The potential gastrointestinal side effects of excipients in imatinib preparations
The potential gastrointestinal side effects of excipients in imatinib preparations
Aim: Chronic myeloid leukemia (CML) is a BCR-ABL positive myeloproliferative disorder characterized by clonal proliferation of the hematopoietic stem cells. Imatinib mesylate represents the most important agent associated with improved survival in CML that has been introduced for clinical use in 2000s. The original imatinib preparation Glivec ® was subsequently followed by the introduction of biosimilar products containing a variety of excipients. Gastrointestinal side effects represent the major limitation for therapeutic use of imatinib. This study was planned to examine whether excipients in the original and biosimilar imatinib products had any role in the emergence of GIS side effects.Materials and methods: Excipients in imatinib preparations used for the treatment of chronic phase (CP) CML patients followed up and treated at the hematology department of Mersin University between 2000 and 2019 were analyzed with respect to their potential GIS side effects.Results: Totally 42 CML patients included in the study. The median age was 53.2, and female:male ratio was 20:22. They had similar demographic characteristics as compared to previously reported CML populations. No patients had GIS side effect requiring drug discontinuation or switch to another agent. While bovine gelatin and polyvinyl alcohol had no significant effects on GIS side effects, those that contained titanium were found to be associated with a significant increase in the risk of GIS side effects (52%, contained titanium vs 0/2, contained no titanium). These side effects are less frequently in products that have lowest number of excipient types.Conclusion: GIS side effects can be triggered by various excipients in imatinib preparations.
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- 1. Hochhaus A, Larson RA, Guilhot F, et al. Long-Term Outcomes of Imatinib Treatment for Chronic Myeloid Leukemia. N Engl J Med 2017;376:917-27.
- 2. Caldemeyer L, Dugan M, Edwards J, et al. LongTerm Side Effects of Tyrosine Kinase Inhibitors in Chronic Myeloid Leukemia. Curr Hematol Malig Rep 2016;11:71-9.
- 3. Eskazan AE, Soysal T. Generic imatinib in the treatment of chronic myeloid leukemia: Cerrahpasa experience. J Oncol Pharm Pract 2016;22:382-4.
- 4. Institute NC. Common Terminology Criteria for Adverse Events (CTCAE): U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute 2010.
- 5. Steegmann JL, Baccarani M, Breccia M, et al. European LeukemiaNet recommendations for the management and avoidance of adverse events of treatment in chronic myeloid leukaemia. Leukemia 2016;30:1648- 71.
- 6. Yu L, Wang HB, Huang XJ, et al. The impact of Glivec related side effects on daily life in Chinese patients with chronic myeloid leukemia in the chronic phase. Zhonghua Xue Ye Xue Za Zhi 2016;37:554-8.
- 7. Druker BJ, Guilhot F, O'Brien SG, et al. Five-year followup of patients receiving imatinib for chronic myeloid leukemia. N Engl J Med 2006;355:2408-17.
- 8. Molica M, Colafigli G, Scalzulli E, et al. Ten-year outcome of chronic-phase chronic myeloid leukemia patients treated with imatinib in real life. Ann Hematol 2019;98:1891-904.
- 9. Kalasz H, Antal I. Drug excipients. Curr Med Chem 2006;13:2535-63.