1
|
Meng M, Ge B, Lei W, Wu Y, Tian M, Lu Y, Shao T, Yang Y, Luo X, Luo J, Gao Y, Li Q, Chen Y. Paediatric off-label use of drugs in Gansu, China: a multicentre cross-sectional study. BMJ Open 2024; 14:e078126. [PMID: 38740506 PMCID: PMC11097813 DOI: 10.1136/bmjopen-2023-078126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 04/19/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVE To examine the current prevalence and cost of paediatric off-label drug prescriptions in Gansu, China, and the potential influencing factors. DESIGN The prevalence of off-label prescriptions in paediatrics was evaluated according to the National Medical Products Administration drug instructions in the China Pharmaceutical Reference (China Pharmaceutical Reference, MCDEX) database. The evidence of the prescription was determined by existing clinical practice guidelines and the Thomson Grade in the Micromedex 2021 compendium. We used logistic regression to investigate the characteristics that influence paediatric off-label drug use after single-factor regression analysis. SETTING A multicentre cross-sectional study of outpatient paediatric prescriptions in 196 secondary and tertiary hospitals in Gansu Province, China, in March and September 2020. RESULTS We retrieved 104 029 paediatric prescriptions, of which 39 480 (38.0%) contained off-label use. The most common diseases treated by off-label drugs were respiratory system diseases (n=15 831, 40.1%). A quarter of off-label prescriptions had adequate evidence basis (n=10 130, 25.6%). Unapproved indications were the most common type of off-label drug use (n=25 891, 65.6%). A total of 1177 different drugs were prescribed off-label, with multienzyme tablets being the most common drug (n=1790, 3.5%). The total cost of the prescribed off-label drugs was ¥106 116/day. Off-label prescriptions were less frequent in tertiary than in secondary hospitals. Topical preparations were more commonly prescribed off-label than other types of drugs. Senior-level clinicians prescribed drugs off-label more often than intermediate and junior clinicians. CONCLUSION Off-label drug use is widespread in paediatric practice in China. Three-quarters of the prescriptions may potentially include inappropriate medication use, resulting in a daily economic burden of about ¥81 000 in 2020 in Gansu Province with 25 million inhabitants. The management of off-label drug use in paediatrics in China needs improvement.
Collapse
Affiliation(s)
- Min Meng
- Chevidence Lab Child & Adolescent Health Department, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatric, Chongqing, China
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, China
| | - Bin Ge
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, China
| | - Wenjuan Lei
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, China
| | - Yuqiong Wu
- Department of Pharmacy, Second Provincial People's Hospital of Gansu, Lanzhou, China
| | - Min Tian
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, China
| | - Yali Lu
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, China
| | - Tingji Shao
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, China
| | - Yan Yang
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, China
| | - Xufei Luo
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Jiawei Luo
- West China Biomedical Big Data Center, West China School of Medicine/West China Hospital of Sichuan University, Chengdu, China
| | - Yang Gao
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, China
- School of Pharmacy, Ningxia Medical University, Yinchuan, China
| | - Qiu Li
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatric, Chongqing, China
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yaolong Chen
- Chevidence Lab Child & Adolescent Health Department, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatric, Chongqing, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017),School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
- Lanzhou University GRADE Center, Lanzhou, China
| |
Collapse
|
2
|
Fontanals S, Esteve A, González A, Ibáñez C, Mesía R, Clopés A. Real-world treatment outcomes of immune checkpoint inhibitors used off-label in oncology: A comprehensive cancer institution experience. Pharmacol Res Perspect 2024; 12:e1167. [PMID: 38193611 PMCID: PMC10775181 DOI: 10.1002/prp2.1167] [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: 07/24/2023] [Revised: 10/26/2023] [Accepted: 12/11/2023] [Indexed: 01/10/2024] Open
Abstract
Off-label use (OLU) is quite common in oncology due to the complexity of cancer and the time-consuming regulatory process. However, outcomes of OLU in cancer treatment remain unclear. This study aimed to evaluate the overall survival (OS), event-free survival (EFS), duration of treatment (DOT), and reason for treatment discontinuation in patients receiving immune checkpoint inhibitors (ICI) as OLU for solid tumors from 2011 to 2020. The study collected data on 356 episodes (353 patients), with a median age of 64.4 years, 36.2% women, and 14.6% ECOG ≥ 2. Median OS was 15.7 (11.9-18.7) months, and median EFS was 5.4 (3.8-6.6) months. Men, patients with metastatic disease or ECOG-PS higher than 1, had worse survival outcomes. The findings derived from this study provide valuable information regarding the real-world use of ICI-OLU and contributes to enhancing the decision-making process for individuals with cancer. Further research on immunotherapy outcomes of OLU in cancer is needed.
Collapse
Affiliation(s)
- Sandra Fontanals
- Pharmacy Department, Catalan Institute of Oncology (ICO)‐ Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), School of MedicineUniversitat de Barcelona (UB), ICO, Hospitalet de LlobregatBarcelonaSpain
| | - Anna Esteve
- Research Management Unit (UGR), Catalan Institute of Oncology (ICO), Medical Oncology Department, ICO‐Badalona, Applied Research Group in Oncology (B‐ARGO)Germans Trias I Pujol Research Institute (IGTP), ICOBadalonaSpain
| | - Andrea González
- Medical Oncology DepartmentCatalan Institute of Oncology (ICO), Badalona‐Applied Research Group in Oncology (B‐ARGO) Germans Trias I Pujol Research Institute (IGTP), ICOBadalonaSpain
| | - Cristina Ibáñez
- Pharmacy Department, Catalan Institute of Oncology (ICO)‐HospitaletBlanquerna Ramon Llull University, School of Health Sciences, ICO, Hospitalet de LlobregatBarcelonaSpain
| | - Ricard Mesía
- Medical Oncology DepartmentCatalan Institute of Oncology (ICO), Badalona‐Applied Research Group in Oncology (B‐ARGO) Germans Trias I Pujol Research Institute (IGTP), ICOBadalonaSpain
| | - Ana Clopés
- Pharmacy Department, Catalan Institute of Oncology (ICO)‐Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), School of Health SciencesBlanquerna Ramon Llull University, ICO, Hospitalet de LlobregatBarcelonaSpain
| |
Collapse
|
3
|
Gross AJ, Pisano CE, Khunsriraksakul C, Spratt DE, Park HS, Sun Y, Wang M, Zaorsky NG. Real-World Data: Applications and Relevance to Cancer Clinical Trials. Semin Radiat Oncol 2023; 33:374-385. [PMID: 37684067 DOI: 10.1016/j.semradonc.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Randomized controlled trials (RCTs) are the gold standard for comparative-effectiveness research (CER). Since the 1980s, there has been a rise in the creation and utilization of large national cancer databases to provide readily accessible "real-world data" (RWD). This review article discusses the role of RCTs in oncology, and the role of RWD from the national cancer database in CER. RCTs remain the preferred study type for CER because they minimize confounding and bias. RCTs have challenges to conduct, including extensive time and resources, but these factors do not impact the internal validity of the result. Generalizability and external validity are potential limitations of RCTs. RWD is ideal for studying cancer epidemiology, patterns of care, disparities in care delivery, quality-of-care evaluation, and applicability of RCT data in specific populations excluded from RCTs. However, retrospective databases with RWD have limitations in CER due to unmeasured confounders and are often suboptimal in identifying causal treatment effects.
Collapse
Affiliation(s)
- Andrew J Gross
- University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
| | - Courtney E Pisano
- University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
| | | | - Daniel E Spratt
- University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
| | - Henry S Park
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
| | - Yilun Sun
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Ming Wang
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Nicholas G Zaorsky
- University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH.
| |
Collapse
|
4
|
Fontanals S, Esteve A, González A, Ibáñez C, Martínez J, Mesía R, Clopés A. Real-world treatment outcomes of medicines used in special situations (off-label and compassionate use) in oncology and hematology: A retrospective study from a comprehensive cancer institution. Cancer Med 2023; 12:17112-17125. [PMID: 37496404 PMCID: PMC10501253 DOI: 10.1002/cam4.6360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/17/2023] [Accepted: 07/09/2023] [Indexed: 07/28/2023] Open
Abstract
PURPOSE Medicines in special situations (MSS) refer to off-label or to unlicensed drugs under investigation (compassionate use). Our objectives were to evaluate characteristics and to estimate overall survival (OS), event-free survival (EFS), and the duration of treatment (DT) of MSS used for cancer treatment at a multicentre comprehensive cancer institution. METHODS Retrospective cohort study on adult cancer patients for whom an MSS treatment was requested (January 2011-December 2020). A descriptive analysis was performed and median OS and EFS and 95% confidence intervals (CIs) were estimated. Survival curves were stratified by type of tumor, ECOG (Eastern Cooperative Oncology Group) performance status (PS), age, sex, treatment stage and type of drug (mechanism of action and target). RESULTS Treatment was initiated in 2092 episodes (1930 patients) out of 2377 MSS episodes (2189 patients) requested, 33% for hematological treatment and 87% for advanced stage cancer. Median OS (months) was 21.1 (95% CI 19.4-22.7), median EFS was 5.6 (95% CI 5.1-6.0) months, and median DT was 4.5 [0.0; 115.3] months. OS and EFS statistically significantly favored female patients, ECOG PS ≥2 episodes showed worse OS and EFS outcomes (p < 0.0001). Statistically significant differences in survival were found within solid and hematological cancer, disease stage, drug mechanism of action, and type of cancer (p < 0.001) but not for age. Survival outcomes by tumor subtype and drug are presented both globally and separately based on disease stage. CONCLUSION MSS uses are practiced across almost all cancer types, mostly for advanced disease. ECOG PS ≥2, along with advanced disease, was related to worse survival. Information about real-world outcomes is valuable and contributes to better decision-making regarding MSS and our experience in this field could be of interest for other colleagues.
Collapse
Affiliation(s)
- Sandra Fontanals
- Pharmacy Department, Catalan Institute of Oncology (ICO)‐Hospitalet, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), School of MedicineUniversitat de Barcelona (UB)BarcelonaSpain
| | - Anna Esteve
- Research Management Unit (Unitat de Gestió de la recerca: UGR), Medical Oncology Department, Catalan Institute of Oncology (ICO), Badalona‐Applied Research Group in Oncology (B‐ARGO)Germans Trias I Pujol Research Institute (IGTP)BadalonaSpain
| | - Andrea González
- Medical Oncology DepartmentCatalan Institute of Oncology (ICO), Badalona‐Applied Research Group in Oncology (B‐ARGO) Germans Trias I Pujol Research Institute (IGTP)BadalonaSpain
| | - Cristina Ibáñez
- Pharmacy Department, Catalan Institute of Oncology (ICO)‐HospitaletSchool of Health Sciences, Blanquerna Ramon Llull UniversityBarcelonaSpain
| | - Javier Martínez
- Pharmacy DepartmentCatalan Institute of Oncology (ICO)‐HospitaletBarcelonaSpain
| | - Ricard Mesía
- Medical Oncology DepartmentCatalan Institute of Oncology (ICO), Badalona‐Applied Research Group in Oncology (B‐ARGO) Germans Trias I Pujol Research Institute (IGTP)BadalonaSpain
| | - Ana Clopés
- Pharmacy Department, Catalan Institute of Oncology (ICO)‐Hospitalet, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL)School of Health Sciences, Blanquerna Ramon Llull UniversityBarcelonaSpain
| |
Collapse
|
5
|
Sans-Pola C, Danés I, Bosch JÀ, Marrero-Álvarez P, Cortés J, Agustí A. Off-label use of rituximab in patients with systemic lupus erythematosus with extrarenal disease activity: a retrospective study and literature review. Front Med (Lausanne) 2023; 10:1159794. [PMID: 37305139 PMCID: PMC10248418 DOI: 10.3389/fmed.2023.1159794] [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: 02/15/2023] [Accepted: 04/21/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Off-label rituximab is commonly used for patients with systemic lupus erythematosus (SLE) with extrarenal disease activity. Methods The outcomes and tolerability of rituximab in adult patients with non-renal SLE treated at our hospital from 2013 to 2020 were described. Patients were followed-up until December 2021. Data were retrieved from electronic medical records. Response was classified into complete, partial or no response according to the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI 2 K)-based definitions. Results A total of 44 cycles were administered to 33 patients. Median age was 45 years and 97% were female. Median follow-up was 5.9 years (IQR 3.7-7.2). The most frequent symptoms that motivated rituximab use were thrombocytopenia (30.3%), arthritis (30.3%), neurological manifestations (24.2%) and cutaneous lupus (15.2%). After most treatment cycles a partial remission was achieved. The median SLEDAI-2 K score declined from 9 (IQR 5-13) to 1.5 (IQR 0-4) (p < 0.00001). The median number of flares significantly declined after receiving rituximab. Platelet counts significantly improved in patients with thrombocytopenia and patients with skin disorders or neurological manifestations also had a partial or complete response. Only 50% of patients with a predominant joint involvement had either a complete or a partial response. The median time to relapse after the first cycle was 1.6 years (95% CI, 0.6-3.1). Anti-dsDNA levels decreased significantly after rituximab from a median of 64.3 (IQR 12-373.9) to 32.7 (IQR 10-173), p = 0.00338. The most frequent adverse events were infusion-related reactions (18.2%) and infections (57.6%). All patients needed further treatment to maintain remission or to treat new flares. Conclusion A partial or complete response was documented after most rituximab cycles in patients with non-renal SLE. Patients with thrombocytopenia, neurolupus, and cutaneous lupus had better response than those with a predominant joint involvement.
Collapse
Affiliation(s)
- Carla Sans-Pola
- Department of Clinical Pharmacology, Vall d’Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Clinical Pharmacology Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Barcelona, Spain
| | - Immaculada Danés
- Department of Clinical Pharmacology, Vall d’Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Clinical Pharmacology Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Barcelona, Spain
| | - Josep Àngel Bosch
- Department of Internal Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Patricia Marrero-Álvarez
- Pharmacy Department, Vall d’Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Josefina Cortés
- Department of Internal Medicine, Vall d’Hebron Hospital Universitari, Barcelona Hospital Campus, Barcelona, Spain
| | - Antònia Agustí
- Department of Clinical Pharmacology, Vall d’Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Clinical Pharmacology Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Barcelona, Spain
| |
Collapse
|
6
|
Gasol M, Paco N, Guarga L, Bosch JÀ, Pontes C, Obach M. Early Access to Medicines: Use of Multicriteria Decision Analysis (MCDA) as a Decision Tool in Catalonia (Spain). J Clin Med 2022; 11:jcm11051353. [PMID: 35268443 PMCID: PMC8910942 DOI: 10.3390/jcm11051353] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 01/13/2023] Open
Abstract
Early access to medicines allows the prescription of a medicine before it is available in the public formulary to patients with severe or rare diseases with high unmet needs who have no authorised therapeutic alternatives available. In this context, consistent decision making is difficult, and a systematic assessment procedure could be useful to tackle complex situations and guarantee the equity of medicines’ access. A multidisciplinary panel (MP) conducted four workshops to develop an early access framework based on a reflective multiple criteria decision analysis (MCDA). A set of 12 criteria was agreed: eight quantitative (severity of disease, urgency, efficacy, safety, internal and external validity, therapeutic benefit and plausibility) and four qualitative (therapeutic alternative, existence of precedents, management impact and costs). Quantitative criteria were weighted using a five-point scale. The relative importance of quantitative criteria had mean weights from 4.7 to 3.6, showing its relevance in the decisions. The framework was tested using two case studies, and reliability was assessed by re-test. The re-test revealed no statistical differences, indicating the consistency and replicability of the framework developed. MCDA may help to structure discussions for heterogeneous treatment requests, providing predictability and robustness in decision making involving sensitive and complex situations.
Collapse
Affiliation(s)
- Montse Gasol
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain;
- Catalan Health Service (CatSalut), 08007 Barcelona, Spain; (N.P.); (L.G.); (M.O.)
- Digitalization for the Sustainability of the Healthcare System (DS3), Bellvitge Biomedical Research Institute (IDIBELL), 08006 Barcelona, Spain
| | - Noelia Paco
- Catalan Health Service (CatSalut), 08007 Barcelona, Spain; (N.P.); (L.G.); (M.O.)
| | - Laura Guarga
- Catalan Health Service (CatSalut), 08007 Barcelona, Spain; (N.P.); (L.G.); (M.O.)
| | - Josep Àngel Bosch
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain;
| | - Caridad Pontes
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain;
- Catalan Health Service (CatSalut), 08007 Barcelona, Spain; (N.P.); (L.G.); (M.O.)
- Digitalization for the Sustainability of the Healthcare System (DS3), Bellvitge Biomedical Research Institute (IDIBELL), 08006 Barcelona, Spain
- Correspondence:
| | - Mercè Obach
- Catalan Health Service (CatSalut), 08007 Barcelona, Spain; (N.P.); (L.G.); (M.O.)
| |
Collapse
|
7
|
Sans-Pola C, Agustí A, Bosch JÀ, Agraz I, Alerany C, Danés I. Off-Label Use of Rituximab in Patients with Different Types of Nephropathies in a Tertiary Hospital: A Retrospective Study. J Clin Med 2021; 10:4941. [PMID: 34768461 PMCID: PMC8584949 DOI: 10.3390/jcm10214941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/20/2021] [Accepted: 10/24/2021] [Indexed: 11/17/2022] Open
Abstract
Off-label use of rituximab is commonly requested for patients with resistant nephropathies. The outcomes and tolerability of rituximab in adult patients with nephropathy treated at our hospital (from 2013 to 2018) were described. Data were retrieved from electronic medical records. Response was classified as complete remission (CR), partial remission (PR), or no response (NR) according to the KDIGO criteria. A total of 89 requests were received for 61 patients. Median age was 58 years (45.9% female). Idiopathic membranous nephropathy (MN) (n = 30) was the most frequent indication, followed by minimal change disease (MCD) (n = 15) and secondary membranoproliferative glomerulonephritis (MPGN) (n = 12). Three patients with focal segmental glomerulosclerosis (FSGS) were included. After most treatment cycles in MN, a CR or PR was observed; median proteinuria levels significantly decreased for these patients (6000 mg/24h (IQR 3584-10,300) vs. 1468.8 (IQR 500-4604.25), p < 0.01). In MPGN, no response was documented after 46.7% of rituximab cycles. A CR or PR was described with the majority of rituximab cycles in MCD, with a significant decrease in proteinuria (6000 mg/24 h (IQR 4007-11,426) vs. 196.8 (IQR 100-1300), p = 0.013). No cycles produced a response in FSGS. Mean CD19+ B-cell decreased in all types of nephropathy (10.44% vs. 0.29%, p < 0.0001). Eleven patients presented infusion-related reactions, and 17 presented infectious complications. The majority of patients with MN and MCD had complete or partial responses; however, neither MPGN nor FSGS had encouraging results.
Collapse
Affiliation(s)
- Carla Sans-Pola
- Department of Clinical Pharmacology, Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain; (C.S.-P.); (I.D.)
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Immunomediated Diseases and Innovative Therapies Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain
| | - Antònia Agustí
- Department of Clinical Pharmacology, Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain; (C.S.-P.); (I.D.)
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Immunomediated Diseases and Innovative Therapies Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain
| | - Josep Àngel Bosch
- Department of Internal Medicine, Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain;
- Department of Internal Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Irene Agraz
- Department of Nephrology, Referrer in Complex Glomerular Diseases in Adults, Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain;
| | - Carmen Alerany
- Pharmacy Service, Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain;
| | - Immaculada Danés
- Department of Clinical Pharmacology, Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain; (C.S.-P.); (I.D.)
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Immunomediated Diseases and Innovative Therapies Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain
| |
Collapse
|
8
|
Delate T, Hansen ML, Gutierrez AC, Le KN. Indications for Rituximab Use in an Integrated Health Care Delivery System. J Manag Care Spec Pharm 2020; 26:832-838. [PMID: 32584674 PMCID: PMC10391100 DOI: 10.18553/jmcp.2020.26.7.832] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Rituximab is a top-selling biologic that was first approved by the FDA in 1997 for a non-Hodgkin lymphoma orphan indication. It has since been approved for additional orphan indications, with rheumatoid arthritis as the only FDA-approved, nonorphan indication. Evidence suggests that rituximab is frequently used off-label, but information on its use over time and indications for use in the United States is limited. OBJECTIVE To assess incident rituximab use over time in an integrated health care delivery system. METHODS This was a cross-sectional, retrospective study. Data were collected from administrative databases and manual chart reviews. Patients who received their first rituximab infusion between October 1, 2009, and December 31, 2017, and who were not a part of a clinical trial were included. Indication for use (FDA-approved orphan/nonorphan, off-label) was determined. Proportions of use were assessed over time. Multivariable logistic regression modeling was performed to assess factors associated with receiving rituximab for an FDA-approved indication. RESULTS A total of 1,674 patients were included. The majority (66.4%) of patients had an FDA-approved indication, with lymphoma being the most common approved indication (66.4%). The most common indication for off-label use was neurologic conditions (72.7%), predominantly demyelinating diseases. Off-label indication use increased from 1.2% in 2009 to 55.6% in 2017. Factors associated with rituximab use for an FDA-approved indication included increased age (adjusted odds ratio [AOR] = 1.05, 95% CI = 1.04-1.07) and increased burden of chronic disease (chronic disease score: AOR = 1.07, 95% CI = 1.02-1.12; Charlson Comorbidity Index score: AOR = 3.52, 95% CI = 3.03-4.10). CONCLUSIONS Off-label use of rituximab grew dramatically over the course of the study. With the recent FDA approval of the rituximab biosimilar and its expected lower price, off-label use will likely continue to rise. Opportunities for cost savings and to ensure appropriate use of these medications should be evaluated. DISCLOSURES This study was funded by Kaiser Permanente. All authors except Hansen are employed by Kaiser Permanente. Hansen has nothing to disclose. Preliminary results were presented at the Mountain States Conference for Residents and Preceptors in May 2019 in Salt Lake City, UT, and at an encore presentation October 2019 at the American College of Clinical Pharmacy Annual Meeting in New York, NY.
Collapse
Affiliation(s)
- Thomas Delate
- Drug Use Management, Kaiser Permanente National Pharmacy, Aurora, Colorado, and Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora
| | - Margaret L. Hansen
- Neurology Department, Wexner Medical Center, The Ohio State University, Columbus
| | | | - Kim N. Le
- Drug Use Management, Kaiser Permanente National Pharmacy, Downey, California
| |
Collapse
|
9
|
Use of non-formulary high-cost medicines in an Australian public hospital. Int J Clin Pharm 2019; 41:920-931. [PMID: 31161497 DOI: 10.1007/s11096-019-00853-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
Background Clinicians prescribe high-cost medicines for rare diseases and nonapproved indications when conventional therapies have failed. Objective To examine the use of non-formulary high-cost medicines at an Australian public hospital. Methods Retrospective audit of individual patient use applications for nonformulary medicines costing more than $5000 AUD per year at a large tertiary referral hospital in Adelaide, South Australia over a 12-month study period from January 2015 to December 2015. Main outcome measures Total cost of non-formulary high-cost medicines, medication class, indications for use, level of supporting evidence and proposed monitoring outcomes. Results Eighty-seven individual patient use applications were examined. All except one were approved, at a total cost of $1,339,203 AUD. The most common drug classes were anti-CD20 (n = 33, 38%), combined antiretrovirals (n = 10, 11%) and TNF-alpha antagonists (n = 10, 11%). There were 56 indications for these medicines with the majority being inflammatory conditions (n = 52, 60%), followed by infections (n = 14, 16%) and malignancies (n = 14, 16%). Of the first-time individual patient use applications (n = 63), there were 25 applications (40%) that provided a case series as supporting evidence. Approximately half of new individual patient use applications (n = 32) proposed an objective monitoring outcome, but few (n = 13, 21%) contained sufficient information to allow a third party to determine efficacy of the medication. Conclusions Non-formulary high-cost medicines are being used for a broad range of indications based largely on low levels of evidence. Prospective definition of an adequate response to treatment and reporting of these outcomes is required to improve the evidence-base and to aid decision-making for subsequent treatment courses.
Collapse
|
10
|
Omodeo P. Down-titration of omalizumab in a patient with chronic spontaneous urticaria. J DERMATOL TREAT 2018; 29:12-13. [PMID: 30351196 DOI: 10.1080/09546634.2018.1529379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Omalizumab was demonstrated to be effective in patients with chronic urticaria resistant to antihistamines and is recommended as an add-on, third line treatment for such subjects. Patient and results: This article reports the history of a patient affected by chronic spontaneous urticaria, unresponsive to antihistamines, who received omalizumab, according to a personalized schedule. Prolonged administration of low dosage drug provided a good and long-lasting control of symptoms. Conclusion: This experience suggests that omalizumab could be used at low dose, with personalized plans, to reduce the risk of adverse events and costs of treatment.
Collapse
Affiliation(s)
- Pinuccia Omodeo
- a Ambulatorio di Allergologia - SOC Malattie Apparato Respiratorio , Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo , Alessandria , Italy
| |
Collapse
|
11
|
Zeitoun JD, Ross JS, Atal I, Vivot A, Downing NS, Baron G, Ravaud P. Postmarketing studies for novel drugs approved by both the FDA and EMA between 2005 and 2010: a cross-sectional study. BMJ Open 2017; 7:e018587. [PMID: 29273664 PMCID: PMC5778291 DOI: 10.1136/bmjopen-2017-018587] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To characterise postmarketing studies for drugs that were newly approved by the US Food and Drug Administration and the European Medicines Agency. DESIGN AND SETTING Cross-sectional analysis of postmarketing studies registered in ClinicalTrials.gov until September 2014 for all novel drugs approved by both regulators between 2005 and 2010. Regulatory documents from both agencies were used. PRIMARY AND SECONDARY OUTCOME MEASURES All identified postmarketing studies were classified according to planned enrolment, funding, status and geographical location, and we determined whether studies studied the originally approved indication. RESULTS Overall, 69 novel drugs approved between 2005 and 2010 were eligible for inclusion. A total of 6679 relevant postmarketing studies were identified; 5972 were interventional (89.4%). The median number of studies per drug was 55 (IQR 33-119) and median number of patients to be enrolled per study was 60 (IQR 28-183). Industry was the primary sponsor of 2713 studies (40.6%) and was a primary or secondary sponsor in 4176 studies (62.5%). In all, 2901 studies (43.4%) were completed, 487 (7.3%) terminated, 1013 (15.2%) active yet not recruiting, 1895 (28.4%) recruiting and 319 (4.8%) not yet recruiting. A total of 80% of studies were conducted in only one country and 84.4% took place in Europe and/or North America; 2441 (36.5%) studied another indication than the originally approved indication. Studies designed in the originally approved indication were found to be more industry-sponsored than others 68.7%vs53.7%; P<0.0001. CONCLUSIONS Postmarketing pharmaceutical research was highly variable and predominantly located in North America and Europe. Postmarketing studies were frequently designed to study indications other than the originally approved one. Although some findings were reassuring, others question the lack of coordination of postmarketing research.
Collapse
Affiliation(s)
- Jean-David Zeitoun
- Centre d’Épidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- Department of Gastroenterology and Nutrition, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Department of Proctology, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Joseph S Ross
- Department of Internal Medicine, Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Ignacio Atal
- Centre d’Épidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne Cité (CRESS), METHODS Team, Paris, France
| | - Alexandre Vivot
- Centre d’Épidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne Cité (CRESS), METHODS Team, Paris, France
| | - Nicholas S Downing
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gabriel Baron
- Centre d’Épidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne Cité (CRESS), METHODS Team, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Philippe Ravaud
- Centre d’Épidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne Cité (CRESS), METHODS Team, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
| |
Collapse
|
12
|
Sicherheit und Wirksamkeitshinweise zum Off-label-Einsatz von Biologikatherapien nach Versagen
konventioneller Therapien bei Patienten mit entzündlich rheumatischen Erkrankungen. Z Rheumatol 2017; 77:28-39. [DOI: 10.1007/s00393-017-0330-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
13
|
Abstract
The off-label use of medicines is a common and extensive clinical practice. Omalizumab has been licensed for use in severe allergic asthma and chronic urticaria. Omalizumab dosing was based on body weight and baseline serum IgE concentration. All patients are required to have a baseline IgE between 30 and 700 IU/ml and body weight not more than 150 kg. The use of off-label drugs may lead to several problems including adverse effects and an increased risk/benefit balance. In this article, there are summarized off-label uses of omalizumab in the last recent years in diseases in which IgE maybe or certainly has a corner role such as allergic rhinitis, allergic bronchopulmonary aspergillosis, anaphylaxis, keratoconjunctivitis, food allergy, drug allergy, urticaria, angioedema, non-atopic asthma, atopic dermatitis, nasal polyps, Churg-Strauss syndrome, eosinophilic otitis media, chronic rhinosinusitis, bullous pemphigoid, contact dermatitis, and others. Use in pregnancy asthmatic women and pre-co-administration with specific immunotherapy will also be revised.
Collapse
Affiliation(s)
- David El-Qutob
- Unit of Allergy, University Hospital of La Plana in Vila-Real, Carretera Vila-Real-Burriana Km. 0.5, Vila-Real, Castellon, 12540, Spain.
| |
Collapse
|
14
|
Calderazzo M, Rende P, Gambardella P, De Sarro G, Gallelli L. A Case of Interstitial Lung Disease Probably Related to Rituximab Treatment. DRUG SAFETY - CASE REPORTS 2016; 2:8. [PMID: 27747720 PMCID: PMC5005575 DOI: 10.1007/s40800-015-0010-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A 44-year-old male developed interstitial lung disease (ILD) during treatment with rituximab (375 mg/m2 weekly intravenous × 4 weeks) for the management of immune thrombocytopenia (ITP). After 1 month of treatment he developed dyspnea, fever (38.9 °C), an increase of C-reactive protein (CRP) and white blood cells with hypoxemia, and decreased platelets. Chest X-ray and high-resolution computed tomography revealed diffuse bilateral lung infiltrates. He was diagnosed with severe ILD; rituximab was discontinued, and treatment with fluticasone combined with salmeterol, methylprednisolone, and omeprazole was started, with an improvement of symptoms over 15 days with normalization in CRP at 30 days. A Naranjo assessment score of 6 was obtained, indicating a probable relationship between the patient's symptoms and the suspect drug. In conclusion, in ITP patients treated with rituximab, we suggest evaluating pulmonary endpoints through pharmaco-epidemiological observational studies.
Collapse
Affiliation(s)
| | - Pierandrea Rende
- Department of Health Science, University of Catanzaro, Viale Europa, Catanzaro, Italy.,Operative Unit of Clinical Pharmacology and Pharmacovigilance, Azienda Ospedaliera Mater Domini, Via T Campanella 115, Catanzaro, Italy
| | - Paolo Gambardella
- Department of Infectious Disease, ASP Lamezia Terme, Catanzaro, Italy
| | - Giovambattista De Sarro
- Department of Health Science, University of Catanzaro, Viale Europa, Catanzaro, Italy.,Operative Unit of Clinical Pharmacology and Pharmacovigilance, Azienda Ospedaliera Mater Domini, Via T Campanella 115, Catanzaro, Italy
| | - Luca Gallelli
- Department of Health Science, University of Catanzaro, Viale Europa, Catanzaro, Italy. .,Operative Unit of Clinical Pharmacology and Pharmacovigilance, Azienda Ospedaliera Mater Domini, Via T Campanella 115, Catanzaro, Italy.
| |
Collapse
|
15
|
Levêque D. Off-label use of targeted therapies in oncology. World J Clin Oncol 2016; 7:253-257. [PMID: 27081648 PMCID: PMC4826971 DOI: 10.5306/wjco.v7.i2.253] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/23/2015] [Accepted: 01/04/2016] [Indexed: 02/06/2023] Open
Abstract
Off-label use is defined by the prescription of a marketed drug outside the conditions described in the summary of product characteristics. In oncology, off-label prescribing of targeted therapies may occur in patients with other tumor types expressing the same target. Agents associated to phenotypic approaches such as therapies against the tumoral vasculature (anti-angiogenic drugs) and new immunotherapies (checkpoint inhibitors) also carry the potential of alternative indications or combinations. Off-label use of targeted therapies is little documented and appears to be in the same range than that regarding older drugs with wide variations among agents. When compared with older agents, off-label use of targeted therapies is probably more rational through tumoral genotyping but is faced with a limited clinical support, reimbursement challenges related to the very high pricing and the cost of genotyping or molecular profiling, when applicable.
Collapse
|
16
|
Hawcutt DB, Cooney L, Oni L, Pirmohamed M. Precision Dosing in Children. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2016. [DOI: 10.1080/23808993.2016.1138845] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
17
|
Ghinea N, Lipworth W, Kerridge I. Off-Label Promotion of Prescription Medicine: Is It Ever Justifiable? Ther Innov Regul Sci 2015; 49:359-363. [PMID: 30222394 DOI: 10.1177/2168479015570337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Off-label promotion has attracted intense scrutiny from regulators in recent decades, resulting in many pharmaceutical companies paying hefty penalties for illegal marketing practices. At the same time, the pharmaceutical industry has accused governments of applying double standards by encouraging the use of cheaper off-label alternatives to registered treatments, and defended their "right" to promote off-label drugs on freedom of speech grounds. However, the debate about off-label promotion and the prescribing that results has largely failed to address the issue that really matters-what impact does off-label promotion and prescribing have on patients and the health system? This paper explores the benefits and problems with off-label prescribing to determine whether off-label promotion is ever justified and, if so, under what conditions.
Collapse
Affiliation(s)
- Narcyz Ghinea
- 1 St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Wendy Lipworth
- 2 Centre for Values, Ethics & Law in Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Ian Kerridge
- 2 Centre for Values, Ethics & Law in Medicine, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
18
|
Salat D, Llop R, Aguilera C, Danés I, Bosch M, Asensio C, Castañeda F, Esterlich E, Vallano A. Therapeutic enquiries about biological agents as a tool to identify safety aspects and patterns of use. Eur J Hosp Pharm 2015; 23:161-165. [PMID: 31156839 DOI: 10.1136/ejhpharm-2015-000770] [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: 08/05/2015] [Revised: 09/22/2015] [Accepted: 10/12/2015] [Indexed: 12/12/2022] Open
Abstract
Background Biotechnological agents (BA) are increasingly being used in clinical practice. We aimed to determine, whether enquiries about them to a therapeutic consultation service have also become more frequent, and to describe the information requested in these consultations. Methods We retrospectively reviewed 14 104 therapeutic consultations collected in a computerised database between 2000 and 2014. Enquiries about BA (monoclonal antibodies, fusion proteins or cytokine antagonists) were chosen. Information on the type of BA, underlying condition, type of enquiry and affiliation of the enquirer was retrieved and compared with data from consultations about other agents. Results During the study period, 365 enquiries about 30 different BA were received. Only 4% of them were received before 2004, while 48.8% were received after 2010. Rituximab, infliximab, adalimumab and etanercept were most frequently enquired about. Agent selection (n=184) and/or adverse effects (n=174) were the most frequent reasons for making an enquiry. Most enquiries about an agent selection were made about an off-label use (n=164), mainly for systemic autoimmune diseases (n=61). Over half of the enquiries about adverse effects were about their teratogenic potential (n=96). Enquiries about BA more often requested an opinion (87.7% vs 77.7%) were made by physicians (89.9% vs 76.9%), from a hospital (81.6% vs 44.5%) and regarded a specific patient (87.4% vs 74.5%). Conclusions Therapeutic consultations about BA are increasing. Most of them are related to uncertainties of health professionals regarding any new medicine: their off-label use, actual adverse effects or the teratogenic potential of the involved agents.
Collapse
Affiliation(s)
- D Salat
- Clinical Pharmacology Service, Hospital Universitari Vall d'Hebron, Fundació Institut Català de Farmacologia, Barcelona, Spain
| | - R Llop
- Clinical Pharmacology Service, Hospital Universitari Vall d'Hebron, Fundació Institut Català de Farmacologia, Barcelona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Aguilera
- Clinical Pharmacology Service, Hospital Universitari Vall d'Hebron, Fundació Institut Català de Farmacologia, Barcelona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - I Danés
- Clinical Pharmacology Service, Hospital Universitari Vall d'Hebron, Fundació Institut Català de Farmacologia, Barcelona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Bosch
- Clinical Pharmacology Service, Hospital Universitari Vall d'Hebron, Fundació Institut Català de Farmacologia, Barcelona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Asensio
- Clinical Pharmacology Service, Hospital Universitari Vall d'Hebron, Fundació Institut Català de Farmacologia, Barcelona, Spain
| | - F Castañeda
- Clinical Pharmacology Service, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - E Esterlich
- Clinical Pharmacology Service, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - A Vallano
- Clinical Pharmacology Service, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Pathology and Experimental Therapeutics, Universitat de Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| |
Collapse
|
19
|
Sutherland A, Waldek S. It is time to review how unlicensed medicines are used. Eur J Clin Pharmacol 2015; 71:1029-35. [PMID: 26153083 PMCID: PMC4532700 DOI: 10.1007/s00228-015-1886-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/05/2015] [Indexed: 11/26/2022]
Abstract
The safe and effective use of medicines is an integral part of the medicine safety agenda. We present a phenomenological topic review of the literature relating to the use of unlicensed medicines (ULM). There is evidence to demonstrate that the use of ULM is associated with increased incidence of adverse drug reactions, and that despite advances in medicine regulation and guidance from professional organisations, the use of ULM in at risk populations has not reduced. There is also evidence to suggest that patients and their carers are not being provided with adequate information about their medicines and that ULM are being used where safer licensed alternatives are available. This is contrary to the philosophy of "patient-focussed care". We conclude that organisational governance processes and professional guidelines have not kept pace with regulatory developments or changes in legal and ethical understanding. We recommend that governance procedures for ULM be updated across healthcare settings to ensure that patients are involved in the decisions made about their medicines including the regulatory status of the medicine. This includes ensuring adequate consent is obtained from the patient (or their advocate). We also recommend that professional bodies clarify their position on when ULM can be used instead of licensed medicines to ensure that licensed medicines are used wherever possible. In the current economic environment, commissioners and clinicians must resist the temptation to use lower-quality ULM in place of licensed ones to cut costs. We go on to recommend areas of further research including the extent of ULM prescribing where licensed alternatives exist and the geographical and social factors that influence clinician prescribing of ULM.
Collapse
Affiliation(s)
- Adam Sutherland
- />Royal Manchester Children’s Hospital, Oxford Road, Manchester, M13 9WL UK
| | | |
Collapse
|