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Lasys T, Santa-Ana-Tellez Y, Siiskonen SJ, Groenwold RHH, Gardarsdottir H. Unintended impact of pharmacovigilance regulatory interventions: A systematic review. Br J Clin Pharmacol 2023; 89:3491-3502. [PMID: 37553757 DOI: 10.1111/bcp.15874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/17/2023] [Accepted: 07/26/2023] [Indexed: 08/10/2023] Open
Abstract
AIMS Studies assessing the impact of pharmacovigilance regulatory interventions often focus on the expected (or intended) outcomes, while any possible unintended impact may be overlooked. The update of the Good Pharmacovigilance Practice guideline in 2017 elaborated on impact assessment, emphasizing the need also to assess possible unintended impact. This systematic literature review investigated how often the unintended impact of regulatory interventions was considered in publications of studies investigating pharmacovigilance regulatory interventions in Europe. METHODS We conducted a systematic review of the literature on MEDLINE and EMBASE from 1 January 2012 to 28 February 2022 to identify publications that investigated the impact of regulatory interventions in Europe. The primary outcome of the study was the number of publications reporting assessments of unintended impact. In addition, we studied the characteristics of these publications, including the type of outcomes assessed, the analytical methods applied and the type of data used. RESULTS In total, 96 publications were included in the analysis. The unintended impact of pharmacovigilance regulatory interventions was investigated in 23 of 96 publications (24%). The drug classes most frequently studied in the publications assessing unintended impact of regulatory interventions were oral glucose-lowering drugs (n = 6, 26%), opioids (n = 4, 17%), antidepressants (n = 4, 17%) and antipsychotics (n = 3, 13%). The reported methods to assess the unintended impact were interrupted time series (n = 10, 43%) and descriptive statistics with or without significance testing (n = 2 [9%] and n = 9 [39%], respectively). The outcomes selected for unintended impact assessments included the use of other drugs (n = 16, 70%), health outcomes (n = 8, 35%) and behavioural changes (n = 4, 17%). Most of the publications reported on the use of electronic health record databases (n = 13, 57%) or claims databases (n = 13, 57%), while registries were used in 4 publications (17%). CONCLUSION The unintended impact of pharmacovigilance regulatory interventions was reported in only a quarter of identified publications. There was no apparent increase in attention to unintended impact assessments after the update of the Good Pharmacovigilance Practice guidelines.
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Affiliation(s)
- Tomas Lasys
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Yared Santa-Ana-Tellez
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Satu J Siiskonen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
- Department of Pharmaceutical Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands
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Morrow RL, Mintzes B, Souverein PC, Hallgreen CE, Ahmed B, Roughead EE, De Bruin ML, Kristiansen SB, Lexchin J, Kemp-Casey A, Sketris I, Mangin D, Pearson SA, Puil L, Lopert R, Bero L, Gnjidic D, Sarpatwari A, Dormuth CR. Hydroxyzine Initiation Following Drug Safety Advisories on Cardiac Arrhythmias in the UK and Canada: A Longitudinal Cohort Study. Drug Saf 2022; 45:623-638. [PMID: 35438459 PMCID: PMC9189086 DOI: 10.1007/s40264-022-01175-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 12/20/2022]
Abstract
Introduction Regulatory advisories on hydroxyzine and risk of QT prolongation and Torsade de pointes (TdP) were issued in the UK in April 2015 and Canada in June 2016. We hypothesized patients with risk factors for QT prolongation and TdP, compared with those without risk factors, would be less likely to initiate hydroxyzine in the UK and in British Columbia (BC), Canada, following advisories. Methods We conducted a longitudinal study with repeated measures, and evaluated hydroxyzine initiation in a UK cohort and a concurrent BC control cohort (April 2013–March 2016) as well as in a BC advisory cohort (June 2014–May 2017). Results This study included 247,665 patients in the UK cohort, 297,147 patients in the BC control cohort, and 303,653 patients in the BC advisory cohort. Over a 12-month post-advisory period, hydroxyzine initiation decreased by 21% in the UK (rate ratio 0.79, 95% confidence interval 0.66–0.96) relative to the expected level of initiation based on the pre-advisory trend. Hydroxyzine initiation did not change in the BC control cohort or following the Canadian advisory in the BC advisory cohort. The decrease in hydroxyzine initiation in the UK in the 12 months after the advisories was not significantly different for patients with risk factors compared with those without risk factors. Conclusion Hydroxyzine initiation decreased in the UK, but not in BC, in the 12 months following safety advisories. The decrease in hydroxyzine initiation in the UK was not significantly different for patients with versus without risk factors for QT prolongation and TdP. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-022-01175-2.
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Affiliation(s)
- Richard L Morrow
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, 210-1110 Government St., Victoria, BC, V8W 1Y2, Canada.
| | - Barbara Mintzes
- Faculty of Medicine and Health and Charles Perkins Centre, School of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Christine E Hallgreen
- Department of Pharmacy, Faculty of Health and Medical Sciences, Copenhagen Centre for Regulatory Science, University of Copenhagen, Copenhagen, Denmark
| | - Bilal Ahmed
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, 210-1110 Government St., Victoria, BC, V8W 1Y2, Canada
| | - Elizabeth E Roughead
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Marie L De Bruin
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- Department of Pharmacy, Faculty of Health and Medical Sciences, Copenhagen Centre for Regulatory Science, University of Copenhagen, Copenhagen, Denmark
| | - Sarah Brøgger Kristiansen
- Department of Drug Design and Pharmacology, Pharmacovigilance Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Joel Lexchin
- Faculty of Health, York University, Toronto, ON, Canada
| | - Anna Kemp-Casey
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Ingrid Sketris
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Sallie-Anne Pearson
- Faculty of Medicine, Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Lorri Puil
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Ruth Lopert
- Department of Health Policy and Management, George Washington University, Washington, DC, USA
| | - Lisa Bero
- School of Medicine and Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Danijela Gnjidic
- Faculty of Medicine and Health and Charles Perkins Centre, School of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | - Ameet Sarpatwari
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Colin R Dormuth
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, 210-1110 Government St., Victoria, BC, V8W 1Y2, Canada
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Yanai K, Yoshikawa T, Church MK. Efficacy and Safety of Non-brain Penetrating H 1-Antihistamines for the Treatment of Allergic Diseases. Curr Top Behav Neurosci 2021; 59:193-214. [PMID: 34622396 DOI: 10.1007/7854_2021_265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
H1 receptor antagonists, known as H1-antihistamines (AHs), inactivate the histamine H1-receptor thereby preventing histamine causing the primary symptoms of allergic diseases, such as atopic dermatitis, pollinosis, food allergies, and urticaria. AHs, which are classified into first-generation (fgAHs) and second-generation (sgAHs) antihistamines, are the first line of treatment for allergic diseases. Although fgAHs are effective, they cause adverse reactions such as potent sedating effects, including drowsiness, lassitude, and cognitive impairment; anticholinergic effects, including thirst and tachycardia. Consequently, the use of fgAHs is not recommended for allergic diseases. Today, sgAHs, which are minimally sedating and, therefore, may be used at more effective doses, are the first-line treatment for alleviating the symptoms of allergic diseases. Pharmacologically, the use of sedating fgAHs is limited to antiemetics, anti-motion sickness drugs, and antivertigo drugs. The use of histamine H1-receptor occupancy (H1RO) based on positron emission tomography (PET) has been developed for the evaluation of brain penetrability. Based on the results of the H1RO-PET studies, non-brain-penetrating AHs (nbpAHs) have recently been reclassified among sgAHs. The nbpAHs are rapidly acting and exhibit minimal adverse reactions and, thus, are considered first-line drugs for allergic diseases. In this review, we will introduce recent topics on the pharmacodynamics and pharmacokinetics of AHs and make recommendations for the use of nbpAHs as first-line treatment options for allergic diseases.
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Affiliation(s)
- Kazuhiko Yanai
- Department of Pharmacology, Tohoku University School of Medicine, Sendai, Japan. .,Cyclotron and Radioisotope Center (CYRIC), Tohoku University, Sendai, Japan.
| | - Takeo Yoshikawa
- Department of Pharmacology, Tohoku University School of Medicine, Sendai, Japan
| | - Martin K Church
- Department of Dermatology and Allergy, Charitè-Universitätsmedizin, Berlin, Germany
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