The prevalence of hepatic and thyroid toxicity associated with imatinib treatment of chronic myeloid leukaemia: a systematic review.

BACKGROUND: Imatinib, a potent inhibitor of targeted protein tyrosine kinases, treats chronic myeloid leukaemia (CML). Data on imatinib-associated changes in hepatic and thyroid functions are limited and conflicting. AIM: To report the prevalence of hepatic and thyroid toxicity associated with the use of imatinib in CML patients. METHOD: Articles for the systematic review were selected from electronic databases (PubMed, CINALH, Web of Science). Readily accessible peer-reviewed full articles in English published 1st January 2000 to 18th July 2023 were included. The search terms included combinations of: imatinib, CML, liver toxicity, hepatic toxicity, thyroid toxicity. Screening of titles, abstracts, full text articles was conducted independently by two reviewers. Inclusions and exclusions were recorded following PRISMA guidelines. Detailed reasons for exclusion were recorded. Included articles were critically appraised. RESULTS: Ten thousand one hundred and twenty-three CML patients were reported in the 82 included studies corresponding to 21 case reports, 2 case series, 39 clinical trials and 20 observational studies were selected. Excluding case studies/reports, 1268 (12.6%; n = 1268/10046) hepatotoxicity adverse events were reported, of which 64.7% were rated as mild grade I & II adverse events, 363 (28.6%) as severe, grade III and IV adverse events; some led to treatment discontinuation, liver transplantation and fatal consequences. Twenty (35.1%) studies reported discontinuation of imatinib treatment due to the severity of hepatic toxicity. Fourteen (8.4%, n = 14/167) thyroid dysfunction adverse events were reported. CONCLUSION: High frequency of mild and severe hepatotoxicity, associated with imatinib in CML patients, was reported in the published literature. Low numbers of mild and manageable thyroid toxicity events were reported.

Assessment of post discharge medication prescription among Lebanese patients with cerebral infarction: Results of a cross-sectional study.

OBJECTIVES: The study objective was to investigate the degree of physician adherence with the international guidelines for post-stroke discharge medications among Lebanese hospitals. PATIENT AND METHODS: This retrospective observational study was conducted in three Lebanese hospitals between January 2016 and December 2017. RESULTS: Out of 200 patients with stroke, 64.7 % were males. The difference of systolic blood pressure from baseline, 2 h, and after 24 h showed significant decrease by mean value 25.18 ± 33.45 (P < 0.001), and 6.44 ± 22.11 (P = 0.019) respectively. Also diastolic blood pressure showed significant decrease between baseline and after 24 h by a mean value 12.17 ± 13.63 (P value <0.001). Concerning post discharge medications adherence, antithrombotic drugs showed the highest percentage (73 %) followed by antihypertensive and lipid lowering agents by comparable results (47.5 % and 40.7 % respectively). The physician adherence for the three medications together showed (30.4 %). CONCLUSION: Secondary prevention for critical diseases such as stroke appears to be inadequate in the study area.