Çapraz Reaktif NSAİİ Aşırı Duyarlılığı Olan Hastalarda Kısmi Selektif COX-2 inhibitörlerinin Güvenliği ve Etkileyen Faktörler

Abstract

AMAÇLAR Nimesulid veya meloksikam gibi kısmi selektif COX-2 inhibitörleri, çapraz reaktif NSAİİ aşırı duyarlılığı olan hastaların çoğunluğu tarafından tolere edilir. Bu çalışmanın amacı, non-immünolojik tipte, çapraz reaktif NSAİİ aşırı duyarlılığında kısmi selektif COX-2 inhibitörleri nimesulid ve meloksikamın güvenliği hakkında daha fazla bilgi elde etmek ve bu ilaçlara karşı intolerans için risk faktörlerinin saptanmasıdır. YÖNTEMLER Çalışmamız 10 yıllık süre içerisinde kliniğimize başvuran, çapraz reaktif NSAİİ aşırı duyarlılığı olan hastaları kapsayan retrospektif bir çalışmadır. En az 2 farklı kimyasal sınıftan NSAİİ ile güvenilir tipte erken tipte aşırı duyarlılık hikaesi olan ve/veya ASA provokasyon testi pozitif olan ve kısmi selektif COX-2 inhibitörleri (nimesulid ve/veya meloksikam) ile alternatif ilaç provokasyon testi yapılan hastalar çalışmaya dahil edildi. Hastaların demografik bilgileri, eşlik eden hastalıkları, atopi durumları, NSAİİ aşırı duyarlılığının süresi, toplam reaksiyon sayısı, reaksiyon ağırlıkları, klinik fenotipleri, solunum fonksiyon testi parametreleri ve alternatif ilaç provokasyon testi sonuçları kaydedilir. Nimesulid ve/veya meloksikam ile yapılan alternatif provokasyon testlerinde reaksiyon görülen ve görülmeyen hastalar bu veriler açısından karşılaştırıldı. BULGULAR Çalışmaya 378'i (%67,5) kadın olmak üzere toplam 560 hasta dahil edildi. Hastaların 394'ünde (%72,6) alergoloji ilişkili komorbidite saptandı. Astım, diğer ilaç alerjileri ve nazal polip en sık eşlik eden hastalıklardı. Nimesulid ve/veya meloksikam ile alternatif ilaç provokasyon testi pozitifliği 560 hastanın 50'sinde (%8,9) tespit edildi. Provokasyon testi pozitifliği nimesulid ile 33/541 (%6,1), meloksikam ile 30/517 (%5,8) ve hem nimesulid hem de meloksikam ile 13/498 (%2,3) saptandı. Provokasyon testi pozitif olan hastalarda NSAİİ aşırı duyarlılığının süresi daha kısaydı ve alergoloji ilişkili komorbiditeler, astım, nazal polip ve astım ve nazal polipin birlikteliği daha sıktı. SONUÇ Kısmi selektif COX-2 inhibitörleri nimesulid ve meloksikam, çapraz reaktif NSAİİ aşırı duyarlılığı olan hastalarda iyi tolere edilen alternatiflerdir. Bu ilaçlara karşı aşırı duyarlılık, astım ve/veya nazal polip hastalarında, diğer çapraz reaktif NSAID aşırı duyarlılığı olan hasta grubuna göre ve aynı zamanda daha kısa süreli NSAID aşırı duyarlılığı olan hastalarda anlamlı derecede daha yüksektir.

Keywords

• NSAİİ
• aşırı duyarlılık
• COX-2 inhibitörü
• nimesulid
• meloksikam
• güvenlik

Safety of partial selective COX-2 inhibitors in patients with cross-reactive NSAID hypersensitivity and factors affecting safety

Abstract

Aims: Partial selective COX-2 inhibitors, such as nimesulide, or meloxicam are tolerated by the majority of the patients with cross-reactive NSAID hypersensitivity. This study aimed to obtain more information about the safety of partial selective COX-2 inhibitors; nimesulide and meloxicam in non-immunologic type, cross-reactive NSAID hypersensitivity and to detect risk factors for intolerance to these drugs. Methods: This is a retrospective study of patients with suggestive of cross-reactive NSAID hypersensitivity who admitted to our clinic over a period of 10 years. Patients who had a reliable history of immediate type NSAIDs hypersensitivity with at least 2 chemically unrelated class and/or positive ASA provocation test and who underwent alternative drug provocation test with partial selective COX-2 inhibitors (nimesulide and/or meloxicam) were included to study. Patients’ demographics, comorbidities, atopy status, duration of NSAID hypersensitivity, total number of reactions, reaction grades, clinical phenotypes, pulmonary function test parameters and results of alternative drug provocation test results are recorded. Patients with and without reactions during alternative provocation tests with nimesulide and/or meloxicam were compared in terms of these data. Results: A total of 560 patients were included in the study, 378 (67.5%) of them were female. Allergic comorbidities were detected in 394 (72.6%) patients. Asthma, other drug allergies and nasal polyp were the most common comorbidities. Alternative drug provocation test positivity with nimesulide and/or meloxicam was detected in 50 of 560 (8.9%) patients. Provocation test positivity was 33/541 (6.1%) with nimesulide, 30/517 (5.8%) with meloxicam and 13/498 (2.3%) with both nimesulide and meloxicam. Duration of NSAID hypersensitivity was shorter and allergic comorbidities, asthma, nasal polyp and the coexistence of asthma and nasal polyp were more common in patients with a positive provocation test. Conclusion: The partial selective COX-2 inhibitors nimesulide and meloxicam are well tolerated alternatives in patients with cross-reactive NSAID hypersensitivity. Hypersensitivity to these drugs is significantly higher in patients with asthma and/or nasal polyp than other group of cross-reactive NSAID hypersensitive patients and also in patients with a shorter duration of NSAID hypersensitivity.

Keywords

• NSAID
• hypersensitivity
• COX-2 inhibitor
• nimesulide
• meloxicam
• safety

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