Abstract
INTRODUCTION: Pralatrexate, the first United States Food and Drug Administration (FDA)-approved selective antifolate agent for relapsed/refractory peripheral T cell lymphoma (PTCL), has an incompletely defined postmarketing safety profile. In this study, we systematically assessed the characteristic spectrum of pralatrexate-related adverse events (AEs) by integrating FDA Adverse Event Reporting System (FAERS) data to improve the safety evidence for this drug and provide scientific support for optimizing clinical risk management strategies. METHODS: A primary suspected drug-related AE analysis set was constructed following a standardized data cleaning process based on all AE reports from the FAERS database from the first quarter of 2004 through the first quarter of 2025. Signal detection analysis was performed using four algorithms, including the reporting odds ratio, proportional reporting ratio, Bayesian confidence propagation neural network, and multi-item gamma Poisson shrinker algorithms. Subgroup analyses were performed for sex, age, and report type categories to explore differences. RESULTS: A total of 2,241 AE reports were extracted from 563 patients using pralatrexate. Patients were predominantly male (58.44%) and aged ≥65 years (45.65%). AEs primarily affected the gastrointestinal, hematopoietic, and integumentary systems. “General disorders and administration site conditions” was the most frequently reported system organ class (N = 354, 15.80%). We detected 84 positive signals, including expected AEs such as mucositis, myelosuppression, skin reaction, and abnormal liver function, as well as several potential new risk signals including hypochloremia, increased platelet counts, prolonged activated partial thromboplastin time, and intestinal ischemia. Mucositis and hematologic toxicity were the primary factors leading to severe outcomes such as death, life-threatening conditions, and hospitalization. The median time to onset of pralatrexate AEs was 16 days (interquartile range, 6–59 days), and the Weibull distribution test was consistent with the early failure type. Subgroup analyses showed that the safety profile of pralatrexate was generally consistent between sexes, but risk of toxic epidermal necrolysis was significantly higher in female patients (reporting odds ratio = 5.14, 95% confidence interval: 1.06–24.79). In addition, AEs showed a significant age-related relationship, with mucosal injury and metabolic disorders predominating in patients aged ≥65 years, whereas malignant neoplasm progression and abnormal liver function were more common in those aged <65 years. CONCLUSION: This study elucidated the safety profile of pralatrexate in real-world settings, validating its established adverse reactions and identifying novel potential AEs. Our findings suggest that clinicians should implement personalized monitoring on the basis of patient sex and age, with a particular emphasis on mucosal toxicity and metabolism-related AEs in patients ≥65 years old. Furthermore, the adverse reaction spectrum of pralatrexate may be broader than previously recognized, necessitating further investigation to optimize medication safety management.