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The prevalence of hepatic and thyroid toxicity associated with imatinib treatment of chronic myeloid leukaemia: a systematic review

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Abstract

Background

Imatinib, a potent inhibitor of targeted protein tyrosine kinases, treats chronic myeloid leukaemia (CML). Data on imatinib-associated changes in hepatic and thyroid functions are limited and conflicting.

Aim

To report the prevalence of hepatic and thyroid toxicity associated with the use of imatinib in CML patients.

Method

Articles for the systematic review were selected from electronic databases (PubMed, CINALH, Web of Science). Readily accessible peer-reviewed full articles in English published 1st January 2000 to 18th July 2023 were included. The search terms included combinations of: imatinib, CML, liver toxicity, hepatic toxicity, thyroid toxicity. Screening of titles, abstracts, full text articles was conducted independently by two reviewers. Inclusions and exclusions were recorded following PRISMA guidelines. Detailed reasons for exclusion were recorded. Included articles were critically appraised.

Results

Ten thousand one hundred and twenty-three CML patients were reported in the 82 included studies corresponding to 21 case reports, 2 case series, 39 clinical trials and 20 observational studies were selected. Excluding case studies/reports, 1268 (12.6%; n = 1268/10046) hepatotoxicity adverse events were reported, of which 64.7% were rated as mild grade I & II adverse events, 363 (28.6%) as severe, grade III and IV adverse events; some led to treatment discontinuation, liver transplantation and fatal consequences. Twenty (35.1%) studies reported discontinuation of imatinib treatment due to the severity of hepatic toxicity. Fourteen (8.4%, n = 14/167) thyroid dysfunction adverse events were reported.

Conclusion

High frequency of mild and severe hepatotoxicity, associated with imatinib in CML patients, was reported in the published literature. Low numbers of mild and manageable thyroid toxicity events were reported.

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  1. Department of Pharmacology, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia

    Mansour Tobaiqy

  2. Department of Biochemistry, College of Sciences, University of Jeddah, Jeddah, Saudi Arabia

    Nawal Helmi

  3. Independent Research Consultant, Aberdeen, UK

    Katie MacLure

  4. Health and Sciences Department, American University of Science and Technology, Beirut, Lebanon

    Sylvia Saade

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Tobaiqy, M., Helmi, N., MacLure, K. et al. The prevalence of hepatic and thyroid toxicity associated with imatinib treatment of chronic myeloid leukaemia: a systematic review. Int J Clin Pharm 46, 368–381 (2024). https://doi.org/10.1007/s11096-023-01671-0

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