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Carpal Tunnel Syndrome Attributed to Medication Use: A Pharmacovigilance Study
Emily Volfson, MSc, MD(C)
1, Andrew Mihalache, MD(C)
1, Ryan Huang, MSc, MD(C)
1, Kevin Zuo, MD, MASc
2; Jonathan Persitz, M.D.
1(1)University of Toronto, Toronto, ON, Canada, (2)Toronto Western Hospital, University Health Network, Toronto, ON, Canada
Introduction:Carpal tunnel syndrome (CTS) is a common compression neuropathy with well-established mechanical and systemic risk factors. However, the role of pharmacological agents in CTS development remains underexplored. This study aims to identify drugs disproportionately associated with CTS reports using data from the Food and Drug Administration Adverse Event Reporting System (FAERS).
Materials and Methods:A retrospective pharmacovigilance analysis was conducted using OpenVigil 2.1 to evaluate adverse event (AE) reports of CTS from FAERS (October 2003-September 2024). Only drugs listed as the primary suspect in ?10 AE reports were included. Disproportionality analysis, including reporting odds ratios (RORs), assessed associations between CTS and specific drugs. Positive signals were validated using Bayesian confidence propagation neural network algorithms, with drugs having ROR ?10 and significant Bayesian confidence intervals (IC025 > 0) considered strongly associated with CTS.
Results:Among 12,929,504 AE reports, 6,837 (0.05%) involved CTS. Female patients comprised 69.5% of CTS cases, with a mean age of 57.0 ± 14.9 years. Ten drugs demonstrated significant overreporting of CTS, including idursulfase (ROR=51.2, 95%CI=39.0-67.2), galsulfase (ROR=26.8, 95%CI=17.2-41.7), laronidase (ROR=20.9, 95%CI=14.4-30.3), tesamorelin (ROR=20.7, 95%CI=13.7-31.3), anastrozole (ROR=20.6, 95%CI=17.0-24.9), alendronic acid (ROR=17.1, 95%CI=14.5-20.1), gamma-hydroxybutyric acid (ROR=16.3, 95%CI=9.6-27.6), rofecoxib (ROR=16.1, 95%CI=14.3-18.2), alendronate (ROR=12.9, 95%CI=11.0-15.2), and tafamidis (ROR=12.0, 95%CI=9.2-15.7).
Conclusion:Several drugs, including enzyme replacement therapies, aromatase inhibitors, bisphosphonates, and others, demonstrated a disproportionately high association with CTS reports. These associations may be influenced by underlying conditions for which the drugs are prescribed. Nevertheless, the findings highlight the need for increased clinical vigilance and monitoring for CTS symptoms in at-risk populations. Future prospective studies are needed to validate these findings and elucidate potential mechanisms.
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