主催: The Japanese Pharmacological Society, The Japanese Society of Clinical Pharmacology
会議名: WCP2018 (18th World Congress of Basic and Clinical Pharmacology)
開催地: Kyoto
開催日: 2018/07/01 - 2018/07/06
Introduction:
Ambrisentan is a propionic acid-based, selective Endothelin receptor antagonist and is one of the treatment modalities for pulmonary artery hypertension (PAH). It acts by selectively blocking the endothelin ETA receptors causing vasodilatation resulting in the decrease in arterial pressure. Due to its rather low popularity as a treatment option among patients suffering from PAH, the recording of an adverse drug reaction is itself a rare entity.
Methodology:
This case report was obtained as part of the pharmacovigilance program of our hospital. A 60-year-old woman, known case of Pulmonary Sarcoidosis, Type 2 Diabetes mellitus and severe PAH presented to our hospital on 6th of April 2017, with complaints of bilateral leg swelling and erythematous rash over the abdomen and left leg. Her drug history revealed that she was on prednisolone 5mg for sarcoidosis since 2013, metformin 500mg and voglibose 0.3 mg for diabetes since 2009. Ambrisentan was initiated on 23rd of March 2017, for severe PAH. Ten days later, patient started noticing the appearance of a rash on the left leg, and she discontinued the drug herself. The case was observed, and relevant data were collected from the case record as per Central Drug Standard Control Organization form and causality assessment was done as per WHO scale.
Result
On local examination: there was non-pitting edema with non-blanchable lesions and indurated skin colored plaques extending up to the upper1/3rd of thigh with peu d'orange appearance over the right leg and maculopapular rash over the left leg. Skin biopsy of the lesion was done which showed reactive, vascular proliferation with no evidence of malignancy or sarcoidosis. Rash subsided spontaneously after stopping the drug.
Causality assessment was done as per WHO scale revealed a probable causal relation to the case.
Conclusion:
The occurrence of rash is common with endothelin antagonists such as Bosentan and Sitaxentan because of the presence of a sulphydryl moiety. However, hypersensitivity reaction with ambrisentan is a rare event. Hence clinicians should be aware of this risk and should try and avoid such reactions by taking a detailed allergic history before prescription.
