Cardiac arrhythmias of BCR-ABL inhibitors with or without triazole antifungal agents: A real-world pharmacovigilance study based on the food and drug administration adverse event reporting system database.

IF 2.3 Q2 MEDICINE, GENERAL & INTERNAL
SAGE Open Medicine Pub Date : 2025-03-25 eCollection Date: 2025-01-01 DOI:10.1177/20503121251328762
Peitao Xie, Lishan Lu, Yixuan Tian, Rongrong Jia, Xuemei Tian, Pu Bai
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引用次数: 0

Abstract

Objectives: Breakpoint Cluster Region (BCR)-Abelson tyrosine kinase (ABL) inhibitors are widely used in the treatment of blood cancers, particularly chronic myelogenous leukemia and are often combined with triazole antifungal agents to prevent fungal infections. However, the cardiac arrhythmia risks associated with BCR-ABL inhibitors in combination with triazole antifungal agents in real-world settings remain poorly understood. To address this gap, we conducted a pharmacovigilance study to evaluate and compare the cardiac arrhythmia profiles of BCR-ABL inhibitors when used with and without triazole antifungal agents in clinical practice.

Methods: A disproportionality analysis was performed using the Food and Drug Administration Adverse Event Reporting System database (2004Q1-2024Q2). To identify potential signals of cardiac arrhythmias associated with BCR-ABL inhibitors, with or without triazole antifungal agents, we calculated reporting odds ratios and 95% confidence intervals. Comparisons were made between BCR-ABL inhibitor monotherapy and all other drugs in the Food and Drug Administration Adverse Event Reporting System database, as well as between BCR-ABL inhibitors combined with triazole antifungal agents and BCR-ABL inhibitor monotherapy. Additionally, the Weibull shape parameter test was also used to evaluate time-to-onset.

Results: From 2004Q1 to 2024Q2, the Food and Drug Administration Adverse Event Reporting System database reported 21,433,114 cases, including 2666 and 68 cases of cardiac arrhythmias linked to BCR-ABL inhibitor monotherapy and its combination with triazole antifungal agents, respectively. The reporting odds ratios and their 95% confidence intervals for BCR-ABL inhibitor monotherapy, asciminib, nilotinib, and ponatinib were 1.31 (1.27-1.36), 2.11 (1.45-3.06), 2.66 (2.53-2.80), and 1.18 (1.05-1.33), respectively. Dasatinib plus triazole antifungal agents (reporting odds ratio: 2.98, 95% CI: 1.93-4.60) and ponatinib plus triazole antifungal agents (reporting odds ratio: 1.53, 95% CI: 1.08-2.16) were associated with a higher disproportionality of cardiac arrhythmias than BCR-ABL inhibitor monotherapy. The median time-to-onset was longer with monotherapy than with BCR-ABL inhibitors plus triazole antifungal agents (2.63 vs. 0.34 months, p < 0.001), both indicating an early failure type.

Conclusions: BCR-ABL inhibitors plus triazole antifungal agents increase the risk of cardiac arrhythmia, particularly in the early stages of treatment, with the risk decreasing over time.

BCR-ABL抑制剂联合或不联合三唑类抗真菌药物的心律失常:基于食品和药物管理局不良事件报告系统数据库的现实世界药物警戒研究。
目的:断点簇区(BCR)-Abelson酪氨酸激酶(ABL)抑制剂广泛用于治疗血癌,特别是慢性髓性白血病,通常与三唑类抗真菌药物联合使用以预防真菌感染。然而,在现实环境中,与BCR-ABL抑制剂联合三唑抗真菌药物相关的心律失常风险仍然知之甚少。为了解决这一差距,我们进行了一项药物警戒研究,以评估和比较临床实践中BCR-ABL抑制剂与三唑类抗真菌药物联合使用和不联合使用时的心律失常情况。方法:使用美国食品药品监督管理局不良事件报告系统数据库(2004Q1-2024Q2)进行歧化分析。为了确定与BCR-ABL抑制剂相关的心律失常的潜在信号,无论是否使用三唑类抗真菌药物,我们计算了报告的优势比和95%置信区间。比较BCR-ABL抑制剂单药治疗与美国食品和药物管理局不良事件报告系统数据库中所有其他药物,以及BCR-ABL抑制剂联合三唑类抗真菌药物与BCR-ABL抑制剂单药治疗。此外,还使用Weibull形状参数检验来评估发病时间。结果:2004年q1 - 2024Q2,美国食品药品监督管理局不良事件报告系统数据库共报告21433114例,其中BCR-ABL抑制剂单药治疗和联合三唑类抗真菌药物治疗相关心律失常分别为2666例和68例。BCR-ABL抑制剂单药治疗、阿西米尼、尼罗替尼和波纳替尼的报告优势比和95%置信区间分别为1.31(1.27-1.36)、2.11(1.45-3.06)、2.66(2.53-2.80)和1.18(1.05-1.33)。达沙替尼加三唑抗真菌药物(报告优势比:2.98,95% CI: 1.93-4.60)和波纳替尼加三唑抗真菌药物(报告优势比:1.53,95% CI: 1.08-2.16)与BCR-ABL抑制剂单药治疗相比,心律失常的歧化率更高。单药治疗比BCR-ABL抑制剂联合三唑类抗真菌药物治疗的中位发病时间更长(2.63个月vs 0.34个月,p)。结论:BCR-ABL抑制剂联合三唑类抗真菌药物增加心律失常的风险,特别是在治疗的早期阶段,随着时间的推移风险降低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
SAGE Open Medicine
SAGE Open Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
3.50
自引率
4.30%
发文量
289
审稿时长
12 weeks
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