A Rare Case of Gemcitabine-Induced Pulmonary Hypertension

Shen, Janice; Chung, Su Yun; Aziminekoo, Elham; Jose, Jyothi; Saif, Muhammad Wasif

doi:10.17140/prrmoj-5-139

Cited by 2 publications

(4 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although a recent study has reported no difference in LRG levels between healthy individuals and patients with UC [14], certain factors, such as age, sex, and BMI, could affect LRG values. A previous study demonstrated an association between CRP and fecal calprotectin levels and age, sex, and BMI [15][16][17][18][19]. Since we could not perform adjustments based on these variables in our analysis due to insufficient data, further data collection is necessary for a better understanding of the effects of the factors affecting LRG.…”

Section: Discussionmentioning

confidence: 97%

Novel Utility of Leucine-Rich Alpha-2-Glycoprotein as a Biomarker in Ulcerative Colitis: A Predictor of Endoscopic Remission Independent of Symptoms

Hayashi,

Kitamura,

Usami

et al. 2023

Inflamm Intest Dis

View full text Add to dashboard Cite

Introduction: Leucine-rich alpha-2-glycoprotein (LRG) is a potential biomarker for disease activity and reflects mucosal healing in patients with ulcerative colitis (UC). However, only a few studies have described a detailed sensitivity analysis of LRG in predicting mucosal healing in patients. This study aimed to evaluate the association between LRG and the endoscopic activity of UC and its predictability for mucosal healing and explore the utility and clinical application of LRG. Methods: The diagnostic accuracy of biomarkers, including LRG, in predicting the endoscopic activity of UC was evaluated. All consecutive patients who underwent total colonoscopy between April 2021 and September 2022 were included. The Mayo endoscopic subscore (MES) was used for assessing endoscopic activity. Furthermore, endoscopic remission was defined as an MES of ≤1. Clinical activity was evaluated based on stool frequency and bloody stool. Receiver operating characteristic curve analysis and binary logistic regression were performed to assess the diagnostic accuracy of the biomarkers. We evaluated LRG trends and treatment response in patients with MES≥2 who underwent induction therapy. Results: This study comprised 214 patients. The proportions of endoscopically- and clinically active patients were 33.6% and 49.1%, respectively. LRG had an area under the curve (AUC) of 0.856, with a higher diagnostic accuracy than other biomarkers, such as C-reactive protein, leukocyte, neutrophil, platelet, and albumin. The cutoff value for LRG was 15.6 μg/mL (sensitivity, 72.2%; specificity, 86.6%). Using the MES, patients with higher scores had higher LRG levels than those with lower scores. The cutoff value, AUC, sensitivity, and specificity varied with a higher AUC for left-sided colitis and pancolitis than for proctitis. Logistic regression analysis showed that LRG was an independent predictor of endoscopic remission using multivariate analysis, even with the factor of clinical activity. The change ratio of LRG pre- and post-treatment was statistically significant in the higher LRG group. Discussion/Conclusion: LRG reflected endoscopic activity independently, regardless of clinical symptoms. An LRG below the cutoff value could indicate a significantly low probability of endoscopic activity in asymptomatic patients, and follow-up endoscopy (not for cancer screening) may be unnecessary. Furthermore, a higher LRG level might be more useful as an indicator of treatment efficacy.

show abstract

Section: Discussionmentioning

confidence: 97%

Novel Utility of Leucine-Rich Alpha-2-Glycoprotein as a Biomarker in Ulcerative Colitis: A Predictor of Endoscopic Remission Independent of Symptoms

Hayashi,

Kitamura,

Usami

et al. 2023

Inflamm Intest Dis

View full text Add to dashboard Cite

show abstract

“…Only four cases of PAH have been so far published in the literature, including two cases of PVOD ( table 3 ). In 2019, S hen et al [ 19 ] reported a case of gemcitabine-induced PAH in which the patient presented with PAH following a course of gemcitabine for metastatic cholangiocarcinoma. The diagnosis was suggested by transthoracic echocardiography (TTE) in view of suggestive clinical features.…”

Section: Discussionmentioning

confidence: 99%

“…The median delay from first and last gemcitabine injection to diagnosis of PAH were 7 (4-50) and 1 (0,5-16) months, respectively. The median number of total chemotherapy injections was 16 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), with a usual gemcitabine dose of 1000 mg/m 2 . At the time of PH diagnosis, 5 patients (55%) had a partial response to treatment or were in remission, 3 patient (33%) had tumor progression and one patient (11%) had stable neoplastic disease.…”

Section: Gemcitabine Exposurementioning

confidence: 99%

See 1 more Smart Citation

Characteristics and outcomes of gemcitabine-associated pulmonary hypertension

Mouillot,

Favrolt,

Khouri

et al. 2024

ERJ Open Res

View full text Add to dashboard Cite

BackgroundDespite its known cardiac and lung toxicities, the chemotherapy drug gemcitabine has only rarely been associated with pulmonary hypertension (PH), and the underlying mechanism remains unclear.ObjectivesTo assess the association between gemcitabine and PH.MethodsWe identified incident cases of precapillary PH confirmed by right heart catheterisation in patients treated with gemcitabine from the French PH Registry between January 2007 to December 2022. The etiology, clinical, functional, radiologic, and hemodynamic characteristics of PH were reviewed at baseline and during follow-up. A pharmacovigilance disproportionality analysis was conducted using the WHO pharmacovigilance database.ResultsWe identified nine cases of PAH, either induced (in eight patients) or exacerbated (in one patient) by gemcitabine. Patients exhibited severe precapillary PH, with a median mean pulmonary arterial pressure of 40 (min-max 26–47) mmHg, a cardiac index of 2.4 (1.6–3.9) L·min−1·m−2, and pulmonary vascular resistance of 6.3 (3.1–12.6) WU. The median time from the initiation of gemcitabine to the onset of PH was 7 (4–50) months, with patients receiving a median of 16 (6–24) gemcitabine injections. Six patients showed clinical improvement upon discontinuation of gemcitabine. In the WHO pharmacovigilance database, we identified a significant signal with 109 cases reporting at least one adverse event related to PH with gemcitabine.ConclusionBoth clinical cases and pharmacovigilance data substantiate a significant association between gemcitabine use and the onset or worsening of precapillary PH. The observed improvement following the discontinuation of treatment underscores the importance of PH screening in gemcitabine-exposed patients experiencing unexplained dyspnea.

show abstract

A Rare Case of Gemcitabine-Induced Pulmonary Hypertension

Cited by 2 publications

References 11 publications

Novel Utility of Leucine-Rich Alpha-2-Glycoprotein as a Biomarker in Ulcerative Colitis: A Predictor of Endoscopic Remission Independent of Symptoms

Novel Utility of Leucine-Rich Alpha-2-Glycoprotein as a Biomarker in Ulcerative Colitis: A Predictor of Endoscopic Remission Independent of Symptoms

Characteristics and outcomes of gemcitabine-associated pulmonary hypertension

Contact Info

Product

Resources

About