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Cowling T, Frey N. Macrocyclic and Linear Gadolinium Based Contrast Agents for Adults Undergoing Magnetic Resonance Imaging: A Review of Safety [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 Jun 6.

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Macrocyclic and Linear Gadolinium Based Contrast Agents for Adults Undergoing Magnetic Resonance Imaging: A Review of Safety [Internet].

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Table 8Summary of Findings of Included Primary Clinical Studies

Main Study FindingsAuthors’ Conclusion
Gutierrez, 2015a6
  • 40 patients that received gadobutrol-enhanced MRI (n = 399) experienced at least one treatment-related adverse event
    • Two patients experienced two serious adverse events that were unrelated to gadobutrol
    • Three patients discontinued the trial due to adverse events (allergic reactions)
  • 38 patients that received gadoteridol-enhanced MRI (n = 393) reported at least one treatment-related adverse event
    • One patient experienced two serious adverse events that were unrelated to gadoteridol
    • One patient discontinued the trial due to adverse events (allergic reactions)
  • No relevant changes to clinical laboratory parameters were observed
  • Gadobutrol was found to have a similar safety profile to other MRI contrast agents
  • The findings were consistent with previous studies, with respect to safety
Gutierrez, 2015b5
  • 67 patients in the study (n = 343) reported at least one adverse event, 14 of which were gadobutrol-related but not serious
  • One patient reported a serious adverse event that was determined to be unrelated to gadobutrol
  • No deaths or discontinuations were reported
  • No significant changes in vital signs, clinical laboratory values or hematological parameters were reported
  • Gadobutrol has a very good safety profile
  • The findings are consistent with previous studies, with respect to safety
Kuwatsuru, 20154
  • 13 patients that received gadobutrol-enhanced MRI (n = 178) experienced 12 mild treatment-emergent adverse events
    • Seven patients experienced seven drug-related treatment-emergent adverse events
    • One patient experienced one severe treatmentemergent adverse event, which resolved after 15 minutes
  • 16 patients that received gadopentetate dimeglumineenhanced MRI (n = 185) experienced 13 mild treatmentemergent adverse events
    • Three patients experienced seven drug-related treatment-emergent adverse events
  • When compared to the baseline values, there were no significant changes in clinical laboratory values, vital signs or physical examinations up to 24 hours after injection
  • No serious adverse events, deaths or discontinuations were reported for gadobutrol or gadopentetate dimeglumine
  • Gadobutrol and gadopentetate are similar in safety and tolerability
  • The observed incidence of treatment-emergent adverse events is similar to previously-reported findings
Liang, 201218
  • Six out of 146 patients included in the safety analysis reported mild adverse events; one adverse event was determined to be related to the treatment
  • Four adverse events were experienced by two patients in the gadobutrol group; four adverse events were experienced by four patients in the gadopentetate dimeglumine group
  • Gadobutrol and gadopentetate dimeglumine are similar with regards to safety
Naito, 20177
  • Patients who received gadodiamide or gadopentetate dimeglumine did not experience contrast-induced nephropathy (CIN)
  • Gadodiamide significantly increased serum cystatin-C levels from 0.74 to 0.79 (p = 0.028)
  • In patients with stage 1 CKD who received gadodiamide, serum cystatin-C levels significantly increased from 0.69 to 0.72 (p = 0.047)
  • In patients with stage 2 CKD who received gadodiamide, serum-creatinine levels significantly increased from 0.74 to 0.77 (p = 0.049); CCr levels significantly decreased from 80.5 to 78.5 (p = 0.039); and eGFR levels significantly decreased from 79.3 to 77.1 (p = 0.039)
  • Small amounts of gadolinium are safe for patients with normal or mildly-diminished renal failure
  • Administration of gadopentetate dimeglumine has no effect on renal function
  • Gadodiamide has slight nephrotoxicity in patients with stage 1 or 2 CKD, however, this finding is not clinically important
Semelka, 201320
  • No patients experienced mild (specifically emesis or hives), moderate or severe adverse events
  • All images were rated as having “good” overall enhancement adequacy (from “poor”, “fair”, or “good”)
  • Adverse events were not noted amongst the 59 patients who received gadobutrol and gadobenate dimeglumine
  • It is feasible to objectively evaluate adverse events and image quality
Tanaka, 201621
  • 19 patients (out of n = 223) reported at least one treatmentemergent adverse event, of which 6 were gadobutrolrelated
  • The most common gadobutrol-related treatment-emergent adverse event was hot flush, experienced by 2 patients
  • No severe adverse events or deaths were reported
  • Gadobutrol demonstrated good tolerability, with only 2.7% of the study population experiencing a mild adverse event
Zech, 201919
  • 9 patients in each group experienced at least 1 adverse event (n = 146 received gadoxetate disodium, n = 149 received gadobenate dimeglumine)
  • 9 of 12 adverse events in the gadoxetate disodium group were probably related to the contrast administration
  • 7 of 14 adverse events in the gadobenate dimeglumine group were possibly or probably related to the contrast administration
  • The safety profiles of gadoxetate disodium and gadobenate dimeglumine are similar regarding adverse events
  • The findings are most meaningful for daily practice in examining focal liver lesions

CCr = creatinine clearance; CKD = chronic kidney disease; CIN = contrast-induced nephropathy; eGFR = estimated glomerular filtration rate; MRI = magnetic resonance imaging

From: Macrocyclic and Linear Gadolinium Based Contrast Agents for Adults Undergoing Magnetic Resonance Imaging: A Review of Safety

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