China Hospital Pharmacovigilance System-based study of trimetazidine-associated Parkinson's syndrome

To evaluate the active monitoring methods and population characteristics of trimetazidine (TMZ)-related Parkinson's syndrome. A retrospective research method was used, and the Chinese Hospital Pharmacovigilance System (CHPS) was used to analyze the clinical data of patients with TMZ-related Parkinson's syndrome admitted to Liaocheng People's Hospital from January 2019 to December 2020. Among the 4 883 cases included in the study, 167 CHPS alarm cases were detected, and 26 positive cases were confirmed after manual review, with a CHPS positive warning rate of 15.57%. The actual incidence of TMZ-related Parkinson's syndrome was 0.53%. The age of the 26 positive cases was (75.08±10.79) years old, and all positive cases had no history of primary Parkinson's disease (IPD) or family history; 21 cases (80.77%) were aged > 65 years old, 19 cases (73.08%) had a history of ischemic encephalopathy, 17 cases (65.38%) had positive symptoms in bilateral limbs, 20 cases (76.92%) showed abnormalities in cranial CT or MRI examinations, and 21 cases (80.77%) used a drug dose of 60-70 mg/d. Among the 26 positive cases, 18 were female patients (69.23%), and 18 had normal renal function (69.23%). Follow-up results showed that 14 (53.85%) did not stop taking TMZ, 8 (30.77%) had no relief or aggravation of symptoms, and 18 (69.23%) had relief or disappearance of symptoms. CHPS can be used to detect TMZ-related Parkinson's syndrome in time, which has obvious advantages over traditional monitoring mode. Age > 65 years old and previous history of ischemic encephalopathy are risk factors for TMZ-related Parkinson's syndrome. No history of IPD, family history, positive symptoms in bilateral limbs, and abnormalities in cranial CT and MRI examinations are helpful for the early diagnosis and differentiation of TMZ-related Parkinson's syndrome. TMZ-related Parkinson's syndrome is more common in women, and TMZ-related Parkinson's syndrome can also occur with normal renal function and normal dosage. TMZ-related Parkinson's syndrome is relatively rare, with low clinical awareness, difficult diagnosis, and serious consequences. Therefore, it is necessary to strengthen the research on TMZ-related Parkinson's syndrome.