Cheng Connie, Lau Jessica E, Earl Marc A
Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio, USA.
J Community Support Oncol. 2015 Jan;13(1):3-7. doi: 10.12788/jcso.0099.
Cholinergic syndrome is a well established acute adverse reaction associated with irinotecan. Cholinergic side effects can be ameliorated or prevented with anticholinergic agents. To date, no formal studies have compared atropine-diphenoxylate and hyoscyamine as premedications for prophylaxis of the cholinergic syndrome with irinotecan infusion.
To compare the incidence of cholinergic syndrome with irinotecan using atropine-diphenoxylate or hyoscyamine as premedication.
We conducted a retrospective, single-center, nonrandomized, cohort study of adult patients treated with atropine-diphenoxylate or hyoscyamine as premedication before receiving irinotecan. For all irinotecan infusions, intravenous atropine was administered for patients experiencing any cholinergic reaction.
A total of 532 irinotecan cycles (354 cycles for atropine-diphenoxylate group; 178 cycles for hyoscyamine group) were analyzed in 80 patients. Overall incidence of cholinergic syndrome did not differ between atropine-diphenoxylate (8.2%) and hyoscyamine (9.0%) groups (P = .76). The incidence of cholinergic syndrome after the £rst cycle of irinotecan was similar between the 2 arms, atropine-diphenoxylate (14.6%) and hyoscyamine (10.7%), with P = .74. The most common cholinergic symptoms documented were abdominal pain or cramping, and diarrhea.
This study was subjected to vulnerabilities to bias and random error because of its observational retrospective design and small number of participants.
Lack of difference in the incidence of cholinergic syndrome observed in irinotecan-treated patients suggests atropinediphenoxylate and hyoscyamine may both be effective prophylactic options. The findings support the need for a larger, randomized study to assess and compare these agents with other potential premedications such as scopolamine and atropine in prevention of irinotecan-related cholinergic syndrome.
胆碱能综合征是一种与伊立替康相关的公认的急性不良反应。抗胆碱能药物可改善或预防胆碱能副作用。迄今为止，尚无正式研究比较阿托品-地芬诺酯和莨菪碱作为预防伊立替康输注所致胆碱能综合征的预处理药物。
比较使用阿托品-地芬诺酯或莨菪碱作为预处理药物时伊立替康所致胆碱能综合征的发生率。
我们对接受伊立替康治疗前使用阿托品-地芬诺酯或莨菪碱作为预处理药物的成年患者进行了一项回顾性、单中心、非随机队列研究。对于所有伊立替康输注，出现任何胆碱能反应的患者均给予静脉注射阿托品。
共分析了80例患者的532个伊立替康治疗周期（阿托品-地芬诺酯组354个周期；莨菪碱组178个周期）。阿托品-地芬诺酯组（8.2%）和莨菪碱组（9.0%）胆碱能综合征的总体发生率无差异（P = 0.76）。伊立替康第一周期后胆碱能综合征的发生率在两组中相似，阿托品-地芬诺酯组为14.6%，莨菪碱组为10.7%，P = 0.74。记录到的最常见胆碱能症状为腹痛或绞痛以及腹泻。
由于本研究为观察性回顾性设计且参与者数量较少，因此容易受到偏倚和随机误差的影响。
在接受伊立替康治疗的患者中观察到胆碱能综合征发生率无差异，提示阿托品-地芬诺酯和莨菪碱可能都是有效的预防选择。这些发现支持需要进行一项更大规模的随机研究，以评估和比较这些药物与其他潜在的预处理药物，如东莨菪碱和阿托品，在预防伊立替康相关胆碱能综合征方面的效果。
