Drug-Related Hypersensitivity Reactions Leading to Emergency Department: Original Data and Systematic Review

The aim of the present study is to describe pharmacological characteristics of drug-related allergies and anaphylaxis leading to the emergency department (ED). An 8-year post hoc analysis on the MEREAFaPS Study database was performed (2012–2019). Subjects who experienced drug-related hypersensitivity leading to an ED visit were selected. Logistic regression analyses were used to estimate the reporting odds ratios (RORs) of drug-related allergies and anaphylaxis adjusting for sex, age classes, and ethnicity. In addition, a systematic review of observational studies evaluating drug-related hypersensitivity reactions leading to ED visits in outpatients was performed. Out of 94,073 ED visits, 14.4% cases were drug-related allergies and 0.6% were anaphylaxis. Females accounted for 56%. Multivariate logistic regression showed a higher risk of drug-related allergy among males and all age classes < 65 years, while a higher risk of anaphylaxis was observed for females (ROR 1.20 [1.01–1.42]) and adults (ROR 2.63 [2.21–3.14]). The systematic review included 37 studies. ED visits related to allergy and anaphylaxis ranged from 0.004% to 88%, and drug-related allergies and anaphylaxis ranged from 0.007% to 88%. Both in our analysis and in primary studies, antibacterials, analgesics, and radiocontrast agents were identified as the most common triggers of hypersensitivity

MEREAFaPS: uno Studio di Farmacovigilanza Attiva e Farmacoepidemiologia in Pronto Soccorso

Adverse drug reactions (ADRs) have a significant impact on the patient’s health. The purpose of this PhD thesis was to analyse the impact of ADRs on the admissions to the emergency room, using the data obtained from the MEREAFaPS study. Elderly patients resulted the most exposed group to ADRs. Gastrointestinal disorders were the most commonly reported adverse reactions. Acetylsalicylic acid and warfarin were the most reported drugs. 17% of serious ADRs and 32% of the resulting deaths were classified as avoidable. Elderly age was found to be the main risk factor associated with ADRs. It is therefore important to underline the need for a more careful use of drugs in this group of patients.Le reazioni avverse a farmaco (ADR) hanno un notevole impatto sulla salute dei pazienti. Lo scopo di questa tesi di dottorato \ue8 stato quello di analizzare l’impatto delle ADR sugli accessi in pronto soccorso, utilizzando i dati ottenuti dallo studio MEREAFaPS. I pazienti anziani sono risultati il gruppo pi\uf9 esposto ad ADR. I disturbi gastrointestinali sono state le reazioni avverse maggiormente riportate. L’acido acetilsalicilico ed il warfarin sono stati i due farmaci pi\uf9 segnalati. Il 17% delle ADR gravi e il 32% dei decessi correlati sono stati classificati come evitabili. L’et\ue0 anziana \ue8 risultato essere il principale fattore di rischio associato ad ADR, si sottolinea per questo la necessit\ue0 di un uso pi\uf9 attento dei farmaci in questo gruppo di pazienti

Pattern of Use and Long-Term Safety of Tyrosine Kinase Inhibitors: A Decade of Real-World Management of Chronic Myeloid Leukemia

Background and Objectives First-line treatment of chronic phase (CP) chronic myeloid leukemia (CML) is based on the first-generation tyrosine kinase inhibitor (TKI) imatinib or the second-generation TKIs dasatinib or nilotinib. Thanks to the efficacy of TKIs, CML has switched from a fatal to a chronic' pathology, and data from clinical trials have become insufficient to drive physicians' prescription choices and address long-term treatment outcomes. On the brink of commercialization of generic imatinib, this study aims to evaluate the therapeutic pattern of CP-CML and the occurrence of adverse events (AEs) over a decade of local real clinical practice. Methods A retrospective cohort study was performed on CP-CML patients followed up in the Local Health Unit of Treviso (Veneto Region, Italy) during the period 2005-2015. Data were captured from both administrative databases and physicians' patient diaries. Results Of 81 CP-CML patients, 73 were treated with first-line imatinib; among the second-generation TKIs, only nilotinib was used (n=8). Overall, 38% of imatinib-treated subjects needed to switch, mainly due to intolerance, whereas no switches occurred in the nilotinib cohort. Osteoarticular pain was the most common AE and was significantly more frequent in the imatinib cohort (68.49 vs. 25.00%, p=0.022). Other common AEs were dermatologic manifestations, asthenia, and diarrhea. Conclusion Although based on a small population, this study represents an unbiased reference on the long-term management of CML in an Italian clinical setting. Our results indicate a better profile of first-line nilotinib, both in terms of persistency and tolerability. AEs remain a major concern, highlighting the importance of close monitoring

Antidepressants and the Risk of Cardiovascular Events in Elderly Affected by Cardiovascular Disease: A Real-Life Investigation From Italy

The purpose of this study was to assess the possible relation between use of antidepressant (AD) drugs, that is, tricyclic ADs, selective serotonin reuptake inhibitors (SSRIs), and atypical ADs (AAs), and the risk of hospitalization for cardiovascular (CV) events among older patients with previous CV diseases