Psychopharmacology (Berl)

RATIONALE: While meta-analyses of clinical trials found that lurasidone and partial dopamine agonists (brexpiprazole and aripiprazole) were the antipsychotics less likely to cause QTc prolongation, and sertindole, amisulpride, and ziprasidone were the most frequently associated with this adverse drug reaction; no real-world studies have investigated this risk between the different antipsychotics. OBJECTIVES AND METHODS: Using data recorded from 1967 to 2019 in VigiBase®, the World Health Organization's Global Individual Case Safety Reports database, we performed disproportionality analysis to investigate the risk of reporting QT prolongation between 20 antipsychotics. RESULTS: Sertindole had the highest risk of reporting QT prolongation, followed by ziprasidone and amisulpride. Lurasidone was associated with the lowest risk. First-generation antipsychotics were associated with a greater QT prolongation reporting risk (ROR, 1.21; 95%CI, 1.10-1.33) than second-generation antipsychotics. A positive correlation was found between the risk of reporting QT prolongation and affinity for hERG channel (R(2) = 0.14, slope = Pearson coefficient = 0.41, p value = 0.1945). CONCLUSIONS: This large study in a real-world setting suggests that sertindole and ziprasidone were the antipsychotics drugs associated with the highest risk of QT prolongation reporting. Our results suggest that lurasidone is less associated with QT interval prolongation reports. Our study also suggests that antipsychotics with the higher hERG affinity are more associated with to QT prolongations reports

Cardiovascular adverse effects of anti–IL-5/IL-5Rα therapies: A real-world study

International audienceOmalizumab, an antibody directed against the receptor-binding domain of IgE, was the first biological therapy marketed in severe allergic asthma. Several observational studies including long-term analyses concluded that omalizumab has showed an overall optimal safety profile1-5.Although higher incidence rate of cerebrovascular and cardiovascular adverse events emerged in some studies3, 4, confounding factors between omalizumab and non-omalizumab patients were likely to explain those results. Recently, mepolizumab, reslizumab (both anti-interleukin 5 (IL5)) and benralizumab (an anti-IL5 receptor-α (IL5Rα)) have been associated with a reduction of the exacerbation rate and the dose of oral steroids in eosinophilic severe asthma. In long-term safety studies, rare cardiovascular events such as myocardial infarction, deep venous thrombosis and stroke have been described with benralizumab and mepolizumab. Nevertheless, an association between these events and these drugs is still unknow6, 7. We performed a pharmacovigilance study in order to assess the effect of anti-IL5/IL5Rα therapies on cardiovascular events

Cardiogenic shock in adults with congenital heart disease: Insights from the FRENSHOCK registry

International audienceBackground: Data on cardiogenic shock in adults with congenital heart disease (ACHD) are scarce.Aim:We sought to describe cardiogenic shock in ACHD patients in a nationwide cardiogenic shock registry.Methods: From the multicentric FRENSHOCK registry (772 patients with cardiogenic shock from 49 French centres between April and October 2016), ACHD patients were compared with adults without congenital heart disease (non-ACHD). The primary outcome was defined by all-cause mortality, chronic ventricular assist device or heart transplantation at 1 year.Results: Out of the 772 patients, seven (0.9%) were ACHD, who were younger (median age: 56 vs. 67 years), had fewer cardiovascular risk factors, such as hypertension (14.3% vs. 47.5%) and diabetes (14.3% vs. 28.3%), and no previous ischaemic cardiopathy (0 vs. 61.5%). Right heart catheterization (57.1% vs. 15.4%), pacemakers (28.6% vs. 4.6%) and implantable cardioverter-defibrillators (28.6% vs. 4.8%) were indicated more frequently in the management of ACHD patients compared with non-ACHD patients, whereas temporary mechanical circulatory support (0 vs. 18.7%) and invasive mechanical ventilation (14.3% vs. 38.1%) were less likely to be used in ACHD patients. At 1 year, the primary outcome occurred in 85.7% (95% confidence interval: 42.1–99.6) ACHD patients and 52.3% (95% confidence interval: 48.7–55.9) non-ACHD patients. Although 1-year mortality was not significantly different between ACHD patients (42.9%) and non-ACHD patients (45.4%), ventricular assist devices and heart transplantation tended to be more frequent in the ACHD group.Conclusions: Cardiogenic shock in ACHD patients is rare, accounting for only 0.9% of an unselected cardiogenic shock population. Despite being younger and having fewer co-morbidities, the prognosis of ACHD patients with cardiogenic shock remains severe, and is similar to that of other patients