The association of chiral characteristic with drug withdrawal due to safety: A comparative analysis

• Published in: British journal of clinical pharmacology 2023-01, Vol.89 (1), p.290-298
• Main Authors: Aydin, Volkan, Bahar, Ayfer, Vizdiklar, Caner, Akici, Ahmet
• Format: Article
• Language: English
• Subjects: drug regulation; Drug-Related Side Effects and Adverse Reactions; Humans; pharmacoepidemiology; pharmacovigilance; pure enantiomer; Stereoisomerism
• ISSN: 0306-5251; 1365-2125
• DOI: 10.1111/bcp.15486

Aims Chirality of drugs might be associated with safety issues through pharmacokinetic or pharmacodynamic variations, interactions, or direct toxicological responses. We aimed to compare chiral status of the available drugs to that of drugs withdrawn due to adverse drug reactions (ADRs). Methods We searched the literature regarding withdrawn drugs due to safety‐related issues (n = 391) to compare them with all available small‐molecule drugs (n = 1633). We examined their chiral status and assigned as achiral compound, chiral mixture or pure enantiomer. We compared the mean survival (i.e., nonwithdrawal) time and withdrawal rates of drugs by their chirality, with further stratification by the launch year, ATC‐1 (Anatomical Therapeutic Chemical) level and ADR. Results We identified higher withdrawal rate in achiral drugs (hazard ratio 2.1, 95% CI: 1.6–2.7) and chiral mixtures (hazard ratio 2.6, 95% CI: 1.9–3.5) compared to that in pure enantiomers. Pure enantiomers had the longest mean survival time (62.4 ± 0.8 years), followed by achiral drugs (55.4 ± 0.9 years, P