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Increased risk of paclitaxel-induced peripheral neuropathy in patients using clopidogrel: a retrospective pilot study

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Abstract

Paclitaxel-induced peripheral neuropathy (PIPN) is one of the serious adverse events associated with paclitaxel-based cancer treatments. A recent case study showed that the antiplatelet agent clopidogrel inhibits paclitaxel metabolism via cytochrome P450 (CYP) 2C8, resulting in severe PIPN. The aim of this study was to determine the impact of clopidogrel as a risk factor for the development of PIPN, using a retrospective cohort study. Data from paclitaxel-treated patients with or without clopidogrel and low-dose aspirin treatment were retrieved from medical charts. A total of 161 adult patients were included in this study: 135 were controls, 9 were clopidogrel-treated and 17 were aspirin-treated. The clopidogrel group had a greater proportion of males and a higher rate of comorbidities, such as diabetes mellitus and dyslipidemia, than the control group. However, patient characteristics were similar between the clopidogrel and aspirin groups. Severe PIPN was diagnosed in 3 (2.2%) and 2 (22.2%) patients in the control and clopidogrel groups, respectively (odds ratio: 12.0; p = 0.031). No patients in the aspirin group presented with severe neuropathy. These pilot data suggest that concomitant treatment with clopidogrel leads to a greater risk of PIPN. The avoidance of concomitant clopidogrel use may be effective in reducing clopidogrel-associated PIPN.

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Acknowledgements

We thank Dr. Mariko Takebe, Dr. Akiyo Kameyama and Mr. Toshio Fujimori for their helpful discussions.

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Authors and Affiliations

  1. Department of Anesthesiology, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan

    Mitsuhiro Matsuo, Hisakatsu Ito, Yoshinori Takemura, Mizuki Hattori, Masaaki Kawakami & Mitsuaki Yamazaki

  2. Department of Hospital Pharmacy, University of Toyama, Toyama, Japan

    Norimasa Takahashi

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  1. Mitsuhiro Matsuo
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  2. Hisakatsu Ito
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  3. Yoshinori Takemura
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  4. Mizuki Hattori
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  5. Masaaki Kawakami
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  6. Norimasa Takahashi
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  7. Mitsuaki Yamazaki
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Correspondence to Mitsuhiro Matsuo.

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Matsuo, M., Ito, H., Takemura, Y. et al. Increased risk of paclitaxel-induced peripheral neuropathy in patients using clopidogrel: a retrospective pilot study. J Anesth 31, 631–635 (2017). https://doi.org/10.1007/s00540-017-2362-y

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  • DOI: https://doi.org/10.1007/s00540-017-2362-y

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