1.Mining and analysis of adverse drug event signals of cinacalcet and etelcalcetide
Hongli WANG ; Guizun ZHONG ; Dongxuan LI ; Zhengze SHEN
China Pharmacy 2024;35(8):986-990
OBJECTIVE To explore and analyze the adverse drug event (ADE) signals of cinacalcet and etelcalcetide, to provide a reference for safe drug use in the clinic. METHODS ADE reports related to cinacalcet and etelcalcetide were extracted from the FDA Adverse Event Reporting System from January 1st, 2004 to June 30th, 2023 using the OpenVigil online tool. The Bayesian confidence propagation neural network method was adopted to detect the signals of ADE from the key organ systems. The signals were encoded according to the preferred term in the ADE terminology set of the Medical Dictionary for Regulatory Activities (26.0 edition). RESULTS A total 41 709 and 1 710 ADE reports were extracted, and 29 and 45 safety signals were detected in key systems for cinacalcet and etelcalcetide, respectively; 20 and 36 positive signals were not included in the drug instructions. Hypocalcemia/decreased serum calcium, abnormal blood parathyroid hormone (PTH)/increased or decreased serum PTH were common ADEs of the two drugs, which were detected in the study. Among the signals not included in the drug instructions, new moderate and strong signals were detected, such as cinacalcet-induced calcification defense (metabolic and nutritional diseases), bone starvation syndrome and high conversion bone diseases (musculoskeletal and connective tissue diseases) as well as etelcalcetide-induced sudden death, necrosis and treatment of non-responders (general disorders, administration site), unstable angina pectoris, myocardial ischemia (cardiac diseases), intestinal perforation, gastric antrum vasodilation and gastric ulcer (gastrointestinal diseases). CONCLUSIONS In the clinical application of the two drugs, apart from the common ADEs such as hypocalcemia and abnormal blood PTH, the surveillance of some new potential ADEs should also be carried out, such as bone starvation syndrome, calcification defense, ventricular disease and other cinacalcet-induced ADEs, sudden death, myocardial ischemia, unstable angina pectoris, intestinal perforation, gastric ulcer and other etecalcetide-induced ADEs. If new ADEs appear, clinic should promptly assess the benefits and risks, and update the treatment plan and pharmacological monitoring plan to ensure the safety of patient medication.
2.Detection and evaluation of the signals of amlodipine and lercanidipine based on FAERS database
Guizun ZHONG ; Ni ZHANG ; Hongli WANG ; Siqi CHEN ; Li GONG ; Lingyun PAN ; Yuntao JIA
China Pharmacy 2022;33(21):2647-2653
OBJECTIVE To detect and evaluate the signals of amlodipine and lercanidipine -induced adverse drug events (ADE). METHODS All ADE reports about “amlodipine”and“lercanidipine”were searched from FAERS database during Jan . 1st,2004 to Sept . 30th,2021. Reported odds ratio and Bayesian confidence propagation neural network were used to detect ADE signals. The moderately strong signals and strong signals in key systems were selected for analysis . RESULTS From FAERS database,249 657 and 10 558 reports were extracted with amlodipine and lercanidipine as suspect drugs ,respectively. In this study,62 and 58 signals related to amlodipine and lercanidipine were detected respectively . At the same time ,moderately strong signals of peripheral edema , hypotension, orthostatic hypotension and hypovolemic shock were detected in the twodrugs,all of which were common adverse reactions of the two drugs. The special ADEs detected in this study were as follows: in the respiratory system , chest and mediastinaldisease system ,strong signals of non -cardiogenic pulmonary edema were detected for amlodipine ,and strong signals of dyspnea at rest for lercanidipine ;in gastrointestinal diseases ,strong signals of gingival hypertrophy were detected only for amlodipine;in skin and subcutaneous tissue disease system ,moderately strong signals related to “vasculitis”were detected for both drugs,moderately strong signals related to linear IgA disease were detected for amlodipine ,and moderately strong signals related to bullous dermatitis were detected for lercanidipine ;in the renal and urinary system disease system ,the signals of acute renal injury were detected for both drugs (amlodipine was detected as a moderately strong signal ,and lecardipine was detected as a strong signal ); in the mental system ,moderately strong signals related to suicide were detected for amlodipine . Both hypotension and acute renal injury ranked in the top two in the number of reports of the two drugs . The time scan results of the information component (IC)of this study showed that the IC values of non -cardiogenic pulmonary edema and suicide completion signals of amlodipine increased from 0.76,-0.49 to 4.48 and 1.95 respectively,and the confidence intervals narrowed from (-0.44,1.97),(-1.01,0.03)to (4.24,4.72)and(1.90,2.01)respectively during 2004 to 2021,suggesting that the signals kept stable . CONCLUSIONS The risks of peripheral edema ,hypotension,arrhythmia,pulmonary edema ,gingival hyperplasia ,skin related ADE ,acute renal injury , depression and suicide should be alert when using amlodipine and lercanidipine in clinic .
3.Analysis of β-blockers associated with acute renal failure signal based on data mining method
Hongli WANG ; Ni ZHANG ; Guizun ZHONG ; Siqi CHEN ; Huanhuan JI ; Li GONG ; Lingyun PAN ; Yuntao JIA
China Pharmacy 2022;33(11):1380-1385
OBJECTIVE To excavate and evaluate β-blockers associated with acute renal failure(ARF)signal. METHODS Using the report odds ratio (ROR)method and Bayesian confidence interval progressive neural network (BCPNN)method,signal detection and analysis were performed for 4 kinds of β-blockers(metoprolol,bisoprolol,atenolol,nebivolol)associated with ARF Δ 基金项目:重庆市临床药学重点专科建设项目 (No.渝卫办发 in FDA adverse event reporting system (FAERS)from the two 〔2020〕68号);重庆医科大学未来医学青年创新团队发展支持计划项 dimensions of Standard International Dictionary of Medical 目(No.W0081) Terms (MedDRA) analysis query (SMQ) term set and *药师,硕士研究生。研究方向:药物警戒。电话:023-68485161。 preferred term (PT) level terms. When the two methods E-mail:2020121624@stu.cqmu.edu.cn detected positive signals at the same time ,it indicated that # 通信作者:主任药师,硕士生导师。研究方向:临床药学、药物警 suspicious signals were detected. RESULTS Totally 14 328 戒。电话:023-63625666。E-mail:jiayuntaomail@hospital.cqmu.edu.cn ARF reports of 4 kinds of β-blockers were retrieved within the ·1380· China Pharmacy 2022Vol. 33 No. 11 中国药房 2022年第33卷第11期 narrow sense of “acute renal failure ”in SMQ term set ,of which men (6 964)were more than women (6 206). The age of patients was mainly concentrated in the middle-aged and elderly (≥45 years old ),and serious adverse events accounted for 77.23%. The results of signal retrieval based on SMQ term set showed that ROR values and 95% confidence intervals of metoprolol ,bisoprolol, atenolol and nebivolol detected by ROR method were 2.58(2.51,2.65),5.30(5.14,5.47),2.80(2.69,2.91)and 3.28(3.04, 3.53)respectively. The signal components (IC)detected by BCPNN method and the lower limit of IC were 1.29(1.25),2.26 (2.22),1.42(1.36)and 1.64(1.53)respectively,suggesting suspicious signals were detected in these four kinds of β-blockers associated ARF. The results of signal detection based on PT level terms showed that 37 positive signals were detected by ROR method,38 positive signals were detected by BCPNN method ,and 36 suspicious signals were detected by the two methods at the same time. For each drug ,12 suspicious signals of metoprolol were detected at the same time ,9 suspicious signals of bisoprolol and atenolol were detected at the same time ,and 6 suspicious signals of nebivolol were detected at the same time ;the number and type of signals were different among the 4 kinds of drug. CONCLUSIONS Four kinds of β-blockers may cause ARF. Compared with metoprolol and atenolol ,bisoprolol and nebivolol have strong statistical correlation with ARF ,suggesting that medical personnel should pay attention to the possible renal related adverse reactions of these drugs in the process of clinical use.
4.Mining and Evaluation of Post-marketing Safe Alert Signals of Pegaspargase and L-asparaginase Based on BCPNN Method
Ni ZHANG ; Hongli WANG ; Guizun ZHONG ; Jun GONG ; Long MENG ; Huilai WANG ; Jianwen XIAO ; Yuntao JIA
China Pharmacy 2021;32(16):2012-2018
OBJECTIVE: To mine and evaluate the post-marketing safety alert signals of pegaspargase (PEG-ASP) and L-asparaginase (L-ASP),and compare the safety differences between them ,so as to provide reference for clinical safe and rational drug use. METHODS : The adverse drug event (ADE) reports of PEG-ASP and L-ASP issued by FDA adverse event reporting system from Jan. 1st,2004-Jun. 30th,2020 were retrieved. BCPNN method was used to mine the safety signals of these two drugs under the condition that the lower limit of information component (IC-2SD)>0 and the number of events ≥3. The medium and strong signals of two drugs with IC -2SD≥1.5 were evaluated and compared in 8 system organ class,such as gastrointestinal system ,hepatobiliary system ,blood and lymphatic system ,blood vessels and lymphatic vessels , nervous system ,immune system ,metabolism and nutrition ,various examinations. IC value of specific ADE signal and its 95% confidence interval were analyzed by time scanning spectrum. RESULTS & CONCLUSIONS :The reports of PEG-ASP and L-ASP as suspected drugs were 2 324 and 3 824;67 and 68 medium and strong signals were included ,respectively. In gastrointestinal system,the common strong signal of PEG-ASP and L-ASP was necrotic pancreatitis. In hepatobiliary system ,both of them showed strong signal in venoocclusive liver disease ,and this ADE was not included in the drug instruction. In blood and lymphatic system , common strong signals of the two drugs were febrile neutropenia ,coagulation disorder ,neutropenia and febrile bone marrow regeneration disorder ;in blood vessels and lymphatic vessels ,in addition to haemodynamic instability ,IC values of other signals of L-ASP were higher than those of PEG-ASP. In nervous system ,IC values of other signals of L-ASP were higher than those of PEG-ASP except for intracranial haemorrhage. In immune system ,anaphylactic reaction was a medium signal for L-ASP but was a strong signal for PEG-ASP. In metabolism and nutritional diseases ,except for tumor lysis syndrome ,IC values of other signals of L-ASP were higher than those of PEG-ASP. The results of time scanning spectrum showed that the signals of necrotic pancreatitis and coagulation disorder of PEG-ASP were stable ,while the signals of veno occlusive liver disease and hypersensitivity were unstable and needed to be observed ;above four signals of L-ASP were stable signals. When using PEG-ASP or L-ASP clinically , close attention should be paid to the safety problems such as hypersensitivity ,coagulation disorder ,thrombosis,necrotic pancreatitis,venoocclusive liver disease and hypoproteinemia.