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Br J Clin Pharmacol. 2020 Jan 7. doi: 10.1111/bcp.14211. [Epub ahead of print]

Cardiac failure in patients treated with azacitidine, a pyrimidine analogue: Case reports and disproportionality analyses in Vigibase.

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CHU de Bordeaux, Pôle de Santé Publique, Service de pharmacologie médicale, Centre Régional de pharmacovigilance de Bordeaux, Bordeaux, France.
CHU de Bordeaux, Service d'Hématologie Clinique et Thérapie Cellulaire Bordeaux, France.
CHU d'Amiens, Pôle Cœur-Thorax-Vaisseaux, Département de Cardiologie, Amiens Cedex, France.
Pharmacie à Usage Intérieur, CHU de Bordeaux, Pessac, France.
Service des soins intensifs cardiologiques Haut-Lévêque (intensive care unit), Pessac, France.
Service d'Hematologie Seniors, Hôpital Saint Louis, Ass Pub Hôp Paris and Paris 7 Université Paris, France.
Service d'Hematologie, Centre Hospitalier du Mans, Le Mans, France.
Service d'Hematologie, Institut Paoli Calmettes, Marseille, France.
Univ. Bordeaux, Inserm, Bordeaux Population Health Research Centre, team Pharmacoepidemiology, Bordeaux, France.



Azacitidine (AZA), a pyrimidine analogue, is validated for high-risk myelodysplastic syndrome or low-blast acute myeloid leukaemia in unfit patients for more intensive treatment. This study assessed the putative link between cardiac failure (CF) and AZA exposure.


Cases of CF in patients treated with AZA were retrospectively collected and described from several centres of the Groupe Francophone des Myélodysplasies. A description analysis and a disproportionality analysis using Vigibase, the WHO Global Individual Case Safety Reports (ICSRs) database, were conducted on ICSRs by the Standardized MedDRA Queries (SMQ broad) cardiac failure and by preferred terms cardiac failure and cardiac failure acute. The reported odds ratio (ROR) and its 95% 2-sided confidence interval was computed by comparing the proportion of CF reports with the suspected drug (AZA) and the proportion of reports of the same adverse drug reaction with all other suspected drugs in the database during the same period.


In the 4 case reports, all patients presented a cardiovascular history. In 1 patient, CF recurred after AZA re-challenge. The pharmacovigilance analysis in Vigibase retrieved 307 ICSRs of CF (SMQ) with AZA. Significant disproportionality signals associated with AZA were identified by using the SMQ cardiac failure (ROR 1.3) and the preferred terms cardiac failure (ROR 5.1) and cardiac failure acute (ROR 23.2).


This study points to the potential role of AZA in the occurrence of CF. Cardiac evaluation before AZA initiation and regular monitoring of cardiac function during AZA treatment should be performed in patients with a history of cardiovascular disease.


anticancer drugs; drug safety; heart failure


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