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Preventive effects of dexamethasone premedication on the development of infusion-related reactions in breast cancer patients receiving trastuzumab
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  • Emi Goto,
  • Takeo Hata,
  • Masami Nishihara,
  • Masashi Neo,
  • Mitsuhiko Iwamoto,
  • Kosei Kimura,
  • Masahiro Goto,
  • Yoshiyuki Rikitake
Emi Goto
Osaka Medical and Pharmaceutical University Hospital

Corresponding Author:emi.goto@ompu.ac.jp

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Takeo Hata
Osaka Medical and Pharmaceutical University Hospital
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Masami Nishihara
Osaka Medical and Pharmaceutical University Hospital
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Masashi Neo
Osaka Medical and Pharmaceutical University
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Mitsuhiko Iwamoto
Osaka Medical and Pharmaceutical University
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Kosei Kimura
Osaka Medical and Pharmaceutical University
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Masahiro Goto
Osaka Medical and Pharmaceutical University
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Yoshiyuki Rikitake
Kobe Pharmaceutical University
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Abstract

Aim To clarify the incidence and risk factors of infusion-related reactions (IRRs) to trastuzumab in breast cancer patients and verify the preventive effects of glucocorticoids. Methods The electronic medical record data at the time of trastuzumab administration were retrospectively reviewed. The following exclusion criteria were applied to 229 breast cancer patients who received trastuzumab at Osaka Medical and Pharmaceutical University Hospital during the 4-year study period: missing information on human epidermal growth factor receptor type 2 (HER2) status (n=1); missing information on eosinophils (n=11); or use of treatments other than trastuzumab (n=41). Results The 176 patients included in the study received 2,320 infusions. Fifty-eight patients (33.0%) experienced IRRs, and IRRs occurred in 80 (3.4%) of the 2,320 infusions. Owing to the hierarchical structure of the data, the independence of the observed values was evaluated using the intraclass correlation coefficient. Multivariate multilevel logistic regression analysis showed that premedication with dexamethasone was effective in lowering IRR risk with trastuzumab (mg; per unit; odds ratio, OR=0.62; 95% confidence interval, 95% CI, 0.44‒0.86; p=0.005). Preoperative status (OR=34.7; 95% CI, 5.0–242.0; p<0.001) and high doses of trastuzumab (mg/kg; per unit; OR=59.6; 95% CI, 19.7–180.0; p<0.001) were independent risk factors for IRRs. Conclusion The results of this study suggest that premedication with dexamethasone has a protective effect against IRRs caused by trastuzumab in breast cancer treatment. Future studies are needed to determine the optimal dosing of dexamethasone to prevent IRRs and the impact of dexamethasone on the efficacy of trastuzumab treatment.
17 Aug 2022Submitted to British Journal of Clinical Pharmacology
18 Aug 2022Submission Checks Completed
18 Aug 2022Assigned to Editor
22 Aug 2022Reviewer(s) Assigned
14 Nov 2022Review(s) Completed, Editorial Evaluation Pending
22 Nov 2022Editorial Decision: Revise Major
14 Dec 20221st Revision Received
15 Dec 2022Submission Checks Completed
15 Dec 2022Assigned to Editor
15 Dec 2022Review(s) Completed, Editorial Evaluation Pending
22 Dec 2022Reviewer(s) Assigned
17 Jan 2023Editorial Decision: Accept