Korean J Radiol.  2024 Sep;25(9):824-832. 10.3348/kjr.2024.0248.

Changing Gadolinium-Based Contrast Agents to Prevent Recurrent Acute Adverse Drug Reactions: 6-Year Cohort Study Using Propensity Score Matching

• Han MW
• Suh CH
• Kim PH
• Kim S
• Kim AY
• Do KH
• Lee JH
• Gwon DI
• Jung AY
• Lee CW

• KMID: 2558921
• DOI: http://doi.org/10.3348/kjr.2024.0248

Abstract

Objective
To determine the preventive effect of changing gadolinium-based contrast agents (GBCAs) to reduce the recurrence of GBCA-associated acute adverse drug reactions (ADRs).
Materials and Methods
This retrospective, observational, single-center study—conducted between January 2016 and December 2021—included 238743 consecutive GBCA-enhanced MRI examinations. We focused on a subgroup of patients who experienced acute GBCA-associated ADRs during any of these examinations and subsequently underwent follow-up GBCAenhanced MRI examinations up until July 2023. The follow-up examinations involved either the same (non-change group) or different (change group) GBCAs compared to the ones that initially caused the acute ADR. Baseline participant characteristics, generic profile of the GBCAs, administration of premedication, history of prior ADR to iodinated contrast media, and symptoms of GBCA-associated acute ADRs were retrospectively analyzed. Multivariable logistic regression with generalized estimating equations and propensity score matching were used.
Results
A total of 1042 instances of acute ADRs (0.44%; 95% confidence interval [CI]: 0.41%–0.46%) were reported. Threehundred and seventy-three patients underwent GBCA-enhanced MRI examinations after experiencing GBCA-associated acute ADRs within the study period; 31.9% (119/373) reexperienced acute ADRs at any of the follow-up examinations. The ADR recurrence was significantly lower in the GBCA change group than in the non-change group according to multivariable logistic regression (adjusted odds ratio [OR]: 0.35; 95% CI: 0.13–0.90; P = 0.03) and analysis with propensity score matching (14.3% [6/42] vs. 36.9% [31/84], respectively; OR: 0.32, 95% CI: 0.11–0.94; P = 0.04). A history of an ADR to iodinated contrast media (OR: 1.14, 95% CI: 0.68–1.90; P = 0.62) and premedication (adjusted OR: 2.09, 95% CI: 0.93–4.68; P = 0.07) were not significantly associated with GBCA-associated acute ADR recurrence. A separate analysis for recurrent allergic-like hypersensitivity reactions demonstrated similar results (adjusted OR: 0.20, 95% CI: 0.06–0.65; P < 0.01).
Conclusion
Changing GBCAs may reduce the risk of GBCA-associated acute ADR recurrence.

Keyword

Contrast media; Drug-related side effects and adverse reactions; Propensity score; Matched-pair analysis