Chien Hsiu-Ting, Lin Fang-Ju, Juang Jyh-Ming Jimmy, Lin Shu-Wen
Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Clin Pharmacol Ther. 2025 Feb;117(2):495-505. doi: 10.1002/cpt.3469. Epub 2024 Oct 9.
Researchers have studied potential corrected QT interval (QTc) prolongation from drug-drug interactions (DDIs), raising unresolved questions about their real-world impact. This retrospective case-crossover study investigated the effects of QT-prolonging drugs and DDIs on QTc prolongation in hospitalized patients aged 45 years and above. The cohort comprised patients who had multiple hospitalizations and developed QTc prolongation (QTc > 500 ms or an increase of >60 ms from baseline) at least 24 hours after admission between 2011 and 2019. Conditional logistic regression compared drug exposure between hospitalizations with QTc prolongation (case window) and those without (reference window). Among 2,276 patients (mean age 71; 43.8% female), the use of QT-prolonging drugs significantly increased the risk of QTc prolongation (odds ratio: 2.42 (95% confidence interval: 1.95-3.02)). The risk was higher with drugs of "known risks" (OR: 3.78 (2.91-4.90)) and "conditional risk" (OR: 2.08 (1.65-2.62)). DDIs, particularly involving multiple "known risk" drugs (OR: 7.86 (4.96-12.45)), strong cytochrome P450 enzyme inhibitors (OR: 5.57 (2.75-11.30)), or the concurrent use of ≥4 QT-prolonging drugs with any risk (OR: 5.28 (3.96-7.03)) substantially increased the risk. Cautious prescribing for patients with multiple risk factors is important to minimize the likelihood of QTc prolongation. However, when considering enhanced monitoring or drug choices, it is crucial to carefully evaluate the overall risk of QT prolongation against the benefits of treatment to ensure optimal patient care.
研究人员已对药物相互作用（DDIs）导致的潜在校正QT间期（QTc）延长进行了研究，但关于其在现实世界中的影响仍存在未解决的问题。这项回顾性病例交叉研究调查了延长QT的药物和药物相互作用对45岁及以上住院患者QTc延长的影响。该队列包括在2011年至2019年期间多次住院且入院至少24小时后出现QTc延长（QTc＞500毫秒或较基线增加＞60毫秒）的患者。条件逻辑回归比较了QTc延长的住院期间（病例窗口）和未出现QTc延长的住院期间（对照窗口）的药物暴露情况。在2276名患者（平均年龄71岁；43.8%为女性）中，使用延长QT的药物显著增加了QTc延长的风险（优势比：2.42（95%置信区间：1.95 - 3.02））。“已知风险”药物（优势比：3.78（2.91 - 4.90））和“条件风险”药物（优势比：2.08（1.65 - 2.62））的风险更高。药物相互作用，特别是涉及多种“已知风险”药物（优势比：7.86（4.96 - 12.45））、强效细胞色素P450酶抑制剂（优势比：5.57（2.75 - 11.30））或同时使用≥4种有任何风险的延长QT药物（优势比：5.28（3.96 - 7.03））会大幅增加风险。对具有多种风险因素的患者谨慎开药对于将QTc延长的可能性降至最低很重要。然而，在考虑加强监测或药物选择时，至关重要的是要仔细评估QT延长的总体风险与治疗益处，以确保为患者提供最佳护理。
