No Causal Link Between Doxycycline and Suicide, Says EMA Safety Committee

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The European Medicines Agency (EMA) announced on Nov. 29, 2024 that its Pharmacovigilance Risk Assessment Committee (PRAC) has found no causal link between doxycycline, a broad-spectrum antibiotic, and the risk of suicide or suicidal thoughts.

PRAC began a review of the safety of doxycycline in November 2023 after reports of a possible risk of suicidal thoughts or actions with the use of doxycycline from the Finnish national competent authority, as well as other cases reported to the European database of suspected side effects, EudraVigilance. The PRAC review included a cumulative data review from all relevant sources by the marketing authorization holders. There was also a study based on real-world evidence that included data from electronic health records and disease registries.

“After reviewing all available evidence from spontaneous reports, the literature, the discussion on possible mechanisms and the study performed via DARWIN EU [the Data Analysis and Real World Interrogation Network], the PRAC considered that the evidence is not sufficient to establish a causal relationship and that no update to the product information of doxycycline is warranted.

Suicide-related events in relation to doxycycline will be closely monitored and any new evidence will be discussed in the Periodic Safety Update Reports (PSURs),” EMA stated in a press release (1).

During the November meeting, PRAC also agreed to provide a direct healthcare professional communication (DHPC) on the liver injury risks associated with Veoza (fezolinetant). Veoza is used to treat moderate-to-severe vasomotor symptoms (i.e., hot flashes) that occur with menopause. PRAC is recommending that liver function be monitored in patients before and during treatment with fezolinetant. The recommendations are a result of a review of fezolinetant that included information from reports of suspected side effects and published scientific studies. The review showed a potential risk of drug-induced liver injury.

“Severe elevations of the liver enzymes alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) (>10x upper limit of normal) with concurrent elevations in bilirubin and/or alkaline phosphatase (ALP) have been reported post marketing in women taking Veoza. In some cases, elevated liver function tests (LFTs) were associated with signs or symptoms suggestive of liver injury such as fatigue, pruritus, jaundice, dark urine, decreased appetite, or abdominal pain.”

Therefore, PRAC is recommending LFTs be performed before treatment is started and monthly tests during the first three months of treatment, with testing conducted thereafter based on symptoms of livery injury. Product information and packaging is being updated with the new safety information.

“Once adopted, the DHPC for Veoza will be disseminated to healthcare professionals by the marketing authorisation holders, according to an agreed communication plan, and published on the Direct healthcare professional communications page and in national registers in EU Member States,” the agency stated in the release.

Reference

1. EMA. Meeting highlights from the Pharmacovigilance Risk Assessment Committee (PRAC) 25-28 November 2024. Press Release. Nov. 29, 2024.