Consensus Report from Oncology Advisory Board Meeting

Strategies for Prevention and Management of CI-AKI and the Role of Contrast in Oncology CT Settings • 23 discomfort following IV administration of iodixanol or iopamidol in patients undergoing CECT as part of their routine medical care [5]. The presence of discomfort (heat, pain, and coldness) and intensity was verbally rated by patients on a 0-10 scale and converted into four categories (none: 0; mild: 1-3; moderate: 4-7; and severe: 8-10, severe). A total of 299 patients were enrolled in the study, out of which 151 patients received iodixanol and 148 patients received iopamidol. The rates of moderate-to-severe discomfort and severe discomfort were significantly less in iodixanol groups than iopamidol group – moderate-to-severe discomfort rates: 35.1% vs 67.3%, respectively, p<0.0001; severe discomfort rates: 2.6% vs 16.3%, respectively; p=0.0004. Heat was the main factor prompting reports of discomfort. A statistically higher proportion of patients in iodixanol group than iopamidol group experienced no discomfort (21.2% vs 7.5%, p=0.0008). Another remarkable observation was higher rate of excellent overall image quality in iodixanol group, although the difference did not reach statistical significance (95.4% vs 89.9%, respectively, p=0.0508). Overall, the rate of severe discomfort with iopamidol was about 6 times greater than that with iodixanol. A post-marketing surveillance study aimed to determine the frequency and severity of adverse drug reactions (ADRs) and discomfort with iodixanol use for CECT scans by radiologists in private practice in Germany [6]. Patients were asked to report immediate or delayed adverse reactions after CM administration. Patients were also asked to rate discomfort (pain, heat, and coldness), if any, on a scale of 0-10. The overall incidence of ADRs was 0.74%, with immediate ADRs accounting for 0.30% and delayed ADRs for 0.42% incidence. Serious ADRs were observed in only 0.05% patients. No contrast-related deaths occurred. Discomfort was generally reported as mild and the composite score of discomfort ranged between 0-3 in majority of the patients (72%). Based on the findings, it was concluded that iodixanol shows excellent safety and tolerability profile. Summary Acute kidney injury is a significant burden in cancer, dramatically increasing patient mortality and hospital costs. The risk of AKI in cancer patients is increased if they receive CM and nephrotoxic chemotherapy. In renally impaired cancer patients, the rate of CI-AKI with Iodixanol may not preclude them from having CECT. In patients with apparently normal renal function but with other risk factors for AKI, iodixanol can help address renal complications. Because iodixanol has been designed to maintain normal osmotic pressure in the veins, it also minimizes contrast-associated pain, which can be severe in oncology patients. Iodixanol has been developed to protect the kidneys and improve patient tolerability. References 1. McDonald JS, McDonald RJ, Williamson EE, et al . Is Intravenous Administration of Iodixanol Associated with Increased Risk of Acute Kidney Injury, Dialysis, or Mortality? A Propensity Score-adjusted Study. Radiology . 2017;285(2):414–424. 2. Cheruvu B, Henning K, Mulligan J, et al . Iodixanol: risk of subsequent contrast nephropathy in cancer patients with underlying renal insufficiency undergoing diagnostic computed tomography examinations. J Comput Assist Tomogr . 2007;31(4):493–498. 3. Nguyen SA, Suranyi P, Ravenel JG, et al . Iso-osmolality versus low- osmolality iodinated CM at IV contrast-enhanced CT: effect on kidney function. Radiology . 2008;248(1):97–105. 4. Terrenato I, Sperati F, Musicco F, et al . Iodixanol versus iopromide in cancer patients: Evidence from a randomized clinical trial. J Cell Physiol . 2018;233(3):2572–2580. 5. Weiland FL, Marti-Bonmati L, Lim L, et al . Comparison of patient comfort between iodixanol and iopamidol in contrast-enhanced computed tomography of the abdomen and pelvis: a randomized trial. Acta Radiol . 2014;55(6):715–724. 6. Häussler MD. Safety and patient comfort with iodixanol: a postmarketing surveillance study in 9515 patients undergoing diagnostic CT examinations. Acta Radiol . 2010;51(8):924–933. Fig. 4. Risk of AKI with iodixanol vs iopromide in low-risk patients. AKI: acute kidney injury (increase in SCr ≥25% or ≥0.5 mg/dl from baseline); SCr: serum creatinine; n.s.: not significant Source: [4]