Drug-induced sinusoidal obstruction syndrome: a real-world pharmacovigilance study based on the FDA Adverse Event Reporting System (FEARS)

Abstract Background Hepatic Sinusoidal Obstruction Syndrome (SOS) represents a rare but serious adverse drug reaction. This study aimed to identify the medications most frequently associated with SOS risk through the analysis of the United States Food and Drug Administration (FDA) Adverse Event Repo...

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Main Authors: Cuicui Sun, Xiaoyan Yang, Lili Wang, Linlin Tang, Jinhua Chen
Format: Article
Language:English
Published: BMC 2025-07-01
Series:BMC Pharmacology and Toxicology
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Online Access:https://doi.org/10.1186/s40360-025-00965-5
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author Cuicui Sun
Xiaoyan Yang
Lili Wang
Linlin Tang
Jinhua Chen
author_facet Cuicui Sun
Xiaoyan Yang
Lili Wang
Linlin Tang
Jinhua Chen
author_sort Cuicui Sun
collection DOAJ
description Abstract Background Hepatic Sinusoidal Obstruction Syndrome (SOS) represents a rare but serious adverse drug reaction. This study aimed to identify the medications most frequently associated with SOS risk through the analysis of the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database. Methods We queried the FAERS database using OpenVigil 2.1 to search for all reported cases of SOS from 2004Q1 to 2022Q3. The 50 most frequently reported medications were ranked based on reported odds ratio (ROR) and proportional reporting ratio (PRR) values. We also compared these drugs with those reported in the LiverTox® database to assess consistency in hepatotoxicity reporting. Results A total of 1,976 SOS reports were indentified within the selected study period. Oxaliplatin was the most frequently reported medication associated with SOS, whereas the drug exhibited the strongest association with SOS death was busulfan. Disproportionality analysis revealed that the top five medications with the greatest association with SOS were tioguanine, inotuzumab ozogamicin, gemtuzumab ozogamicin, busulfan, and dactinomycin. Approximately half of the top 50 drugs (28 based on ROR and 27 based on PRR) were not outlined in LiverTox®. Conclusions Our study offers a potential list of drugs commonly associated with SOS and identified several novel drugs associated with SOS that had not been previously described in LiverTox®. Clinical trial number Not applicable.
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spelling doaj-art-ad8e343d88c3409ab898b20ebceb23e12025-08-20T03:46:20ZengBMCBMC Pharmacology and Toxicology2050-65112025-07-0126111110.1186/s40360-025-00965-5Drug-induced sinusoidal obstruction syndrome: a real-world pharmacovigilance study based on the FDA Adverse Event Reporting System (FEARS)Cuicui Sun0Xiaoyan Yang1Lili Wang2Linlin Tang3Jinhua Chen4Department of Pharmacy, Qilu Hospital of Shandong UniversityDepartment of Pharmacy, Jinan Maternity and Child Care HospitalShandong Academy of Pharmaceutical SciencesAffiliated Hospital of Shandong Second Medical UniversityDepartment of Pharmacy, Henan Engineering Research Center for Tumor Precision Medicine and Comprehensive Evaluation, Henan Provincial Key Laboratory of Anticancer Drug Research, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer HospitalAbstract Background Hepatic Sinusoidal Obstruction Syndrome (SOS) represents a rare but serious adverse drug reaction. This study aimed to identify the medications most frequently associated with SOS risk through the analysis of the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database. Methods We queried the FAERS database using OpenVigil 2.1 to search for all reported cases of SOS from 2004Q1 to 2022Q3. The 50 most frequently reported medications were ranked based on reported odds ratio (ROR) and proportional reporting ratio (PRR) values. We also compared these drugs with those reported in the LiverTox® database to assess consistency in hepatotoxicity reporting. Results A total of 1,976 SOS reports were indentified within the selected study period. Oxaliplatin was the most frequently reported medication associated with SOS, whereas the drug exhibited the strongest association with SOS death was busulfan. Disproportionality analysis revealed that the top five medications with the greatest association with SOS were tioguanine, inotuzumab ozogamicin, gemtuzumab ozogamicin, busulfan, and dactinomycin. Approximately half of the top 50 drugs (28 based on ROR and 27 based on PRR) were not outlined in LiverTox®. Conclusions Our study offers a potential list of drugs commonly associated with SOS and identified several novel drugs associated with SOS that had not been previously described in LiverTox®. Clinical trial number Not applicable.https://doi.org/10.1186/s40360-025-00965-5LiverTox®PharmacovigilanceProportional reporting ratio (PRR)Reported odds ratio (ROR)Sinusoidal Obstruction Syndrome (SOS)United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database
spellingShingle Cuicui Sun
Xiaoyan Yang
Lili Wang
Linlin Tang
Jinhua Chen
Drug-induced sinusoidal obstruction syndrome: a real-world pharmacovigilance study based on the FDA Adverse Event Reporting System (FEARS)
BMC Pharmacology and Toxicology
LiverTox®
Pharmacovigilance
Proportional reporting ratio (PRR)
Reported odds ratio (ROR)
Sinusoidal Obstruction Syndrome (SOS)
United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database
title Drug-induced sinusoidal obstruction syndrome: a real-world pharmacovigilance study based on the FDA Adverse Event Reporting System (FEARS)
title_full Drug-induced sinusoidal obstruction syndrome: a real-world pharmacovigilance study based on the FDA Adverse Event Reporting System (FEARS)
title_fullStr Drug-induced sinusoidal obstruction syndrome: a real-world pharmacovigilance study based on the FDA Adverse Event Reporting System (FEARS)
title_full_unstemmed Drug-induced sinusoidal obstruction syndrome: a real-world pharmacovigilance study based on the FDA Adverse Event Reporting System (FEARS)
title_short Drug-induced sinusoidal obstruction syndrome: a real-world pharmacovigilance study based on the FDA Adverse Event Reporting System (FEARS)
title_sort drug induced sinusoidal obstruction syndrome a real world pharmacovigilance study based on the fda adverse event reporting system fears
topic LiverTox®
Pharmacovigilance
Proportional reporting ratio (PRR)
Reported odds ratio (ROR)
Sinusoidal Obstruction Syndrome (SOS)
United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database
url https://doi.org/10.1186/s40360-025-00965-5
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