From the Guidelines
Yes, side effects can appear later on after starting a treatment, and it is crucial to monitor for late effects, especially in cancer survivors, as the risk of secondary cancers, cardiovascular disease, and other complications increases with longer follow-up time. This is evident in the study by 1, which highlights the importance of monitoring for late effects in survivors of Hodgkin lymphoma. The study notes that secondary cancers, such as solid tumors, can develop more than 10 years after treatment completion, and the risk is highest when radiation therapy is used as a component of first-line treatment.
Some of the key late effects that can appear later on include:
- Secondary cancers, such as lung and breast cancers
- Cardiovascular disease
- Hypothyroidism
- Fertility issues
- Hearing impairment
- Endocrine deficiencies
- Growth retardation
- Chronic kidney disease
- Impaired fertility
- Cardiotoxicity
- Neurocognitive impairment
According to the study by 1, monitoring for late effects is becoming increasingly important, especially as survival outcomes for patients with high-risk neuroblastoma who receive multimodality therapy continue to improve. The study recommends that a personalized survivorship care plan be developed for each patient, and that monitoring for late effects should be done at each follow-up visit, typically starting 2 or more years after completion of systemic therapy.
It is also important to note that some treatments, such as immune checkpoint inhibitors, can cause late-onset toxicities, and constant vigilance and early recognition and treatment of immune-related adverse events is crucial, as highlighted in the study by 1. Therefore, it is essential to prioritize monitoring for late effects and to develop personalized survivorship care plans to minimize the risk of long-term complications and improve quality of life.
From the FDA Drug Label
In most cases, these changes appeared soon after initiation, were transient, were not accompanied by symptoms, and resolved or improved on continued therapy or after a brief interruption in therapy. The FDA drug label does indicate that side effects can appear soon after initiation of the drug, but it does not provide information on whether side effects can appear later on. However, it does mention that persistent increases in serum transaminases have occurred in approximately 0.7% of patients receiving atorvastatin calcium in clinical trials 2.
- Postmarketing reports have also identified adverse reactions that have been reported during post-approval use of atorvastatin calcium, including rare reports of cognitive impairment, which can occur with variable times to symptom onset (1 day to years) 2. It is also worth noting that the label mentions elevations of CK (>10 x ULN) were higher in the high-dose atorvastatin calcium group (0.3%) compared to the low-dose atorvastatin calcium group (0.1%) 2. However, the label does not provide clear information on whether side effects can appear later on, so a conservative clinical decision would be to monitor patients closely for any adverse reactions.
From the Research
Side Effects Appearance
- Side effects can appear later on in certain medical conditions, as evident from a study on cancer survivors 3.
- The study found that many cancer survivors experience long-term and/or latent side effects due to cancer treatment, which can contribute to worse quality of life, morbidity, and mortality.
- In contrast, other studies have shown that certain medications, such as beta blockers, calcium channel blockers, and angiotensin receptor blockers, do not exhibit significant adverse reactions 4.
- However, some medications like diuretics and statins have been associated with an increased risk of new onset diabetes in patients with impaired glucose tolerance 5.
- The timing of side effects can vary depending on the medication and individual patient factors, as seen in studies on the prevalence of use of antiplatelet drugs, beta-blockers, statins, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in older patients with coronary artery disease 6.
- Adherence to medications like statins, beta-blockers, and angiotensin-converting enzyme inhibitors can also impact the appearance of side effects, with long-term adherence rates varying significantly over time 7.