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Ferreira-da-Silva R, Reis-Pardal J, Pinto M, Monteiro-Soares M, Sousa-Pinto B, Morato M, Polónia JJ, Ribeiro-Vaz I. A Comparison of Active Pharmacovigilance Strategies Used to Monitor Adverse Events to Antiviral Agents: A Systematic Review. Drug Saf 2024:10.1007/s40264-024-01470-0. [PMID: 39160354 DOI: 10.1007/s40264-024-01470-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2024] [Indexed: 08/21/2024]
Abstract
INTRODUCTION The safety of antiviral agents in real-world clinical settings is crucial, as pre-marketing studies often do not capture all adverse events (AE). Active pharmacovigilance strategies are essential for detecting and characterising these AE comprehensively. OBJECTIVE The aim of this study was to identify and characterise active pharmacovigilance strategies used in real-world clinical settings for patients under systemic antiviral agents, focusing on the frequency of AE and the clinical data sources used. METHODS We conducted a systematic review by searching three electronic bibliographic databases targeting observational prospective active pharmacovigilance studies, phase IV clinical trials for post-marketing safety surveillance, and interventional studies assessing active pharmacovigilance strategies, focusing on individuals exposed to systemic antiviral agents. RESULTS We included 36 primary studies, predominantly using Drug Event Monitoring (DEM), with a minority employing sentinel sites and registries. Human immunodeficiency virus (HIV) was the most common condition, with the majority using DEM. Within the DEM, there was a wide range of incidences of patients experiencing at least one AE, and most of these studies used one or two data sources. Sentinel site studies were less common, with two on hepatitis C virus (HCV) and one on HIV, each relying on one or two data sources. The single study using a registry focusing on HIV therapy reported using just one data source. Patient interviews were the most common data source, followed by medical records and laboratory tests. The quality of the studies was considered 'good' in 18/36, 'fair' in 1/36, and 'poor' in 17/36 studies. CONCLUSION DEM was the predominant pharmacovigilance strategy, employing multiple data sources, and appears to increase the likelihood of detecting higher AE incidence. Establishing such a framework would facilitate a more detailed and consistent approach across different studies and settings.
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Affiliation(s)
- Renato Ferreira-da-Silva
- Porto Pharmacovigilance Centre, Faculty of Medicine of the University of Porto, Porto, Portugal.
- Center for Health Technology and Services Research, Associate Laboratory RISE-Health Research Network (CINTESIS@RISE), Porto, Portugal.
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal.
| | - Joana Reis-Pardal
- Center for Health Technology and Services Research, Associate Laboratory RISE-Health Research Network (CINTESIS@RISE), Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | - Manuela Pinto
- São João University Hospital Centre, Porto, Portugal
| | - Matilde Monteiro-Soares
- Center for Health Technology and Services Research, Associate Laboratory RISE-Health Research Network (CINTESIS@RISE), Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
- Portuguese Red Cross Health School-Lisbon, Lisbon, Portugal
- Cross I&D, Lisbon, Portugal
| | - Bernardo Sousa-Pinto
- Center for Health Technology and Services Research, Associate Laboratory RISE-Health Research Network (CINTESIS@RISE), Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | - Manuela Morato
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy of the University of Porto, Porto, Portugal
- LAQV@REQUIMTE, Faculty of Pharmacy of the University of Porto, Porto, Portugal
| | - Jorge Junqueira Polónia
- Porto Pharmacovigilance Centre, Faculty of Medicine of the University of Porto, Porto, Portugal
- Center for Health Technology and Services Research, Associate Laboratory RISE-Health Research Network (CINTESIS@RISE), Porto, Portugal
- Department of Medicine, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Inês Ribeiro-Vaz
- Porto Pharmacovigilance Centre, Faculty of Medicine of the University of Porto, Porto, Portugal
- Center for Health Technology and Services Research, Associate Laboratory RISE-Health Research Network (CINTESIS@RISE), Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
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Wang L, Feng W, Duan J, Liang J. Pharmacovigilance Bibliometrics: Visualizing Thematic Development in the Category of Pharmacology and Pharmacy in Web of Science. Front Pharmacol 2021; 12:731757. [PMID: 34671257 PMCID: PMC8521010 DOI: 10.3389/fphar.2021.731757] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Pharmacovigilance studies include monitoring and preventing the occurrence of new, rare, or serious adverse drug reactions, making it possible to discover new safety issues without delay. Bibliometrics could assist scholars to analyze the development of pharmacovigilance. Methods: The MeSH terms of both pharmacovigilance and “adverse drug reaction reporting system” were retrieved in the Science Citation Index Expanded. The articles from 1974 to July 2021 in the pharmacology and pharmacy category were recruited. The citation reports including the publication numbers, h-index, and sum and average cited times in terms of annuals, countries, organizations, authors and journals were tabulated. The coauthorship relations in the analysis units of countries, organizations, and authors; the top 10 burst references; the document citation network; and the author’s keywords co-occurrence overlay map were visualized by bibliometric software including the website (https://bibliometric.com/), VOSviewer, CiteSpace, and CitNetExplorer. Results: From 1974 to the present, the most high-yield publication year, country, institute, author, and journal were 2020 (n = 222), France (n = 522), Netherlands Pharmacovigilance Centre Lareb (n = 82), Jean–Louis Montastruc (n = 125), Drug Safety (n = 384), respectively, in all 2,128 articles. Similarly, the United States, Institut National de la Sante et de la Recherche Medicale, and Jean–Louis Montastruc had the most coauthorship strength at the macrolevel (global), mesolevel (local), and microlevel (individual). The topics of burst references covered are the development of methodology, issues of patients reporting and under-reporting, evaluation of methods and databases, assessment of causality, and perspectives in pharmacovigilance. Eight clusters were grouped in the document citation network. “Pharmacovigilance,” “adverse drug reactions,” “pharmacoepidemiology,” “drug safety,” and “signal detection” were the research priorities, while “drug-related side effects and adverse reactions,” “VigiBase,” “disproportionality analysis,” “social media,” “FAERS,” “chemotherapy,” “patient safety,” “reporting odds ratio,” and “preventability” might be the future research hotspots. Conclusion: Positive synergies can be observed in this study by employing the multiple software tools which established the relationship between the units of analysis. The bibliometric analysis can organize the thematic development and guide the hotspots of pharmacovigilance in pharmacology and pharmacy.
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Affiliation(s)
- Li Wang
- Department of Pharmacy, Peking University International Hospital, Beijing, China
| | - Wanyu Feng
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
| | - Jingli Duan
- Department of Pharmacy, Peking University International Hospital, Beijing, China
| | - Jun Liang
- Department of Oncology, Peking University International Hospital, Beijing, China
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Brown JP, Douglas IJ, Hanif S, Thwaites RMA, Bate A. Measuring the Effectiveness of Real-World Evidence to Ensure Appropriate Impact. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1241-1244. [PMID: 34452702 DOI: 10.1016/j.jval.2021.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/22/2021] [Accepted: 03/25/2021] [Indexed: 06/13/2023]
Abstract
The value of real-world evidence (RWE) in medicines regulation and health technology assessment has been increasingly emphasized. Nevertheless, although RWE is increasingly used, there has been limited systematic evidence of its value. A recent study that examined the role and impact of RWE in regulatory assessments conducted through the European Medicines Agency provided such evidence. Results of the study demonstrated RWE was important to decision making, particularly for certain questions such as the quantification of adverse events, the evaluation of risk minimization measures, and the assessment of product usage. The study suggested, however, that in many of the assessments further RWE would have been valuable and concluded that RWE has, as yet, played a limited role in hypothesis generation and in the assessment of medication effectiveness. This study had been possible only because of the transparency of the European Medicines Agency decision making. Ensuring transparency of RWE evidence collection, study design and conduct, and of decision making based on this evidence will facilitate further development of the uses and value of RWE. Keywords: benefit-risk assessment; medicines regulation; real-world evidence; regulatory decision making.
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Affiliation(s)
- Jeremy P Brown
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England, UK.
| | - Ian J Douglas
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England, UK
| | | | | | - Andrew Bate
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England, UK; Global Safety, GSK, Brentford, Middlesex, England, UK
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Smith MJ, Komparic A, Thompson A. Deploying the Precautionary Principle to Protect Vulnerable Populations in Canadian Post-Market Drug Surveillance. CANADIAN JOURNAL OF BIOETHICS 2020. [DOI: 10.7202/1070232ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Drug regulatory bodies aim to ensure that patients have access to safe and effective drugs; however, no matter the quality of pre-licensure studies, uncertainty will remain regarding the safety and effectiveness of newly approved drugs until a large and diverse population uses those drugs. Recent analyses of Canada’s post-market drug surveillance (PMDS) system have found that Canada’s PMDS system requires strengthening and that efforts must be improved to monitor and address the safety and effectiveness of approved drugs among vulnerable populations. Given the uncertainty that exists when drugs enter the market, some have suggested that the precautionary principle is relevant to guiding decision-making in this context. This paper responds to recommendations that the Canadian PMDS system should be responsive to the health needs of vulnerable populations by assessing the utility of deploying the precautionary principle to guide a post-market strategy for vulnerable populations.
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Affiliation(s)
- Maxwell J. Smith
- School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Ana Komparic
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Alison Thompson
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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Torre C, Cary M, Borges FC, Ferreira PS, Alarcão J, Leufkens HG, Costa J, Martins AP. Intensive Monitoring Studies for Assessing Medicines: A Systematic Review. Front Med (Lausanne) 2019; 6:147. [PMID: 31380375 PMCID: PMC6659411 DOI: 10.3389/fmed.2019.00147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 06/12/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction: Intensive monitoring (IM) is one of the methods of post-marketing active surveillance based upon event monitoring, which has received interest in the current medicines regulatory landscape. For a specific period of time, IM involves primary data collection and is actively focused on gathering longitudinal information, mainly safety, since the first day of drug use. Objectives: To describe IM systems and studies' data published over 11-years period (2006-2016). Specifically, we reviewed study population/event surveillance, methodological approaches, limitations, and its applications in the real-world evidence generation data. Methods: We completed a systematic search of MEDLINE and EMBASE to identify studies published from 2006 to 2016, that used IM methodology. We extracted data using a standardized form and results were analyzed descriptively. The methodological quality of selected studies was assessed using the modified Downs and Black checklist. Results: From 1,400 screened citations, we identified 86 papers, corresponding to 69 different studies. Seventy percent of reviewed studies corresponded to established IM systems, of which, more than half were prescription event monitoring (PEM) and modified-PEM. Among non-established IM systems, vaccines were the most common studied drugs (n = 14). The median cohort size ranged from 488 (hospitals) to 10,479 (PEM) patients. Patients and caregivers were the event data source in 39.1% of studies. The mean overall quality score was similar between established and non-established IM. Conclusions: Over the study period, IM studies were implemented in 26 countries with different maturity levels of post-marketing surveillance systems. We identified two major limitations: only 20% of studies were conducted at hospital-level, which is a matter of concern, insofar as healthcare systems are facing a lack of access to new medicines at ambulatory care level. Additionally, IM access to data of drug exposure cohorts, either at identification or at follow-up stages, could somehow constitute a barrier, given the complexity of managerial, linkable, and privacy data issues.
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Affiliation(s)
- Carla Torre
- Centre for Health Evaluation and Research (CEFAR), National Association of Pharmacies, Lisbon, Portugal
- Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Maria Cary
- Centre for Health Evaluation and Research (CEFAR), National Association of Pharmacies, Lisbon, Portugal
| | - Fábio Cardoso Borges
- Department of Epidemiology and National Cancer Registry (RON), Portuguese Institute of Oncology, Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Paula S. Ferreira
- Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
- Setubal and Santarem Regional Pharmacovigilance Unit, Lisbon, Portugal
| | - Joana Alarcão
- Faculty of Medicine, Center for Evidence-Based Medicine, University of Lisbon, Lisbon, Portugal
| | - Hubert G. Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - João Costa
- Faculty of Medicine, Center for Evidence-Based Medicine, University of Lisbon, Lisbon, Portugal
- Faculty of Medicine, Institute of Molecular Medicine and Laboratory of Clinical Pharmacology and Therapeutics, University of Lisbon, Lisbon, Portugal
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Hans M, Gupta SK. Comparative evaluation of pharmacovigilance regulation of the United States, United Kingdom, Canada, India and the need for global harmonized practices. Perspect Clin Res 2018; 9:170-174. [PMID: 30319947 PMCID: PMC6176689 DOI: 10.4103/picr.picr_89_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The primary focus of the pharmacovigilance (PV) practice has been on the collection, assessment, and reporting of the adverse drug reactions to medicinal products. Globalization of the pharmaceutical industry has prompted efforts to toward harmonization of PV practices worldwide to enable improved knowledge of medicine's benefit-risk profile and risk communication. Even as PV has evolved over the past decade, there still exist few areas of discordance across global PV practices. This article compares the PV legislation in the United States, United Kingdom, Canada, and India with a view to understand areas of harmony in the current legislation across regions and further compare health authorities' requirements with recommendations made by international organizations. Identification of potential areas of disharmony would pave the way to design solutions and strategies toward creation of a comprehensive PV system, which can be easily implemented across the globe, thus promoting the safer use of medicines.
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Affiliation(s)
- Mohit Hans
- Department of Clinical Research, Delhi Institute of Pharmaceutical Sciences and Research, New Delhi, India
| | - Suresh Kumar Gupta
- Department of Clinical Research, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
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7
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Wiktorowicz M, Moscou K, Lexchin J. Transnational pharmacogovernance: emergent patterns in the jazz of pharmaceutical policy convergence. Global Health 2018; 14:86. [PMID: 30134929 PMCID: PMC6106922 DOI: 10.1186/s12992-018-0402-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/30/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND As a transnational policy network, the International Council for Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) aligns international regulatory standards to address the pressures of globalization on the pharmaceutical industry and increase access to new medicines. Founding ICH members include regulators and pharmaceutical industry trade associations in the European Union, the United States and Japan. In this paper we explore the manner in which state interdependence fosters the conditions for regulatory harmonization by tracing the underlying parallels between ICH and member state pharmacogovernance to clarify emergent patterns in regulatory policy convergence. RESULTS A shift to the life cycle approach to pharmaceutical regulation corresponded with international convergence in pre-market standards as emphasis shifted to post-market standards where convergence remains unresolved. Transnational pharmacogovernance was found to concentrate regulatory authority within a co-regulatory model of bilateral negotiation with pharmaceutical trade associations in defining safety and efficacy standards. Given a context of state interdependence, parallels were found between transnational and ICH member pharmacogovernance modes that guide policy development. Divergent modes of state regulatory governance that re-calibrate perceptions of risk and risk mitigation were found to coincide with post-market policy dissonance. CONCLUSION Although interdependence fostered harmonization in pre-market standards and aligned with increased focus on post-market approaches, the confluence of divergent state governance modes and perceptions of risk may inspire improvisation in post-market standards. As the ICH expands to an ensemble with a greater global reach, further research is needed to clarify the manner in which interdependence shapes transnational pharmacogovernance and the conditions that foster policy convergence in the public interest.
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Affiliation(s)
- Mary Wiktorowicz
- School of Health Policy and Management, York University, Toronto, Canada
| | - Kathy Moscou
- School of Health Policy and Management, York University, Toronto, Canada
- WHO Collaborating Centre for Governance, Accountability and Transparency in the Pharmaceutical Sector, University of Toronto, Toronto, Canada
- Faculty of Education, Brandon University, Brandon, Canada
| | - Joel Lexchin
- School of Health Policy and Management, York University, Toronto, Canada
- WHO Collaborating Centre for Governance, Accountability and Transparency in the Pharmaceutical Sector, University of Toronto, Toronto, Canada
- University Health Network, Faculty of Medicine, University of Toronto, Toronto, Canada
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8
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Kim HS, Lee S, Kim JH. Real-world Evidence versus Randomized Controlled Trial: Clinical Research Based on Electronic Medical Records. J Korean Med Sci 2018; 33:e213. [PMID: 30127705 PMCID: PMC6097073 DOI: 10.3346/jkms.2018.33.e213] [Citation(s) in RCA: 215] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/24/2018] [Indexed: 12/29/2022] Open
Abstract
Real-world evidence (RWE) and randomized control trial (RCT) data are considered mutually complementary. However, compared with RCT, the outcomes of RWE continue to be assigned lower credibility. It must be emphasized that RWE research is a real-world practice that does not need to be executed as RCT research for it to be reliable. The advantages and disadvantages of RWE must be discerned clearly, and then the proper protocol can be planned from the beginning of the research to secure as many samples as possible. Attention must be paid to privacy protection. Moreover, bias can be reduced meaningfully by reducing the number of dropouts through detailed and meticulous data quality management. RCT research, characterized as having the highest reliability, and RWE research, which reflects the actual clinical aspects, can have a mutually supplementary relationship. Indeed, once this is proven, the two could comprise the most powerful evidence-based research method in medicine.
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Affiliation(s)
- Hun-Sung Kim
- Department of Medical Informatics, The Catholic University of Korea College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Suehyun Lee
- Division of Biomedical Informatics, Systems Biomedical Informatics Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ju Han Kim
- Division of Biomedical Informatics, Systems Biomedical Informatics Research Center, Seoul National University College of Medicine, Seoul, Korea
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Walker VM, Davey Smith G, Davies NM, Martin RM. Mendelian randomization: a novel approach for the prediction of adverse drug events and drug repurposing opportunities. Int J Epidemiol 2018; 46:2078-2089. [PMID: 29040597 PMCID: PMC5837479 DOI: 10.1093/ije/dyx207] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2017] [Indexed: 12/18/2022] Open
Abstract
Identification of unintended drug effects, specifically drug repurposing opportunities and adverse drug events, maximizes the benefit of a drug and protects the health of patients. However, current observational research methods are subject to several biases. These include confounding by indication, reverse causality and missing data. We propose that Mendelian randomization (MR) offers a novel approach for the prediction of unintended drug effects. In particular, we advocate the synthesis of evidence from this method and other approaches, in the spirit of triangulation, to improve causal inferences concerning drug effects. MR addresses some of the limitations associated with the existing methods in this field. Furthermore, it can be applied either before or after approval of the drug, and could therefore prevent the potentially harmful exposure of patients in clinical trials and beyond. The potential of MR as a pharmacovigilance and drug repurposing tool is yet to be realized, and could both help prevent adverse drug events and identify novel indications for existing drugs in the future.
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Affiliation(s)
- Venexia M Walker
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Bristol Medical School, University of Bristol, Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Bristol Medical School, University of Bristol, Bristol, UK
| | - Neil M Davies
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Bristol Medical School, University of Bristol, Bristol, UK
| | - Richard M Martin
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Bristol Medical School, University of Bristol, Bristol, UK
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Detecting Signals of Disproportionate Reporting from Singapore's Spontaneous Adverse Event Reporting System: An Application of the Sequential Probability Ratio Test. Drug Saf 2017; 40:703-713. [PMID: 28455793 DOI: 10.1007/s40264-017-0531-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The ability to detect safety concerns from spontaneous adverse drug reaction reports in a timely and efficient manner remains important in public health. OBJECTIVE This paper explores the behaviour of the Sequential Probability Ratio Test (SPRT) and ability to detect signals of disproportionate reporting (SDRs) in the Singapore context. METHODS We used SPRT with a combination of two hypothesised relative risks (hRRs) of 2 and 4.1 to detect signals of both common and rare adverse events in our small database. We compared SPRT with other methods in terms of number of signals detected and whether labelled adverse drug reactions were detected or the reaction terms were considered serious. The other methods used were reporting odds ratio (ROR), Bayesian Confidence Propagation Neural Network (BCPNN) and Gamma Poisson Shrinker (GPS). RESULTS The SPRT produced 2187 signals in common with all methods, 268 unique signals, and 70 signals in common with at least one other method, and did not produce signals in 178 cases where two other methods detected them, and there were 403 signals unique to one of the other methods. In terms of sensitivity, ROR performed better than other methods, but the SPRT method found more new signals. The performances of the methods were similar for negative predictive value and specificity. CONCLUSIONS Using a combination of hRRs for SPRT could be a useful screening tool for regulatory agencies, and more detailed investigation of the medical utility of the system is merited.
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Agyemang E, Bailey L, Talbot J. Additional Risk Minimisation Measures for Medicinal Products in the European Union: A Review of the Implementation and Effectiveness of Measures in the United Kingdom by One Marketing Authorisation Holder. Pharmaceut Med 2017; 31:101-112. [PMID: 28413313 PMCID: PMC5376384 DOI: 10.1007/s40290-017-0184-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction Additional risk minimisation measures (aRMMs) for medicinal products are necessary to address specific important safety issues which may not be practically achieved through routine risk management measures alone. The implementation and determination of effectiveness for aRMMs can be a challenge as it involves multiple stakeholders. It is therefore important to have concise objectives to avoid undue burden on patients, healthcare professionals and the healthcare system. Aim The aim of this study was to examine how aRMMs are implemented and how effectiveness is assessed in the European Union (EU) using practical examples from Roche Products Limited in the United Kingdom (UK) (referred to as the ‘Company’). Methods Three centrally authorised products were selected from the Company’s portfolio, each of which had aRMMs to address important safety concerns; specifically, teratogenicity, medication error and infections. The implementation of EU aRMMs, effectiveness checks and specific UK activities were analysed. Hard copy folders and electronic sites for Company aRMMs were used to assess process indicators. Periodic benefit-risk evaluation reports for specified time intervals and the Company safety database was used in checking safety outcomes for the selected products. For each product, the effectiveness of aRMMs was analysed based on specific process indicators and the subsequent safety outcomes. Literature searches were performed on scientific databases for the purposes of the broader study. Results The main process indicators in measuring effectiveness of Company aRMMs were distribution metrics for educational materials, assessment of awareness and clinical actions among healthcare professionals (HCPs). Case reports of pregnancy, medication errors and progressive multifocal leukoencephalopathy (PML) were the outcome indicators for Erivedge®▼, Kadcyla®▼ and MabThera® (the latter specifically in autoimmune indications: rheumatoid arthritis, granulomatosis with polyangiitis and microscopic polyangiitis) respectively. No pregnancy, one medication error and 10 confirmed PML cases were reported for Erivedge®▼, Kadcyla®▼ and MabThera® respectively. Conclusions For the chosen products, a reasonable awareness of aRMMs amongst HCPs is a positive indicator of success in the use of educational materials. However, low response rates from surveys indicate that voluntary feedback may not always achieve the desired level of response in measuring effectiveness. There is a challenge in determining overall effectiveness of aRMMs due to a lack of defined success thresholds. Further regulatory guidance to outline the elements and desired outcomes of aRMMs will be useful for consistency in achieving successful outcomes.
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Affiliation(s)
- Elaine Agyemang
- Roche Products Limited, 6 Falcon Way, Shire Park, Welwyn Garden City, AL7 1TW UK.,School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, AL10 9AB UK
| | - Lorna Bailey
- Roche Products Limited, 6 Falcon Way, Shire Park, Welwyn Garden City, AL7 1TW UK
| | - John Talbot
- School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, AL10 9AB UK
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12
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Kim HS, Kim H, Jeong YJ, Kim TM, Yang SJ, Baik SJ, Lee SH, Cho JH, Choi IY, Yoon KH. Development of Clinical Data Mart of HMG-CoA Reductase Inhibitor for Varied Clinical Research. Endocrinol Metab (Seoul) 2017; 32:90-98. [PMID: 28256114 PMCID: PMC5368128 DOI: 10.3803/enm.2017.32.1.90] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/02/2017] [Accepted: 01/06/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The increasing use of electronic medical record (EMR) systems for documenting clinical medical data has led to EMR data being increasingly accessed for clinical trials. In this study, a database of patients who were prescribed statins for the first time was developed using EMR data. A clinical data mart (CDM) was developed for cohort study researchers. METHODS Seoul St. Mary's Hospital implemented a clinical data warehouse (CDW) of data for ~2.8 million patients, 47 million prescription events, and laboratory results for 150 million cases. We developed a research database from a subset of the data on the basis of a study protocol. Data for patients who were prescribed a statin for the first time (between the period from January 1, 2009 to December 31, 2015), including personal data, laboratory data, diagnoses, and medications, were extracted. RESULTS We extracted initial clinical data of statin from a CDW that was established to support clinical studies; the data was refined through a data quality management process. Data for 21,368 patients who were prescribed statins for the first time were extracted. We extracted data every 3 months for a period of 1 year. A total of 17 different statins were extracted. It was found that statins were first prescribed by the endocrinology department in most cases (69%, 14,865/21,368). CONCLUSION Study researchers can use our CDM for statins. Our EMR data for statins is useful for investigating the effectiveness of treatments and exploring new information on statins. Using EMR is advantageous for compiling an adequate study cohort in a short period.
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Affiliation(s)
- Hun Sung Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyunah Kim
- College of Pharmacy, Sookmyung Women's University, Seoul, Korea
| | - Yoo Jin Jeong
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tong Min Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Jung Yang
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Jung Baik
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Hyoung Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Young Choi
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Kun Ho Yoon
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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13
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Bouvy JC, Huinink L, De Bruin ML. Benefit-risk reassessment of medicines: a retrospective analysis of all safety-related referral procedures in Europe during 2001-2012. Pharmacoepidemiol Drug Saf 2016; 25:1004-14. [DOI: 10.1002/pds.4011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/04/2016] [Accepted: 03/19/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Jacoline C. Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science; Utrecht University; Utrecht The Netherlands
- Institute for Medical Technology Assessment (iMTA), Faculty of Health, Policy and Management; Erasmus University Rotterdam; Rotterdam The Netherlands
| | - Lotte Huinink
- Institute for Medical Technology Assessment (iMTA), Faculty of Health, Policy and Management; Erasmus University Rotterdam; Rotterdam The Netherlands
| | - Marie L. De Bruin
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science; Utrecht University; Utrecht The Netherlands
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14
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Duggirala HJ, Tonning JM, Smith E, Bright RA, Baker JD, Ball R, Bell C, Bright-Ponte SJ, Botsis T, Bouri K, Boyer M, Burkhart K, Steven Condrey G, Chen JJ, Chirtel S, Filice RW, Francis H, Jiang H, Levine J, Martin D, Oladipo T, O’Neill R, Palmer LAM, Paredes A, Rochester G, Sholtes D, Szarfman A, Wong HL, Xu Z, Kass-Hout T. Use of data mining at the Food and Drug Administration. J Am Med Inform Assoc 2015. [DOI: 10.1093/jamia/ocv063] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Abstract
Objectives This article summarizes past and current data mining activities at the United States Food and Drug Administration (FDA).
Target audience We address data miners in all sectors, anyone interested in the safety of products regulated by the FDA (predominantly medical products, food, veterinary products and nutrition, and tobacco products), and those interested in FDA activities.
Scope Topics include routine and developmental data mining activities, short descriptions of mined FDA data, advantages and challenges of data mining at the FDA, and future directions of data mining at the FDA.
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Affiliation(s)
| | | | - Ella Smith
- Center for Food Safety and Applied Nutrition, FDA
| | | | | | - Robert Ball
- Center for Biologics Evaluation and Research, FDA
| | - Carlos Bell
- Center for Drug Evaluation and Research, FDA
| | | | | | | | - Marc Boyer
- Center for Food Safety and Applied Nutrition, FDA
| | | | | | | | | | | | | | | | | | - David Martin
- Center for Biologics Evaluation and Research, FDA
| | | | | | | | | | | | | | | | | | - Zhiheng Xu
- Center for Devices and Radiological Health, FDA
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Abstract
Pharmacovigilance (PV) plays a key role in the healthcare system through
assessment, monitoring and discovery of interactions amongst drugs and their
effects in human. Pharmaceutical and biotechnological medicines are designed to
cure, prevent or treat diseases; however, there are also risks particularly
adverse drug reactions (ADRs) can cause serious harm to patients. Thus, for
safety medication ADRs monitoring required for each medicine throughout its life
cycle, during development of drug such as pre-marketing including early stages
of drug design, clinical trials, and post-marketing surveillance. PV is concerns
with the detection, assessment, understanding and prevention of ADRs.
Pharmacogenetics and pharmacogenomics are an indispensable part of the clinical
research. Variation in the human genome is a cause of variable response to drugs
and susceptibility to diseases are determined, which is important for early drug
discovery to PV. Moreover, PV has traditionally involved in mining spontaneous
reports submitted to national surveillance systems. The research focus is
shifting toward the use of data generated from platforms outside the
conventional framework such as electronic medical records, biomedical
literature, and patient-reported data in health forums. The emerging trend in PV
is to link premarketing data with human safety information observed in the
post-marketing phase. The PV system team obtains valuable additional
information, building up the scientific data contained in the original report
and making it more informative. This necessitates an utmost requirement for
effective regulations of the drug approval process and conscious pre and post
approval vigilance of the undesired effects, especially in India. Adverse events
reported by PV system potentially benefit to the community due to their
proximity to both population and public health practitioners, in terms of
language and knowledge, enables easy contact with reporters by electronically.
Hence, PV helps to the patients get well and to manage optimally or ideally,
avoid illness is a collective responsibility of industry, drug regulators,
clinicians and other healthcare professionals to enhance their contribution to
public health. This review summarized objectives and methodologies used in PV
with critical overview of existing PV in India, challenges to overcome and
future prospects with respect to Indian context.
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16
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Kajungu DK, Erhart A, Talisuna AO, Bassat Q, Karema C, Nabasumba C, Nambozi M, Tinto H, Kremsner P, Meremikwu M, D’Alessandro U, Speybroeck N. Paediatric pharmacovigilance: use of pharmacovigilance data mining algorithms for signal detection in a safety dataset of a paediatric clinical study conducted in seven African countries. PLoS One 2014; 9:e96388. [PMID: 24787710 PMCID: PMC4006882 DOI: 10.1371/journal.pone.0096388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/07/2014] [Indexed: 11/18/2022] Open
Abstract
Background Pharmacovigilance programmes monitor and help ensuring the safe use of medicines which is critical to the success of public health programmes. The commonest method used for discovering previously unknown safety risks is spontaneous notifications. In this study we examine the use of data mining algorithms to identify signals from adverse events reported in a phase IIIb/IV clinical trial evaluating the efficacy and safety of several Artemisinin-based combination therapies (ACTs) for treatment of uncomplicated malaria in African children. Methods We used paediatric safety data from a multi-site, multi-country clinical study conducted in seven African countries (Burkina Faso, Gabon, Nigeria, Rwanda, Uganda, Zambia, and Mozambique). Each site compared three out of four ACTs, namely amodiaquine-artesunate (ASAQ), dihydroartemisinin-piperaquine (DHAPQ), artemether-lumefantrine (AL) or chlorproguanil/dapsone and artesunate (CD+A). We examine two pharmacovigilance signal detection methods, namely proportional reporting ratio and Bayesian Confidence Propagation Neural Network on the clinical safety dataset. Results Among the 4,116 children (6–59 months old) enrolled and followed up for 28 days post treatment, a total of 6,238 adverse events were reported resulting into 346 drug-event combinations. Nine signals were generated both by proportional reporting ratio and Bayesian Confidence Propagation Neural Network. A review of the manufacturer package leaflets, an online Multi-Drug Symptom/Interaction Checker (DoubleCheckMD) and further by therapeutic area experts reduced the number of signals to five. The ranking of some drug-adverse reaction pairs on the basis of their signal index differed between the two methods. Conclusions Our two data mining methods were equally able to generate suspected signals using the pooled safety data from a phase IIIb/IV clinical trial. This analysis demonstrated the possibility of utilising clinical studies safety data for key pharmacovigilance activities like signal detection and evaluation. This approach can be applied to complement the spontaneous reporting systems which are limited by under reporting.
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Affiliation(s)
- Dan K. Kajungu
- Research Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
- Uganda Malaria Surveillance project/Infectious Disease Research Collaboration, Kampala, Uganda
- Santé Stat. and Analytical Research Institute (SSARI), Kampala, Uganda
- * E-mail:
| | | | - Ambrose Otau Talisuna
- Malaria Public Health Department, University of Oxford-KEMRI-Wellcome Trust Programme, Nairobi, Kenya
- Uganda Malaria Surveillance project/Infectious Disease Research Collaboration, Kampala, Uganda
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique/Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
| | - Corine Karema
- National Malaria Control Program–TRAC Plus, Ministry of Health, Kigali, Rwanda
| | - Carolyn Nabasumba
- Epicentre, Paris, France/Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda
| | | | - Halidou Tinto
- Institut de Recherches en Sciences de la Santé, Bobo Dioulasso, Burkina Faso/Centre Muraz, Bobo Dioulasso, Burkina Faso
| | - Peter Kremsner
- Institut für Tropenmedizin, Universität Tübingen, Germany and Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Martin Meremikwu
- Department of Paediatrics, University of Calabar, Calabar, Nigeria/Institute of Tropical Diseases Research & Prevention, Calabar, Nigeria
| | - Umberto D’Alessandro
- Institute of Tropical Medicine, Antwerp, Belgium
- Medical Research Council Unit, Fajara, The Gambia
| | - Niko Speybroeck
- Research Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
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17
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Pillans PI. Clinical perspectives in drug safety and adverse drug reactions. Expert Rev Clin Pharmacol 2014; 1:695-705. [PMID: 24422739 DOI: 10.1586/17512433.1.5.695] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Adverse drug reactions (ADRs) remain a common clinical problem since they can mimic many diseases and cause significant morbidity and mortality. Judicious prescribing is important to minimize their occurrence. Apart from the recent identification of a few pharmacogenomic biomarkers for serious reactions, many remain unpredictable. Spontaneous reporting continues to play an important role in pharmacovigilance and the value of astute clinical observation and well-documented reports of suspicions of a causal link cannot be underestimated. Many national reporting schemes have developed considerable experience and expertise over many years and have large ADR databases, which are national assets. Despite advances in pharmacovigilance, numerous deficiencies have been identified; postmarketing surveillance remains the weakest link in the regulatory process. Regulatory authorities have tended to act later rather than sooner in response to safety signals, and this, when combined with under-reporting, may have led to exposure of a large number of patients to drug-related harm before restriction or withdrawal. In an attempt to improve vigilance, international surveillance may benefit by moving from its current passive/reactive mode toward active surveillance systems with a prospective, comprehensive and systematic approach to monitoring, collecting, analyzing and reporting data on ADRs. This will include increased pressure on pharmaceutical companies to conduct postmarketing studies. Such an active/proactive approach, while maintaining focus on ADR detection, could also aim to extend knowledge of safety, such that emerging changes in risk-benefit during a drug's marketed life are effectively communicated to clinicians and patients. Drug safety monitoring and its regulation are now undergoing an overhaul and it is hoped that vigilance, public safety and trust will improve as a result.
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Affiliation(s)
- Peter Ian Pillans
- Princess Alexandra Hospital, Woolloongabba, Brisbane, 4102, Queensland, Australia.
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18
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Affiliation(s)
- Stephen J W Evans
- Department of Medical Statistics, Room 37b, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK,
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19
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Ryan PB, Stang PE, Overhage JM, Suchard MA, Hartzema AG, DuMouchel W, Reich CG, Schuemie MJ, Madigan D. A Comparison of the Empirical Performance of Methods for a Risk Identification System. Drug Saf 2013; 36 Suppl 1:S143-58. [PMID: 24166231 DOI: 10.1007/s40264-013-0108-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Patrick B Ryan
- Janssen Research and Development LLC, 1125 Trenton-Harbourton Road, Room K30205, PO Box 200, Titusville, NJ, 08560, USA,
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20
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Arlett PR, Kurz X. New approaches to strengthen pharmacovigilance. DRUG DISCOVERY TODAY. TECHNOLOGIES 2013; 8:e1-e42. [PMID: 24103839 DOI: 10.1016/j.ddtec.2011.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Medication-wide association studies. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2013; 2:e76. [PMID: 24448022 PMCID: PMC4026636 DOI: 10.1038/psp.2013.52] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 08/09/2013] [Indexed: 11/23/2022]
Abstract
Undiscovered side effects of drugs can have a profound effect on the health of the nation, and electronic health-care databases offer opportunities to speed up the discovery of these side effects. We applied a “medication-wide association study” approach that combined multivariate analysis with exploratory visualization to study four health outcomes of interest in an administrative claims database of 46 million patients and a clinical database of 11 million patients. The technique had good predictive value, but there was no threshold high enough to eliminate false-positive findings. The visualization not only highlighted the class effects that strengthened the review of specific products but also underscored the challenges in confounding. These findings suggest that observational databases are useful for identifying potential associations that warrant further consideration but are unlikely to provide definitive evidence of causal effects.
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22
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Aydinkarahaliloglu ND, Aykac E, Kasap Y, Durmus N, Babacanoglu C, Basgut CE, Artiran G, Kerman S. Pharmaceutical risk management in Turkey: the first national overview. Regul Toxicol Pharmacol 2013; 67:344-50. [PMID: 23994623 DOI: 10.1016/j.yrtph.2013.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 08/17/2013] [Indexed: 11/26/2022]
Abstract
Risk management plans and actions aim to limit the known risks of drugs and provide valuable data to evaluate actual risks and pre-disposing factors for adverse drug reactions. In this study, it is aimed to evaluate and summarize the risk management actions in Turkey between 2005 and 2013 for the first time. The drugs monitored with a risk management plan and actions taken are evaluated by examining the records of the Turkish Pharmaceuticals and Medical Devices Agency retrospectively. Various risk management actions such as provision of information, summary of product characteristics and patient information leaflets, direct communication with healthcare professionals, patient and physician brochures, change of the legal status of the drug, education of doctors and pharmacists, control of number and validity of prescriptions, using informed consent forms, using "drug safety surveillance form" for the TNF blockers (firstly on the world), using web-based monitoring system, web-based prescription and web-based adverse reaction monitoring system were used for safe use of drugs during and after authorization in Turkey. Although, most of the actions are similar to those of international health authorities, the remaining are specific to the conditions of Turkey such as "drug safety surveillance form" for the TNF blockers.
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Affiliation(s)
- N D Aydinkarahaliloglu
- Department of Risk Management, Turkish Medicines and Medical Devices Agency, Ankara 06520, Turkey
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23
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Abstract
Risk communication is central to the risk management strategy of a pharmaceutical company. Pharmaceutical companies primarily communicate risk through labelling tools such as the Summary of Product Characteristics (SmPC), package insert, patient information leaflet (PIL) and the carton, which are currently regulated based on templates such as those of the EU. Recent research raises concern about how effective the SmPC is alone in communicating risk. There is some evidence that carton design can influence risk comprehension. Processes to check new trade names cannot be confused with existing names is a simple measure to mitigate one form of risk. Given the central role and the vast amount of resource that is consumed, it is surprising there has not been extensive original research to see whether product information such as the SmPC is a good tool for communicating risk. Recently, EU agencies have assessed the communication value of the PIL and revised the template and guidelines. However, no evaluation of user testing has been conducted at European level since the introduction of these new requirements. As regards 'Dear Healthcare Professional Communications', there is inconsistent evidence about their ability to change patient and physician behaviour. There is a dearth of evidence about what sort of communications materials are the most effective under which circumstances. The use of templates restricts the flexibility of companies to adapt their risk messages to their targets. Effective communication requires understanding how different audiences perceive the message and what the fundamental drivers are for altering patient and prescriber behaviour to be safer. This requires careful consideration of the relationship between risk communication, perception and management. However, the focus of a company's risk communication plan is normally on the International Conference on Harmonisation (ICH) regions and their regulations. Although the same regulatory tools are used globally, we are not aware of any research into their effectiveness outside the ICH regions. What listed companies can communicate about benefits and risks is strongly influenced by the obligations of companies to the market and investors. There needs to be internal coordination for simultaneous release. Internal communications about significant issues should be restricted to those who know how to manage the risk of insider dealing from internal communications that may later be made public. Unfortunately, there is evidence that some companies do not have a cohesive strategy for communicating risk which should take into account all forms of promotional material and company-sponsored information sources on the Internet. A pharmaceutical company is not the only stakeholder responsible for communicating risks on their products. However, the relative roles and responsibilities of all relevant stakeholders are not defined and are often unclear. This means it is difficult to evaluate whether a company's actions might be duplicative or inefficient. We recommend that companies have a dedicated communications group whose role is to coordinate the company's communications strategy mapped to objectives that have been agreed with key stakeholders apart from just regulatory agencies. This same group can assess effectiveness of the communications, monitor audience reaction and adjust the communication strategy accordingly.
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Duijnhoven RG, Straus SMJM, Raine JM, de Boer A, Hoes AW, De Bruin ML. Number of patients studied prior to approval of new medicines: a database analysis. PLoS Med 2013; 10:e1001407. [PMID: 23526887 PMCID: PMC3601954 DOI: 10.1371/journal.pmed.1001407] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 02/07/2013] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND At the time of approval of a new medicine, there are few long-term data on the medicine's benefit-risk balance. Clinical trials are designed to demonstrate efficacy, but have major limitations with regard to safety in terms of patient exposure and length of follow-up. This study of the number of patients who had been administered medicines at the time of medicine approval by the European Medicines Agency aimed to determine the total number of patients studied, as well as the number of patients studied long term for chronic medication use, compared with the International Conference on Harmonisation's E1 guideline recommendations. METHODS AND FINDINGS All medicines containing new molecular entities approved between 2000 and 2010 were included in the study, including orphan medicines as a separate category. The total number of patients studied before approval was extracted (main outcome). In addition, the number of patients with long-term use (6 or 12 mo) was determined for chronic medication. 200 unique new medicines were identified: 161 standard and 39 orphan medicines. The median total number of patients studied before approval was 1,708 (interquartile range [IQR] 968-3,195) for standard medicines and 438 (IQR 132-915) for orphan medicines. On average, chronic medication was studied in a larger number of patients (median 2,338, IQR 1,462-4,135) than medication for intermediate (878, IQR 513-1,559) or short-term use (1,315, IQR 609-2,420). Safety and efficacy of chronic use was studied in fewer than 1,000 patients for at least 6 and 12 mo in 46.4% and 58.3% of new medicines, respectively. Among the 84 medicines intended for chronic use, 68 (82.1%) met the guideline recommendations for 6-mo use (at least 300 participants studied for 6 mo and at least 1,000 participants studied for any length of time), whereas 67 (79.8%) of the medicines met the criteria for 12-mo patient exposure (at least 100 participants studied for 12 mo). CONCLUSIONS For medicines intended for chronic use, the number of patients studied before marketing is insufficient to evaluate safety and long-term efficacy. Both safety and efficacy require continued study after approval. New epidemiologic tools and legislative actions necessitate a review of the requirements for the number of patients studied prior to approval, particularly for chronic use, and adequate use of post-marketing studies. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Ruben G. Duijnhoven
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
- Medicines Evaluation Board, Utrecht, the Netherlands
| | - Sabine M. J. M. Straus
- Medicines Evaluation Board, Utrecht, the Netherlands
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - June M. Raine
- Medicines and Healthcare products Regulatory Agency, London, United Kingdom
| | - Anthonius de Boer
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Arno W. Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marie L. De Bruin
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
- Medicines Evaluation Board, Utrecht, the Netherlands
- * E-mail:
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25
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26
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Abstract
Current concerns over the safety of medicines once they have been marketed mean that pharmacoepidemiology is of increasing importance. There are three main areas in which further research is needed. 1 To improve the methods used to make causal inference of effects of medicines and to raise the quality of the reporting and critical appraisal tools, so that the strengths and weaknesses of the new methods can be judged. 2 To apply the methods in areas where randomized trials cannot easily be done, such as in pregnancy. 3 To use electronic health records as fully as possible, using linkage between different databases, ensuring the data are of as high quality as possible. Public health and public perceptions mean that much of pharmacoepidemiology must be done using non-industry funding sources.
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Affiliation(s)
- Stephen J W Evans
- Department of Medical Statistics, The London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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27
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Abstract
Adverse drug reactions are the fifth most frequent cause of deaths in developed countries, effectively a global epidemic. However, progress in ameliorating the problem has been slow. Pharmacovigilance currently operates without clear objectives in relation to individual decisions, with no protocol (although risk management plans are a great step forward), with obscure materials and methods used for making decisions, with very limited reasoning and discussion, and little or no follow up and audit of the results. Problems include under-reporting, poor quality reports, underuse of the latest communications technology and suboptimal individual feedback to reporters. Assessment of causality is poor, impeding decision-making. After signal detection, more active measures to assess the risk to public health are needed. Other essential factors include precision about the ways in which data are prepared and transformed into databases, the recognition of secondary effects, which may be more obvious than the primary effect, but not so easy to link causally, and cognisance of all kinds of interactions. Areas that should be developed include pharmacoepidemiology, knowledge finding (through data mining), and communication and systems technology. The general way forward seems clear: a rigorous way of documenting all the steps, from getting reports of harms into regulatory databases to assessing their effects on public health, is essential and should be publicly reviewed for weaknesses. In turn, matters would be much improved by input on benefit/harm perceptions from patient groups, influencing decisions about what should be the true targets for regulatory and pharmacovigilance activities, avoiding second guessing by regulators.
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Prieto L, Spooner A, Hidalgo-Simon A, Rubino A, Kurz X, Arlett P. Evaluation of the effectiveness of risk minimization measures. Pharmacoepidemiol Drug Saf 2012; 21:896-9. [PMID: 22730332 DOI: 10.1002/pds.3305] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 05/11/2012] [Accepted: 05/16/2012] [Indexed: 11/11/2022]
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Härmark L, van Grootheest K. Web-based intensive monitoring: from passive to active drug surveillance. Expert Opin Drug Saf 2011; 11:45-51. [PMID: 22007719 DOI: 10.1517/14740338.2012.629184] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Recently, the European pharmacovigilance legislative framework changed. Post-authorisation safety studies (PASS) and additional monitoring of drugs will be important tools in ensuring the safety of drugs. Methods that can facilitate gathering of the requested information are essential. In this article, web-based intensive monitoring is described and future applications of this method are discussed. AREAS COVERED Web-based intensive monitoring is a non-interventional observational cohort study using patients as a source of information. Eligible patients are identified in the pharmacy, and information about drug use and adverse events is collected through web-based questionnaires. An overview of the results as well as the pros and cons of this method is given. A discussion on how this methodology can be expanded to other settings and how it can be used in the future is included. EXPERT OPINION The main idea with web-based intensive monitoring, using a specific inclusion point, letting patients be the source of information and following the patients over time via web questionnaires, can be a useful tool in post-marketing surveillance. Aspects other than adverse drug reactions, such as information about indication for use and off-label use, dosage and compliance can also be collected.
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Affiliation(s)
- Linda Härmark
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237MH 's-Hertogenbosch, 's-Hertogenbosch, The Netherlands.
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Monitoring drug safety with registries: useful components of postmarketing pharmacovigilance systems. J Clin Epidemiol 2011; 65:121-5. [PMID: 21982719 DOI: 10.1016/j.jclinepi.2011.06.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 04/21/2011] [Accepted: 06/21/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE At the time of licensing by regulatory agencies, the full range of risks and possible adverse drug reactions associated with a medication is rarely fully realized. This commentary aims to describe the role of registries as useful components of postmarketing pharmacovigilance systems for monitoring highly specialized medications associated with significant financial costs. STUDY DESIGN AND SETTING We consider the limitations of traditional pharmacovigilance programs and discuss the strengths, limitations, and uses of registries in postmarketing pharmacovigilance systems. RESULTS Registries have become increasingly appealing in postmarketing surveillance of medications; however, their exact role continues to evolve. Key registry projects, including the Prospective Immunogenicity Surveillance Registry, British Society for Rheumatology Biologics Register, Australian Rheumatology Association Database, the Haemostasis Registry, and the Bosentan Patient Registry highlight the value of registries for monitoring the incidence of rare adverse events. CONCLUSION Although often limited by lack of a control group and the need for complete case ascertainment to maintain data integrity, registries are a useful component of postmarketing pharmacovigilance systems for monitoring highly specialized medications associated with significant financial costs.
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Choi NK, Chang Y, Kim JY, Choi YK, Park BJ. Comparison and validation of data-mining indices for signal detection: using the Korean national health insurance claims database. Pharmacoepidemiol Drug Saf 2011; 20:1278-86. [DOI: 10.1002/pds.2237] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 06/29/2011] [Accepted: 07/19/2011] [Indexed: 11/09/2022]
Affiliation(s)
| | - Yoosoo Chang
- Department of Occupational Medicine, Health Screening Center; Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine; Seoul; Korea
| | - Ju-Young Kim
- Department of Family Medicine, Health Promotion Center; Seoul National University Bundang Hospital; Bundang; Korea
| | - Yu-Kyong Choi
- Department of Internal Medicine; Neul-yullin St. Mary's Orthopedic Hospital; Gumi; Korea
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Härmark L, van Puijenbroek E, Straus S, van Grootheest K. Intensive monitoring of pregabalin: results from an observational, Web-based, prospective cohort study in the Netherlands using patients as a source of information. Drug Saf 2011; 34:221-31. [PMID: 21332246 DOI: 10.2165/11585030-000000000-00000] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Pregabalin is one of the first drugs registered for the treatment of neuropathic pain. It is also indicated as adjuvant therapy in the treatment of epilepsy and for generalized anxiety disorder. Pregabalin is a GABA analogue and exerts its effect by binding to the α(2)-δ subunit of voltage-gated calcium channels, leading to a decreased synaptic release of neurotransmitters. OBJECTIVE To gain insight into the safety and user profile of pregabalin in daily practice, reported by patients via a Web-based intensive monitoring system based at the Netherlands Pharmacovigilance Centre Lareb. METHODS Lareb Intensive Monitoring is an observational prospective cohort study with no limiting inclusion or exclusion criteria compared with clinical trials. First-time users of pregabalin were identified through the first prescription signal in intensive monitoring participating pharmacies between 1 August 2006 and 31 January 2008. Eligible patients received information about the pregabalin study in the pharmacy. When registering online, patient characteristics and information about pregabalin and other concomitant drug use were collected. After registration, the patient received questionnaires by e-mail 2 weeks, 6 weeks, 3 months and 6 months after the start of pregabalin. In these questionnaires, possible adverse drug reactions (ADRs) were addressed. Reactions not labelled in the Summary of Product Characteristics of pregabalin, and reactions that were labelled but were interesting for other reasons, were analysed on a case-by-case basis. RESULTS In total, 1373 patients filled in the online registration form. The average age of participants was 54.5 years (range 11-89), with 58.0% being female. The indication for pregabalin use was neuropathic pain in 85.9% of participants. The average daily dose was 201 mg, and 80.5% of all users used pregabalin capsule 75 mg. All patients who registered for the study were sent a questionnaire; 1051 (76.5%) patients filled in at least one questionnaire. There were no statistically significant differences found regarding sex, age or daily dosage between this latter group compared with the patients who registered for the study but did not fill in a questionnaire. At least one possible ADR was reported by 69.3% of patients and serious ADRs were reported by 11 patients. The five most frequently reported possible ADRs were dizziness, somnolence, feeling drunk, fatigue and increased weight. Four associations were further analysed. Headache was analysed because of its high frequency. The time to onset ranged from a few hours to 5 months, with a median time to onset of 2 days. In 15 reports the headache passed without withdrawing the drug, and in ten cases the headache disappeared after drug withdrawal. Upper abdominal pain, a possible drug interaction between pregabalin and blood glucose-lowering agents, and suicidal ideation were considered to be signals. CONCLUSIONS Web-based intensive monitoring is an observational prospective cohort study. It will therefore provide a picture of the use of pregabalin and its ADRs in daily practice. This study indicates that pregabalin is a relatively safe drug. Eleven patients (<1.0%) experienced a serious ADR while using the drug. The most frequently reported possible ADRs correspond with the reactions most frequently reported during clinical trials. The study demonstrates that a web-based intensive monitoring system can contribute to greater knowledge about a reaction, such as headache, with quantification and information about latencies and time course of the reaction. It can also detect signals worth further investigation, such as abdominal pain and possible interaction with oral antidiabetics.
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Affiliation(s)
- Linda Härmark
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, s-Hertogenbosch, the Netherlands.
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Raine J, Wise L, Blackburn S, Eichler HG, Breckenridge A. European Perspective on Risk Management and Drug Safety. Clin Pharmacol Ther 2011; 89:650-4. [DOI: 10.1038/clpt.2011.28] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ebbers HC, Mantel-Teeuwisse AK, Moors EH, Schellekens H, Leufkens HG. Todayʼs Challenges in Pharmacovigilance. Drug Saf 2011; 34:273-87. [DOI: 10.2165/11586350-000000000-00000] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Park MY, Kim EY, Lee YH, Kim W, Kim KS, Sheen SS, Lim HS, Park RW. Analysis of Relationship between Levofloxacin and Corrected QT Prolongation Using a Clinical Data Warehouse. Healthc Inform Res 2011; 17:58-66. [PMID: 21818458 PMCID: PMC3092995 DOI: 10.4258/hir.2011.17.1.58] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 03/25/2011] [Indexed: 01/08/2023] Open
Abstract
Objective The aim of this study was to examine whether or not levofloxacin has any relationship with QT prolongation in a real clinical setting by analyzing a clinical data warehouse of data collected from different hospital information systems. Methods Electronic prescription data and medical charts from 3 different hospitals spanning the past 9 years were reviewed, and a clinical data warehouse was constructed. Patients who were both administrated levofloxacin and given electrocardiograms (ECG) were selected. The correlations between various patient characteristics, concomitant drugs, corrected QT (QTc) prolongation, and the interval difference in QTc before and after levofloxacin administration were analyzed. Results A total of 2,176 patients from 3 different hospitals were included in the study. QTc prolongation was found in 364 patients (16.7%). The study revealed that age (OR 1.026, p < 0.001), gender (OR 0.676, p = 0.007), body temperature (OR 1.267, p = 0.024), and cigarette smoking (OR 1.641, p = 0.022) were related with QTc prolongation. After adjusting for related factors, 12 drugs concomitant with levofloxacin were associated with QTc prolongation. For patients who took ECGs before and after administration of levofloxacin during their hospitalization (n = 112), there was no significant difference in QTc prolongation. Conclusions The age, gender, body temperature, cigarette smoking and various concomitant drugs might be related with QTc prolongation. However, there was no definite causal relationship or interaction between levofloxacin and QTc prolongation. Alternative surveillance methods utilizing the massive accumulation of electronic medical data seem to be essential to adverse drug reaction surveillance in future.
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Affiliation(s)
- Man Young Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
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Gabe ME, Davies GA, Murphy F, Davies M, Johnstone L, Jordan S. Adverse drug reactions: treatment burdens and nurse-led medication monitoring. J Nurs Manag 2011; 19:377-92. [PMID: 21507109 DOI: 10.1111/j.1365-2834.2011.01204.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Marie E Gabe
- Research Capacity Building Collaboration (RCBC) Wales, College of Human and Health Sciences, Swansea University, Swansea, UK.
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Pearson JF, Brownstein CA, Brownstein JS. Potential for electronic health records and online social networking to redefine medical research. Clin Chem 2010; 57:196-204. [PMID: 21159898 DOI: 10.1373/clinchem.2010.148668] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Recent legislation in the US requires that all medical records become electronic over the next decade. In addition, ongoing developments in patient-oriented care, most notably with the advent of health social networking and personal health records, provide a plethora of new information sources for research. CONTENT Electronic health records (EHRs) show great potential for use in observational studies to examine drug safety via pharmacovigiliance methods that can find adverse drug events as well as expand drug safety profiles. EHRs also show promise for head-to-head comparative effectiveness trials and could play a critical role in secondary and tertiary diabetes prevention efforts. A growing subset of EHRs, personal health records (PHRs), opens up the possibility of engaging patients in their care, as well as new opportunities for participatory research and personalized medicine. Organizations nationwide, from providers to employers, are already investing heavily in PHR systems. Additionally, the explosive use of online social networking sites and mobile technologies will undoubtedly play a role in future research efforts by making available a veritable flood of information, such as real-time exercise monitoring, to health researchers. SUMMARY The future confluence of health information technologies will enable researchers and clinicians to reveal novel therapies and insights into treatments and disease management, as well as environmental and genomic interactions, at an unprecedented population scale.
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Affiliation(s)
- John F Pearson
- Children's Hospital Informatics Program at the Harvard-MIT Division of Health Sciences and Technology, Boston, MA, USA
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Osimani B. Pharmaceutical risk communication: Sources of uncertainty and legal tools of uncertainty management. HEALTH RISK & SOCIETY 2010. [DOI: 10.1080/13698575.2010.509493] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mol PGM, Straus SMJM, Piening S, de Vries JTN, de Graeff PA, Haaijer-Ruskamp FM. A decade of safety-related regulatory action in the Netherlands: a retrospective analysis of direct healthcare professional communications from 1999 to 2009. Drug Saf 2010; 33:463-74. [PMID: 20486729 DOI: 10.2165/11532840-000000000-00000] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND As pre-approval trials are inherently limited in assessing the complete benefit-risk profile of a new drug, serious safety issues may emerge once a drug gains widespread use after approval. Regulators face the dilemma of balancing timely market access with the need for complete data on risks. This challenge has led to a life-cycle approach but, so far, few data are available on post-approval safety issues requiring regulatory action. OBJECTIVE The aim of this study is to determine the frequency, timing and nature of safety issues that necessitated safety-related regulatory action in the form of a Direct Healthcare Professional Communication (DHPC) issued by pharmaceutical companies in collaboration with the Dutch Medicines Evaluation Board during the past decade. METHODS All DHPCs issued in the Netherlands from 1 January 1999 to 1 January 2009 were retrospectively collected from the national regulatory authorities. Elapsed time between the approval date and the issue of the DHPC was determined. Characteristics of the action including the nature of the safety issue (according to Medical Dictionary for Regulatory Activities [MedDRA] terminology), type of drug and procedural aspects of the regulatory action taken were reviewed. DHPC characteristics were tabulated and explorative non-parametric tests were performed to study the effect of safety issue, drug class, drug type, orphan drug and first-in-class status on elapsed time from approval to the DHPC. RESULTS 157 DHPCs were issued concerning 112 different active substances, approximately 9% (112/1200) of active substances available in the Netherlands in 2007. The number of DHPCs issued increased by 2.1 (95% CI 1.2, 3.1; p < 0.001) DHPCs per year over the past decade, reaching a total of 25 in 2008. The median time between approval and DHPC was 5.3 years (range 0.13-48 years). No significant trend in elapsed time to DHPC was observed in relation to the studied years (p = 0.06). One-third of all DHPCs were issued in the first 3 years after approval, but 27% (n = 43/157) of the DHPCs were issued 10 or more years after approval. Timing of DHPCs differed depending on safety issue, drug class, drug type and orphan drug status. DHPCs mostly concerned adverse events in the system organ class of 'cardiac disorders' (15%), 'injury, poisoning and procedural complications' (13%) and 'general disorders and administration site conditions' (10%). In ten cases the drug was eventually withdrawn. Withdrawal occurred a median duration of 2.4 years after registration (range of 1.5-48 years) and was most frequently due to cardiac disorders (including QT interval prolongation; four occasions) and hepatobiliary disorders (two occasions). CONCLUSIONS In the past decade, the number of DHPCs has increased over time. This is likely caused by a multitude of factors: increased risk awareness by the public, media, regulators and other stakeholders; the type of drugs approved, such as orphan drugs and biologicals; and the regulatory process, including conditional approvals. The number of DHPCs may in the future increase further with the possibility of screening large epidemiological databases proactively for adverse drug events. Nine percent of all marketed drugs required a safety-related action. Regulatory action is taken shortly (<3 years) after market approval nearly as often as after intermediate (3-10 years) and long-term (>10 years) market exposure. These findings underline the need for risk management during the whole life cycle of a drug.
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Affiliation(s)
- Peter G M Mol
- University Medical Center Groningen, Groningen, the Netherlands.
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Johansson S, Wallander MA, de Abajo FJ, García Rodríguez LA. Prospective drug safety monitoring using the UK primary-care General Practice Research Database: theoretical framework, feasibility analysis and extrapolation to future scenarios. Drug Saf 2010; 33:223-32. [PMID: 20158286 DOI: 10.2165/11319010-000000000-00000] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Post-launch drug safety monitoring is essential for the detection of adverse drug signals that may be missed during preclinical trials. Traditional methods of postmarketing surveillance such as spontaneous reporting have intrinsic limitations, many of which can be overcome by the additional application of structured pharmacoepidemiological approaches. However, further improvement in drug safety monitoring requires a shift towards more proactive pharmacoepidemiological methods that can detect adverse drug signals as they occur in the population. OBJECTIVE To assess the feasibility of using proactive monitoring of an electronic medical record system, in combination with an independent endpoint adjudication committee, to detect adverse events among users of selected drugs. METHODS UK General Practice Research Database (GPRD) information was used to detect acute liver disorder associated with the use of amoxicillin/clavulanic acid (hepatotoxic) or low-dose aspirin (acetylsalicylic acid [non-hepatotoxic]). Individuals newly prescribed these drugs between 1 October 2005 and 31 March 2006 were identified. Acute liver disorder cases were assessed using GPRD computer records in combination with case validation by an independent endpoint adjudication committee. Signal generation thresholds were based on the background rate of acute liver disorder in the general population. RESULTS Over a 6-month period, 8148 patients newly prescribed amoxicillin/clavulanic acid and 5577 patients newly prescribed low-dose aspirin were identified. Within this cohort, searches identified 11 potential liver disorder cases from computerized records: six for amoxicillin/clavulanic acid and five for low-dose aspirin. The independent endpoint adjudication committee refined this to four potential acute liver disorder cases for whom paper-based information was requested for final case assessment. Final case assessments confirmed no cases of acute liver disorder. The time taken for this study was 18 months (6 months for recruitment and 12 months for data management and case validation). To reach the estimated target exposure necessary to raise or rule out a signal of concern to public health, we determined that a recruitment period 2-3 times longer than that used in this study would be required. Based on the real market uptake of six commonly used medicinal products launched between 2001 and 2006 in the UK (budesonide/eformoterol [fixed-dose combination], duloxetine, ezetimibe, metformin/rosiglitazone [fixed-dose combination], tiotropium bromide and tadalafil) the target exposure would not have been reached until the fifth year of marketing using a single database. CONCLUSION It is feasible to set up a system that actively monitors drug safety using a healthcare database and an independent endpoint adjudication committee. However, future successful implementation will require multiple databases to be queried so that larger study populations are included. This requires further development and harmonization of international healthcare databases.
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Choi NK, Chang Y, Choi YK, Hahn S, Park BJ. Signal detection of rosuvastatin compared to other statins: data-mining study using national health insurance claims database. Pharmacoepidemiol Drug Saf 2010; 19:238-46. [DOI: 10.1002/pds.1902] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bate A, Evans SJW. Quantitative signal detection using spontaneous ADR reporting. Pharmacoepidemiol Drug Saf 2009; 18:427-36. [PMID: 19358225 DOI: 10.1002/pds.1742] [Citation(s) in RCA: 501] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Quantitative methods are increasingly used to analyse spontaneous reports. We describe the core concepts behind the most common methods, the proportional reporting ratio (PRR), reporting odds ratio (ROR), information component (IC) and empirical Bayes geometric mean (EBGM). We discuss the role of Bayesian shrinkage in screening spontaneous reports, the importance of changes over time in screening the properties of the measures. Additionally we discuss three major areas of controversy and ongoing research: stratification, method evaluation and implementation. Finally we give some suggestions as to where emerging research is likely to lead.
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Affiliation(s)
- A Bate
- WHO Collaborating Centre for International Drug Monitoring, Uppsala, Sweden.
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Schermer M, Bolt I, de Jongh R, Olivier B. The Future of Psychopharmacological Enhancements: Expectations and Policies. NEUROETHICS-NETH 2009. [DOI: 10.1007/s12152-009-9032-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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van Staa T, Sprafka J. Study of adverse outcomes in women using testosterone therapy. Maturitas 2009; 62:76-80. [DOI: 10.1016/j.maturitas.2008.11.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Accepted: 11/05/2008] [Indexed: 11/26/2022]
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Abstract
Current regulatory guidelines related to pharmaceutical risk minimization put most emphasis on risk communication and control of the use of drugs. Little, if any, consideration is given to those aspects of an adverse drug reaction that ultimately determine whether the risk can be minimized. However, this limited scope is unfortunate and could prevent risk minimization activities from improving drug use safety. This article attempts to present an overview of possible elements of pharmaceutical risk minimization and to place these in a framework. The promotion of drug safety through risk communication and control of use should be advanced, with more attention to actionable and evidence-based guidance relating to the 'pretreatment evaluation', and in particular the 'on-treatment management' of the patient.
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Pharmacovigilance: methods, recent developments and future perspectives. Eur J Clin Pharmacol 2008; 64:743-52. [DOI: 10.1007/s00228-008-0475-9] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Accepted: 02/14/2008] [Indexed: 10/22/2022]
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Cooper AJP, Lettis S, Chapman CL, Evans SJW, Waller PC, Shakir S, Payvandi N, Murray AB. Developing tools for the safety specification in risk management plans: lessons learned from a pilot project. Pharmacoepidemiol Drug Saf 2008; 17:445-54. [PMID: 18383441 DOI: 10.1002/pds.1576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE Following the adoption of the ICH E2E guideline, risk management plans (RMP) defining the cumulative safety experience and identifying limitations in safety information are now required for marketing authorisation applications (MAA). A collaborative research project was conducted to gain experience with tools for presenting and evaluating data in the safety specification. This paper presents those tools found to be useful and the lessons learned from their use. METHODS Archive data from a successful MAA were utilised. Methods were assessed for demonstrating the extent of clinical safety experience, evaluating the sensitivity of the clinical trial data to detect treatment differences and identifying safety signals from adverse event and laboratory data to define the extent of safety knowledge with the drug. RESULTS The extent of clinical safety experience was demonstrated by plots of patient exposure over time. Adverse event data were presented using dot plots, which display the percentages of patients with the events of interest, the odds ratio, and 95% confidence interval. Power and confidence interval plots were utilised for evaluating the sensitivity of the clinical database to detect treatment differences. Box and whisker plots were used to display laboratory data. CONCLUSIONS This project enabled us to identify new evidence-based methods for presenting and evaluating clinical safety data. These methods represent an advance in the way safety data from clinical trials can be analysed and presented. This project emphasises the importance of early and comprehensive planning of the safety package, including evaluation of the use of epidemiology data.
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Eguale T, Tamblyn R, Winslade N, Buckeridge D. Detection of Adverse Drug Events and Other Treatment Outcomes Using an Electronic Prescribing System. Drug Saf 2008; 31:1005-16. [DOI: 10.2165/00002018-200831110-00005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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