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Adverse events associated with currently used medical treatments for cystinuria and treatment goals: results from a series of 442 patients in France.
- Source :
-
BJU international [BJU Int] 2019 Nov; Vol. 124 (5), pp. 849-861. Date of Electronic Publication: 2019 Mar 25. - Publication Year :
- 2019
-
Abstract
- Objective: To evaluate medical treatments, in terms of adverse events (AEs) and therapeutic goals, in a large series of patients with cystinuria.<br />Patients and Methods: Data from 442 patients with cystinuria were recorded retrospectively. Crystalluria was studied in 89 patients. A mixed-effects logistic regression model was used to estimate how urine pH, specific gravity and cysteine-binding thiols (CBT) correlate with risk of cystine crystalluria.<br />Results: Alkalizing agents and CBT agents were given to 88.8% (n = 381) and 55.3% (n = 238) of patients, respectively. Gastrointestinal AEs were reported in 12.3%, 10.4% and 2.6% of patients treated with potassium bicarbonate, potassium citrate and sodium bicarbonate, respectively (P = 0.008). The percentages of patients who experienced at least one AE with tiopronin (24.6%) and with D-penicillamine (29.5%) were similar (P = 0.45). Increasing urine pH and decreasing urine specific gravity significantly reduced the risk of cystine crystalluria, whereas D-penicillamine and tiopronin treatments did not reduce this risk (odds ratio [OR] 1 for pH ≤6.5; OR 0.52 [95% confidence interval {95% CI} 0.28-0.95] for 7.0 <pH ≤7.5, P = 0.03; OR 0.26 [95% CI 0.13-0.53] for 7.5 < pH ≤8.0, P <0.001; OR 1 for specific gravity ≤1.005 OR 5.76 [95% CI 1.45-22.85] for 1.006 ≤ specific gravity ≤1.010, P = 0.01; and OR 11.06 [95% CI 2.76-44.26] for 1.011 ≤ specific gravity ≤ 1.014, P < 0.001). Increased urine pH significantly increased the risk of calcium phosphate crystalluria (OR 1 for pH≤ 6.5; OR 6.09 [95% CI 2.15-17.25] for pH >8.0, P <0.001).<br />Conclusion: Adverse events were frequent with D-penicillamine and tiopronin. Alkaline hyperdiuresis was well tolerated and reduced cystine crystalluria. Urine specific gravity ≤1.005 and urine pH >7.5, while warning about calcium-phosphate crystallization, should be the goals of medical therapy.<br /> (© 2019 The Authors BJU International © 2019 BJU International Published by John Wiley & Sons Ltd.)
- Subjects :
- Adolescent
Adult
Aged
Child
Child, Preschool
Drug-Related Side Effects and Adverse Reactions
Female
France
Humans
Hydrogen-Ion Concentration
Infant
Male
Middle Aged
Penicillamine adverse effects
Penicillamine therapeutic use
Retrospective Studies
Sodium Bicarbonate adverse effects
Sodium Bicarbonate therapeutic use
Tiopronin adverse effects
Tiopronin therapeutic use
Treatment Outcome
Urinalysis
Young Adult
Cystinuria drug therapy
Cystinuria prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1464-410X
- Volume :
- 124
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- BJU international
- Publication Type :
- Academic Journal
- Accession number :
- 30801923
- Full Text :
- https://doi.org/10.1111/bju.14721