Ocular Toxoplasmosis: Therapy-Related Adverse Drug Reactions and Their Management

 

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Abstract

Background There are different treatment options for ocular toxoplasmosis (OT). “Classic” therapy consists of pyrimethamine, sulfadiazine and folinic acid combined with systemic steroids and is still widely used. However, potentially severe side effects of this therapy have been reported. The aim of this retrospective study was to evaluate the incidence and types of adverse drug reactions in patients treated for OT. Clinical management of each adverse drug reaction was assessed.

Patients and Methods In this retrospective analysis, we reviewed data of patients with OT, who were consecutively examined between December 2011 and December 2015 at the Department of Ophthalmology, University Hospital Zurich.

Results In total, 49 patients had at least one episode of active OT. In 54 (83.0 %) of 65 treated episodes, the classic regimen was used. Of the 37 patients who received classic treatment, 9 (24.3 %) developed at least one adverse drug reaction which led to drug discontinuation, including elevated creatinine (5.4 %), elevated liver enzymes (5.4 %), vomiting (5.4 %), rash (5.4 %) and facial swelling (2.7 %). In 5 patients, treatment was switched to another drug, while in the other 4 patients, therapy was stopped. In these 9 patients, inflammation was well controlled 8 weeks after onset of therapy. No patient suffered from severe side effects, such as potentially life-threatening allergic reactions or pancytopenia.

Conclusions In OT patients who were treated with classic therapy, adverse drug reactions are common. Therefore, clinical and laboratory monitoring is mandatory. Adverse drug reactions may require interdisciplinary management.

Zusammenfassung

Hintergrund Es existieren verschiedene Optionen zur Behandlung der okulären Toxoplasmose (OT). Die klassische Therapie bestehend aus Sulfadiazin, Pyrimethamin und Folinsäure kombiniert mit systemischen Steroiden wird oft verwendet. Potenziell schwere Nebenwirkungen wurden beschrieben. Das Ziel dieser Arbeit war die Bestimmung der Häufigkeit sowie der Art der Nebenwirkungen unter der Anti-Toxoplasmose-Therapie.

Patienten und Methoden Wir analysierten in dieser retrospektiven Studie Daten von Patienten mit OT, die zwischen Dezember 2011 und Dezember 2015 an der Augenklinik des Universitätsspitals Zürich gesehen wurden.

Ergebnisse Insgesamt litten 49 Patienten an mindestens einer Episode von aktiver OT. In 54 (83 %) von 65 behandelten Episoden wurde die klassische Therapie gewählt. Von 37 Personen unter klassischer Therapie entwickelten 9 (24.3 %) mindestens eine Nebenwirkung, welche die Beendigung der Therapie zur Folge hatte. Nebenwirkungen beinhalteten erhöhte Nierenwerte (5.4 %), erhöhte Leberwerte (5.4 %), Erbrechen (5.4 %), Exanthem (5.4 %) und Gesichtsschwellung (2.7 %). Bei 5 Patienten wurde die Therapie umgestellt, bei 4 Patienten gestoppt. In allen 9 Patienten war die Entzündung 8 Wochen nach Therapiebeginn unter Kontrolle. Kein Patient erlitt eine schwere Nebenwirkung wie eine potenziell lebensbedrohliche allergische Reaktion oder eine Panzytopenie.

Schlussfolgerungen Nebenwirkungen der klassischen Therapie sind bei der okulären Toxoplasmose häufig. Klinisches Monitoring und regelmässige Laborkontrollen sind deshalb unumgänglich. Bei Therapienebenwirkungen ist ein interdisziplinäres Management angezeigt.

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