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
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Patients who experience adverse drug reactions from iodinated contrast media (ICM) may need to undergo contrast-enhanced studies again.
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Switching of ICM away from the ICM that caused the previous adverse drug reactions showed significantly lower recurrence rates.
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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:
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Inverse probability of treatment weighting
- OR:
-
Odds ratio
- PSM:
-
Propensity score matching
- SMD:
-
Standardized mean difference
References
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
Cochran ST, Bomyea K, Sayre JW (2001) Trends in adverse events after IV administration of contrast media. AJR Am J Roentgenol 176:1385–1388
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
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
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
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
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
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
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
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
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
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
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
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
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
ACR Committee on Drugs and Contrast Media (2020) ACR manual on contrast media. American College of Radiology, Silver Spring, MD
Robins JM, Hernán MA, Brumback B (2000) Marginal structural models and causal inference in epidemiology. Epidemiology 11:550–560
Acknowledgements
This study was supported by a grant from Guerbet.
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The scientific guarantor of this publication is CWL.
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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.
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Only if the study is on human subjects: written informed consent was waived by the Institutional Review Board.
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Methodology
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Retrospective
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Observational
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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