Analysis of adverse drug events in pulmonary Mycobacterium avium complex disease using spontaneous reporting system

Takuya Ozawa, Ho Namkoong, Risako Takaya, Yusuke Takahashi, Koichi Fukunaga, Yuki Enoki, Kazuaki Taguchi, Junko Kizu, Kazuaki Matsumoto, Naoki Hasegawa

Research output: Contribution to journalArticlepeer-review

Abstract

Background: In Japan, Mycobacterium avium complex lung disease (MAC-LD) is the most common in nontuberculous mycobacterial lung disease. Patients often experience adverse events, resulting in the discontinuation of treatment, which causes treatment failure. The JADER (Japanese Adverse Drug Event Report) database is a database of adverse events that allows us to collect real-world data on adverse events. We can collect large-scale data cost-effectively and detect signals of potential adverse events such as reporting odds ratio (ROR) by using spontaneous reporting systems. In this study, we aimed to elucidate the adverse events of clarithromycin (CAM), ethambutol (EB), and rifampicin (RFP) using the JADER database. Methods: We included cases of MAC-LD between April 2004 and June 2017. We investigated sex, age, and medications that may have caused the adverse events, outcomes, and time of onset. We calculated the safety signal index as the ROR. Time-to-event analysis was performed using the Weibull distribution. Results: The total number of adverse events of CAM, EB, and RFP was 2780, with 806 patients. In the overall adverse events, hematologic and lymphatic disorders were the most common adverse events, with 17.3%, followed by eye disorders (16.6%), and hepatobiliary disorders (14.0%). The outcomes were as follows: recovery, 40.0%; remission, 27.1%; non-recovery, 11.2%; and death, 7.1%. Regarding the most common onset time of CAM, EB, and RFP was within 120 days at 40%, 181–300 days at 43.6%, and within 120 days at 88.5%. For CAM, the RORs of infections and infestations, hepatobiliary system disorders, and immune system disorders were 4.13 (95% confidence interval [CI], 2.3–7.44), 2.61 (95% CI, 1.39–4.91), and 2.38 (95% CI, 1.04–5.44). For EB, the ROR of eye disorders was 215.79 (95% CI, 132.62–351.12). For RFP, the RORs of renal and urinary tract disorders and investigations were 7.03 (95% CI, 3.35–14.77) and 6.99 (95% CI, 3.22–15.18). The β value of EB was 2.07 (95% CI, 1.48–2.76), which was classified as a wear-out failure type. Conclusions: For MAC-LD, the adverse event which has the highest ROR is infections and infestations in CAM, eye disorders in EB, renal and urinary tract disorders in RFP. Adverse events of EB occur after 180 days, whereas the adverse events of CAM and RFP occur early in the course of treatment.

Original languageEnglish
Article number580
JournalBMC infectious diseases
Volume22
Issue number1
DOIs
Publication statusPublished - 2022 Dec
Externally publishedYes

Keywords

  • Adverse events
  • Clarithromycin
  • Ethambutol
  • Japanese Adverse Drug Event Report (JADER)
  • Mycobacterium avium complex (MAC)
  • Reporting odds ratio
  • Rifampicin
  • Weibull distribution

ASJC Scopus subject areas

  • Infectious Diseases

Fingerprint

Dive into the research topics of 'Analysis of adverse drug events in pulmonary Mycobacterium avium complex disease using spontaneous reporting system'. Together they form a unique fingerprint.

Cite this