Literature analysis of dropped head syndrome induced by mitogen-activated extracellular signal regulated kinase inhibitors
10.3760/cma.j.cn114015-20201230-01299
- VernacularTitle:丝裂原细胞外激酶抑制剂致垂头综合征文献病例分析
- Author:
Junmei SHANG
1
;
Xin LIU
1
;
Bo ZHANG
1
Author Information
1. 中国医学科学院北京协和医院药剂科/疑难重症及罕见病国家重点实验室，北京 100730
- Publication Type:Journal Article
- Keywords:
Mitogen-activated protein kinases;
Polymyositis;
Creatine kinase;
Dropped head syndrome
- From:
Adverse Drug Reactions Journal
2021;23(5):247-251
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical features of dropped head syndrome(DHS) related to mitogen-activated extracellular signal regulated kinase inhibitors.Methods:Case reports of dropped head syndrome caused by MEK inhibitors were collected by searching PubMed and Embase databases as of December 20, 2020. The following information of patients including gender, age, primary diseases, use of MEK inhibitors, occurrence time and clinical symptoms of DHS, and treatments and outcomes were extracted and analyzed descriptively.Results:A total of 7 patients were entered; 4 from the United States, 2 from France, and 1 from Germany. There were 4 males and 3 females, aged from 56 to 76 years. The primary diseases were metastatic melanoma in 6 patients and Erdheim-Chester disease in 1 patient. Of them, 3 patients were treated with selumetinib, 2 were with cobimetinib, and 1 was with binimetinib and trametinib respectively. Time from the first application of MEK inhibitors to the onset of DHS was from 0.5 to 20 months with a median time of 1 (1, 2) month. Major symptoms of DHS were neck pain, neck extensor weakness, and limited head lifting, which might be accompanied by neck stiffness in some patients. The pain on the neck could spread to the shoulders and occipital region, and a few patients might only have interscapular pain. At the time of diagnosis of DHS, the serum concentration of creatine kinase (CK) was elevated (150~1 011 U/L). After the diagnosis of DHS, 5 patients stopped taking MEK inhibitors and DHS symptoms were relieved or disappeared; 2 patients were treated with glucocorticoids for 1 to 4 weeks, but DHS symptoms were not relieved, then they stopped taking MEK inhibitors and DHS symptoms were improved. In total, the symptoms of DHS in the 7 patients were relieved after 14-30 days of MEK inhibitors withdrawal, with serum CK returning to within normal range. Three patients rechallenged MEK inhibitors with reduced doses; 1 patient had no recurrence of DHS and the remaining 2 patients had mild recurrences of DHS, which could resolve spontaneously or stay a stable condition.Conclusions:DHS related to MEK inhibitors usually occurs within 1 month of medication, accompanied by an increase in CK level. The symptoms can be relieved or disappear after stopping medication in time and CK level will return to normal.
