Frequency, characteristics and risk factors of QT interval prolonging drugs and drug-drug interactions in cancer patients: a multicenter study

Khan, Qudrat; Ismail, Mohammad; Khan, Sehrash

doi:10.1186/s40360-017-0181-2

Cited by 16 publications

(26 citation statements)

References 27 publications

(28 reference statements)

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“…Among the detected drug interactions that need be taken into account is ciprofloxacin and metronidazole; these drugs cause QT prolongation and their concurrent use increases the risk of this side effect, and so attention should be given to such interaction [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Assessing Drug-Drug Interaction Potential among Patients Admitted to Surgery Departments in Three Palestinian Hospitals

Rabba

Hussein

Sbeih

et al. 2020

BioMed Research International

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Background. Drug-drug interactions (DDIs) are a common issue that leads to adverse drug reactions in hospitals. Patients in the surgical department are expected to have potential DDIs that may lead to morbidity and mortality. Objectives. To study potential DDI prevalence in the surgery departments in 3 hospitals in Palestine. Moreover, to identify pertinent factors that are associated with drug-drug interactions. Method. A cross-sectional study in 3 governmental Palestinian hospitals: Palestine Medical Complex, Rafidia Hospital, and Beit Jala Hospital. Patients who are 20 years old or above and admitted to the surgical wards between September 2017 and February 2018 were included in the study. Patient demographics, all medications given in the hospital, and hospitalization period were obtained from medical files. The digital clinical decision support system Micromedex® was used for analysis and classification of possible drug interactions. Bivariate analysis and logistic regression were used to study the risk factors for developing DDIs. Results. 502 patients were included in this report. The prevalence of potential DDIs among patients admitted to surgery wards in three Palestinian hospitals was 56%. The number of detected potential DDIs per patient was 2.22±3.76. The number of prescribed medications (P<0.001) was found to increase the possibility of having drug interactions. Conclusions. DDIs in Palestinian hospitals are a prevalent problem, and caution should be taken when ordering medications to hospitalized patients in surgery departments.

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Section: Discussionmentioning

confidence: 99%

Assessing Drug-Drug Interaction Potential among Patients Admitted to Surgery Departments in Three Palestinian Hospitals

Rabba

Hussein

Sbeih

et al. 2020

BioMed Research International

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“…Furthermore, in special populations such as cancer patients there is increased risk of drug interactions resulting in QTc prolongation. For example, greater prevalence is associated with breast and gastrointestinal cancer diagnoses as well as solid-based malignancy [59]. Finally, TdP may be influenced by an individual’s repolarization reserve [60], which is genetically determined and involves compensatory mechanisms that modulate unfavorable changes in depolarizing or repolarizing currents which may contribute to arrhythmogenesis.…”

Section: Long Qtc Syndromes (Lqts)mentioning

confidence: 99%

QT Assessment in Early Drug Development: The Long and the Short of It

Lester

Paglialunga

Johnson

2019

IJMS

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The QT interval occupies a pivotal role in drug development as a surface biomarker of ventricular repolarization. The electrophysiologic substrate for QT prolongation coupled with reports of non-cardiac drugs producing lethal arrhythmias captured worldwide attention from government regulators eventuating in a series of guidance documents that require virtually all new chemical compounds to undergo rigorous preclinical and clinical testing to profile their QT liability. While prolongation or shortening of the QT interval may herald the appearance of serious cardiac arrhythmias, the positive predictive value of an abnormal QT measurement for these arrhythmias is modest, especially in the absence of confounding clinical features or a congenital predisposition that increases the risk of syncope and sudden death. Consequently, there has been a paradigm shift to assess a compound’s cardiac risk of arrhythmias centered on a mechanistic approach to arrhythmogenesis rather than focusing solely on the QT interval. This entails both robust preclinical and clinical assays along with the emergence of concentration QT modeling as a primary analysis tool to determine whether delayed ventricular repolarization is present. The purpose of this review is to provide a comprehensive understanding of the QT interval and highlight its central role in early drug development.

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“…In a cross-sectional retrospective study of 555 patients with cancer, 92.6% of patients received QTc-prolonging drugs, mostly commonly antiemetic agents, proton pump inhibitors, and antimicrobial agents, and 21.8% received medications involved in QTc-prolonging drugedrug interactions. 34 Furthermore, a systematic review of patients receiving conventional cancer treatment reported a QTc prolongation incidence of between 0% and 22%. 35 The present study included a large number of patients with HR+/HER2-mBC (24,340 women) and assessed several risk factors for QTc prolongation, including concomitant medication use, cardiovascular disease, electrolyte abnormalities, and congenital long QT syndrome.…”

Section: Risk Factormentioning

confidence: 99%

Risk Factors of QTc Prolongation in Women With Hormone Receptor‒positive/Human Epidermal Growth Factor Receptor 2‒negative Metastatic Breast Cancer: A Retrospective Analysis of Health Care Claims Data

Ward

Harnett

Bell

et al. 2019

Clinical Therapeutics

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Purpose: In addition to biomarker status, treatment selection for metastatic breast cancer (mBC) includes individual patient and clinical characteristics such as tumor burden, timing of disease recurrence, and comorbidities. Women with mBC may take medications that can increase the risk of drug-induced toxicities, including prolongation of cardiac repolarization (prolongation of QT interval). Corrected QT (QTc) prolongation, a toxicity associated with many cancer treatments, can lead to potentially life-threatening ventricular arrhythmias. As such, it is important to identify patients at risk for QTc prolongation due to comorbid conditions, concomitant medications, or electrolyte abnormalities. This real-world study estimated the proportion of women with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) mBC who may be at risk of developing QTc prolongation. Results in the elderly are also included. Methods: This retrospective, cross-sectional cohort study used the Truven Health MarketScan and Optum Clinformatics administrative claims databases. Patients' medical and pharmacy data were evaluated to assess the risk of QTc prolongation. Prescription and medication administration claims were evaluated during the 7-day period before the index date (ie, first secondary neoplasm diagnosis). In addition, International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification, codes were evaluated 12 months before the index date to describe congenital long QT syndrome, cardiac disease, and electrolyte abnormalities. Findings: A cohort of 24,340 women with HR+/ HER2-mBC were identified, including 5059 women aged 65e74 years and 4851 aged 75 years. Based on an overall analysis of risk factors (congenital long QT syndrome, cardiovascular disease, electrolyte abnormalities, or concomitant medications), 29.5% of all patients, 33.2% of patients aged 65e74 years, and 40.5% of patients aged 75 years had risk factors for QTc prolongation. Implications: This analysis of real-world data indicates that almost 1 in 3 women with HR+/HER2-mBC had congenital long QT syndrome, cardiovascular disease, and/or electrolyte abnormalities or received a concomitant medication that could increase the risk of developing QTc prolongation. The risk factors for congenital long QT syndrome, cardiovascular disease, or electrolyte abnormalities were more common in older patients. This analysis emphasizes the importance of individualized benefit/ risk assessment during treatment decisions, especially when considering drugs with known or possible QTc prolongation risk.

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Frequency, characteristics and risk factors of QT interval prolonging drugs and drug-drug interactions in cancer patients: a multicenter study

Cited by 16 publications

References 27 publications

Assessing Drug-Drug Interaction Potential among Patients Admitted to Surgery Departments in Three Palestinian Hospitals

Assessing Drug-Drug Interaction Potential among Patients Admitted to Surgery Departments in Three Palestinian Hospitals

QT Assessment in Early Drug Development: The Long and the Short of It

Risk Factors of QTc Prolongation in Women With Hormone Receptor‒positive/Human Epidermal Growth Factor Receptor 2‒negative Metastatic Breast Cancer: A Retrospective Analysis of Health Care Claims Data

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