内容紹介
Summary
Hypomagnesemia caused by panitumumab can often lead to severe adverse effects, such as arrhythmia. However, the risk factors are still controversial. To clarify the risk factors and time to onset of panitumumab-induced hypomagnesemia, we retrospectively investigated the records of 30 patients who had received panitumumab. They were divided into Grade ≥2 hypomagnesemia and non-Grade ≥2 hypomagnesemia groups, according to their serum magnesium levels, and we compared patients' backgrounds, laboratory values, and concomitant drugs between the 2 groups. Univariate analysis revealed that hypocalcemia and non-administration of an oral magnesium preparation were significantly associated with Grade ≥2 hypomagnesemia induced by panitumumab. Incipient grade 1 hypocalcemia was observed after incipient Grade 1 hypomagnesemia in both groups. The occurrence of these complications was significant in the Grade ≥2 hypomagnesemia group. Thereafter, in all patients of the Grade ≥2 hypomagnesemia group that exhibited both complications, hypomagnesemia developed to Grade 2 or higher. The development of Grade 3 and Grade 4 hypomagnesemia without the development of Grade 2 hypomagnesemia was observed in 2 patients each. Thus, aggravation of hypomagnesemia can be expected upon the administration of panitumumab, and therefore, not only serum magnesium levels, but also serum calcium levels need to be monitored.
要旨
panitumumabの投与により起こる低マグネシウム(Mg)血症は,不整脈のような重篤な副作用を引き起こす可能性があるが,その重症化をもたらす危険因子については未だ十分に解明されていない。本研究ではpanitumumabによる低Mg血症の危険因子およびその発現時期を薬剤疫学的に特定することを試みた。panitumumabを投与された患者30名を対象に,Grade 2以上の低Mg血症発現群およびGrade 2以上の低Mg血症非発現群に分類し,患者背景,臨床検査値および併用薬を比較した。単変量解析により,Grade 2以上の低Mg血症発現群では血清補正カルシウム(Ca)値の低下および経口Mg製剤の非投与であることに有意差が認められた。Grade 1の低Mg血症初発後にGrade 1の低Ca血症を初発しており,両者の併発はGrade 2以上の低Mg血症発現群で有意に多く認められた。その後,両者を併発したGrade 2以上の低Mg血症発現群すべての患者では,低Mg血症はGrade 2以上への重症化がみられており,Grade 2の低Mg血症を経ずにGrade 3およびGrade 4の低Mg血症に増悪した患者もそれぞれ2名ずつ認められた。血清Mg値だけでなく血清補正Ca値のモニタリングを行うことは,panitumumab投与時の低Mg血症のGrade 2以上への重症化を防止できる可能性が示唆された。
目次
Hypomagnesemia caused by panitumumab can often lead to severe adverse effects, such as arrhythmia. However, the risk factors are still controversial. To clarify the risk factors and time to onset of panitumumab-induced hypomagnesemia, we retrospectively investigated the records of 30 patients who had received panitumumab. They were divided into Grade ≥2 hypomagnesemia and non-Grade ≥2 hypomagnesemia groups, according to their serum magnesium levels, and we compared patients' backgrounds, laboratory values, and concomitant drugs between the 2 groups. Univariate analysis revealed that hypocalcemia and non-administration of an oral magnesium preparation were significantly associated with Grade ≥2 hypomagnesemia induced by panitumumab. Incipient grade 1 hypocalcemia was observed after incipient Grade 1 hypomagnesemia in both groups. The occurrence of these complications was significant in the Grade ≥2 hypomagnesemia group. Thereafter, in all patients of the Grade ≥2 hypomagnesemia group that exhibited both complications, hypomagnesemia developed to Grade 2 or higher. The development of Grade 3 and Grade 4 hypomagnesemia without the development of Grade 2 hypomagnesemia was observed in 2 patients each. Thus, aggravation of hypomagnesemia can be expected upon the administration of panitumumab, and therefore, not only serum magnesium levels, but also serum calcium levels need to be monitored.
要旨
panitumumabの投与により起こる低マグネシウム(Mg)血症は,不整脈のような重篤な副作用を引き起こす可能性があるが,その重症化をもたらす危険因子については未だ十分に解明されていない。本研究ではpanitumumabによる低Mg血症の危険因子およびその発現時期を薬剤疫学的に特定することを試みた。panitumumabを投与された患者30名を対象に,Grade 2以上の低Mg血症発現群およびGrade 2以上の低Mg血症非発現群に分類し,患者背景,臨床検査値および併用薬を比較した。単変量解析により,Grade 2以上の低Mg血症発現群では血清補正カルシウム(Ca)値の低下および経口Mg製剤の非投与であることに有意差が認められた。Grade 1の低Mg血症初発後にGrade 1の低Ca血症を初発しており,両者の併発はGrade 2以上の低Mg血症発現群で有意に多く認められた。その後,両者を併発したGrade 2以上の低Mg血症発現群すべての患者では,低Mg血症はGrade 2以上への重症化がみられており,Grade 2の低Mg血症を経ずにGrade 3およびGrade 4の低Mg血症に増悪した患者もそれぞれ2名ずつ認められた。血清Mg値だけでなく血清補正Ca値のモニタリングを行うことは,panitumumab投与時の低Mg血症のGrade 2以上への重症化を防止できる可能性が示唆された。