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Acute Adverse Reactions to Nonionic Iodinated Contrast Media

A Meta-Analysis

Suh, Young Joo MD, PhD*; Yoon, Soon Ho MD; Hong, Hyunsook PhD; Hahn, Seokyung PhD§; Kang, Dong-Yoon MD; Kang, Hye-Ryun MD, PhD∥,¶,#; Choi, Young-Hun MD, PhD; Lee, Whal MD, PhD

doi: 10.1097/RLI.0000000000000568
Original Articles
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Objectives We aimed to meta-analytically compare the incidence of acute adverse reactions (AARs) to nonionic iodinated contrast media (ICM) according to the type of ICM in patients who underwent radiologic examinations with administration of ICM via intravascular route.

Materials and Methods A systematic literature search identified studies evaluating the incidence of AARs to 7 nonionic ICM (iobitridol, iohexol, iomeprol, iopamidol, iopromide, ioversol, and iodixanol) with extractable outcomes. These outcomes were pooled using a random-effects model, and the effect of ICM type on the incidence of overall and severe AARs was evaluated using meta-regression analysis.

Results Thirty studies with 1,360,488 exposures to ICM were included. The pooled incidences of overall and severe AARs to nonionic ICM were 1.03% (95% confidence interval [CI], 0.81%–1.30%; I2 = 0.99) and 0.0141% (95% CI, 0.0108%–0.0183%; I2 = 0.56), respectively. Iomeprol had the highest overall AAR incidence (1.74%; 95% CI, 0.79%–3.76%; I2 = 0.99), followed by iohexol (1.21%; 95% CI, 0.67%–2.17%; I2 = 0.99), iopamidol (1.10%; 95% CI, 0.60%–2.03%; I2 = 0.99), ioversol (0.88%; 95% CI, 0.43%–1.83%; I2 = 0.96), iodixanol (0.85%; 95% CI, 0.36%–1.95%; I2 = 0.99), iopromide (0.82%; 95% CI, 0.43%–1.55%; I2 = 0.99), and iobitridol (0.77%; 95% CI, 0.36%–1.62%; I2 = 0.99). Multivariable meta-regression analysis revealed that study design (P = 0.0014) and premedication (P = 0.0230) were statistically significant determinants affecting the incidence of overall AARs. Iodinated contrast media type did not affect the incidence of overall and severe AARs (P = 0.1453 and 0.4265, each).

Conclusions The varying pooled incidences of overall and severe AARs to specific types of nonionic ICM do not remain as significant after adjusting confounders. Our results may support nonrestriction of certain types of nonionic ICM in the context of AAR avoidance.

From the *Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine

Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine

Medical Research Collaborating Center, Seoul National University Hospital

§Department of Medicine, Seoul National University College of Medicine

Drug Safety Monitoring Center

Department of Internal Medicine, Seoul National University Hospital

#Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea.

Received for publication January 3, 2019; and accepted for publication, after revision, February 28, 2019.

Conflicts of interest and sources of funding: This study was supported by a grant from the SNUH Research Fund (grant no. 23-2017-0060).

The authors report no conflicts of interest.

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.investigativeradiology.com).

Correspondence to: Soon Ho Yoon, MD, Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. E-mail: yshoka@gmail.com.

Online date: July 1, 2019

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