Drug-induced aortic aneurysms, ruptures and dissections

Spigset, Olav

doi:10.5772/19347

Cited by 4 publications

(6 citation statements)

References 63 publications

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“…We selected capecitabine as an active comparator to address potential confounding effects associated with drug indications and administration routes. Capecitabine, an oral anticancer drug independent of the VEGF pathway, is not associated with AAD incidence . Given the diverse risks of fluoroquinolone-induced AAD based on administration routes, we opted for capecitabine due to its comparable route of administration.…”

Section: Discussionmentioning

confidence: 99%

“…Patients diagnosed with AAD before or on the index date and those with congenital diseases related to arterial aneurysm were excluded (eTable 1 in Supplement 1 ). 23 , 24 , 25 Diagnoses were based on International Statistical Classification of Diseases and Related Health Problems, Tenth Revision ( ICD-10 ) codes. Lastly, patients prescribed both VEGFR-TKIs and capecitabine were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…Demographic information, including sex and age, was recorded on the index date. Medical history, 25 , 27 , 28 , 29 medication history, 23 , 30 and anticancer therapy administered within a year prior to enrollment were recorded (eTable 2 in Supplement 1 ). Data on cancer subtypes as diagnosed on the index date were collected.…”

Section: Methodsmentioning

confidence: 99%

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Aneurysm and Artery Dissection After Oral VEGFR-TKI Use in Adults With Cancer

Kang,

Yeon,

Kim

et al. 2023

JAMA Netw Open

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ImportanceThe association of tyrosine kinase inhibitors targeting vascular endothelial growth factor receptors (VEGFR-TKIs) with aneurysm and artery dissection (AAD) has been frequently reported in spontaneous reporting databases.ObjectiveTo investigate the risk and incidence of AAD occurrence in patients with cancer treated with oral VEGFR-TKIs, with capecitabine as an active comparator.Design, Setting, and ParticipantsThis national, historical cohort study was conducted using national claims data from the National Health Insurance Service in Korea from 2007 to 2020, with a 1-year follow-up. Patients with cancer aged 40 years or older prescribed oral VEGFR-TKIs or capecitabine were enrolled. Data were analyzed from September 2022 through April 2023.ExposureOral VEGFR-TKIs (sorafenib, regorafenib, vandetanib, sunitinib, lenvatinib, axitinib, and pazopanib) or capecitabine as a comparator.Main Outcomes and MeasuresHazard ratios (HRs) were used to investigate the association between VEGFR-TKI use and AAD after propensity score matching. The primary outcome was AAD, and secondary outcomes were aortic aneurysm and dissection and AAD with rupture. Outcomes were defined using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis codes.ResultsAmong 127 710 patients with cancer eligible for the study (80 386 males [62.9%]; mean [SD] age, 62.6 [10.9] years), 37 308 patients received VEGFR-TKIs and 90 402 patients received capecitabine. Among 27 535 matched patients receiving VEGFR-TKIs, the incidence of AAD within 1 year of treatment initiation was 6.0 per 1000 person-years. The median (IQR) time to AAD onset in the matched AAD group was 114 (67-257) days after treatment initiation, with the highest incidence observed during the first 3 months (45 incidents vs 31, 17, and 16 incidents during 3- to 6-month, 6- to 9-month, and 9- to 12-month periods, respectively). Cox regression modeling showed that the risk of AAD occurrence was significantly higher among patients prescribed VEGFR-TKIs than those receiving capecitabine (HR, 1.48; 95% CI, 1.08-2.02); similar results were obtained among females (HR, 2.08; 95% CI, 1.26-3.42), older adults (aged ≥65 years; HR, 1.42; 95% CI, 1.01-1.99), and patients with dyslipidemia (HR, 1.58; 95% CI, 1.11-2.24).Conclusions and RelevanceIn this study, the use of oral VEGFR-TKIs was associated with an increased risk of AAD occurrence. These findings elucidate vascular toxic effects and may provide a substantial reference for reducing the socioeconomic burden of adverse events associated with VEGFR-TKI use.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Aneurysm and Artery Dissection After Oral VEGFR-TKI Use in Adults With Cancer

Kang,

Yeon,

Kim

et al. 2023

JAMA Netw Open

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“…7 It is also noteworthy to declare that we could not assess the possible biochemical adverse effect of the medication cocktail other than methylprednisolone in the formation of aortic aneurysm and dissection in our patient. 8 By identifying the unknown aspects of the COVID-19 disease in vascular endothelial damage and thrombus formation in arteries of different calibers, vascular events might occur either due to cytokine storm or hypoxia induced apoptosis (ceramide pathway). We assume that aortitis and endothelial cell damage by COVID-19 induced inflammatory responses have led to acute aortic dissection on the background of elastin arteriopathy and negative effects of corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

Acute aortic dissection in a patient with Williams syndrome infected by COVID-19

2020

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“…These include a variety of medications (glucocorticoids, phosphodiesterase-5 inhibitors [sildenafil], vascular endothelial growth factor inhibitors, anticoagulants, fibrinolytics, cocaine, amphetamine, and methamphetamine [3,4-methylenedioxymethamphetamine, ecstasy], cocaine). 13 Implicated nonmedicinal toxins include tobacco, 14 cadmium, 15 and N-(2-aminoethyl) ethanolamine (used in fabric softeners, cleaners, coatings, fuels, and lubricants). 16 Accordingly, we have added toxins to our schematic diagram (J.A.E.)…”

mentioning

confidence: 99%