2023-04-21 21:00:00
[의약뉴스] Among the adverse reactions reported in patients taking immuno-anticancer drugs, there are very few psychiatric side effects, but a study has been announced that requires attention as it leads to fatal results in not a few cases.
The Lancet Discovery Science eClinicalMedicine published the results of a study analyzing psychiatric adverse reactions related to immuno-oncology drugs on the 20th.
The research team collected adverse reaction cases reported for 10 years from 2012 to 2021 through the U.S. Food and Drug Administration (FDA) adverse reaction reporting system.
As a result of the analysis, a total of 91,683 adverse reactions were reported in patients taking immuno-anticancer drugs during this period, of which only 2,488 cases, or 2.71%, were identified as psychiatric side effects.
By year, the rate of reported psychiatric adverse reactions was the lowest at 2.25% in 2021, and the highest at 3.41% in 2017.
By immunotherapy class, PD-L1 inhibitors had the lowest rate of psychiatric adverse reactions at 1.91%, PD-1 inhibitors had the highest rate at 2.89%, and CTLA-4 inhibitors at 2.63%.
In addition, among the adverse reactions reported in monotherapy, they accounted for 2.67% and 2.99% in combination therapy, and the proportion of psychiatric adverse reactions in combination therapy was slightly greater.
Including overlapping symptoms, there were a total of 3259 psychiatric adverse reactions, of which confusion was the most common with 557 cases (17.09%), insomnia with 389 cases (11.94%), anxiety with 298 cases (9.14%), and depression with 298 cases (9.14%). 260 cases (7.98%) followed by delirium with 231 cases (7.09%), and 3 or more adverse reactions were reported in 76 cases.
In multivariate analysis, differences by age were remarkable. Compared to those under 65 years of age, the risk increased significantly with increasing age, with 65 to 74 years old (OR=1.44, 95% CI 1.22-1.70) and 75 years or older (OR=1.84, 95% CI 1.54-2.20).
By type of immunotherapy, the risk of PD-L1 inhibitors was relatively low compared to PD-1 inhibitors (OR=0.85, 95% CI 0.71-1.01), and the risk of CTLA-4 inhibitors was relatively high (OR=1.02, 95% CI 0.71-1.01). CI 0.79-1.29), and the risk of combination therapy was relatively higher (OR=1.14, 95% CI 0.96-1.35).
By gender, the risk tended to be slightly higher in men than in women (OR=1.1, 95% CI 0.96-1.26), and the risk was slightly lower when chemotherapy was used together than when it was not used. (OR=0.9, 95% CI 0.72-1.11), and the risk was slightly higher when targeted therapy was used together than when it was not (OR=1.15, 95% CI 0.91-1.39).
On the other hand, 215 cases, or 21.54%, of a total of 998 cases of psychiatric adverse reactions related to immuno-anticancer drugs led to fatal results.
Also, the risk of fatal outcome was higher in men and the elderly, but there was no significant difference in combination therapy with chemotherapy or combination therapy with targeted therapies, and the primary site did not have a significant effect.
Among lung cancer, skin cancer, and kidney cancer, where immuno-anticancer drugs are most commonly used, the mortality rate was highest in lung cancer at 24.73%, followed by skin cancer at 21.59% and kidney cancer at 15.6%.
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