Safety AssessmentAll ADRs are shown in Table S1, and occurred in 198 of the 1,057 patients (18.73%). Thirst was the most frequent ADR(n=106, 10.03%), but there was no significant different prevalenceof it among the dosages of tolvaptan. The relationshipbetween dosage of tolvaptan and other ADR could not be evaluatedbecause of lower prevalence. Other frequent ADRs werehypernatremia (35 patients, 3.31%), renal impairment (15 patients,1.42%), increased BUN (9 patients, 0.85%), hyperkalemia(8 patents, 0.76%), dehydration (7 patients, 0.66%), hyperuricemia(6 patients, 0.57%), increased serum creatinine (5 patients,0.47%), increased serum sodium (5 patients, 0.47%), and rapidcorrection of hyponatremia (5 patients, 0.47%). The time to observationof the major ADRs is shown in Table 2. A large proportionof the major ADRs, including thirst and hypernatremia,occurred within 3 days of beginning administration of tolvaptan.Serum sodium, potassium, BUN and Cr concentration s were notsignificantly changed through the treatment period (Figure 3).Similarly, AST, ALT, T-Bil and eGFR did not significantlychange during tolvaptan treatment (Figure S1). In total, therewere 25 patients with serious ADRs. Of these, there were 8 casesof renal dysfunction, 6 of electrolyte imbalance including 2 ofhypernatremia, 8 cardiovascular-related disorders and although37 deaths were reported, there was only 1 case as an ADR. Inthe single case of death, the patient had disuse syndrome andsevere debility, but no further detailed information was available.Subgroup analysis was performed to evaluate the changesin serum sodium levels. In patients with serum sodium levels≥135 mEq/L at BL, mean serum sodium levels did not change,whereas in patients with serum sodium levels <135 mEq/L at BL,the serum sodium levels were significantly increased (Figure 4).
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