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Objective. Each TNF-α inhibitor (TNFi) can induce lupus or lupus-like syndrome. Nevertheless, the risk may differ between drugs because of different apoptosis induction properties. The aim of this study was to assess the putative association of each TNFi with lupus or lupus-like-syndrome.Methods. All spontaneous reports of TNFi-related lupus recorded in the French pharmacovigilance database between January 2000 and December 2012 were described. We conducted disproportionality analyses (case/non-case method) to assess the link between TNFi and lupus, calculating reporting odds ratios (RORs). We used isoniazid as positive control and acetaminophen as negative control. We performed sensitivity analyses to test for event-related and drug-related competition biases.Results. Among 309 671 spontaneous reports, 5213 involved TNFi. Among these, 39 were lupus or lupus-like syndromes: 25 involved infliximab, 9 adalimumab and 5 etanercept. The male:female sex ratio was 0.1 and the mean age was 44.9 years. Among the 39 cases, 28% fulfilled at least four ACR criteria for SLE. Median time to lupus onset was 11 months. Cutaneous and rheumatological involvement were the most frequent. Antinuclear autoantibodies were present in all patients, with anti-DNA specificity in 77.8%. Improvement was observed after TNFi withdrawal. There was a significant association between TNFi and lupus (ROR = 7.72, 95% CI 5.50, 10.83). The ROR was similar for infliximab (10.97, 95% CI 7.27, 16.56) and adalimumab (9.03, 95% CI 4.64, 17.58) and was 4.02 (95% CI 1.66, 9.75) for etanercept. Sensitivity analyses led to similar results.Conclusion. Although CIs overlap, there is a clear trend towards a decreased risk with etanercept compared with monoclonal TNFis. [ABSTRACT FROM PUBLISHER]

Objectives. The aim of this research was to describe the cases of TNF-α antagonist-related alopecia reported in the French Pharmacovigilance Database (FPVD) and to investigate the association between exposure to TNF-α antagonists and occurrence of alopecia.Methods. All spontaneous reports of TNF-α antagonist-related alopecia recorded in the FPVD between January 2000 and April 2012 were colligated and described. We conducted disproportionality analyses (case/non-case method) to assess the link between the occurrence of alopecia and exposure to TNF-α antagonists. Cases were all reports of alopecia and non-cases were all other reports recorded during the study period. Exposure to TNF-α antagonists was sought in cases and in non-cases. Reporting odds ratios (RORs) were calculated to assess the association. Docetaxel was used as positive control and acetaminophen as negative control. We performed sensitivity analyses excluding cases of androgenic alopecia and those occurring in psoriatic patients.Results. Among 282 590 spontaneous reports of adverse drug reactions (ADRs) collated in the FPVD, 1068 cases (alopecia reports) were identified. Of these cases, 52 (4.9%) occurred during exposure to TNF-α antagonists (18 involved infliximab, 17 adalimumab, 15 etanercept and 2 certolizumab). Exposure to TNF-α antagonists was more frequent among alopecia reports than among other ADR reports for all TNF-α antagonists pooled (ROR 3.0, 95% CI 2.3, 4.0) as well as for each antagonist separately, with similar values. Sensitivity analyses yielded similar results. The RORs were 29.9 (95% CI 25.3, 35.5) with docetaxel and 0.3 (95% CI 0.2, 0.4) with acetaminophen.Conclusion. The present study confirms a strong link between TNF-α antagonist exposure (class effect) and the occurrence of alopecia. [ABSTRACT FROM PUBLISHER]

Objectives: While drug-induced tics have been described, in particular with neuroleptics, psychostimulants, or anti-epileptics, the strength and the direction of these associations are still debated. The aim of this study was to investigate the association between tics and drug exposure through a two-step analysis in two pharmacovigilance databases., Methods: We first performed a descriptive clinical analysis of cases registered in the French pharmacovigilance database (FPVD) from January 1985 to December 2018. We then performed a disproportionality analysis in VigiBase®, the WHO pharmacovigilance database, from January 1967 to June 2019, through the calculation of reporting odds ratio (ROR)., Results: The drugs most frequently associated with tics in the FPVD were methylphenidate, lamotrigine, montelukast, tramadol, mirtazapine, venlafaxine, aripiprazole, and risperidone. In VigiBase®, we found a significant ROR with methylphenidate (ROR 37.54, 95% confidence interval [CI] 34.81-40.48), montelukast (ROR 12.18, 95% CI 10.29-14.41), aripiprazole (ROR 7.40, 95% CI 6.35-8.62), risperidone (ROR 4.40, 95% CI 3.72-5.21), and venlafaxine (ROR 1.52, 95% CI 1.14-2.03)., Conclusion: This postmarketing study confirmed a potential harmful association with methylphenidate (the highest association, as expected), aripiprazole, risperidone, lamotrigine, and venlafaxine and, interestingly, found a strong signal with montelukast, which, to our knowledge, had never been published before., (© 2020 John Wiley & Sons Ltd.)

Background: Change-point analysis (CPA) is a powerful method to analyse pharmacovigilance data but it has never been used on the disproportionality metric., Objectives: To optimize signal detection investigating the interest of time-series analysis in pharmacovigilance and the benefits of combining CPA with the proportional reporting ratio (PRR)., Methods: We investigated the couple benfluorex and aortic valve incompetence (AVI) using the French National Pharmacovigilance and EudraVigilance databases: CPA was applied on monthly counts of reports and the lower bound of monthly computed PRR (PRR-). We stated a CPA hypothesis that the substance-event combination is more likely to be a signal when the 2 following criteria are fulfilled: PRR- is greater than 1 with at least 5 cases, and CPA method detects at least 2 successive change points of PRR- which made consecutively increasing segments. We tested this hypothesis by 95 test cases identified from a drug safety reference set and 2 validated signals from EudraVigilance database: CPA was applied on PRR-., Results: For benfluorex and AVI, change points detected by CPA on PRR- were more meaningful compared with monthly counts of reports: More change points detected and detected earlier. In the reference set, 14 positive controls satisfied CPA hypothesis, 6 positive controls only met first requirements, 3 negative controls only met first requirement, and 2 validated signals satisfied CPA hypothesis., Conclusions: The combination of CPA and PRR represents a significant advantage in detecting earlier signals and reducing false-positive signals. This approach should be confirmed in further studies., (© 2018 John Wiley & Sons, Ltd.)