpdd.370] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 05/22/2017] [Indexed: 12/29/2022]
Affiliation(s)
- J. Täubel
- Richmond Pharmacology Ltd; London UK
- St George's, University of London; London UK
| | - G. Ferber
- Statistik Georg Ferber GmbH; Riehen Switzerland
| | | | - E. Santamaría
- Clinical Research, J. Uriach y Compañía, S.A.; Barcelona Spain
| | - I. Izquierdo
- Clinical Research, J. Uriach y Compañía, S.A.; Barcelona Spain
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Donado E, Izquierdo I, Pérez I, García O, Antonijoan RM, Gich I, Solans A, Peña J, Morganroth J, Barbanoj MJ. No cardiac effects of therapeutic and supratherapeutic doses of rupatadine: results from a 'thorough QT/QTc study' performed according to ICH guidelines. Br J Clin Pharmacol 2010; 69:401-10. [PMID: 20406224 PMCID: PMC2848413 DOI: 10.1111/j.1365-2125.2009.03599.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Accepted: 11/09/2009] [Indexed: 12/17/2022] Open
Abstract
AIMS To evaluate the effects of therapeutic and supratherapeutic doses of rupatadine on cardiac repolarization in line with a 'thorough QT/QTc study' protocol performed according to International Conference on Harmonization guidelines. METHODS This was a randomized (gender-balanced), parallel-group study involving 160 healthy volunteers. Rupatadine, 10 and 100 mg day(-1), and placebo were administered single-blind for 5 days, whilst moxifloxacin 400 mg day(-1) was given on days 1 and 5 in open-label fashion. ECGs were recorded over a 23-h period by continuous Holter monitoring at baseline and on treatment days 1 and 5. Three 10-s ECG samples were downloaded at regular intervals and were analysed independently. The primary analysis of QTc was based on individually corrected QT (QTcI). Treatment effects on QTcI were assessed using the largest time-matched mean difference between the drug and placebo (baseline-subtracted) for the QTcI interval. A negative 'thorough QT/QTc study' is one where the main variable is around < or =5 ms, with a one-sided 95% confidence interval that excludes an effect >10 ms. RESULTS The validity of the trial was confirmed by the fact that the moxifloxacin-positive control group produced the expected change in QTcI duration (around 5 ms). The ECG data for rupatadine at both 10 and 100 mg showed no signal effects on the ECG, after neither single nor repeated administration. Furthermore, no pharmacokinetic/pharmacodynamic relationship, gender effects or clinically relevant changes in ECG waveform outliers were observed. No deaths or serious or unexpected adverse events were reported. CONCLUSIONS This 'thorough QT/QTc study' confirmed previous experience with rupatadine and demonstrated that it had no proarrhythmic potential and raised no concerns regarding its cardiac safety.
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Affiliation(s)
- Ester Donado
- Clinical Development Unit, J Uriach y Compañía, Palau-solità i PlegamansBarcelona, Spain
- Department of Pharmacology and Therapeutics, Autonomous University of BarcelonaBarcelona, Spain
| | - Iñaki Izquierdo
- Clinical Development Unit, J Uriach y Compañía, Palau-solità i PlegamansBarcelona, Spain
| | - Iñaki Pérez
- Clinical Development Unit, J Uriach y Compañía, Palau-solità i PlegamansBarcelona, Spain
| | - Olga García
- Clinical Development Unit, J Uriach y Compañía, Palau-solità i PlegamansBarcelona, Spain
| | - Rosa Ma Antonijoan
- CIM-Sant Pau, Institut de Recerca, Clinical Pharmacology Service, Hospital de la Santa Creu i Sant PauBarcelona, Spain
- Department of Pharmacology and Therapeutics, Autonomous University of BarcelonaBarcelona, Spain
| | - Ignaci Gich
- CIM-Sant Pau, Institut de Recerca, Clinical Pharmacology Service, Hospital de la Santa Creu i Sant PauBarcelona, Spain
- Department of Pharmacology and Therapeutics, Autonomous University of BarcelonaBarcelona, Spain
| | - Anna Solans
- Pharmacokinetic and Bioanalysis Department, J Uriach y CompañiaBarcelona, Spain
| | - Juana Peña
- Pharmacokinetic and Bioanalysis Department, J Uriach y CompañiaBarcelona, Spain
| | - Joel Morganroth
- University of Pennsylvania School of MedicinePhiladelphia, PA, USA
| | - Manuel J Barbanoj
- CIM-Sant Pau, Institut de Recerca, Clinical Pharmacology Service, Hospital de la Santa Creu i Sant PauBarcelona, Spain
- Department of Pharmacology and Therapeutics, Autonomous University of BarcelonaBarcelona, Spain
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