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基于抗 CD38 单克隆抗体治疗的多发性骨髓瘤患者乙型肝炎病毒再激活:药物警戒分析。

Hepatitis B reactivation in patients with multiple myeloma treated with anti-CD38 monoclonal antibody-based therapies: a pharmacovigilance analysis.

机构信息

Department of Pharmacy, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA.

Department of Pharmacy, Levine Cancer Institute, Atrium Health, 100 Medical Park Drive, Concord, NC, 28025, USA.

出版信息

Int J Clin Pharm. 2023 Dec;45(6):1492-1495. doi: 10.1007/s11096-023-01608-7. Epub 2023 Jun 8.

DOI:10.1007/s11096-023-01608-7
PMID:37289318
Abstract

BACKGROUND

Daratumumab and isatuximab are anti-CD38 monoclonal antibodies indicated for the treatment of multiple myeloma. These agents can increase the risk of infectious complications, including viral infections. Cases of hepatitis B virus (HBV) reactivation have been reported in the literature in patients receiving anti-CD38 monoclonal antibody-based therapies.

AIM

The objective of this analysis was to determine if the association between anti-CD38 monoclonal antibody exposure and the development of hepatitis B reactivation had a detectable reporting signal in the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS).

METHOD

We conducted a post marketing pharmacovigilance analysis by querying the FAERS for reports of HBV reactivation with daratumumab or isatuximab exposure reported between 2015 and 2022. Disproportionality signal analysis was conducted by calculating reporting odds ratios (RORs).

RESULTS

Sixteen cases of hepatitis B virus reactivation were reported in the FAERS database among patients receiving daratumumab or isatuximab reported between 2015 and 2022. The ROR for HBV reactivation was statistically significant for both daratumumab (ROR 4.76, 95% CI 2.76-8.22) and isatuximab (ROR 9.31, 95% CI 3.00-28.92).

CONCLUSION

Overall, our analysis demonstrates a significant reporting signal for HBV reactivation with daratumumab and isatuximab.

摘要

背景

达雷妥尤单抗和伊沙妥昔单抗是两种抗 CD38 单克隆抗体,用于治疗多发性骨髓瘤。这些药物会增加感染并发症的风险,包括病毒感染。文献中已有报道称,接受抗 CD38 单克隆抗体治疗的患者会出现乙型肝炎病毒(HBV)再激活的情况。

目的

本分析旨在确定抗 CD38 单克隆抗体暴露与 HBV 再激活之间的关联是否在美国食品药品监督管理局(FDA)不良事件报告系统(FAERS)中存在可检测的报告信号。

方法

我们通过查询 FAERS 中 2015 年至 2022 年期间报告的达雷妥尤单抗或伊沙妥昔单抗暴露与 HBV 再激活相关的报告,进行了上市后药物警戒分析。通过计算报告比值比(ROR)进行了比例失调信号分析。

结果

在 2015 年至 2022 年期间,FAERS 数据库中报告了 16 例接受达雷妥尤单抗或伊沙妥昔单抗治疗的患者发生 HBV 再激活的病例。HBV 再激活的 ROR 对于达雷妥尤单抗(ROR 4.76,95%CI 2.76-8.22)和伊沙妥昔单抗(ROR 9.31,95%CI 3.00-28.92)均具有统计学意义。

结论

总体而言,我们的分析表明达雷妥尤单抗和伊沙妥昔单抗与 HBV 再激活之间存在显著的报告信号。

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本文引用的文献

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Cumulative Incidence and Relative Risk of Infection in Patients With Multiple Myeloma Treated With Anti-CD38 Monoclonal Antibody-Based Regimens: A Systematic Review and Meta-analysis.接受基于抗CD38单克隆抗体方案治疗的多发性骨髓瘤患者感染的累积发病率和相对风险:一项系统评价和荟萃分析。
Open Forum Infect Dis. 2022 Oct 31;9(11):ofac574. doi: 10.1093/ofid/ofac574. eCollection 2022 Nov.
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Hepatitis B virus and hepatitis C virus reactivation in cancer patients receiving novel anticancer therapies.癌症患者在接受新型抗癌疗法时乙型肝炎病毒和丙型肝炎病毒的再激活。
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Risk of hepatitis B reactivation in patients with myeloproliferative neoplasms treated with ruxolitinib.
接受鲁索替尼治疗的骨髓增殖性肿瘤患者发生乙型肝炎病毒再激活的风险。
World J Hepatol. 2023 Nov 27;15(11):1188-1195. doi: 10.4254/wjh.v15.i11.1188.
Isatuximab plus pomalidomide and low-dose dexamethasone versus pomalidomide and low-dose dexamethasone in patients with relapsed and refractory multiple myeloma (ICARIA-MM): follow-up analysis of a randomised, phase 3 study.
依沙佐米联合泊马度胺和低剂量地塞米松与泊马度胺和低剂量地塞米松治疗复发/难治性多发性骨髓瘤患者(ICARIA-MM):一项随机、3 期研究的随访分析。
Lancet Oncol. 2022 Mar;23(3):416-427. doi: 10.1016/S1470-2045(22)00019-5. Epub 2022 Feb 10.
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Daratumumab for the Treatment of Multiple Myeloma: A Review of Clinical Applicability and Operational Considerations.达雷妥尤单抗治疗多发性骨髓瘤:临床适用性和操作注意事项的综述。
Ann Pharmacother. 2022 Aug;56(8):927-940. doi: 10.1177/10600280211058754. Epub 2021 Dec 28.
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Daratumumab, lenalidomide, and dexamethasone versus lenalidomide and dexamethasone alone in newly diagnosed multiple myeloma (MAIA): overall survival results from a randomised, open-label, phase 3 trial.达雷妥尤单抗、来那度胺和地塞米松与来那度胺和地塞米松单独治疗新诊断多发性骨髓瘤(MAIA)的疗效比较:一项随机、开放标签、3 期临床试验的总生存结果。
Lancet Oncol. 2021 Nov;22(11):1582-1596. doi: 10.1016/S1470-2045(21)00466-6. Epub 2021 Oct 13.
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Hepatitis B Virus Screening and Management for Patients With Cancer Prior to Therapy: ASCO Provisional Clinical Opinion Update.癌症患者治疗前的乙型肝炎病毒筛查和管理:ASCO 临时临床意见更新。
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Carfilzomib, dexamethasone, and daratumumab versus carfilzomib and dexamethasone for patients with relapsed or refractory multiple myeloma (CANDOR): results from a randomised, multicentre, open-label, phase 3 study.卡非佐米、地塞米松和达雷妥尤单抗与卡非佐米和地塞米松治疗复发或难治性多发性骨髓瘤患者(CANDOR):一项随机、多中心、开放性、3 期研究的结果。
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Hepatitis B virus reactivation in a myeloma patient with resolved infection who received daratumumab-containing salvage chemotherapy.骨髓瘤患者在接受含达雷妥尤单抗的挽救性化疗后,乙型肝炎病毒再激活,该患者既往乙型肝炎病毒感染已痊愈。
J Clin Exp Hematop. 2020 Jun 20;60(2):51-54. doi: 10.3960/jslrt.19034. Epub 2020 May 13.
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Subcutaneous versus intravenous daratumumab in patients with relapsed or refractory multiple myeloma (COLUMBA): a multicentre, open-label, non-inferiority, randomised, phase 3 trial.皮下注射与静脉注射达雷妥尤单抗治疗复发或难治性多发性骨髓瘤患者(COLUMBA):一项多中心、开放标签、非劣效性、随机、3期试验
Lancet Haematol. 2020 May;7(5):e370-e380. doi: 10.1016/S2352-3026(20)30070-3. Epub 2020 Mar 23.
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Hepatitis B Reactivation Rate and Fate Among Multiple Myeloma Patients Receiving Regimens Containing Lenalidomide and/or Bortezomib.接受含来那度胺和/或硼替佐米方案治疗的多发性骨髓瘤患者中乙肝再激活率及转归情况
Turk J Haematol. 2019 Nov 18;36(4):266-273. doi: 10.4274/tjh.galenos.2019.2019.0103. Epub 2019 Aug 1.