1.The Safety Profiles of Biological Drugs for Rheumatoid Arthritis
Tetsu KOBAYASHI ; Kazushige MURAYAMA ; Yuki OHTA ; Nana KAWASAKI ; Satoshi TOYOSHIMA ; Akiko ISHII-WATABE
Japanese Journal of Pharmacoepidemiology 2017;21(2):63-76
To identify the most frequently reported preferred terms (PTs) in the cases of rheumatoid arthritis (RA) patients treated with immunosuppressive biological drugs as suspected drugs, we analyzed the cases in the Japanese Adverse Drug Event Report (JADER) database. We found that pneumonia, interstitial lung disease, Pneumocystis jiroveci pneumonia (PCP), cellulitis, sepsis, and herpes zoster were the most frequently reported PTs. We obtained the reporting odds ratio (ROR) and the time to onset of these six PTs and compared them in the cases reported for each immunosuppressant as a suspected drug. We focused on RA treatment, including five tumor necrosis factor (TNF) antagonists (infliximab, etanercept, adalimumab, golimumab, and certolizumab pegol). For pneumonia, interstitial lung disease and sepsis, no specific correlation was observed for each immunosuppressant for RA. In the case of PCP, the highest ROR was observed in the patients treated with infliximab. The time to onset of PCP in the infliximab-treated patients (median, 0.19 yr) was significantly shorter than the onset time in the patients treated with tocilizumab, an interleukin-6 receptor blocker that is another type of drug for RA(0.32 yr, p<0.01, Mann-Whitney test). The onset time in the patients treated with golimumab (0.24 yr) was also significantly shorter than the onset time for tocilizumab(p<0.05), but the ROR was not as high. These results suggested a correlation between PCP and infliximab. In the cases of cellulitis and herpes zoster, a similar correlation was observed with tocilizumab and certolizumab pegol, respectively. We should consider these results when patients have a respiratory disorder or skin/subcutaneous tissue disorder.
2.The Safety Profiles of Biological Drugs for Rheumatoid Arthritis
Tetsu KOBAYASHI ; Kazushige MURAYAMA ; Yuki OHTA ; Nana KAWASAKI ; Satoshi TOYOSHIMA ; Akiko ISHII-WATABE
Japanese Journal of Pharmacoepidemiology 2017;21(2):63-76
To identify the most frequently reported preferred terms (PTs) in the cases of rheumatoid arthritis (RA) patients treated with immunosuppressive biological drugs as suspected drugs, we analyzed the cases in the Japanese Adverse Drug Event Report (JADER) database. We found that pneumonia, interstitial lung disease, Pneumocystis jiroveci pneumonia (PCP), cellulitis, sepsis, and herpes zoster were the most frequently reported PTs. We obtained the reporting odds ratio (ROR) and the time to onset of these six PTs and compared them in the cases reported for each immunosuppressant as a suspected drug. We focused on RA treatment, including five tumor necrosis factor (TNF) antagonists (infliximab, etanercept, adalimumab, golimumab, and certolizumab pegol). For pneumonia, interstitial lung disease and sepsis, no specific correlation was observed for each immunosuppressant for RA. In the case of PCP, the highest ROR was observed in the patients treated with infliximab. The time to onset of PCP in the infliximab-treated patients (median, 0.19 yr) was significantly shorter than the onset time in the patients treated with tocilizumab, an interleukin-6 receptor blocker that is another type of drug for RA(0.32 yr, p<0.01, Mann-Whitney test). The onset time in the patients treated with golimumab (0.24 yr) was also significantly shorter than the onset time for tocilizumab(p<0.05), but the ROR was not as high. These results suggested a correlation between PCP and infliximab. In the cases of cellulitis and herpes zoster, a similar correlation was observed with tocilizumab and certolizumab pegol, respectively. We should consider these results when patients have a respiratory disorder or skin/subcutaneous tissue disorder.
3.Clinical Characteristics of Esophageal Motility Disorders in Patients With Heartburn
Satsuki TAKAHASHI ; Tomoaki MATSUMURA ; Tatsuya KANEKO ; Mamoru TOKUNAGA ; Hirotaka OURA ; Tsubasa ISHIKAWA ; Ariki NAGASHIMA ; Wataru SHIRATORI ; Naoki AKIZUE ; Yuki OHTA ; Atsuko KIKUCHI ; Mai FUJIE ; Keiko SAITO ; Kenichiro OKIMOTO ; Daisuke MARUOKA ; Tomoo NAKAGAWA ; Makoto ARAI ; Jun KATO ; Naoya KATO
Journal of Neurogastroenterology and Motility 2021;27(4):545-554
Background/Aims:
Esophageal motility disorders (EMDs) contribute to the pathophysiology of gastroesophageal reflux disease. However, the causes of EMDs and their impact on gastroesophageal reflux disease-associated symptoms remain unknown. This study aims to elucidate clinical features associated with various types of EMDs in patients with heartburn symptoms.
Methods:
Of the 511 patients who underwent high-resolution manometry, 394 who were evaluated for heartburn symptoms were examined. Patients subjected to high-resolution manometry were classified into 4 groups: outflow obstruction group, hypermotility group, hypomotility group, and normal motility group. Symptoms were evaluated using 3 questionnaires. Patient characteristics and symptoms for each EMD type were compared with those of the normal motility group.
Results:
Of the 394 patients, 193 (48.9%) were diagnosed with EMDs, including 71 with outflow obstruction, 15 with hypermotility, and 107 with hypomotility. The mean dysphagia score was significantly higher in each of the 3 EMD groups compared with those with normal motility. The mean acid reflux and dyspepsia scores were significantly lower in the outflow obstruction group (P < 0.05). The mean body mass index and median Brinkman index were significantly higher in the hypermotility group (P = 0.001 and P = 0.018, respectively), whereas the mean diarrhea and constipation scores were significantly lower in the hypomotility group (P < 0.05).
Conclusions
The results of our study indicate that different EMDs have distinct characteristics. Cigarette smoking and high body mass index were associated with esophageal hypermotility. Assessment of the dysphagia symptom scores may help identify patients with EMDs.
4.Clinical Characteristics of Esophageal Motility Disorders in Patients With Heartburn
Satsuki TAKAHASHI ; Tomoaki MATSUMURA ; Tatsuya KANEKO ; Mamoru TOKUNAGA ; Hirotaka OURA ; Tsubasa ISHIKAWA ; Ariki NAGASHIMA ; Wataru SHIRATORI ; Naoki AKIZUE ; Yuki OHTA ; Atsuko KIKUCHI ; Mai FUJIE ; Keiko SAITO ; Kenichiro OKIMOTO ; Daisuke MARUOKA ; Tomoo NAKAGAWA ; Makoto ARAI ; Jun KATO ; Naoya KATO
Journal of Neurogastroenterology and Motility 2021;27(4):545-554
Background/Aims:
Esophageal motility disorders (EMDs) contribute to the pathophysiology of gastroesophageal reflux disease. However, the causes of EMDs and their impact on gastroesophageal reflux disease-associated symptoms remain unknown. This study aims to elucidate clinical features associated with various types of EMDs in patients with heartburn symptoms.
Methods:
Of the 511 patients who underwent high-resolution manometry, 394 who were evaluated for heartburn symptoms were examined. Patients subjected to high-resolution manometry were classified into 4 groups: outflow obstruction group, hypermotility group, hypomotility group, and normal motility group. Symptoms were evaluated using 3 questionnaires. Patient characteristics and symptoms for each EMD type were compared with those of the normal motility group.
Results:
Of the 394 patients, 193 (48.9%) were diagnosed with EMDs, including 71 with outflow obstruction, 15 with hypermotility, and 107 with hypomotility. The mean dysphagia score was significantly higher in each of the 3 EMD groups compared with those with normal motility. The mean acid reflux and dyspepsia scores were significantly lower in the outflow obstruction group (P < 0.05). The mean body mass index and median Brinkman index were significantly higher in the hypermotility group (P = 0.001 and P = 0.018, respectively), whereas the mean diarrhea and constipation scores were significantly lower in the hypomotility group (P < 0.05).
Conclusions
The results of our study indicate that different EMDs have distinct characteristics. Cigarette smoking and high body mass index were associated with esophageal hypermotility. Assessment of the dysphagia symptom scores may help identify patients with EMDs.
5.A Case of Brugada Syndrome Treated With Percutaneous Epicardial Catheter Ablation
Masahiro OGAWA ; Yoshiyuki HYOUDOU ; Masayuki OKIJIMA ; Hirotaka INOUE ; Kouji KONDOU ; Yuki FUJII ; Atsuya SAKAIDE ; Keisuke TSUJIKAWA ; Kazuyoshi NISHIYAMA ; Ryouta TANI ; Izumi OHTA ; Mizuki ENDOU ; Kimitoshi SANO ; Kenji NAKAMAE ; Shinji KANEKO ; Masaya FUJITA ; Yousuke TATAMI ; Osamu KAWAGUCHI
Journal of the Japanese Association of Rural Medicine 2020;69(4):385-
This case report describes our first experience performing percutaneous epicardial catheter ablation for Burugada syndrome in our hospital. We describe the good results achieved in this case. The patient was a man in his 30s with no remarkable medical history. However, his family history was notable for the sudden death of his grandfather at age 37 years and his father at age 27 years. While asleep, the patient experienced convulsions and lost consciousness. During emergency transportation, defibrillation was performed 7 times by the ambulance crew. When the patient arrived at our hospital, sinus rhythm was observed on ECG. During resuscitation, Burugada syndrome was diagnosed based on ECG findings. On hospital day 6, an internal cardioverter defibrillator was implanted. After discharge, the defibrillator operated 10 times, so we opted for ablation treatment. Fractionated potential of over 150 ms was confirmed in the right ventricular outflow tract. A low voltage zone of <1 mV could be mapped, and the same site was cauterized a total of 46 times. As a result, ST segment amplitude decreased significantly in lead V1 on ECG. Percutaneous epicardial catheter ablation performed with reference to Nademanee’s report achieved good results in this case of Burugada syndrome.