Drug-induced immune thrombocytopenia: A descriptive survey in the French PharmacoVigilance database
Drug-induced immune thrombocytopenia: A descriptive survey in the French PharmacoVigilance database
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DOI：
10.3109/09537104.2011.633179
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发表时间：
2012-01-01
期刊：
影响因子：
3.3
通讯作者：
Montastruc, Jean-Louis
中科院分区：
文献类型：
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作者：
Moulis, Guillaume;Sommet, Agnes;Montastruc, Jean-Louis
本调查的目的是描述法国药物警戒数据库（FPVD）中报告的药物诱导的免疫性血小板减少症（ITP），并讨论涉及的药物。向FPVD提出的请求使用了7个最准确的诊断代码来识别ITP。该研究仅限于2007年至2010年报告的病例，并且根据法国因果关系评估评分至少为“可能”。然后，我们描述了人群的特点，涉及的药物，临床症状和ITP的过程。对于每种药物，我们估计了乔治为药物诱导的ITP开发的因果关系评估评分。我们纳入了59例药物诱导的ITP。其中，45.8%为疫苗接种后感染：主要发生在儿童中（中位年龄：16岁）。主要疫苗为白喉-破伤风-脊髓灰质炎（DTP，9例）、流感（n = 8）和麻疹、腮腺炎和风疹（MMR，n = 7）。关于33例非疫苗接种病例：一些药物是众所周知的触发ITP（e。G.非甾体抗炎药（NSAID），n = 5;阿昔单抗，n = 4，对乙酰氨基酚，n = 2）。其他诱发ITP的药物也参与其中，如5-羟色胺再摄取抑制剂或贝伐单抗。平均年龄为57.1 ± 21.7岁; 60.6%的患者为男性，25%有自身免疫性前驱疾病。在55种疑似毒品中，根据乔治量表，3种被列为“可能”，28种被列为“可能”。在接种疫苗和其他病例中，中位延迟时间为14天，血小板最低值的中位值< 10 000 μ l（-1），出血症状很少严重（仅2例胃肠道出血）。45例（76.3%）患者接受了特异性治疗。5例药物诱发病例导致慢性化。其中，依折麦布在2份报告中被怀疑。在FPVD中，DTP、MMR和流感疫苗是最常报告的诱导ITP的疫苗，可能是因为它们的广泛使用。我们的研究证实NSAID、阿昔单抗和对乙酰氨基酚经常引发ITP。它还允许怀疑其他药物，如血清素再摄取抑制剂或贝伐单抗。依折麦布可能诱导慢性ITP。药物诱导的ITP很少严重。最后，本研究还表明，ITP的慢性化并不排除医源性原因的可能性。
The aim of this survey was to describe drug-induced immune thrombocytopenia (ITP) reported in the French PharmacoVigilance database (FPVD) and to discuss the drugs involved. The request to the FPVD used the seven most accurate diagnosis codes to identify ITP. The study was restricted to cases reported from 2007 to 2010 and at least "possible" according to the French causality assessment score. We then described the population's characteristics, the drugs involved, the clinical symptoms, and the course of ITP. For each drug, we estimated the causality assessment score developed by George for drug-induced ITP. We included 59 drug-induced ITP. Among them, 45.8% were post-vaccinal: they mainly occurred in children (median age: 16 years). Main vaccines were diphtheria-tetanus-poliomyelitis (DTP, 9 cases), influenza (n = 8) and measles, mumps, and rubella (MMR, n = 7). Regarding the 33 non-vaccinal cases: some drugs are well-known as triggering ITP (e. g. non-steroidal anti-inflammatory drugs (NSAIDs), n = 5; abciximab, n = 4, acetaminophen, n = 2). Other drugs inducing ITP were involved, like serotonin reuptake inhibitors or bevacizumab. Mean age was 57.1 +/- 21.7; 60.6% of the patients were male and 25% had autoimmune antecedents. Among the 55 suspected drugs, three were classified as "probable" and 28 as "possible" according to George scale. In both vaccinal and other cases, median delay was 14 days, median platelet value at nadir was < 10 000 mu l(-1) and hemorrhagic symptoms were rarely severe (only 2 gastrointestinal hemorrhages). Specific treatment was introduced in 45 (76.3%) patients. Five drug-induced cases led to chronicity. Among them, ezetimibe was suspected in two reports. In the FPVD, DTP, MMR, and influenza vaccines are the most often reported vaccines inducing ITP, perhaps because of their wide use. Our study confirmed that NSAIDs, abciximab, and acetaminophen frequently trigger ITP. It also allows to suspect other drugs like serotonin reuptake inhibitors or bevacizumab. Ezetimibe may induce chronic ITP. Drug-induced ITP is rarely severe. Finally, this study also shows that chronicity of ITP does not rule out the possibility of an iatrogenic cause.