Safety profile of D-penicillamine: a comprehensive pharmacovigilance analysis by FDA adverse event reporting system

Background D-penicillamine (D-pen) is a copper-chelating drug and has immune-modulatory properties. D-pen is used to treat rheumatoid arthritis, Wilson’s disease, and kidney stones (cystinuria). However, associated adverse events (AEs) of D-pen treatment are frequent and often serious. Therefore, a comprehensive assessment of the safety profile of D-pen is urgently needed.Research design and methods We identified and analyzed AEs associated with D-pen between April-1970 to July-2020 from the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) databases and calculated the reported odds ratio (ROR) with 95% confidence intervals (CI) using the disproportionality analysis.Results A total of 9,150,234 AEs related to drugs were reported in the FAERS database, of which 542 were related to D-Pen. We report that D-pen was associated with dystonia (ROR: 20.52; 95%CI: 12.46–33.80), drug hypersensitivity (ROR: 5.42; 95%CI: 3.72–7.90), pancytopenia (ROR: 10.20; 95%CI: 5.61–18.56), joint swelling (ROR: 9.07; 95%CI: 5.51–14.94), renal-impairment (ROR: 6.68; 95%CI: 3.67–12.15), dysphagia (ROR: 5.05; 95%CI: 2.76–8.89), aggravation of condition (ROR: 4.16; 95%CI: 2.60–6.67), congestive cardiac failure (ROR: 4.04; 95%CI: 2.22–7.35), peripheral edema (ROR: 3.77; 95%CI: 2.17–6.55), tremor (ROR: 3.46; 95%CI: 2.00–6.01), pyrexia (ROR: 3.46; 95%CI: 2.00–6.01), and gait disturbance (ROR: 2.41; 95%CI: 1.29–4.52).Conclusions Patients taking D-pen require close monitoring of renal function, blood counts, immunity, liver, cardiac function, and neurological function. D-pen suppresses immune system which maximizes the risk of infection.