Comparative Safety Profiles and Usage Patterns of Iodinated Contrast Media in Medical Imaging

Area of Science:

• Radiology and Imaging
• Pharmacovigilance
• Patient Safety

Background:

• Nonionic iodinated contrast media (ICMs) are essential for computed tomography (CT).
• Understanding usage patterns and hypersensitivity reaction (HSR) profiles of different ICMs is crucial for optimizing patient safety.
• Previous studies have indicated variations in HSR rates among ICMs, necessitating further investigation.

Purpose of the Study:

• To analyze usage patterns and HSR profiles of six nonionic ICMs in CT scans.
• To compare the incidence and severity of HSRs across different ICMs.
• To evaluate the impact of premedication protocols on HSR rates and inform evidence-based contrast agent selection.

Main Methods:

• Retrospective review of 248,209 CT scans from January 2020 to December 2022.
• Comparison of six ICMs (iomeprol, iohexol, ioversol, iopromide, iodixanol, iobitridol) based on usage rates and HSR data.
• Assessment of premedication protocol reinforcement and quarterly HSR trends.

Main Results:

• A total of 1603 HSRs (0.65%) were recorded, predominantly mild (86.2%).
• Second-line agents (iobitridol, iodixanol) demonstrated 7-8 times higher HSR rates than first-line agents.
• A modified premedication protocol significantly reduced moderate HSRs (p=0.0075), with a trend of higher rates in Q1 and a significant increase in severe HSRs in Q3 (p=0.033).

Conclusions:

• Second-line ICMs are associated with substantially higher HSR rates, emphasizing careful selection.
• Reinforced premedication protocols are effective in mitigating moderate HSRs, improving patient safety.
• Further research into the mechanisms of ICM-related HSRs is warranted to refine clinical management strategies.