Drug-Related Nephrotoxic and Ototoxic Reactions A Link through a Predictive Mechanistic Commonality

Background: Drug-induced ototoxicity is a subject of interest because many diseases are treated with drugs that have potential toxic effects oil the ear. There is evidence that both inner ear and kidney tissue are immunologically, biochemically and functionally related. It has been Suggested that drugs that influence the transport of sodium and/or potassium change ionic homeostasis in the inner ear and. hence. induce functional disturbances such as hearing loss, tinnitus and vertigo. Objectives: To assess whether renal Suspected adverse drug reactions (sADRs) have Predictive value for ear and labyrinth adverse drug reactions (ADRs) and whether drug classes involved have influence ion transport systems. Study design: Data were obtained front the Netherlands Pharmacovigilance Centre Lareb. The study base comprised all reports of sADRS up until 1 January 2007. Cases were all sADRs for relevant renal disorders and all sADRs for relevant ear disorders. All other reported sADRs were selected as 'non-cases'. The relationship between drug classes and renal, ear and labyrinth sADRs was evaluated by calculating reporting odds ratios (RORs). An ROR >= 1.50 was regarded as a cut-off value for an association. Drug classes were classified into four groups: (A) ROR kidney <1.50 and ROR ear <1.50 or no reports oil ear sADRs (reference group); (B) ROR kidney < 1.50 and ROR ear >= 1.50 (C) ROR kidney >= 1.50 and ROR ear <1.50 or no reports on ear sADRs and (D) ROR kidney ! 1.50 and ROR car ! 1.50. For each group, we calculated odds ratios (ORs) for the association between the group classification and the effect oil ion channels/ion transport systems in kidney and car tissues. Results: Of 193 drug classes with relevant ADRs for renal disorders, 120 drug classes also had reports oil ototoxic reactions. Fourteen out of 120 drug classes had an ROR >= 1.50 for the association between the drug class and both renal and ear sADRs. Among these drug classes were several with a well known abitity to induce renal (adverse) effects and ear and labyrinth disorders, Such as loop diuretics. aminoolycosides and quinine. We found that one mechanistic commonality of the drug classes mentioned in the reports was the ability to affect ion transport systems. The percentage of drugs having this property differed between the four groups. The ORs for groups D and B were significantly higher compared with the reference group (OR 12.2, 95% CI 3.0. 30.5 and OR 9.7, 95% CI 2.4, 18.7, respectively), whereas there was no association for group C. Conclusion: Our data suggest that renal sADRs as such are not a market for drug-induced car and labyrinth disorders. However, the ability of drugs to act on ion channels or ion transport systems and, therefore, have ail influence on ionic homeostasis in the kidney and car might be a predictor for the possible Occurrence of drug-related ototoxicity.