FAERS based pharmacovigilance study and network pharmacology analysis of Lutathera and Pluvicto

Lutetium Lu 177-based agents Lutathera (targeting SSTR in GEP-NETs) and Pluvicto (targeting PSMA in mCRPC) exhibited significant efficacy in clinical trials, yet real-world safety validation remains imperative. We performed disproportionality analysis on FAERS reports and applied network pharmacology to identify drug targets, construct protein-protein interaction networks, and elucidate adverse event mechanisms through KEGG pathway enrichment. Shared adverse reactions for both agents include pleural effusion (ROR 1.68, 95%CI: 1.03-2.74) and pulmonary embolism (ROR 1.06, 95%CI: 0.61-1.82). Lutathera shows higher risks of gastrointestinal toxicities such as intestinal obstruction (ROR 5.33, 95%CI: 3.82-7.43) and infection-related events like liver abscess (ROR 26.16, 95%CI: 15.73-43.51). Pluvicto is associated with subdural hematoma (ROR 6.91, 95%CI: 3.82-12.5) and loss of libido (ROR 16.29, 95%CI: 10.88-24.38). KEGG pathway enrichment analysis further delineates mechanistic divergence, revealing significant target enrichment in peptide GPCRs (-log10(P) = 62.44) and neuropeptide signaling pathway (-log10(P) = 23.63) for Lutathera versus predominant involvement of proteasome (-log10(P) = 80.59) and peptide ligand-binding receptors (-log10(P) = 22.84) for Pluvicto. This FAERS analysis characterizes agent-specific safety profiles, informing pharmacovigilance strategies. Mechanistic profiling of adverse drug reactions optimizes evidence-based treatment, enhancing medication safety and refining benefit-risk profiles in clinical practice. • FAERS reveals shared and drug-specific safety profiles for Lu-177 agents. • Lutathera linked to GI toxicities and infection-related adverse events. • Pluvicto shows higher risk of subdural hematoma and loss of libido.