Ocular toxoplasmosis: adverse reactions to treatment in a Brazilian cohort

• Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene Vol. 112; no. 4; pp. 188 - 192
• Main Authors: Guaraldo, Lusiele, Villar, Bianca Balzano de la Fuente, Durão, Nicolle Marins Gomes, Louro, Virgínia Clare, Quintana, Marcel de Souza Borges, Curi, André Luiz Land, Neves, Elizabeth Souza
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-04-2018
• Subjects: Adolescent; Adrenal Cortex Hormones - adverse effects; Adrenal Cortex Hormones - therapeutic use; Adult; Adverse Drug Reaction Reporting Systems; Aged; Antidotes - adverse effects; Antidotes - therapeutic use; Antiprotozoal Agents - adverse effects; Antiprotozoal Agents - therapeutic use; Brazil - epidemiology; Comorbidity; Drug-Related Side Effects and Adverse Reactions - epidemiology; Drug-Related Side Effects and Adverse Reactions - therapy; Female; Humans; Leucovorin - adverse effects; Leucovorin - therapeutic use; Male; Middle Aged; Prospective Studies; Pyrimethamine - adverse effects; Pyrimethamine - therapeutic use; Sulfadiazine - adverse effects; Sulfadiazine - therapeutic use; Toxoplasmosis, Ocular - drug therapy; Toxoplasmosis, Ocular - epidemiology; Treatment Outcome; Young Adult; Brazil; adverse drug reactions; drug therapy; uveitis; ocular toxoplasmosis
• ISSN: 0035-9203; 1878-3503
• DOI: 10.1093/trstmh/try040

Abstract
Background
The purpose of this study was to estimate the frequency and describe the adverse drug reactions (ADRs) associated with the classic treatment of ocular toxoplasmosis (OT), namely sulfadiazine, pyrimethamine, corticosteroids and folinic acid.
Methods
We performed a descriptive study of a prospective cohort of patients with OT treated with the classic therapy. Data were collected during medical consultations and treatment.
Results
Of the 147 patients studied, 85% developed one or more ADR. Women presented more ADRs than men (95% vs 77%). Of the total reactions (n=394), 82% were mild, but we found one life-threatening event (Stevens–Johnson syndrome). The most frequent types (71%) of ADRs were gastrointestinal, skin and neurological or psychiatric. The majority of ADRs (90.3%) occurred before the second week of treatment. A third of the patients were treated for the ADR and 10% dropped out of OT treatment. Most (70%) of the ADRs were characterized as being probably caused by the drugs and may be associated with prednisone, sulfadiazine and sulfadiazine/prednisone. Six percent of ADRs were not previously described, such as taste alteration, constipation/bloating, dyspnoea, sweating and somnolence.
Conclusions
Our results suggest a high rate of ADRs to OT classic treatment, which requires careful follow-up in order to identify and treat ADRs early.