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N-(2,3-dihydroxypropyl) carbamoyl side chain: a potentially significant factor for recurrent iodinated contrast medium-related adverse drug reactions

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Abstract

Purpose

To determine whether switching to contrast media based on the sharing of N-(2,3-dihydroxypropyl) carbamoyl side chain reduces the recurrence of iodinated contrast media (ICM)-associated adverse drug reactions (ADRs).

Materials and methods

This single-center retrospective study included 2133 consecutive patients (mean age ± SD, 56.1 ± 11.4 years; male, 1052 [49.3%]) who had a history of ICM-associated ADRs and underwent contrast-enhanced CT examinations. The per-patient and per-exam-based recurrence ADR rates were compared between cases of switching and non-switching the ICM from ICMs that caused the previous ADRs, and between cases that used ICMs with common and different carbamoyl side chains from ICMs that caused the previous ADRs. Downgrade rates (no recurrence or the occurrence of ADR less severe than index ADRs) were also compared. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analysis were additionally performed.

Results

In per-patient analysis, switching of ICM showed a lower recurrence rate (switching, 10.4% [100/965] vs. non-switching, 28.4% [332/1168]), with the adjusted odds ratio (OR) of 0.27 (95% CI: 0.21, 0.34; p < 0.001). The result was consistent in PSM (OR, 0.29 [95% CI: 0.22, 0.39]; p < 0.001), IPTW (OR, 0.28 [95% CI: 0.22, 0.36]; p < 0.001), and in per-exam analysis (5.5% vs. 13.8%; OR, 0.32 [95% CI: 0.27, 0.37]; p < 0.001). There was lower per-exam recurrence (5.0% [195/3938] vs. 7.8% [79/1017]; OR, 0.63 [95% CI: 0.47, 0.83]; p = 0.001) and higher downgrade rates (95.6% [3764/3938] vs. 93.3% [949/1017]; OR, 1.51 [95% CI: 1.12, 2.03]; p = 0.006) when using different side chain groups.

Conclusion

Switching to an ICM with a different carbamoyl side chain reduced the recurrent ADRs and their severity during subsequent examinations.

Clinical relevance statement

Switching to an iodinated contrast media with a different carbamoyl side chain reduced the recurrent adverse drug reactions and their severity during subsequent examinations.

Key Points

  • Patients who experience adverse drug reactions from iodinated contrast media (ICM) may need to undergo contrast-enhanced studies again.

  • Switching of ICM away from the ICM that caused the previous adverse drug reactions showed significantly lower recurrence rates.

  • Compared to common side chain groups, there were significant differences in the per-exam recurrence rates and downgrade rates when using ICMs with different side chains.

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Change history

  • 19 April 2024

    Source Line layout was corrected.

Abbreviations

ADR:

Adverse drug reaction

CECT:

Contrast-enhanced CT

ICM:

Iodinated contrast media

IPTW:

Inverse probability of treatment weighting

OR:

Odds ratio

PSM:

Propensity score matching

SMD:

Standardized mean difference

References

  1. Shahid I, Lancelot E, Desché P (2020) Future of diagnostic computed tomography: an update on physicochemical properties, safety, and development of x-ray contrast media. Invest Radiol 55:598–600

    Article  PubMed  Google Scholar 

  2. Cochran ST, Bomyea K, Sayre JW (2001) Trends in adverse events after IV administration of contrast media. AJR Am J Roentgenol 176:1385–1388

    Article  CAS  PubMed  Google Scholar 

  3. Jang EB, Suh CH, Kim PH et al (2023) Incidence and severity of nonionic low-osmolar iodinated contrast medium-related adverse drug reactions in the Republic of Korea: comparison by generic. Medicine (Baltimore) 102:e33717

    Article  CAS  PubMed  Google Scholar 

  4. Mervak BM, Davenport MS, Ellis JH, Cohan RH (2015) Rates of breakthrough reactions in inpatients at high risk receiving premedication before contrast-enhanced CT. AJR Am J Roentgenol 205:77–84

    Article  PubMed  Google Scholar 

  5. Abe S, Fukuda H, Tobe K, Ibukuro K (2016) Protective effect against repeat adverse reactions to iodinated contrast medium: premedication vs. changing the contrast medium. Eur Radiol 26:2148–2154

    Article  PubMed  Google Scholar 

  6. Cha MJ, Kang DY, Lee W et al (2019) Hypersensitivity reactions to iodinated contrast media: a multicenter study of 196 081 patients. Radiology 293:117–124

    Article  PubMed  Google Scholar 

  7. Lee SY, Yang MS, Choi YH et al (2017) Stratified premedication strategy for the prevention of contrast media hypersensitivity in high-risk patients. Ann Allergy Asthma Immunol 118:339–344.e331

    Article  PubMed  Google Scholar 

  8. McDonald JS, Larson NB, Kolbe AB et al (2021) Prevention of allergic-like reactions at repeat ct: steroid pretreatment versus contrast material substitution. Radiology 301:133–140

    Article  PubMed  Google Scholar 

  9. Park HJ, Park JW, Yang MS et al (2017) Re-exposure to low osmolar iodinated contrast media in patients with prior moderate-to-severe hypersensitivity reactions: a multicentre retrospective cohort study. Eur Radiol 27:2886–2893

    Article  PubMed  Google Scholar 

  10. Park SJ, Kang DY, Sohn KH et al (2018) Immediate mild reactions to CT with Iodinated contrast media: strategy of contrast media readministration without corticosteroids. Radiology 288:710–716

    Article  PubMed  Google Scholar 

  11. Sohn KH, Seo JH, Kang DY, Lee SY, Kang HR (2021) Finding the optimal alternative for immediate hypersensitivity to low-osmolar iodinated contrast. Invest Radiol 56:480–485

    Article  CAS  PubMed  Google Scholar 

  12. Lerondeau B, Trechot P, Waton J et al (2016) Analysis of cross-reactivity among radiocontrast media in 97 hypersensitivity reactions. J Allergy Clin Immunol 137:633–635.e634

    Article  CAS  PubMed  Google Scholar 

  13. Ahn JH, Hong SP, Go TH, Kim H (2023) Contrast agent selection to prevent recurrent severe hypersensitivity reaction to iodinated contrast media based on nationwide database. J Comput Assist Tomogr 47:608–612

    Article  PubMed  Google Scholar 

  14. Kim S, Jeon KN, Jung JW et al (2023) Substitution with low-osmolar iodinated contrast agent to minimize recurrent immediate hypersensitivity reaction. Radiology 309:e222467

    Article  PubMed  Google Scholar 

  15. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457

    Article  Google Scholar 

  16. ACR Committee on Drugs and Contrast Media (2020) ACR manual on contrast media. American College of Radiology, Silver Spring, MD

    Google Scholar 

  17. Robins JM, Hernán MA, Brumback B (2000) Marginal structural models and causal inference in epidemiology. Epidemiology 11:550–560

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

This study was supported by a grant from Guerbet.

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Author notes

  1. These authors contributed equally: Pyeong Hwa Kim, Chong Hyun Suh.

Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea

    Pyeong Hwa Kim, Chong Hyun Suh, Eun Bee Jang, Kye Jin Park, Hyo Jung Park, Ah Young Kim, Kyung-Hyun Do, Jeong Hyun Lee, Jin Hyoung Kim, Ah Young Jung & Choong Wook Lee

  2. Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea

    Seonok Kim

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  1. Pyeong Hwa Kim
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Corresponding author

Correspondence to Choong Wook Lee.

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Guarantor

The scientific guarantor of this publication is CWL.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

The statistical expert, SK from Asan Medical Center, kindly provided statistical advice for this manuscript and participated as a co-author.

Informed consent

Only if the study is on human subjects: written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Study subjects or cohorts have not been previously reported.

Methodology

  • Retrospective

  • Observational

  • Performed at one institution

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Kim, P.H., Suh, C.H., Jang, E.B. et al. N-(2,3-dihydroxypropyl) carbamoyl side chain: a potentially significant factor for recurrent iodinated contrast medium-related adverse drug reactions. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10730-7

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  • DOI: https://doi.org/10.1007/s00330-024-10730-7

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