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向美国食品药品监督管理局报告的Xeljanz/Xeljanz XR、Olumiant和Rinvoq不良事件的特征。

Characteristics of adverse event reporting of Xeljanz/Xeljanz XR, Olumiant, and Rinvoq to the US Food and Drug Administration.

作者信息

Qian Jingjing, Xue Xiangzhong, Shannon John

机构信息

Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Alabama.

出版信息

J Manag Care Spec Pharm. 2022 Sep;28(9):1046-1052. doi: 10.18553/jmcp.2022.28.9.1046.

Abstract

On September 9, 2021, the US Food and Drug Administration (FDA) issued a drug safety communication and required revisions to the Boxed Warning for Xeljanz/Xeljanz XR (tofacitinib), Olumiant (baricitinib), and Rinvoq (upadacitinib) to include information about the risk of serious heart-related events, cancer, blood clots, and death. The Boxed Warning was based on a large safety randomized clinical trial of tofacitinib, but neither baricitinib nor upadacitinib has been studied in similar large safety clinical trials. To evaluate characteristics of adverse event (AE) reporting of tofacitinib/XR, baricitinib, and upadacitinib to the FDA. We analyzed the public FDA's Adverse Event Reporting System data to examine reported AEs that were related to any of the 3 drugs between January 1, 2019, and September 30, 2021. Both brand and generic names of these drugs were used to identify these AEs. Frequencies of AE reports were evaluated by patient demographics (age and sex), type of reporter, reporter region, seriousness, and reactions related to death, cardiovascular, cancer, and blood clots. Chi-square tests were used to compare the proportion of characteristics of AEs between these drugs at < 0.05. We identified 56,833 AE reports of tofacitinib/XR, 2,318 reports of baricitinib, and 5,359 reports of upadacitinib. Higher proportions of patients reporting AEs for tofacitinib/XR were older and female than for baricitinib and upadacitinib. Higher proportions of tofacitinib/XR and baricitinib AEs were reported by health professionals than for upadacitinib. Higher proportions of upadacitinib AEs were in the United States and more serious than those of tofacitinib/XR and baricitinib AEs (all group and paired comparisons at < 0.05). Regarding reactions, baricitinib AEs had highest proportions of death (7.2%) and cancer-related (4.1%) events, whereas tofacitinib/XR AEs had the highest proportions of cardiovascular-related (14.1%) and blood clot-related (14.8%) events. Although baricitinib and upadacitinib are in the same drug class as tofacitinib/XR, their risk of serious cardiovascular events, cancer, blood clots, and death might not be similar. Findings from this hypothesis-generating study suggest that there may be differential AEs between Janus kinase inhibitors, and therefore, future research for robust comparative safety is warranted.

摘要

2021年9月9日,美国食品药品监督管理局(FDA)发布了一份药品安全通讯,并要求对尚杰(托法替布)、艾乐明(巴瑞替尼)和瑞福(乌帕替尼)的黑框警告进行修订,以纳入有关严重心脏相关事件、癌症、血栓和死亡风险的信息。该黑框警告基于一项关于托法替布的大型安全性随机临床试验,但巴瑞替尼和乌帕替尼均未在类似的大型安全性临床试验中进行研究。为评估向FDA报告的托法替布/尚杰XR、巴瑞替尼和乌帕替尼不良事件(AE)的特征。我们分析了FDA公开的不良事件报告系统数据,以检查2019年1月1日至2021年9月30日期间报告的与这三种药物中任何一种相关的AE。使用这些药物的品牌名和通用名来识别这些AE。通过患者人口统计学特征(年龄和性别)、报告者类型、报告者地区、严重程度以及与死亡、心血管、癌症和血栓相关的反应来评估AE报告的频率。使用卡方检验比较这些药物之间AE特征的比例,P<0.05。我们识别出56833份托法替布/尚杰XR的AE报告、2318份巴瑞替尼的报告和5359份乌帕替尼的报告。与巴瑞替尼和乌帕替尼相比,报告托法替布/尚杰XR不良事件的患者中,年龄较大和女性的比例更高。与乌帕替尼相比,卫生专业人员报告托法替布/尚杰XR和巴瑞替尼不良事件的比例更高。乌帕替尼不良事件在美国的比例更高,且比托法替布/尚杰XR和巴瑞替尼的不良事件更严重(所有组间和配对比较,P<0.05)。关于反应,巴瑞替尼不良事件中死亡(7.2%)和癌症相关(4.1%)事件的比例最高,而托法替布/尚杰XR不良事件中心血管相关(14.1%)和血栓相关(14.8%)事件的比例最高。尽管巴瑞替尼和乌帕替尼与托法替布/尚杰XR属于同一药物类别,但它们发生严重心血管事件、癌症、血栓和死亡的风险可能并不相似。这项产生假设的研究结果表明,Janus激酶抑制剂之间可能存在不同的不良事件,因此,有必要开展进一步的研究以进行有力的安全性比较。

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