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Association of Torsade de Pointes and QT Prolongation With Antifungal Triazoles: Analysis Using a Pharmacovigilance

Katsuhiro Ohyama1, Shota Akiyama2, Megumi Iida2

  • 1Center for Experiential Pharmacy Practice, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan ohyamakt@toyaku.ac.jp.

In Vivo (Athens, Greece)
|October 31, 2023
PubMed
Abstract

Insights

Antifungal triazoles increase the risk of Torsade de pointes (TdP)/QT prolongation (QTP), particularly in younger and older patients. Monitoring is crucial, especially early in treatment, for these serious cardiac events.

Area of Science:

  • Pharmacovigilance
  • Cardiology
  • Infectious Diseases

Background:

  • Torsade de pointes (TdP)/QT prolongation (QTP) are severe adverse events linked to antifungal triazoles.
  • Understanding the age-specific risks and onset patterns of TdP/QTP is critical for patient safety.

Purpose of the Study:

  • To assess the association between antifungal triazoles and TdP/QTP across different age groups.
  • To analyze the time-to-onset profile of TdP/QTP following antifungal triazole administration.

Main Methods:

  • Analysis of the Japanese Adverse Drug Event Report database (JADER) from April 2004 to March 2022.
  • Evaluation of TdP/QTP association with antifungal triazoles by age using adjusted reporting odds ratio (aROR).
  • Time-to-onset analysis using Weibull distribution based on administration route.

Main Results:

  • Antifungal triazoles showed a significant association with TdP/QTP (aROR=1.77).
  • Increased risk observed in patients ≤29 years and ≥50 years (excluding ≥90).
  • Median time-to-onset was 8 days for IV and 23 days for oral routes, with early hazard for oral administration.

Conclusions:

  • Antifungal triazoles are associated with TdP/QTP in various age groups, including younger patients.
  • Close patient monitoring for TdP/QTP is recommended, especially during the early phase of treatment.
Keywords:
Japanese Adverse Drug Event Report databaseQT prolongationTorsade de pointesantifungal triazoledisproportionality analysis

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