Frequency, characteristics and risk factors of QT interval prolonging drugs and drug-drug interactions in cancer patients: a multicenter study
Frequency, characteristics and risk factors of QT interval prolonging drugs and drug-drug interactions in cancer patients: a multicenter study
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DOI：
10.1186/s40360-017-0181-2
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发表时间：
2017-12-01
影响因子：
2.9
通讯作者：
Khan, Sehrash
中科院分区：
文献类型：
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作者：
Khan, Qasim;Ismail, Mohammad;Khan, Sehrash
工作背景：癌症患者可能接受大量药物治疗，这些药物可能延长QT间期和随后的TdP（尖端扭转型室性心动过速）。本研究旨在确定QT延长药物的患病率，其TdP风险，QT延长药物-药物相互作用（QT-DDI），水平，预测因子，和TdP风险的药物参与QT-DDIS.Methods：这项多中心研究包括癌症患者从三个主要的三级保健医院开伯尔-普赫图赫瓦，巴基斯坦。Micromedex DrugReax（R）用于鉴别QT-DDI。TdP风险由AZCERT（亚利桑那州治疗教育和研究中心）分类确定。结果：555例患者中，51%为女性。平均年龄为46.9 ± 15.7岁。在92.6%的患者中共鉴定出28种不同的QT延长药物。总体而言，21.8%的患者出现QT-DDI。在识别的288例QT-DDI中，所有记录均为严重程度和一般程度。根据AZCERT分类，59.9%的相互作用药物被纳入列表-1（已知的TdP风险），4.7%被纳入列表-2（可能的TdP风险），6.8%被纳入列表-3（TdP的条件风险）。单变量logistic回归分析显示，各种预测因素，如8-9处方药，（p < 0.001）和>= 10种药物（p < 0.001），2种QT药物（p < 0.001）和≥ 3种QT药物（p < 0.001），乳腺癌（p = 0.03），胃肠道癌（p = 0.03），4-5种支持性治疗药物（p< 0.001），6-8种支持治疗药物结论：QT间期延长药物和QT-DDI在肿瘤患者中的使用率较高。需要采取适当的预防措施，以防止这些相互作用的有害后果。
Background: Cancer patients may receive a high number of medications with the potential to prolong QT interval and subsequent TdP (torsades de pointes). This study aimed to identify the prevalence of QT prolonging drugs, their TdP risk, QT prolonging drug-drug interactions (QT-DDIs), levels, predictors, and TdP risk of drugs involved in QT-DDIs.Methods: This multicenter study included cancer patients from three major tertiary care hospitals of Khyber-Pakhtunkhwa, Pakistan. Micromedex DrugReax (R) was used for identification of QT-DDIs. TdP risks were identified by AZCERT (Arizona Center for Education and Research on Therapeutics) classification. Logistic regression analysis was performed to identify predictors of QT-DDIs.Results: Of 555 patients, 51% were females. Mean age was 46.9 +/- 15.7 years. Total 28 distinct QT prolonging drugs were identified in 92.6% of the patients. Overall 21.8% patients were presented with QT-DDIs. Of total 288 identified QT-DDIs, all were of major-severity and fair-documentation. According to AZCERT classification, 59.9% of the interacting drugs were included in list-1 (known risk of TdP), 4.7% in list-2 (possible risk of TdP) and 6.8% in list-3 (conditional risk of TdP). Univariate logistic regression analysis showed significant results for various predictors such as, 8-9 prescribed medications (p < 0.001) and >= 10 medications (p < 0.001), 2 QT drugs (p < 0.001) and >= 3 QT drugs (p < 0.001), breast cancer (p = 0.03), gastrointestinal cancer (p = 0.03), 4-5 supportive care drugs (p< 0.001), 6-8 supportive care drugs (p < 0.001) and > 8 supportive care drugs (p < 0.001).Conclusions: A high prevalence of QT prolonging drugs and QT-DDIs was reported in oncology. Appropriate precautions are needed to prevent harmful consequences of these interactions.