[HTML][HTML] MSBIS: a multi-step biomedical informatics screening approach for identifying medications that mitigate the risks of metoclopramide-induced Tardive …

D Xu, AG Ham, RD Tivis, ML Caylor, A Tao, ST Flynn… - …, 2017 - thelancet.com
D Xu, AG Ham, RD Tivis, ML Caylor, A Tao, ST Flynn, PJ Economen, HK Dang, RW Johnson…
EBioMedicine, 2017thelancet.com
In 2009 the US Food and Drug Administration (FDA) placed a black box warning on
metoclopramide (MCP) due to the increased risks and prevalence of tardive dyskinesia (TD).
In this study, we developed a multi-step biomedical informatics screening (MSBIS) approach
leveraging publicly available bioactivity and drug safety data to identify concomitant drugs
that mitigate the risks of MCP-induced TD. MSBIS includes (1) TargetSearch (http://dxulab.
org/software) bioinformatics scoring for drug anticholinergic activity using CHEMBL …
Abstract
In 2009 the U.S. Food and Drug Administration (FDA) placed a black box warning on metoclopramide (MCP) due to the increased risks and prevalence of tardive dyskinesia (TD). In this study, we developed a multi-step biomedical informatics screening (MSBIS) approach leveraging publicly available bioactivity and drug safety data to identify concomitant drugs that mitigate the risks of MCP-induced TD. MSBIS includes (1) TargetSearch (http://dxulab.org/software) bioinformatics scoring for drug anticholinergic activity using CHEMBL bioactivity data; (2) unadjusted odds ratio (UOR) scoring for indications of TD-mitigating effects using the FDA Adverse Event Reporting System (FAERS); (3) adjusted odds ratio (AOR) re-scoring by removing the effect of cofounding factors (age, gender, reporting year); (4) logistic regression (LR) coefficient scoring for confirming the best TD-mitigating drug candidates. Drugs with increasing TD protective potential and statistical significance were obtained at each screening step. Fentanyl is identified as the most promising drug against MCP-induced TD (coefficient: −2.68; p-value<0.01). The discovery is supported by clinical reports that patients fully recovered from MCP-induced TD after fentanyl-induced general anesthesia. Loperamide is identified as a potent mitigating drug against a broader range of drug-induced movement disorders through pharmacokinetic modifications. Using drug-induced TD as an example, we demonstrated that MSBIS is an efficient in silico tool for unknown drug-drug interaction detection, drug repurposing, and combination therapy design.
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