Hypophosphatemia is Associated with the Serial Administration of Triple-Dose Gadolinium to Patients for Brain MRI

Area of Science:

• Neurology
• Radiology
• Metabolic Medicine

Background:

• Multiple Sclerosis (MS) patients often undergo serial Magnetic Resonance Imaging (MRI) for monitoring.
• Gadolinium-based contrast agents, particularly triple-dose Gadolinium (TdGd), are frequently used in MS patients.

Purpose of the Study:

• To investigate the metabolic abnormality of hypophosphatemia in MS patients undergoing frequent TdGd administration.
• To assess the relationship between cumulative TdGd exposure and the incidence of hypophosphatemia.

Main Methods:

• Monitoring of clinical adverse events and laboratory abnormalities during monthly MRI visits.
• Definition of hypophosphatemia as serum phosphate levels below 2.5 mg/dL.
• Statistical analysis using McNemar's test and generalized estimating equations (GEE).

Main Results:

• An increased incidence of hypophosphatemia was observed, rising from 4% at screening to an average of 15.1% during the first 12 months of serial TdGd use.
• Fifty-nine percent of patients developed hypophosphatemia at least once during the study period.
• A significant decreasing trend in hypophosphatemia was noted by month 24 (9.8%), coinciding with reduced TdGd administration.

Conclusions:

• Serial TdGd administration in MS patients is associated with an increased frequency of hypophosphatemia.
• The occurrence of hypophosphatemia appears to be cumulative with TdGd dosage.
• Reducing the frequency of TdGd administration led to a marked decrease in hypophosphatemia.