Iodixanol vs iopromide in cancer patients: evidence from a randomized clinical trial

Abstract

Purpose: To assess the safety profile of iso-osmolar contrast medium (CM) vs low osmolar CM in cancer patients with an estimated glomerular filtration rate (eGFR) > 60 ml/min.

Materials and Methods: In this multicentre, blind trial of patients seeking a chest-abdomen-pelvis CT with iodated CM, participants were centrally randomized to iodixanol or iopromide. Contrast induced nephropathy (CIN) at 24 and/or 72 hours were our primary outcomes. We further considered irreversible CIN, average eGFR percentage variation (%Δ), and adverse events (AEs).

Results: Overall, 607 patients were enrolled. Among them, 497 eligible patients were randomized to iodixanol (N:247) or iopromide (N:250). No differences emerged by descriptive characteristics. Seven and 3 CIN at 24 hours (p = 0.34) and 8 and 2 CIN at 72 hours (p = 0.11) occurred in the iopromide and iodixanol group, respectively. Within the subgroup of individual patients who developed CIN (N:17), the event rate was higher in the iopromide arm (p = 0.045). No cases of permanent CIN or significant differences in terms of AEs or GFR %Δ were observed.

Conclusions: Our results suggest a more favourable safety profile of iodixanol vs iopromide. Adequately sized trials with similar design are warranted to confirm our findings and clarify the underlying biological mechanisms. This article is protected by copyright. All rights reserved

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