Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Kyounggi-do, Republic of Korea.
Department of Statistics, Keimyung University, Daegu, Republic of Korea.
Drug Saf. 2022 Sep;45(9):995-1002. doi: 10.1007/s40264-022-01213-z. Epub 2022 Jul 30.
The recurrence rates of immediate adverse drug reactions (ADRs) to the alternative radiocontrast media (RCM) are not well known. Previous studies suggest selection of alternative RCM considering carbamoyl side chains; however, its usefulness for preventing the recurrence of ADRs has not been clearly verified.
The aim of this study was to verify the recurrence rate of immediate ADRs according to the alternative RCM.
This retrospective study analyzed 6420 contrast-enhanced computed tomography (CT) cases of 2009 patients registered in the ADR system from 861,664 CT cases in a single tertiary hospital between 2015 and 2020. Iohexol, iopromide, iobitridol, and iopamidol were used for CT. According to the carbamoyl side chains present, iohexol belongs to group 1, iopromide belongs to groups 1 and 2, iobitridol belongs to group 2, and iopamidol belongs to group 3.
Replacing iobitridol with iopamidol (odds ratio [OR] 2.595, 95% confidence interval [CI] 1.48-4.550) or iopromide (OR 3.354, 95% CI 1.420-7.926) as the subsequent RCM was associated with increased recurrence, while replacing iopamidol with iobitridol (OR 0.506, 95% CI 0.282-0.908) and iopromide with iohexol (OR 0.355, 95% CI 0.177-0.711) was associated with decreased recurrence. Other changes did not influence the recurrence of ADRs.
The recurrence of immediate ADRs increased in certain RCM combinations of preceding and subsequent CT scans, and the RCMs did not show cross-reactivity. Therefore, the clinical benefit of the alternative RCM considering cross-reactivity is limited. This result suggests that the side chains of RCM do not have an important role in the recurrence of immediate ADRs.
替代造影剂（RCM）引起的即时药物不良反应（ADR）的复发率尚不清楚。既往研究提示根据氨甲酰侧链选择替代 RCM；然而，其在预防 ADR 复发方面的作用尚未得到明确验证。
本研究旨在验证根据替代 RCM 即时 ADR 的复发率。
本回顾性研究分析了 2015 年至 2020 年期间，一家三级医院的 861664 例 CT 中，6420 例 2009 例患者的 ADR 系统登记的对比增强 CT（CT）病例。碘海醇、碘普罗胺、碘比醇和碘帕醇用于 CT。根据存在的氨甲酰侧链，碘海醇属于 1 组，碘普罗胺属于 1 组和 2 组，碘比醇属于 2 组，碘帕醇属于 3 组。
用碘帕醇（比值比[OR]2.595，95%置信区间[CI]1.48-4.550）或碘普罗胺（OR 3.354，95%CI1.420-7.926）替代碘比醇作为后续 RCM 与复发增加相关，而用碘比醇（OR 0.506，95%CI0.282-0.908）和碘普罗胺（OR 0.355，95%CI0.177-0.711）替代碘帕醇与复发减少相关。其他变化不影响 ADR 的复发。
某些前后 CT 扫描中 RCM 的组合会增加即时 ADR 的复发，且 RCM 之间没有交叉反应。因此，考虑交叉反应的替代 RCM 的临床获益有限。该结果表明 RCM 的侧链在即时 ADR 复发中没有重要作用。
