{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T17:21:42Z","timestamp":1790270502909,"version":"4.1.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The real-world cardiac safety profile of systemic antifungal agents has not been thoroughly investigated. Based on the US Food and Drug Administration Adverse Event Reporting System FDA Adverse Event Reporting System database, this study analyzed the arrhythmogenic toxicity of nine systemic antifungal drugs, aiming to provide references for clinical safe medication practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research design and methods<\/jats:title>\n                    <jats:p>Adverse events were described and classified using arrhythmogenic toxicity-related Standardized MedDRA Queries (SMQs) from the MedDRA. To identify the association between systemic antifungal agents and arrhythmogenic toxicity, this study used four algorithms: Reporting odds ratio (ROR), Proportional reporting ratio (PRR), Multi-item gamma-poisson shrinker (MGPS), and Bayesian confidence propagation Neural Network (BCPNN).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 42,393 reports were included. The ranking of the number of positive signals across four types of SMQs was as follows: Itraconazole (4), Fluconazole (3), Posaconazole (3), Voriconazole (2), Caspofungin (1), Amphotericin B (1), Flucytosine (0), Isavuconazole (0), Micafungin (0). Itraconazole demonstrated the strongest ROR value of 2.95 in \u201cCardiac arrhythmia terms, nonspecific\u201d. The highest ROR values in \u201cBradyarrhythmias\u201d were 5.53 for both posaconazole and fluconazole. Fluconazole exhibited higher ROR values than other drugs in both \u201cTachyarrhythmias\u201d and \u201cTorsade de pointes\/QT prolongation\u201d, with values of 3.53 and 14.55, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study employed four disproportionality analysis methods to analyze the association between systemic antifungal agents and arrhythmogenic toxicity signals. Itraconazole, fluconazole, and posaconazole demonstrated stronger arrhythmogenic risks, whereas micafungin, flucytosine, and isavuconazole showed negative signals across all four SMQs. In clinical practice, individual patient risk should be comprehensively assessed to guide personalized drug selection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1804602","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T08:20:11Z","timestamp":1779783611000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparative risk of arrhythmias associated with systemic antifungal agents: a disproportionality analysis of the FAERS database"],"prefix":"10.3389","volume":"17","author":[{"given":"Xiaohu","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Pharmacy, The First Affiliated Hospital of Bengbu Medical University","place":["Bengbu, China"]},{"name":"School of Pharmacy, Bengbu Medical University","place":["Bengbu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The First Affiliated Hospital of Bengbu Medical University","place":["Bengbu, China"]},{"name":"School of Pharmacy, Bengbu Medical University","place":["Bengbu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The First Affiliated Hospital of Bengbu Medical University","place":["Bengbu, China"]},{"name":"School of Pharmacy, Bengbu Medical University","place":["Bengbu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingti","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The First Affiliated Hospital of Bengbu Medical University","place":["Bengbu, China"]},{"name":"School of Pharmacy, Bengbu Medical University","place":["Bengbu, China"]},{"name":"Institute of Emergency and Critical Care Medicine, The First Affifiliated Hospital of Bengbu Medical University","place":["Bengbu, China"]},{"name":"State Key Laboratory of Neurology and Oncology Drug Development","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1186\/s12882-022-02770-2","article-title":"Tolerability and epidemiology of nephrotoxicity associated with conventional amphotericin B therapy: a retrospective study in tertiary care centers in Palestine","volume":"23","author":"Abdel-Hafez","year":"2022","journal-title":"BMC Nephrol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"ofad436","DOI":"10.1093\/ofid\/ofad436","article-title":"Schr\u00f6dinger's cat paradox: bartonella serology cannot be used to speciate bartonella endocarditis","volume":"10","author":"Boodman","year":"2023","journal-title":"Open Forum Infect. 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