Lim Su Jin, Suh Pae Sun, Suh Chong Hyun, Kim Pyeong Hwa, Park Kye Jin, Park Hyo Jung, Lee Choong Wook
Department of Radiology, National Cancer Center, Seoul, Republic of Korea.
Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
Eur Radiol. 2025 May;35(5):2569-2579. doi: 10.1007/s00330-024-11114-7. Epub 2024 Oct 18.
To systematically review and meta-analyze the recurrent rate of iodinated contrast medium (ICM)-associated adverse drug reactions (ADRs) and the preventive effect of using alternative ICM lacking a common carbamoyl side chain.
A systematic literature search was conducted in the MEDLINE and EMBASE databases to identify studies that investigated the recurrence rate of ICM-associated ADRs or hypersensitivity reactions (HSRs). Studies that included patients who subsequently underwent contrast-enhanced computed tomography scans after their index reactions were included, while studies with overlapping cohorts were excluded. The first search was conducted on November 10, 2023. The pooled recurrence rate of ICM-associated ADR was determined using the DerSimonian-Laird random-effects model. Subgroup analyses were also conducted based on the substitution of ICM, with particular consideration given to the N-(2,3-dihydroxypropyl) carbamoyl side chain.
A total of ten original articles were included in the analysis, collectively spanning from June 2001 to March 2021. The pooled recurrence rate of ICM-associated ADR was not significantly different from that of ICM-associated HSR (16.6% [95% CI, 7.8-31.9%] vs. 15.5% [95% CI, 10.8-21.8%], p = 0.87). In the subgroup analyses, the pooled odds ratio for ICM-associated recurrent ADR when using a different ICM compared with using the same ICM was 0.31 (95% CI, 0.21-0.45), which means a 69% reduction. Moreover, the pooled odds ratio for ICM-associated recurrent ADR when substituting ICMs with different side chains compared with substituting with common side chains was 0.65 (95% CI, 0.52-0.82), which means an additional 35% reduction.
Substituting with an alternative ICM led to a 69% reduction in recurrent ADRs, with an additional 35% reduction observed when using ICM lacking a common carbamoyl side chain.
Question No standardized guidelines exist for replacing previously used iodinated contrast medium (ICM) to prevent recurrent adverse reactions. Findings Using alternative contrast medium with a different carbamoyl side chain prevents adverse drug reactions effectively. Clinical relevance This study advocates using alternative ICM without a common carbamoyl side chain to prevent recurrent adverse drug reactions in patients with a history of such events.
系统评价和荟萃分析碘化造影剂（ICM）相关药物不良反应（ADR）的复发率以及使用缺乏常见氨基甲酰侧链的替代ICM的预防效果。
在MEDLINE和EMBASE数据库中进行系统文献检索，以识别调查ICM相关ADR或过敏反应（HSR）复发率的研究。纳入了那些在首次反应后随后接受对比增强计算机断层扫描的患者的研究，而排除了队列重叠的研究。首次检索于2023年11月10日进行。使用DerSimonian-Laird随机效应模型确定ICM相关ADR的合并复发率。还根据ICM的替代情况进行亚组分析，特别考虑N-（2,3-二羟丙基）氨基甲酰侧链。
分析共纳入10篇原创文章，时间跨度从2001年6月至2021年3月。ICM相关ADR的合并复发率与ICM相关HSR的合并复发率无显著差异（16.6% [95%CI，7.8 - 31.9%] 对15.5% [95%CI，10.8 - 21.8%]，p = 0.87）。在亚组分析中，与使用相同ICM相比，使用不同ICM时ICM相关复发性ADR的合并比值比为0.31（95%CI，0.21 - 0.45），这意味着降低了69%。此外，与用常见侧链替代相比，用不同侧链替代ICM时ICM相关复发性ADR的合并比值比为0.65（95%CI，0.52 - 0.82），这意味着额外降低了35%。
用替代ICM替代可使复发性ADR降低69%，使用缺乏常见氨基甲酰侧链的ICM时可额外降低35%。
问题 目前尚无用于替代先前使用的碘化造影剂（ICM）以预防复发性不良反应的标准化指南。研究结果 使用具有不同氨基甲酰侧链的替代造影剂可有效预防药物不良反应。临床意义 本研究提倡使用没有常见氨基甲酰侧链的替代ICM来预防有此类事件病史患者的复发性药物不良反应。
