Aims: The aim of this study was to characterise clinical priority of adverse events with sacubitril/valsartan for targeting preventive measures. Methods: We used the US Food and Drug Administration adverse event reporting system (worldwide pharmacovigilance database) to compare adverse events recording sacubitril/valsartan as suspect with other cardiovascular drugs. Disproportionality analyses were performed by calculating the reporting odds ratios, deemed significant when the lower limit of the 95% confidence interval was greater than 1. Clinical priority was assigned to adverse events with significant disproportionality by scoring (range 0-10 points) five features (number of events, magnitude of the lower limit of the 95% confidence interval, mortality frequency, important/designated medical event, biological plausibility). Results: Sacubitril/valsartan was recorded in 20,021 reports, with 178 adverse events associated with significant disproportionality: 71.9%, 25.9% and 2.2% were classified as weak, moderate and strong clinical priorities, respectively. Increased reporting emerged for several cardiovascular adverse events, including 'renal failure' (N = 388; lower limit of the 95% confidence interval 2.26), 'hyperkalaemia' (314; 2.42) and 'angioedema' (309; 1.56). Sudden cardiac death (priority score 9 points) was the only designated medical event with strong clinical priority. Notably, sudden cardiac death occurred early after sacubitril/valsartan administration (average onset 124 days), with concomitant drugs known for pro-arrhythmic potential (e.g. amiodarone, escitalopram, mirtazapine, loop diuretics) in 26.2% of records. Conclusion: The increased cardiovascular reporting of sacubitril/valsartan in the real world was largely predictable from pre-approval evidence, underlying disease and likely patients' comorbidities. The unexpected reporting of sudden cardiac death occurred well before the complete development of positive electrical remodelling induced by sacubitril/valsartan, and calls for stringent clinical monitoring (to reduce the pro-arrhythmic burden related to co-medications), and further investigation on appropriate combination with other preventive measures.

Gatti, M., Antonazzo, I., Diemberger, I., De Ponti, F., Raschi, E. (2021). Adverse events with sacubitril/valsartan in the real world: Emerging signals to target preventive strategies from the FDA adverse event reporting system. EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, 28(9), 983-989 [10.1177/2047487320915663].

Adverse events with sacubitril/valsartan in the real world: Emerging signals to target preventive strategies from the FDA adverse event reporting system

Antonazzo I. C.;
2021

Abstract

Aims: The aim of this study was to characterise clinical priority of adverse events with sacubitril/valsartan for targeting preventive measures. Methods: We used the US Food and Drug Administration adverse event reporting system (worldwide pharmacovigilance database) to compare adverse events recording sacubitril/valsartan as suspect with other cardiovascular drugs. Disproportionality analyses were performed by calculating the reporting odds ratios, deemed significant when the lower limit of the 95% confidence interval was greater than 1. Clinical priority was assigned to adverse events with significant disproportionality by scoring (range 0-10 points) five features (number of events, magnitude of the lower limit of the 95% confidence interval, mortality frequency, important/designated medical event, biological plausibility). Results: Sacubitril/valsartan was recorded in 20,021 reports, with 178 adverse events associated with significant disproportionality: 71.9%, 25.9% and 2.2% were classified as weak, moderate and strong clinical priorities, respectively. Increased reporting emerged for several cardiovascular adverse events, including 'renal failure' (N = 388; lower limit of the 95% confidence interval 2.26), 'hyperkalaemia' (314; 2.42) and 'angioedema' (309; 1.56). Sudden cardiac death (priority score 9 points) was the only designated medical event with strong clinical priority. Notably, sudden cardiac death occurred early after sacubitril/valsartan administration (average onset 124 days), with concomitant drugs known for pro-arrhythmic potential (e.g. amiodarone, escitalopram, mirtazapine, loop diuretics) in 26.2% of records. Conclusion: The increased cardiovascular reporting of sacubitril/valsartan in the real world was largely predictable from pre-approval evidence, underlying disease and likely patients' comorbidities. The unexpected reporting of sudden cardiac death occurred well before the complete development of positive electrical remodelling induced by sacubitril/valsartan, and calls for stringent clinical monitoring (to reduce the pro-arrhythmic burden related to co-medications), and further investigation on appropriate combination with other preventive measures.
Articolo in rivista - Articolo scientifico
disproportionality; pharmacovigilance; Sacubitril/valsartan; sudden cardiac death;
English
2021
28
9
983
989
none
Gatti, M., Antonazzo, I., Diemberger, I., De Ponti, F., Raschi, E. (2021). Adverse events with sacubitril/valsartan in the real world: Emerging signals to target preventive strategies from the FDA adverse event reporting system. EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, 28(9), 983-989 [10.1177/2047487320915663].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/400980
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