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Vicente-Oliveros N, Gramage-Caro T, Corral de la Fuente E, Delgado-Silveira E, Álvarez-Díaz AM. Analysis of adverse drug events as a way to improve cancer patient care. Eur J Hosp Pharm 2023; 31:27-30. [PMID: 35332064 PMCID: PMC10800239 DOI: 10.1136/ejhpharm-2021-003199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/08/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To define the signals that a new artificial intelligence (AI) system must emit to improve adverse drug events (ADEs) management in oral antineoplastic agents (OAA). METHODS A multidisciplinary group of experts in patient safety was set up to define what signals the new AI system must emit to improve ADEs management in OAAs. The baseline data for the new AI system were generated through an observational and ambispective study carried out in a university hospital. All patients who met the inclusion criteria were selected consecutively every working day for 6 months. The ADEs were collected by interview and by the review of health records. The ADEs were categorised according to how they could be detected: patient, analysis, examination. RESULTS The group defined what signals the AI system must emit to improve ADEs management in OAAs: a signal to educate the patient when the possible ADEs were categorised as patient, a signal as a reminder to request a blood test or a microbiological culture when the possible ADEs were categorised as analysis, and a signal as a reminder for the necessity of a clinical examination when the possible ADEs were categorised as examination. A total of 1652 ADEs were reported in the interviews (ADE-interview) with the pharmacist, and doctors noted 1989 ADEs in the health record (ADE-HR). The most frequent ADEs were identified in the patient category. CONCLUSION This study opens a new way for better management of ADEs and is the first step in the development of a future technology, which will improve the quality of life of patients.
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Affiliation(s)
| | | | - Elena Corral de la Fuente
- Early Phase Clinical Drug Development in Oncology, South Texas Accelerated Research Therapeutics (START). Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain
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Fusaroli M, Simonsen A, Borrie SA, Low DM, Parola A, Raschi E, Poluzzi E, Fusaroli R. Identifying Medications Underlying Communication Atypicalities in Psychotic and Affective Disorders: A Pharmacovigilance Study Within the FDA Adverse Event Reporting System. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:3242-3259. [PMID: 37524118 DOI: 10.1044/2023_jslhr-22-00739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
PURPOSE Communication atypicalities are considered promising markers of a broad range of clinical conditions. However, little is known about the mechanisms and confounders underlying them. Medications might have a crucial, relatively unknown role both as potential confounders and offering an insight on the mechanisms at work. The integration of regulatory documents with disproportionality analyses provides a more comprehensive picture to account for in future investigations of communication-related markers. The aim of this study was to identify a list of drugs potentially associated with communicative atypicalities within psychotic and affective disorders. METHOD We developed a query using the Medical Dictionary for Regulatory Activities to search for communicative atypicalities within the FDA Adverse Event Reporting System (updated June 2021). A Bonferroni-corrected disproportionality analysis (reporting odds ratio) was separately performed on spontaneous reports involving psychotic, affective, and non-neuropsychiatric disorders, to account for the confounding role of different underlying conditions. Drug-adverse event associations not already reported in the Side Effect Resource database of labeled adverse drug reactions (unexpected) were subjected to further robustness analyses to account for expected biases. RESULTS A list of 291 expected and 91 unexpected potential confounding medications was identified, including drugs that may irritate (inhalants) or desiccate (anticholinergics) the larynx, impair speech motor control (antipsychotics), or induce nodules (acitretin) or necrosis (vascular endothelial growth factor receptor inhibitors) on vocal cords; sedatives and stimulants; neurotoxic agents (anti-infectives); and agents acting on neurotransmitter pathways (dopamine agonists). CONCLUSIONS We provide a list of medications to account for in future studies of communication-related markers in affective and psychotic disorders. The current test case illustrates rigorous procedures for digital phenotyping, and the methodological tools implemented for large-scale disproportionality analyses can be considered a road map for investigations of communication-related markers in other clinical populations. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.23721345.
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Affiliation(s)
- Michele Fusaroli
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Arndis Simonsen
- Psychosis Research Unit, Department of Clinical Medicine, Aarhus University, Denmark
- Interacting Minds Centre, School of Culture and Society, Aarhus University, Denmark
| | - Stephanie A Borrie
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan
| | - Daniel M Low
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge
- Speech and Hearing Bioscience and Technology Program, Harvard Medical School, Boston, MA
| | - Alberto Parola
- Department of Psychology, University of Turin, Italy
- Department of Linguistics, Cognitive Science and Semiotics, School of Communication and Culture, Aarhus University, Denmark
| | - Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Elisabetta Poluzzi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Riccardo Fusaroli
- Interacting Minds Centre, School of Culture and Society, Aarhus University, Denmark
- Department of Linguistics, Cognitive Science and Semiotics, School of Communication and Culture, Aarhus University, Denmark
- Linguistic Data Consortium, School of Arts & Sciences, University of Pennsylvania, Philadelphia
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El-Dahiyat F, Abu Hammour K, Abu Farha R, Manaseer Q, Al Momanee A, Allan A, Alkhawaldeh R. Jordanians' knowledge, attitude and practice regarding adverse drug reactions reporting. Saudi Pharm J 2023; 31:1197-1201. [PMID: 37273263 PMCID: PMC10236368 DOI: 10.1016/j.jsps.2023.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/13/2023] [Indexed: 06/06/2023] Open
Abstract
Objectives The purpose of the current study was to evaluate the general public knowledge, attitudes, and practice regarding Adverse Drug Reactions (ADRs) reporting and pharmacovigilance in Jordan. Methods A cross-sectional study was conducted between July 16, 2022, and July 30, 2022, in Jordan. During the study period, an electronic survey consisting of 4 sections was administered to a convenience sample of Jordanians (aged 18 or above) using 2 social media platforms (Facebook and WhatsApp). Logistic regression analysis was used to screen the predictors of ADRs reporting by the participants. Results A total of 441 participants completed the survey. The majority of the participants (67.6%) were females, 53.1% between 26 and 45 years old. Almost all participants (96.3%) were always aware of the indication of the medications they take, the time and frequency (87.8%), and the duration of medications (84.4%). Nearly one-third of the participants (37.4%) asked about their medications' ADRs. However, the drug information leaflet was the most frequently used source of ADR information (33.3%). The majority of responders believed that both healthcare providers and consumers should report ADRs (93.4% and 80.3%, respectively). Only one-quarter of respondents (27.2%) believed that consumers could directly report ADRs through the Jordan pharmacovigilance program. The majority of patients who had experienced ADRs (70.3%) were aware that ADRs should be reported, and among them, 91.9% had reported the ADRs to healthcare providers. Furthermore, few participants (8.1%) reported it to the Jordan National Pharmacovigilance Centre (JNCP). Linear regression revealed that none of the demographic characteristics (age, gender, education, job, and social status) were affecting public reporting practice of the ADRs (P > 0.05 for all). Conclusion Respondents showed fair knowledge about adverse drug reactions and their reporting. However, there is a need to initiate educational activities and intervention programs to raise awareness about the JNPC, which will have a positive impact on public health and ensure safe medication use in Jordan.
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Affiliation(s)
- Faris El-Dahiyat
- Clinical Pharmacy Program, College of Pharmacy, Al Ain University, Al Ain, United Arab Emirates
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Khawla Abu Hammour
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, the University of Jordan, Amman, Jordan
| | - Rana Abu Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Qusai Manaseer
- Orthopedic Department, Jordan University Teaching hospital, Amman, Jordan
| | - Ala'a Al Momanee
- Pharmacy Department, Jordan University Teaching Hospital, Amman, Jordan
| | - Aya Allan
- Pharmacy Department, Jordan University Teaching Hospital, Amman, Jordan
| | - Rama Alkhawaldeh
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
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Montané E, Santesmases J. Characteristics of drug safety alerts issued by the Spanish Medicines Agency. Front Pharmacol 2023; 14:1090707. [PMID: 36794271 PMCID: PMC9922741 DOI: 10.3389/fphar.2023.1090707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/11/2023] [Indexed: 02/01/2023] Open
Abstract
Objectives: To describe the characteristics of safety alerts issued by the Spanish Medicines Agency (AEMPS) and the Spanish Pharmacovigilance System over a 7-year period and the regulatory actions they generated. Methods: A retrospective analysis was carried out of drug safety alerts published on the AEMPS website from 1 January 2013 to 31 December 2019. Alerts that were not drug-related or were addressed to patients rather than healthcare professionals were excluded. Results: During the study period, 126 safety alerts were issued, 12 of which were excluded because they were not related to drugs or were addressed to patients and 22 others were excluded as they were duplications of previous alerts. The remaining 92 alerts reported 147 adverse drug reactions (ADRs) involving 84 drugs. The most frequent source of information triggering a safety alert was spontaneous reporting (32.6%). Four alerts (4.3%) specifically addressed health issues related to children. ADRs were considered serious in 85.9% of the alerts. The most frequent ADRs were hepatitis (seven alerts) and congenital malformations (five alerts), and the most frequent drug classes were antineoplastic and immunomodulating agents (23%). Regarding the drugs involved, 22 (26.2%) were "under additional monitoring." Regulatory actions induced changes in the Summary of Product Characteristics in 44.6% of alerts, and in eight cases (8.7%), the alert led to withdrawal from the market of medicines with an unfavorable benefit/risk ratio. Conclusion: This study provides an overview of drug safety alerts issued by the Spanish Medicines Agency over a 7-year period and highlights the contribution of spontaneous reporting of ADRs and the need to assess safety throughout the lifecycle of medicines.
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Affiliation(s)
- Eva Montané
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain,*Correspondence: Eva Montané,
| | - Javier Santesmases
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Dal-Ré R, Porcher R, Rosendaal FR, Schwarzer-Daum B. Regulatory agencies disregard real-world effectiveness evidence on product labels beyond what is reasonable. J Clin Epidemiol 2023; 153:83-90. [PMID: 36371045 DOI: 10.1016/j.jclinepi.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/19/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Rafael Dal-Ré
- Epidemiology Unit, Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Raphaël Porcher
- Université de Paris, Centre of Research in Epidemiology and Statistics (CRESS-UMR1153), Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Monti M, Sullo FG, Iamurri AP, Gianni C, Silimbani P, Bartolini G, Valgiusti M, Esposito L, Montanari D, Antonini S, Frassineti GL. Recurrent pneumothorax in a patient with liposarcoma as either a complication of lung micrometastasis or a potential adverse event from antibiotic therapy: A case report. Oncol Lett 2022; 24:202. [PMID: 35720484 PMCID: PMC9178694 DOI: 10.3892/ol.2022.13324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Abstract
Spontaneous pneumothorax (PNX) is an infrequent manifestation of primary lung cancer, soft tissue sarcoma and metastasis. There are no easily accessible data in the literature regarding the correlation between PNX and antibiotics, whereas cases of PNX following chemotherapy have been observed. Only 1-10% of treatment-related adverse events are estimated to be reported to the Food and Drug Administration. The present study described a case of PNX of the left lung in a 70-year-old treatment-naive patient with retroperitoneal liposarcoma. The PNX developed after 8 days of treatment with levofloxacin and after 6 days of piperacillin/tazobactam treatment for a suspicious inflammatory area in the right lung detected by an FDG-PET scan before the patient started chemotherapy. A chest CT scan confirmed the presence of metastasis in the right lung, but neither FDG-PET/CT nor CT showed metastatic disease in the left lung. A total of 14 days after the end of the third cycle of doxorubicin (2 months after the initial diagnosis of PNX), the patient manifested a massive PNX of the right lung. In conclusion, these findings indicated that spontaneous PNX could be linked to the use of some antibiotics.
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Affiliation(s)
- Manlio Monti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’, I-47014 Meldola, Italy
| | - Francesco Giulio Sullo
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’, I-47014 Meldola, Italy
| | - Andrea Prochowski Iamurri
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’, I-47014 Meldola, Italy
| | - Caterina Gianni
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’, I-47014 Meldola, Italy
| | - Paolo Silimbani
- Oncology Pharmacy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’, I-47014 Meldola, Italy
| | - Giulia Bartolini
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’, I-47014 Meldola, Italy
| | - Martina Valgiusti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’, I-47014 Meldola, Italy
| | - Luca Esposito
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’, I-47014 Meldola, Italy
| | - Daniela Montanari
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’, I-47014 Meldola, Italy
| | - Stefano Antonini
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’, I-47014 Meldola, Italy
| | - Giovanni Luca Frassineti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’, I-47014 Meldola, Italy
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Public Awareness about Medicine Information, Safety, and Adverse Drug Reaction (ADR) Reporting in Dammam, Saudi Arabia. PHARMACY 2020; 8:pharmacy8040222. [PMID: 33218152 PMCID: PMC7712078 DOI: 10.3390/pharmacy8040222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/29/2020] [Accepted: 11/05/2020] [Indexed: 11/23/2022] Open
Abstract
This study aimed to assess public knowledge about medicine information, safety, and adverse drug reaction reporting (ADR) in Dammam, Saudi Arabia. A cross sectional study was conducted using purposive stratified sampling in different settings of Dammam city for three months (January–March 2020). The target population was identified as consumers who had used the medicines in the last 3 months. The questionnaire was adopted from the literature and was validated. Content and face validities were established, and reliability was assessed. The study was approved by the concerned ethics committee. A total of 915 participants returned completed questionnaires. A total of 54.4% participants aged between 18 and 30 years, 65.8% were females and 53.1% had obtained bachelor level education. The mean score for knowledge of medicines (K1) was 5.46 ± 1.07. The mean score for knowledge regarding medication safety (K2) was 5.94 ± 1.73. The mean score for tendency to report a suspected ADR (T1) was 3.43 ± 1.57. Gender was a determinant of knowledge regarding medication safety (K2) (p < 0.01) and ADR reporting tendency (T1) (p < 0.01). The marital status of patients was a determinant for both knowledge of medicines (K1) (p < 0.01) and, knowledge regarding medication safety (K2) (p < 0.01). The results of this study highlighted that although the scores for knowledge of medicines, and tendency to report ADR were better, the score for knowledge regarding medication safety was unsatisfactory.
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Penedones A, Alves C, Batel Marques F. A comparison between two recommendations to conduct and report systematic reviews on drug's safety. Syst Rev 2019; 8:238. [PMID: 31619279 PMCID: PMC6796334 DOI: 10.1186/s13643-019-1167-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 09/21/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Several recommendations are available to conduct and report a systematic review of adverse drug reactions. This study is aimed at identifying and comparing the methodologies of the two most commonly used recommendations to conduct and report systematic reviews on drug's safety. METHODS Two systematic reviews were conducted following the recommendations "Cochrane Handbook for Systematic Reviews of Interventions" and "Systematic Reviews' Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare." The methods of each recommendation were characterized, and the results and the discussion of each systematic review were also evaluated. RESULTS The methodologies of both recommendations are similar. The review question was structured. Both recommendations suggest to include pre- and post-marketing data. The recommended data sources differed and, consequently, the results of the systematic reviews (37 vs. 35 studies). Other aspects of search literature were identical. Different tools are suggested to evaluate the methodological quality of the included studies. For case reports, both recommendations only report some questions that may be helpful to assess risk of bias. The reporting of the results and discussion is also identical for both recommendations. CONCLUSIONS Few methodological differences were observed between the analyzed recommendations to conduct a systematic review on drug's safety. Combining their methods into a single and recognized recommendation could be of great value.
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Affiliation(s)
- Ana Penedones
- Centre for Health Technology Assessment and Drug Research (CHAD), Association for Innovation and Biomedical Research on Light and Image (AIBILI), Azinhaga Sta. Comba, Celas, 3000-548 Coimbra, Portugal
- Laboratory of Social Pharmacy and Public Health, School of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Carlos Alves
- Centre for Health Technology Assessment and Drug Research (CHAD), Association for Innovation and Biomedical Research on Light and Image (AIBILI), Azinhaga Sta. Comba, Celas, 3000-548 Coimbra, Portugal
- Laboratory of Social Pharmacy and Public Health, School of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Francisco Batel Marques
- Centre for Health Technology Assessment and Drug Research (CHAD), Association for Innovation and Biomedical Research on Light and Image (AIBILI), Azinhaga Sta. Comba, Celas, 3000-548 Coimbra, Portugal
- Laboratory of Social Pharmacy and Public Health, School of Pharmacy, University of Coimbra, Coimbra, Portugal
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Wang CH, Li CH, Hsieh R, Fan CY, Hsu TC, Chang WC, Hsu WT, Lin YY, Lee CC. Proton pump inhibitors therapy and the risk of pneumonia: a systematic review and meta‐analysis of randomized controlled trials and observational studies. Expert Opin Drug Saf 2019; 18:163-172. [DOI: 10.1080/14740338.2019.1577820] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Cheng-Han Li
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ronan Hsieh
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Cheng-Yi Fan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tze-Chun Hsu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Che Chang
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wan-Ting Hsu
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Yu-Ya Lin
- Department of Pharmacy, E-Da hospital, Kaohsiung, Taiwan
| | - Chien-Chang Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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Alves C, Mendes D, Batel Marques F. Statins and risk of cataracts: A systematic review and meta-analysis of observational studies. Cardiovasc Ther 2019; 36:e12480. [PMID: 30597753 DOI: 10.1111/1755-5922.12480] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/21/2018] [Accepted: 12/28/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Two previous meta-analyses evaluated the risk of cataracts associated with statins, but did not include relevant studies suggesting a cataractogenic effect. AIMS The aim of this systematic review and meta-analysis of observational studies is to evaluate such association considering the latest published evidence. METHODS A literature search was conducted to identify observational, comparative studies evaluating the risk of developing cataracts in patients treated with statins. A meta-analysis was performed to estimate odds ratios (ORs). Results were stratified according to the following studies' subgroups: design, methodological quality, method of diagnosis of cataract, patients' age, and median follow-up. Meta-regressions evaluated the influence of the following risk factors: smoking, hypertension, corticosteroids, selective serotonin reuptake inhibitors (SSRI), diabetes mellitus, and cardiovascular disease. RESULTS Twenty-one studies were included. Treatment with statins was associated with an increased risk of cataracts [OR: 1.11 (95% CI: 1.02-1.21); P = 0.017; I2 = 97.5%]. This risk remained statistically significant among case-controls, good methodological quality studies, studies with length of follow-up ≥5 years and those which outcome was cataract surgery. Between-studies heterogeneity was high among all risk estimates. Meta-regressions identified an inverse relationship between the risk of cataracts and the proportion of diabetic patients in the studies. CONCLUSIONS The results point out an increased risk of cataract development with statins. However, since the magnitude of the effect is low and between-studies heterogeneity is high, the extent in which these results have impact on the benefit/risk ratio of statins is difficult to ascertain due to the uncertainty of the findings.
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Affiliation(s)
- Carlos Alves
- Laboratory of Social Pharmacy and Public Health, School of Pharmacy, University of Coimbra, Coimbra, Portugal.,CHAD-Centre for Health Technology Assessment and Drug Research, Coimbra Regional Pharmacovigilance Unit (UFC), AIBILI-Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Diogo Mendes
- CHAD-Centre for Health Technology Assessment and Drug Research, Coimbra Regional Pharmacovigilance Unit (UFC), AIBILI-Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Francisco Batel Marques
- Laboratory of Social Pharmacy and Public Health, School of Pharmacy, University of Coimbra, Coimbra, Portugal.,CHAD-Centre for Health Technology Assessment and Drug Research, Coimbra Regional Pharmacovigilance Unit (UFC), AIBILI-Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
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Yoon D, Song I, Noh Y, Li J, Shin JY. Consistency of listed indications and contraindications between the U.S., the U.K., Japan, and Korea on prescription drug labels. Regul Toxicol Pharmacol 2018; 98:168-170. [PMID: 30056245 DOI: 10.1016/j.yrtph.2018.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 05/04/2018] [Accepted: 07/25/2018] [Indexed: 11/17/2022]
Abstract
Inclusion of indications and contraindications in drug labeling is essential for drug approval. Little is known regarding how well new drug information labels agree across countries. To compare the number of indications and contraindications on the labels of drugs in the U.S., U.K., Japan, and Korea, we selected 81 new drugs approved in these countries between 2008 and 2016 and assessed the number of indications and contraindications on each label. Average and median numbers with standard deviations were presented for the 81-drug set, and for subsets grouped according to drug class. Correlation analyses were conducted to estimate Pearson and concordance correlation coefficients. No significant difference was observed across countries in the number of indications, the average being 1.69, 1.67, 1.54, and 1.51 in the U.S., the U.K., Korea, and Japan (p = 0.31), respectively. By contrast, substantial variation was observed in the number of contraindications, the average being 1.54, 2.42, 3.53, and 3.00 in the U.S., the U.K., Korea, and Japan (p < 0.001), respectively. Pearson correlation coefficients comparing contraindications were 0.40, 0.48, and 0.47 for U.S.-U.K., U.S.-Korea, and U.S.-Japan, but 0.83, 0.73, and 0.71 for U.K.-Korea, U.K.-Japan, and Korea-Japan, respectively (p < 0.01). There is consistency in the number of indications, but a substantial discrepancy in contraindications listed in drug labeling across countries. Further study is warranted to improve global harmonization of contraindication listings.
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Affiliation(s)
- Dongwon Yoon
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Inmyung Song
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Yunha Noh
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Junqing Li
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea.
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Bouquet É, Star K, Jonville-Béra AP, Durrieu G. Pharmacovigilance in pediatrics. Therapie 2018; 73:171-180. [DOI: 10.1016/j.therap.2017.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 11/15/2017] [Indexed: 12/20/2022]
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Lane S, Lynn E, Shakir S. Investigation assessing the publicly available evidence supporting postmarketing withdrawals, revocations and suspensions of marketing authorisations in the EU since 2012. BMJ Open 2018; 8:e019759. [PMID: 29362275 PMCID: PMC5786078 DOI: 10.1136/bmjopen-2017-019759] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To assess the sources of publicly available evidence supporting withdrawal, revocation or suspension of marketing authorisations ('regulatory actions') due to safety reasons in the EU since 2012 and to investigate the time taken since initial marketing authorisation to reach these regulatory decisions. SETTING This investigation examined the sources of evidence supporting 18 identified prescription medicinal products which underwent regulatory action due to safety reasons within the EU in the period 1 July 2012 to 31 December 2016. RESULTS Eighteen single or combined active substances ('medicinal products') withdrawn, revoked or suspended within the EU for safety reasons between 2012 and 2016 met the inclusion criteria. Case reports were most commonly cited, supporting 94.4% of regulatory actions (n=17), followed by randomised controlled trial, meta-analyses, animal and in vitro, ex vivo or in silico study designs, each cited in 72.2% of regulatory actions (n=13). Epidemiological study designs were least commonly cited (n=8, 44.4%). Multiple sources of evidence contributed to 94.4% of regulatory decisions (n=17). Death was the most common adverse drug reaction leading to regulatory action (n=5; 27.8%), with four of these related to medication error or overdose. Median (IQR) time taken to reach a decision from the start of regulatory review was found to be 204.5 days (143, 535 days) and decreased across the study period. Duration of marketing prior to regulatory action, from the medicinal product's authorisation date, increased across the period 2012-2016. CONCLUSIONS The sources of evidence supporting pharmacovigilance regulatory activities appear to have changed since implementation of Directive 2010/84/EU and Regulation (EU) No. 1235/2010. This, together with a small improvement in regulatory efficiency, suggests progress towards more rapid regulatory decisions based on more robust evidence. Future research should continue to monitor sources of evidence supporting regulatory decisions and the time taken to reach these decisions over time.
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Affiliation(s)
- Samantha Lane
- Drug Safety Research Unit, Southampton, Hampshire, UK
| | - Elizabeth Lynn
- Drug Safety Research Unit, Southampton, Hampshire, UK
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Saad Shakir
- Drug Safety Research Unit, Southampton, Hampshire, UK
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
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Qatmosh SA, Koni AA, Qeeno BG, Arandy DA, Abu-Hashia MW, Al-hroub BM, Zyoud SH. Comparative analysis of package inserts of local and imported antihypertensive medications in Palestine. BMC Public Health 2017; 17:741. [PMID: 28946858 PMCID: PMC5613627 DOI: 10.1186/s12889-017-4782-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 09/21/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Package inserts (PIs) as a reliable reference for patients and health care providers should provide accurate, complete and up-to-date information. The purpose of the current study is to assess and compare the PIs of antihypertensive agents locally produced in Palestine and their imported counterparts. METHODS Thirty-five PIs were assessed for the presence of 31 information statements using a scoring method. Word counting of 20 headings and subheadings was used to evaluate and compare local and imported PIs for information quantity. RESULTS None of the analysed PIs fulfilled the criteria. All of them included the brand name, active ingredients, indications, directions for use, adverse drug reactions, drug-drug interactions, pregnancy and lactation considerations, and storage. Whereas none of them, either local or imported PIs, included the shelf life and instructions to convert tablets or capsules into liquid forms. Additionally, only one (5%) imported and no (0%) local PIs mentioned the duration of therapy. Moreover, 93.4% of local PIs were deficient in areas regarding the inactive ingredients and date of last revision, and 86.7% did not mention the drug dose and possibility of tablet splitting. Furthermore, the maximum dose was not indicated in 90% of imported and 86.7% of local PIs. In general, imported PIs contained more detailed information than their local counterparts, where the range of differences in medians between the local and imported PIs was from 1.5-fold for pregnancy considerations to >42.00-fold for the effect on the ability to drive and use machines. CONCLUSIONS The findings of this study revealed the superiority of imported over local PIs in both quality and quantity of information provided. This emphasises the need for appropriate measures to be taken by the Ministry of Health and local manufacturers to ensure efficiency of local PIs in providing accurate, complete and up-to-date information.
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Affiliation(s)
- Sandra A. Qatmosh
- 0000 0004 0631 5695grid.11942.3fPharmD Program, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Amer A. Koni
- 0000 0004 0631 5695grid.11942.3fPharmD Program, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Baraa G. Qeeno
- 0000 0004 0631 5695grid.11942.3fPharmD Program, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Dina A. Arandy
- 0000 0004 0631 5695grid.11942.3fPharmD Program, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Maysa W. Abu-Hashia
- 0000 0004 0631 5695grid.11942.3fPharmD Program, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Bahaa M. Al-hroub
- 0000 0004 0631 5695grid.11942.3fPharmD Program, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Sa’ed H. Zyoud
- 0000 0004 0631 5695grid.11942.3fPoison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- 0000 0004 0631 5695grid.11942.3fDepartment of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
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Shah RR. Importance of Publishing Adverse Drug Reaction Case Reports: Promoting Public Health and Advancing Pharmacology and Therapeutics. DRUG SAFETY - CASE REPORTS 2017; 4:11. [PMID: 28933008 PMCID: PMC5607154 DOI: 10.1007/s40800-017-0053-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article, which encourages physicians to publish case reports of adverse drug reactions (ADRs), is a review of how well-documented published case reports have contributed to promoting public safety and health and thus served to advance basic pharmacology. The origin of a number of regulatory guidelines can ultimately be traced to safety concerns triggered by such reports. It illustrates how case reports of ADRs, when coupled with simultaneous monitoring of drug pharmacokinetics, have also led to further investigations resulting in major advances in pharmacology, especially pharmacogenetics, mechanisms of drug-drug interactions and modulation of drug metabolism during inflammatory co-morbidities. Published case reports differ significantly from spontaneous case reports since they enjoy quality-compliant peer review and an immediate wider visibility among the readership, triggering others to report similar cases, and ultimately leading to prescribing restrictions on or withdrawals of the drug from the market depending on the risk. Therefore, the reporter should not be discouraged by (a) the unusual or bizarre nature of the reaction; (b) the interval, however long, from commencing drug administration to the onset of the suspected reaction; (c) however well-known the drug or the period for which it has been on the market; and (d) any pressure not to publish. Case reports should be published in reputable journals that are searchable through databases such as PubMed.
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Outcomes From the First 6 Years of Operation of the Central Portugal Pharmacovigilance Unit. J Patient Saf 2016; 16:e136-e142. [PMID: 27997457 DOI: 10.1097/pts.0000000000000273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of this study was to analyze and characterize the outcomes of the Central Portugal Regional Pharmacovigilance Unit over a 6-year period. METHODS Spontaneous reports received between January 2009 and December 2014 were considered. The annual reporting ratios were estimated. The cases were characterized according to their seriousness, previous description, causality assessment, reporting professional, pharmacotherapeutic groups of the suspected drugs, and type of adverse drug reactions most frequently reported. RESULTS The Pharmacovigilance Unit received 1277 reports that contained 3222 adverse events. In 2014, the reporting rate was estimated at 124 reports per million inhabitants. Sixty-five percent of the reports were assessed as serious. Seventy-three percent of the cases were assessed as being at least possibly related with the suspected drug. Physicians reported 49% of the cases. The suspected drugs most frequently reported were "anti-infectives for systemic use" (n = 494, 38%). The most frequently reported adverse events were "general disorders and administration site conditions" (n = 667, 21%). CONCLUSIONS Despite the continuous efforts carried out by the Central Portugal Regional Pharmacovigilance Unit in promoting spontaneous reports of suspected adverse drug reactions, the results, although representing a contribution to the postmarketing safety monitoring of drugs, are still modest illustrating the need to promote the adherence of health-care professionals to the pharmacovigilance system and to increase their reporting rates of suspected ADRs.
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Inácio P, Cavaco A, Airaksinen M. The value of patient reporting to the pharmacovigilance system: a systematic review. Br J Clin Pharmacol 2016; 83:227-246. [PMID: 27558545 DOI: 10.1111/bcp.13098] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 08/07/2016] [Accepted: 08/15/2016] [Indexed: 12/18/2022] Open
Abstract
AIMS Current trends in pharmacovigilance systems are veering towards patient involvement in spontaneous reporting of adverse drug reactions (ADRs). The aim of the current systematic review was to identify what is known and what remains unknown with respect to patient reporting to pharmacovigilance systems. METHODS A systematic literature search was conducted in PubMed, CINAHL, Journals@Ovid and the Cochrane Library. Studies were included if they contained: (i) reviews about patient reporting; (ii) evaluation of patient reports to national or supranational pharmacovigilance authorities; (iii) a comparison between patient and healthcare professional (HCP) reports submitted to pharmacovigilance authorities; and (iv) surveys of patient experiences, opinions and awareness about reporting ADRs. The methodological quality of the studies was assessed according to principles of Grading of Recommendations, Assessment, Development and Evaluations (GRADE). RESULTS A total of thirty four studies were included. Five of the studies were reviews (two of which systematic reviews), fourteen retrospective observational studies, nine surveys and six applied mixed research methods. Patient reporting has the advantages of bringing novel information about ADRs. It provides a more detailed description of ADRs, and reports about different drugs and system organ classes when compared with HCP reporting. In addition, patients describe the severity and impact of ADRs on daily life, complementing information derived from HCPs. Patient reporting is relatively rare in most countries. CONCLUSIONS Patient reporting adds new information, and perspective about ADRs in a way otherwise unavailable. This can contribute to better decision-making processes in regulatory activities. The present review identified gaps in knowledge that should be addressed to improve our understanding of the full potential and drawbacks of patient reporting.
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Affiliation(s)
- Pedro Inácio
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Afonso Cavaco
- iMed.ULisboa Research Institute for Medicines and Pharmaceutical Sciences, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
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Mendes D, Alves C, Batel Marques F. Testing the usefulness of the number needed to treat to be harmed (NNTH) in benefit-risk evaluations: case study with medicines withdrawn from the European market due to safety reasons. Expert Opin Drug Saf 2016; 15:1301-12. [PMID: 27467204 DOI: 10.1080/14740338.2016.1217989] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To explore the usefulness of number needed to treat to be harmed (NNTH), in benefit-risk assessments, by studying the agreement between NNTH values and withdrawals of medicines from European market due to safety reasons. METHODS Medicines with data from longitudinal studies were included. Studies were identified from European Medicines Agency's Reports. Meta-analyses were performed to pool odds ratios (OR) with 95% confidence-intervals (CI). Published control event rates were applied to ORs to calculate NNTHs (95%CI) for selected adverse events. RESULTS NNTH (95%CI) decreased from pre- to post-marketing for the eight medicines included: peripheral neuropathy (∞ vs. 12[non-significant; NS] with almitrine; heart valve disease with benfluorex (∞ vs. NNTH ranging from 7[4-13] to 7[5-9]); myopathy (-4096[NS] vs. 797[421-1690]), new-onset diabetes (113[NS] vs. 390[425-778]), bleeding (∞ vs. 517[317-1153]), and infection (∞ vs. 253[164-463]) with niacin-laropiprant; psychiatric disorders (12[7-34] vs. 9[5-24]) with rimonabant; myocardial infarction (MI) [-1305 vs. 270[89-4362]) with rofecoxib; MI (-510 vs. NNTH ranging from 152[55-4003] to 568[344-1350]) with rosiglitazone; cardiovascular events (∞ vs. 245[129-1318]) with sibutramine; and liver injury (∞ vs. 5957[NS]) with ximelagatran. CONCLUSION NNTH have potential of use as a supportive tool in benefit-risk re-evaluations of medicines and may help regulators to making decisions on drug safety.
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Affiliation(s)
- Diogo Mendes
- a AIBILI - Association for Innovation and Biomedical Research on Light and Image , CHAD - Centre for Health Technology Assessment and Drug Research , Coimbra , Portugal.,b School of Pharmacy , University of Coimbra , Coimbra , Portugal
| | - Carlos Alves
- a AIBILI - Association for Innovation and Biomedical Research on Light and Image , CHAD - Centre for Health Technology Assessment and Drug Research , Coimbra , Portugal.,b School of Pharmacy , University of Coimbra , Coimbra , Portugal
| | - Francisco Batel Marques
- a AIBILI - Association for Innovation and Biomedical Research on Light and Image , CHAD - Centre for Health Technology Assessment and Drug Research , Coimbra , Portugal.,b School of Pharmacy , University of Coimbra , Coimbra , Portugal
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Penedones A, Mendes D, Alves C, Marques FB. Drug-Induced Ocular Adverse Reactions: Review of the Safety Alerts Issued During the Last Decade. J Ocul Pharmacol Ther 2015; 31:258-68. [DOI: 10.1089/jop.2014.0165] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ana Penedones
- CHAD–Centre for Health Technology Assessment and Drug Research, AIBILI–Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
- School of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Diogo Mendes
- CHAD–Centre for Health Technology Assessment and Drug Research, AIBILI–Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
- School of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Carlos Alves
- CHAD–Centre for Health Technology Assessment and Drug Research, AIBILI–Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
- School of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Francisco Batel Marques
- CHAD–Centre for Health Technology Assessment and Drug Research, AIBILI–Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
- School of Pharmacy, University of Coimbra, Coimbra, Portugal
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21
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Drug-safety alerts issued by regulatory authorities: usefulness of meta-analysis in predicting risks earlier. Eur J Clin Pharmacol 2014; 70:745-56. [DOI: 10.1007/s00228-014-1670-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 03/18/2014] [Indexed: 11/26/2022]
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Mendes D, Alves C, Batel-Marques F. Safety profiles of adalimumab, etanercept and infliximab: a pharmacovigilance study using a measure of disproportionality in a database of spontaneously reported adverse events. J Clin Pharm Ther 2014; 39:307-13. [DOI: 10.1111/jcpt.12148] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 02/06/2014] [Indexed: 11/29/2022]
Affiliation(s)
- D. Mendes
- CHAD - Centre for Health Technology Assessment and Drug Research; AIBILI - Association for Innovation and Biomedical Research on Light; Coimbra Portugal
- Central Portugal Regional Pharmacovigilance Unit; AIBILI - Association for Innovation and Biomedical Research on Light; Coimbra Portugal
- School of Pharmacy; University of Coimbra; Coimbra Portugal
| | - C. Alves
- CHAD - Centre for Health Technology Assessment and Drug Research; AIBILI - Association for Innovation and Biomedical Research on Light; Coimbra Portugal
- Central Portugal Regional Pharmacovigilance Unit; AIBILI - Association for Innovation and Biomedical Research on Light; Coimbra Portugal
- School of Pharmacy; University of Coimbra; Coimbra Portugal
- Health Sciences Research Centre; University of Beira Interior; Covilhã Portugal
| | - F. Batel-Marques
- CHAD - Centre for Health Technology Assessment and Drug Research; AIBILI - Association for Innovation and Biomedical Research on Light; Coimbra Portugal
- Central Portugal Regional Pharmacovigilance Unit; AIBILI - Association for Innovation and Biomedical Research on Light; Coimbra Portugal
- School of Pharmacy; University of Coimbra; Coimbra Portugal
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