title: Hypophosphatemia is Associated with the Serial Administration of Triple-Dose Gadolinium to Patients for Brain MRI.
abstract: OBJECTIVE
  The purpose of this study is to report a metabolic abnormality associated with frequent, triple-dose Gadolinium (TdGd) use in MS patients during BECOME trial.
  
  
  METHODS
  Potential clinical adverse events and lab abnormalities were monitored at each monthly MRI visit. Hypophosphatemia was defined as phosphate <2.5 mg/dL. Statistical analysis included McNemar's test for pairwise comparisons across visits and generalized estimating equations (GEE) to fit models over time.
  
  
  RESULTS
  Eight hundred seventy seven phosphate values were analyzed from the first 12 months. Compared with 4% of subjects at screening, an average of 15.1% (95% confidence interval (CI): 11.4%-19.7%) of patients had hypophosphatemia at visits from months 1 to 12, during which subjects received serial TdGd. Forty four of seventy five (59%) patients developed hypophosphatemia at least once. We also found a significant increasing trend in hypophosphatemia by visit when treatment groups were evaluated together or separately (p < .001). There was a statistically significant decrease in frequency to 9.8% (95% CI: 4.6-19.8%) by month 24 (p = .005) coinciding with a period of less frequent gadolinium administration.
  
  
  CONCLUSIONS
  Serial TdGd in MS patients, unrelated to immunomodulatory treatment, was associated with increased frequency of hypophosphatemia that progressed with cumulative triple-dose and markedly decreased in second year, with less frequent triple-dose administration.
authors: Department of Radiology, Case Western Reserve University School of Medicine 2109 Adelbert Rd, Cleveland, OH 44106.
authors: Leo J
authors: LJ
authors: Wolansky
authors: Diego
authors: D
authors: Cadavid
authors: Vineet
authors: V
authors: Punia
authors: Soyeon
authors: S
authors: Kim
authors: Jojy
authors: J
authors: Cheriyan
authors: Mershad
authors: M
authors: Haghighi
authors: Stuart D
authors: SD
authors: Cook
mesh_terms: D000293:Adolescent; D000328:Adult; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D017674:Hypophosphatemia / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology*; D010710:Phosphates / Q000097:blood; D055815:Young Adult
chemical_list: D003287:Contrast Media; D010710:Phosphates; D019786:Gadolinium DTPA
keywords: Multiple sclerosis; adverse effects; gadolinium; hypophosphatemia; phosphate