Peripheral Neuropathy Associated With Proteasome Inhibitors and Immunomodulatory Drugs: A Pharmacovigilance...

Area of Science:

• Pharmacovigilance
• Neurology
• Oncology

Background:

• Immunomodulatory drugs (IMIDs) and proteasome inhibitors (PIs) are key treatments for multiple myeloma (MM).
• Peripheral neuropathy is a significant adverse effect associated with these MM therapies.
• Understanding the specific nerve dysfunction types linked to IMIDs and PIs is crucial for patient management.

Purpose of the Study:

• To investigate the association between IMIDs and PIs and peripheral neuropathy in multiple myeloma patients.
• To stratify these associations based on the type of nerve dysfunction: sensory, motor, or autonomic.
• To identify specific drugs within these classes that pose a higher risk for neuropathy.

Main Methods:

• Analysis of individual case safety reports (ICSRs) from VigiBase (WHO global database).
• Inclusion of ICSRs reported between December 1, 2001, and May 31, 2023.
• Identification of peripheral neuropathy using MedDRA terms and standardized queries; disproportionality analysis using ROR and IC.

Main Results:

• All analyzed IMIDs and PIs showed associations with peripheral neuropathy.
• Both drug classes were linked to peripheral sensory neuropathy.
• Specific associations included bortezomib, ixazomib, carfilzomib, and thalidomide with autonomic neuropathy; bortezomib, thalidomide, lenalidomide, and pomalidomide with peripheral motor neuropathy.

Conclusions:

• IMIDs and PIs are significantly associated with various types of peripheral neuropathy in multiple myeloma patients.
• Bortezomib and thalidomide showed strong associations with peripheral motor neuropathy.
• These findings highlight the need for vigilant monitoring of neurological adverse events in patients receiving IMIDs and PIs for multiple myeloma.