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卡非佐米相关心血管不良事件的真实世界经验:SEER-医疗保险数据集分析。

Real-world experience of carfilzomib-associated cardiovascular adverse events: SEER-Medicare data set analysis.

机构信息

Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA.

Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.

出版信息

Cancer Med. 2021 Jan;10(1):70-78. doi: 10.1002/cam4.3568. Epub 2020 Nov 10.

Abstract

Carfilzomib was approved for the treatment of multiple myeloma in 2012 and since then there have been concerns for cardiovascular toxicity from its use. With this study, we aim to further study the hazards and underlying risk factors for cardiovascular adverse events associated with carfilzomib. This study was conducted using Surveillance, Epidemiology, and End Results (SEER)-Medicare data set of multiple myeloma from 2001 to 2015. Data were analyzed for hazards ratio of cardiovascular adverse events between carfilzomib users and nonusers. We identified 7330 patients with multiple myeloma of whom 815 were carfilzomib users. Carfilzomib users had a statistically significant hazard ratio of 1.41 with p < 0.0001 for all cardiovascular adverse events as compared to nonusers. Carfilzomib use was significantly associated with increased risk of heart failure (HR 1.47, p = 0.0002), ischemic heart disease (HR 1.45, p = 0.0002), and hypertension (HR 3.33, p < 0.0001), whereas there was no association between carfilzomib use and cardiac conduction disorders (arrhythmia and heart blocks). Carfilzomib users were at higher risk of new-onset edema (HR 5.09, p < 0.0001), syncope (HR 4.27, p < 0.0001), dyspnea (HR 1.33, p < 0.0001), and chest pain (HR 1.18, p < 0.0001) as compared to carfilzomib nonusers. Age above 75 years, preexisting cardiovascular disease, obesity, and twice a week carfilzomib schedule were significant risk factors associated with cardiovascular adverse events in carfilzomib users. The median time of the onset for all cardiovascular adverse events was 3.1 months. This study has identified a significantly higher likelihood of cardiovascular adverse events in elderly Medicare patients receiving carfilzomib.

摘要

卡非佐米于 2012 年被批准用于多发性骨髓瘤的治疗,此后一直存在对其使用引起心血管毒性的担忧。本研究旨在进一步研究与卡非佐米相关的心血管不良事件的危害和潜在危险因素。本研究使用了 2001 年至 2015 年期间监测、流行病学和最终结果(SEER)-医疗保险多发性骨髓瘤数据集。对卡非佐米使用者和非使用者之间心血管不良事件的危害比进行了数据分析。我们确定了 7330 名多发性骨髓瘤患者,其中 815 名患者使用了卡非佐米。与非使用者相比,卡非佐米使用者发生所有心血管不良事件的风险比具有统计学意义(HR 1.41,p<0.0001)。卡非佐米的使用与心力衰竭(HR 1.47,p=0.0002)、缺血性心脏病(HR 1.45,p=0.0002)和高血压(HR 3.33,p<0.0001)的风险增加显著相关,而卡非佐米的使用与心脏传导障碍(心律失常和心脏阻滞)无关。卡非佐米使用者发生新发水肿(HR 5.09,p<0.0001)、晕厥(HR 4.27,p<0.0001)、呼吸困难(HR 1.33,p<0.0001)和胸痛(HR 1.18,p<0.0001)的风险高于卡非佐米非使用者。年龄大于 75 岁、既往存在心血管疾病、肥胖和每周两次卡非佐米治疗方案是卡非佐米使用者发生心血管不良事件的显著危险因素。所有心血管不良事件的中位发病时间为 3.1 个月。本研究确定了在接受卡非佐米治疗的老年医疗保险患者中,心血管不良事件发生的可能性显著增加。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/556d/7826471/7b12b344fc04/CAM4-10-70-g001.jpg

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