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Barberio J, Hernandez RK, Naimi AI, Patzer RE, Kim C, Lash TL. Characterizing Fit-for-Purpose Real-World Data: An Assessment of a Mother-Infant Linkage in the Japan Medical Data Center Claims Database. Clin Epidemiol 2024; 16:31-43. [PMID: 38313043 PMCID: PMC10838663 DOI: 10.2147/clep.s429246] [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: 08/01/2023] [Accepted: 12/13/2023] [Indexed: 02/06/2024] Open
Abstract
Purpose Observational postapproval safety studies are needed to inform medication safety during pregnancy. Real-world databases can be valuable for supporting such research, but fitness for regulatory purpose must first be vetted. Here, we demonstrate a fit-for-purpose assessment of the Japan Medical Data Center (JMDC) claims database for pregnancy safety regulatory decision-making. Patients and Methods The Duke-Margolis framework considers a database's fitness for regulatory purpose based on relevancy (capacity to answer the research question based on variable availability and a sufficiently sized, representative population) and quality (ability to validly answer the research question based on data completeness and accuracy). To assess these considerations, we examined descriptive characteristics of infants and pregnancies among females ages 12-55 years in the JMDC between January 2005 and March 2022. Results For relevancy, we determined that critical data fields (maternal medications, infant major congenital malformations, covariates) are available. Family identification codes permitted linkage of 385,295 total mother-infant pairs, 57% of which were continuously enrolled during pregnancy. The prevalence of specific congenital malformation subcategories and maternal medical conditions were representative of the general population, but preterm births were below expectations (3.6% versus 5.6%) in this population. For quality, our methods are expected to accurately identify the complete set of mothers and infants with a shared health insurance plan. However, validity of gestational age information was limited given the high proportion (60%) of missing live birth delivery codes coupled with suppression of infant birth dates and inaccessibility of disease codes with gestational week information. Conclusion The JMDC may be well suited for descriptive studies of pregnant people in Japan (eg, comorbidities, medication usage). More work is needed to identify a method to assign pregnancy onset and delivery dates so that in utero medication exposure windows can be defined more precisely as needed for many regulatory postapproval pregnancy safety studies.
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Affiliation(s)
- Julie Barberio
- Department of Epidemiology, Emory University, Atlanta, GA, USA
- Center for Observational Research, Amgen, Inc, Thousand Oaks, CA, USA
| | | | - Ashley I Naimi
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Rachel E Patzer
- Department of Epidemiology, Emory University, Atlanta, GA, USA
- Regenstrief Institute, Indianapolis, IN, USA
| | - Christopher Kim
- Center for Observational Research, Amgen, Inc, Thousand Oaks, CA, USA
| | - Timothy L Lash
- Department of Epidemiology, Emory University, Atlanta, GA, USA
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2
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Hernandez RK, Nakasian SS, Bollinger L, Bradbury BD, Jick SS, Muntner P, Ng E, Chia V. Changes in Medication Use During Pregnancy for Women with Chronic Conditions: An Analysis of Claims Data. Ther Innov Regul Sci 2022; 57:570-579. [PMID: 36562933 DOI: 10.1007/s43441-022-00489-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Evaluation of drug safety during pregnancy is dependent on the number of exposed women during routine clinical practice with data available for analysis. We examined medication fills in pregnant and nonpregnant women within select disease cohorts: general population, migraine, diabetes, and hyperlipidemia to explore the potential use of claims data to assess medication use and safety during pregnancy. METHODS This cohort study, using IBM MarketScan® Research Databases claims data, included women 10-54 years of age with pregnancy resulting in a liveborn infant between January 2010 and September 2015 and matched nonpregnant women. Medication use (antidepressants, antihypertensives, sedatives, glucose-lowering medications, antiepileptics, antipsychotics, lipid-lowering medications) was abstracted from pharmacy claims 180 days before last menstrual period through 180 days postdelivery. RESULTS Among 753,760 women in the general pregnancy population (including 73,268 migraine, 50,155 hyperlipidemia, and 8361 diabetes; non-exclusive cohorts), antidepressants, antihypertensives, and sedatives were the most commonly used medications during pregnancy. Medications of interest were less commonly used in the pregnancy cohort than in the matched nonpregnant cohort within each time period (e.g., 3.7% vs 13.1% antidepressant use in 1st trimester). Most prescription fills were less common during pregnancy then pre-pregnancy. Post-pregnancy, prescription fills increased to or exceeded pre-pregnancy levels, except antihypertensive and glucose-lowering medications, which increased during pregnancy. CONCLUSIONS Medication use among pregnant women was low and different from that among matched nonpregnant women. The underlying size of large commercial claims databases offer opportunities for efficient evaluation of potential safety concerns, particularly for rare drug exposures, compared to traditional pregnancy registries.
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Affiliation(s)
- Rohini K Hernandez
- Center for Observational Research, Amgen Inc., One Amgen Center Dr, Thousand Oaks, CA, 91320, USA.
| | | | | | - Brian D Bradbury
- Center for Observational Research, Amgen Inc., One Amgen Center Dr, Thousand Oaks, CA, 91320, USA
| | - Susan S Jick
- Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Boston, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, USA
| | - Eric Ng
- Global Patient Safety, Amgen Inc., Thousand Oaks, USA
| | - Victoria Chia
- Center for Observational Research, Amgen Inc., One Amgen Center Dr, Thousand Oaks, CA, 91320, USA
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3
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Dolk H, Damase‐Michel C, Morris JK, Loane M. COVID-19 in pregnancy-what study designs can we use to assess the risk of congenital anomalies in relation to COVID-19 disease, treatment and vaccination? Paediatr Perinat Epidemiol 2022; 36:493-507. [PMID: 35234297 PMCID: PMC9115419 DOI: 10.1111/ppe.12840] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/07/2021] [Accepted: 11/08/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The COVID-19 pandemic has accelerated pregnancy outcome research, but little attention has been given specifically to the risk of congenital anomalies (CA) and first trimester exposures. OBJECTIVES We reviewed the main data sources and study designs used internationally, particularly in Europe, for CA research, and their strengths and limitations for investigating COVID-19 disease, medications and vaccines. POPULATION We classify research designs based on four data sources: a) spontaneous adverse event reporting, where study subjects are positive for both exposure and outcome, b) pregnancy exposure registries, where study subjects are positive for exposure, c) congenital anomaly registries, where study subjects are positive for outcome and d) population healthcare data where the entire population of births is included, irrespective of exposure and outcome. STUDY DESIGN Each data source allows different study designs, including case series, exposed pregnancy cohorts (with external comparator), ecological studies, case-control studies and population cohort studies (with internal comparator). METHODS The quality of data sources for CA studies is reviewed in relation to criteria including diagnostic accuracy of CA data, size of study population, inclusion of terminations of pregnancy for foetal anomaly, inclusion of first trimester COVID-19-related exposures and use of an internal comparator group. Multinational collaboration models are reviewed. RESULTS Pregnancy exposure registries have been the main design for COVID-19 pregnancy studies, but lack detail regarding first trimester exposures relevant to CA, or a suitable comparator group. CA registries present opportunities for improving diagnostic accuracy in COVID-19 research, especially when linked to other data sources. Availability of inpatient hospital medication use in population healthcare data is limited. More use of ongoing mother-baby linkage systems would improve research efficiency. Multinational collaboration delivers statistical power. CONCLUSIONS Challenges and opportunities exist to improve research on CA in relation to the COVID-19 pandemic and future pandemics.
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Rogers JR, Pavisic J, Ta CN, Liu C, Soroush A, Cheung YK, Hripcsak G, Weng C. Leveraging electronic health record data for clinical trial planning by assessing eligibility criteria's impact on patient count and safety. J Biomed Inform 2022; 127:104032. [PMID: 35189334 PMCID: PMC8920749 DOI: 10.1016/j.jbi.2022.104032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To present an approach on using electronic health record (EHR) data that assesses how different eligibility criteria, either individually or in combination, can impact patient count and safety (exemplified by all-cause hospitalization risk) and further assist with criteria selection for prospective clinical trials. MATERIALS AND METHODS Trials in three disease domains - relapsed/refractory (r/r) lymphoma/leukemia; hepatitis C virus (HCV); stages 3 and 4 chronic kidney disease (CKD) - were analyzed as case studies for this approach. For each disease domain, criteria were identified and all criteria combinations were used to create EHR cohorts. Per combination, two values were derived: (1) number of eligible patients meeting the selected criteria; (2) hospitalization risk, measured as the hazard ratio between those that qualified and those that did not. From these values, k-means clustering was applied to derive which criteria combinations maximized patient counts but minimized hospitalization risk. RESULTS Criteria combinations that reduced hospitalization risk without substantial reductions on patient counts were as follows: for r/r lymphoma/leukemia (23 trials; 9 criteria; 623 patients), applying no infection and adequate absolute neutrophil count while forgoing no prior malignancy; for HCV (15; 7; 751), applying no human immunodeficiency virus and no hepatocellular carcinoma while forgoing no decompensated liver disease/cirrhosis; for CKD (10; 9; 23893), applying no congestive heart failure. CONCLUSIONS Within each disease domain, the more drastic effects were generally driven by a few criteria. Similar criteria across different disease domains introduce different changes. Although results are contingent on the trial sample and the EHR data used, this approach demonstrates how EHR data can inform the impact on safety and available patients when exploring different criteria combinations for designing clinical trials.
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Affiliation(s)
- James R. Rogers
- Department of Biomedical Informatics, Columbia University, New York, NY
| | - Jovana Pavisic
- Department of Pediatrics, Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Columbia University Irving Medical Center, New York, NY
| | - Casey N. Ta
- Department of Biomedical Informatics, Columbia University, New York, NY
| | - Cong Liu
- Department of Biomedical Informatics, Columbia University, New York, NY
| | - Ali Soroush
- Department of Biomedical Informatics, Columbia University, New York, NY,Division of Gastroenterology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | | | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY,Medical Informatics Services, New York-Presbyterian Hospital, New York, NY
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, New York, NY, United States.
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5
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Belleudi V, Fortinguerra F, Poggi FR, Perna S, Bortolus R, Donati S, Clavenna A, Locatelli A, Davoli M, Addis A, Trotta F. The Italian Network for Monitoring Medication Use During Pregnancy (MoM-Net): Experience and Perspectives. Front Pharmacol 2021; 12:699062. [PMID: 34248644 PMCID: PMC8262612 DOI: 10.3389/fphar.2021.699062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/04/2021] [Indexed: 11/25/2022] Open
Abstract
There is an acute need for research to acquire high-quality information on the use of medicines in pregnancy, both in terms of appropriateness and safety. For this purpose, the Italian Medicines Agency established a Network for Monitoring Medication use in pregnancy (MoM-Net) through the conduction of population-based studies using administrative data available at regional level. This paper aimed to describe the experiences and challenges within the network. MoM-Net currently involves eight regions and several experts from public and academic institutions. The first study conducted aimed to identify drug use before, during and after pregnancy investigating specific therapeutic categories, analysing regional variability and monitoring drug use in specific subpopulations (i.e. foreign women/multiple pregnancies). Aggregated demographic, clinical, and prescription data were analysed using a distributed network approach based on common data model. The study population included all women delivering during 2016–2018 in the participating regions (n = 449,012), and corresponding to 59% of deliveries in Italy. Seventy-three per cent of the cohort had at least one drug prescription during pregnancy, compared to 57% before and 59% after pregnancy. In general, a good adherence to guidelines for pregnant women was found although some drug categories at risk of inappropriateness, such as progestins and antibiotics, were prescribed. A strong variability in the use of drugs among regions and in specific subpopulations was observed. The MoM-Net represents a valuable surveillance system on the use of medicines in pregnancy, available to monitor drug categories at high risk of inappropriateness and to investigate health needs in specific regions or subpopulations.
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Affiliation(s)
- Valeria Belleudi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Francesca R Poggi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Renata Bortolus
- Directorate General for Preventive Health - Office 9, Ministry of Health, Rome, Italy
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Antonio Clavenna
- Laboratory for Mother and Child Health, Department of Public Health - Istituto di Ricerche Farmacologiche Mario Negri IRCSS, Milan, Italy
| | - Anna Locatelli
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Monza, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Antonio Addis
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
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Rogers JR, Hripcsak G, Cheung YK, Weng C. Clinical comparison between trial participants and potentially eligible patients using electronic health record data: A generalizability assessment method. J Biomed Inform 2021; 119:103822. [PMID: 34044156 DOI: 10.1016/j.jbi.2021.103822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To present a generalizability assessment method that compares baseline clinical characteristics of trial participants (TP) to potentially eligible (PE) patients as presented in their electronic health record (EHR) data while controlling for clinical setting and recruitment period. METHODS For each clinical trial, a clinical event was defined to identify patients of interest using available EHR data from one clinical setting during the trial's recruitment timeframe. The trial's eligibility criteria were then applied and patients were separated into two mutually exclusive groups: (1) TP, which were patients that participated in the trial per trial enrollment data; (2) PE, the remaining patients. The primary outcome was standardized differences in clinical characteristics between TP and PE per trial. A standardized difference was considered prominent if its absolute value was greater than or equal to 0.1. The secondary outcome was the difference in mean propensity scores (PS) between TP and PE per trial, in which the PS represented prediction for a patient to be in the trial. Three diverse trials were selected for illustration: one focused on hepatitis C virus (HCV) patients receiving a liver transplantation; one focused on leukemia patients and lymphoma patients; and one focused on appendicitis patients. RESULTS For the HCV trial, 43 TP and 83 PE were found, with 61 characteristics evaluated. Prominent differences were found among 69% of characteristics, with a mean PS difference of 0.13. For the leukemia/lymphoma trial, 23 TP and 23 PE were found, with 39 characteristics evaluated. Prominent differences were found among 82% of characteristics, with a mean PS difference of 0.76. For the appendicitis trial, 123 TP and 242 PE were found, with 52 characteristics evaluated. Prominent differences were found among 52% of characteristics, with a mean PS difference of 0.15. CONCLUSIONS Differences in clinical characteristics were observed between TP and PE among all three trials. In two of the three trials, not all of the differences necessarily compromised trial generalizability and subsets of PE could be considered similar to their corresponding TP. In the remaining trial, lack of generalizability appeared present, but may be a result of other factors such as small sample size or site recruitment strategy. These inconsistent findings suggest eligibility criteria alone are sometimes insufficient in defining a target group to generalize to. With caveats in limited scalability, EHR data quality, and lack of patient perspective on trial participation, this generalizability assessment method that incorporates control for temporality and clinical setting promise to better pinpoint clinical patterns and trial considerations.
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Affiliation(s)
- James R Rogers
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY, United States; Medical Informatics Services, New York-Presbyterian Hospital, New York, NY, United States
| | - Ying Kuen Cheung
- Department of Biostatistics, Columbia University, New York, NY, United States
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, New York, NY, United States.
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7
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Shinde M, Cosgrove A, Woods CM, Chang C, Nguyen CP, Moeny D, Ajao A, Kolonoski J, Tsai HT. Utilization of hydroxyprogesterone caproate among pregnancies with live birth deliveries in the sentinel distributed database. J Matern Fetal Neonatal Med 2021; 35:6291-6296. [PMID: 33926341 DOI: 10.1080/14767058.2021.1910669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The U.S. Food and Drug Administration (FDA) approved Makena® (hydroxyprogesterone caproate [HPC] injection) in February 2011 for reducing the risk of preterm birth (PTB) in women with a singleton pregnancy who had a history of singleton spontaneous PTB (sPTB). Makena was approved under accelerated approval and required a postmarketing study to verify its clinical benefits. However, the postmarketing trial (PROLONG) failed to verify Makena's clinical benefit to neonates and substantiate its effect on reducing the risk of recurrent PTB. This study examined the utilization of HPC, along with another progestogen (vaginal progesterone) used to reduce the risk of sPTB during pregnancy, to inform the landscape of HPC use in the United States. METHODS We included pregnant women aged 10-54 years with a live birth delivery from 1 January, 2008 to 31 December, 2018 in the Sentinel Distributed Database (SDD). We examined the prevalence of injectable HPC (Makena and its generics), compounded HPC, and vaginal progesterone use during the second and third trimesters during the study period. We also assessed the proportion of these HPC-exposed pregnancies with obstetrical conditions of interest as potential reasons for use: (1) history of preterm delivery; (2) cervical shortening in the current pregnancy; and (3) preterm labor in the current pregnancy. RESULTS We identified a total of 3,445,739 live-birth pregnancies (among 2.9 million women) between 2008 and 2018 in the SDD. Of these pregnancies, 6.5 per 1,000 pregnancies used injectable HPC, 2.3 per 1,000 pregnancies used compounded HPC, and 1.5 per 1,000 pregnancies used vaginal progesterone during the second and/or third trimesters. The yearly uptakeof pregnancies with injectable HPC use increased during the study period from 2.1 per 1,000 pregnancies in 2012 to 12.6 per 1,000 pregnancies in 2018; use of compounded HPC decreased from 3.3 per 1,000 pregnancies to 0.25 per 1,000 pregnancies over the same period. Of 16,524 pregnancies with injectable HPC use, 12,054 (73%) had at least one related obstetrical condition, including 6,439 (39%) with a recorded history of preterm delivery. In addition, 4,665 (28%) had a PTB recorded as the outcome for the current pregnancy. CONCLUSIONS We found modest use of HPC during the second and/or third trimesters among all live-birth pregnancies in SDD. The majority of pregnancies with injectable HPC use had at least one of three obstetrical indications of interest recorded before or during the pregnancy.
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Affiliation(s)
- Mayura Shinde
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Austin Cosgrove
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Corinne M Woods
- Division of Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Christina Chang
- Division of Urology, Obstetrics, and Gynecology, Office of Rare Diseases, Pediatrics, Urologic and Reproductive Medicine, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Christine P Nguyen
- Division of Urology, Obstetrics, and Gynecology, Office of Rare Diseases, Pediatrics, Urologic and Reproductive Medicine, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - David Moeny
- Division of Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Adebola Ajao
- Division of Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Joy Kolonoski
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Huei-Ting Tsai
- Division of Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
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Chambers CD, Krishnan JA, Alba L, Albano JD, Bryant AS, Carver M, Cohen LS, Gorodetsky E, Hernandez-Diaz S, Honein MA, Jones BL, Murray RK, Namazy JA, Sahin L, Spong CY, Vasisht KP, Watt K, Wurst KE, Yao L, Schatz M. The safety of asthma medications during pregnancy and lactation: Clinical management and research priorities. J Allergy Clin Immunol 2021; 147:2009-2020. [PMID: 33713765 DOI: 10.1016/j.jaci.2021.02.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/19/2021] [Indexed: 12/26/2022]
Abstract
Asthma is one of the most common underlying diseases in women of reproductive age that can lead to potentially serious medical problems during pregnancy and lactation. A group of key stakeholders across multiple relevant disciplines was invited to take part in an effort to prioritize, strategize, and mobilize action steps to fill important gaps in knowledge regarding asthma medication safety in pregnancy and lactation. The stakeholders identified substantial gaps in the literature on the safety of asthma medications used during pregnancy and lactation and prioritized strategies to fill those gaps. Short-term action steps included linking data from existing complementary study designs (US and international claims data, single drug pregnancy registries, case-control studies, and coordinated systematic data systems). Long-term action steps included creating an asthma disease registry, incorporating the disease registry into electronic health record systems, and coordinating care across disciplines. The stakeholders also prioritized establishing new infrastructures/collaborations to perform research in pregnant and lactating women and to include patient perspectives throughout the process. To address the evidence gaps, and aid in populating product labels with data that inform clinical decision making, the consortium developed a plan to systematically obtain necessary data in the most efficient and timely manner.
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Affiliation(s)
| | | | - Lorene Alba
- Asthma and Allergy Foundation of America, Arlington, Va
| | | | | | | | - Lee S Cohen
- Massachusetts General Hospital, Boston, Mass
| | | | | | | | - Bridgette L Jones
- Children's Mercy Kansas City, Kansas City, Mo; University of Missouri Kansas City School of Medicine, Children's Mercy Kansas City, Kansas City, Mo
| | | | | | - Leyla Sahin
- US Food and Drug Administration, Silver Spring, Md
| | - Catherine Y Spong
- the Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Tex
| | - Kaveeta P Vasisht
- US Food and Drug Administration, Office of Women's Health, Silver Spring, Md
| | - Kevin Watt
- University of Utah School of Medicine, Salt Lake City, Utah
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9
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Whitmore CC, Hawley RE, Min JY, Mitchel E, Daugherty JR, Griffin MR, Grijalva CG. Building a Data Linkage Foundation for Mother-Child Pharmacoepidemiology Research. Pharmaceut Med 2020; 35:39-47. [PMID: 33369725 DOI: 10.1007/s40290-020-00371-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Expanding our understanding of the effects of maternal medication exposure through research is a public health priority and will help inform both clinical and policy decision making, ultimately improving outcomes for pregnant women and their children. OBJECTIVE Our objective was to describe a linked-data research platform that facilitates studies of pregnancy medication exposures and policy changes on maternal and child health outcomes. METHODS Mothers receiving Medicaid benefits were probabilistically linked with newborns in the Tennessee Medicaid program (TennCare) through three distinct linkage processes. Medicaid claims data and state birth and fetal death certificate records (vital records) were used to identify and link potential mothers, deliveries, and newborn children. The linkage process started with the creation of a merged pool of potential mothers and eligible deliveries, which was linked to vital records and to children's records. In the last step, linked records from the preceding steps were combined into the final Mother-child linked records. For each data linkage step, rubrics and scoring systems for exact and partial matches and mismatches among key linkage fields were applied and used to examine the strength of the probabilistic linkages. Summary linkage yields for year 2013 are reported for illustration purposes. RESULTS Among the 84,253 potential deliveries, 1,761,557 eligible potential mothers, and 51,400 eligible children identified in Tennessee Medicaid records in 2013, a total of 60,265 of these records were uniquely linked to vital records, including 46,172 (77%) with linked mother-child-vital records. Among the 51,400 eligible children records identified in Tennessee Medicaid for that year, 97% (50,053) had at least one link to vital records or a mother-delivery record. In linked records, the median maternal age was 24 years, and the median gestational age was 39 weeks. About 33% of pregnant women underwent cesarean birth, and 1% of births were classified as complicated deliveries. CONCLUSIONS Supplementing existing Medicaid claims data with birth certificate records complements administrative claims information and allows for detailed assessments of pregnancy exposures and policy changes on mother and child outcomes.
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Affiliation(s)
- Christine C Whitmore
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA. .,Vanderbilt University Medical Center, Nashville, TN, USA.
| | - R Eric Hawley
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA.,Vanderbilt University Medical Center, Nashville, TN, USA.,Veterans Health Administration Tennessee Valley Healthcare System, Geriatric Research and Education Clinical Center, Health Services Research and Development Center, Nashville, TN, USA.,CGS Administrators, Nashville, TN, USA
| | - Jea Young Min
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA.,Vanderbilt University Medical Center, Nashville, TN, USA.,Veterans Health Administration Tennessee Valley Healthcare System, Geriatric Research and Education Clinical Center, Health Services Research and Development Center, Nashville, TN, USA.,Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Ed Mitchel
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA.,Vanderbilt University Medical Center, Nashville, TN, USA
| | - James R Daugherty
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA.,Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marie R Griffin
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA.,Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA.,Vanderbilt University Medical Center, Nashville, TN, USA.,Veterans Health Administration Tennessee Valley Healthcare System, Geriatric Research and Education Clinical Center, Health Services Research and Development Center, Nashville, TN, USA
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10
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Sarayani A, Wang X, Thai TN, Albogami Y, Jeon N, Winterstein AG. Impact of the Transition from ICD-9-CM to ICD-10-CM on the Identification of Pregnancy Episodes in US Health Insurance Claims Data. Clin Epidemiol 2020; 12:1129-1138. [PMID: 33116906 PMCID: PMC7571578 DOI: 10.2147/clep.s269400] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/15/2020] [Indexed: 11/23/2022] Open
Abstract
Background Before October 2015, pregnancy cohorts assembled from US health insurance claims have relied on medical encounters with International Classification of Diseases-ninth revision-clinical modification (ICD-9-CM) codes. We aimed to extend existing pregnancy identification algorithms into the ICD-10-CM era and evaluate performance. Methods We used national private insurance claims data (2005-2018) to develop and test a pregnancy identification algorithm. We considered validated ICD-9-CM diagnosis and procedure codes that identify medical encounters for live birth, stillbirth, ectopic pregnancy, abortions, and prenatal screening to identify pregnancies. We then mapped these codes to the ICD-10-CM system using general equivalent mapping tools and reconciled outputs with literature and expert opinion. Both versions were applied to the respective coding period to identify pregnancies. We required 45 weeks of health plan enrollment from estimated conception to ensure the capture of all pregnancy endpoints. Results We identified 7,060,675 pregnancy episodes, of which 50.1% met insurance enrollment requirements. Live-born deliveries comprised the majority (76.5%) of episodes, followed by abortions (20.3%). The annual prevalence for all pregnancy types was stable across the ICD transition period except for postterm pregnancies, which increased from 0.5% to 3.4%. We observed that ICD codes indicating gestational age were available for 86.8% of live-born deliveries in the ICD-10 era compared to 23.5% in the ICD-9 era. Patterns of prenatal tests remained stable across the transition period. Conclusion Translation of existing ICD-9-CM pregnancy algorithms into ICD-10-CM codes provided reasonable consistency in identifying pregnancy episodes across the ICD transition period. New codes for gestational age can potentially improve the precision of conception estimates and minimize measurement biases.
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Affiliation(s)
- Amir Sarayani
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Xi Wang
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Thuy Nhu Thai
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Faculty of Pharmacy, Ho Chi Minh City University of Technology (HUTECH), Ho Chi Minh City, Vietnam
| | - Yasser Albogami
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Nakyung Jeon
- College of Pharmacy, Chonnam National University, Gwang-ju, Korea
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy and Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA.,Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
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11
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Liu W, Menzin TJ, Woods CM, Haug NR, Li J, Mathew JA, Nguyen CP, Chai GP, Moeny DG, Shinde M. Phosphodiesterase type 5 inhibitor use among pregnant and reproductive-age women in the United States. Pharmacoepidemiol Drug Saf 2020; 30:126-134. [PMID: 33020970 DOI: 10.1002/pds.5112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To assess the prevalence and potential indications of PDE5 inhibitor use among pregnant and reproductive-age women in the United States. METHODS We identified women 15 to 50 years with a livebirth from January 2001 through March 2018 in Sentinel Database. We assessed the prevalence of PDE5 inhibitor use prior to and during pregnancy by trimester, identified potential on- and off-label indications using predefined diagnosis codes recorded within 90 days before the estimated last menstrual period through delivery. Separately, we used data from IQVIA's National Prescription Audit and Total Patient Tracker to estimate the dispensed prescriptions for PDE5 inhibitors and the number of patients with PDE5 inhibitor prescriptions. RESULTS We identified approximately 3.3 million pregnancies during 2001 to 2018, 96 of which had PDE5 inhibitor use during pregnancy. Prevalence of PDE5 inhibitor use was 2.61, 0.62, and 0.62 per 100, 000 live-born pregnancies during the first, second, or third trimesters, respectively. Among women exposed to a PDE5 inhibitor from 90 days before conception to the end of pregnancy, 25.0%, 31.1%, and 15.5% had a diagnosis code for fetal growth restriction, preeclampsia, and pulmonary arterial hypertension. In IQVIA data, an estimated 223, 000 prescriptions from July 2015 through June 2018 and 58, 000 women received prescriptions for PDE5 inhibitors in 2017, of whom approximately 15, 000 (26%) were aged 15 to 50 years. CONCLUSION We found a low prevalence of PDE5 inhibitor use in pregnant and reproductive-age women. Given the very low prevalence of use and the inconsistency of neonatal mortality data across STRIDER centers, the risk to public health is low at present.
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Affiliation(s)
- Wei Liu
- Division of Epidemiology, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Talia J Menzin
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Corinne M Woods
- Division of Epidemiology, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Nicole R Haug
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Jie Li
- Division of Epidemiology, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Justin A Mathew
- Division of Epidemiology, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Christine P Nguyen
- Division of Bone, Reproductive, and Urologic Products, Office of New Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Grace P Chai
- Division of Epidemiology, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - David G Moeny
- Division of Epidemiology, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Mayura Shinde
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
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12
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Havard A, Barbieri S, Hanly M, Perez-Concha O, Tran DT, Kennedy D, Jorm LR. Medications used disproportionately during pregnancy: Priorities for research on the risks and benefits of medications when used during pregnancy. Pharmacoepidemiol Drug Saf 2020; 30:53-64. [PMID: 32935407 DOI: 10.1002/pds.5131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 07/30/2020] [Accepted: 09/04/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE To identify medications used disproportionately more or less among pregnant women relative to women of childbearing age. METHODS Medication use among pregnant women in New South Wales, Australia was identified using linked perinatal and pharmaceutical dispensing data from 2006 to 2012. Medication use in women of childbearing age (including pregnant women) was identified using pharmaceutical dispensing data for a 10% random sample of the Australian population. Pregnant social security beneficiaries (n = 111 612) were age-matched (1:3) to female social security beneficiaries in the 10% sample. For each medication, the risk it was dispensed during pregnancy relative to being dispensed during an equivalent time period among matched controls was computed. Medications were mapped to Australian pregnancy risk categories. RESULTS Of the 181 included medications, 35 were statistically significantly more commonly dispensed to pregnant women than control women. Of these, 23 are categorised as posing no increased risk to the foetus. Among medications suspected of causing harm or having insufficient safety data, the strongest associations were observed for hydralazine, ondansetron, dalteparin sodium and ranitidine. Use was less likely during pregnancy than control periods for 127 medications, with the strongest associations observed for hormonal contraceptives and progestogens. CONCLUSIONS Most medications found to be used disproportionately more by pregnant women are indicated for pregnancy-related problems. A large number of medications were used disproportionately less among pregnant women, where avoidance of some of these medications may pose a greater risk of harm. For many other medications avoided during pregnancy, current data are insufficient to inform this risk-benefit assessment.
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Affiliation(s)
- Alys Havard
- Centre for Big Data Research in Health (CBDRH), University of New South Wales, Sydney, New South Wales, Australia
| | - Sebastiano Barbieri
- Centre for Big Data Research in Health (CBDRH), University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Hanly
- Centre for Big Data Research in Health (CBDRH), University of New South Wales, Sydney, New South Wales, Australia
| | - Oscar Perez-Concha
- Centre for Big Data Research in Health (CBDRH), University of New South Wales, Sydney, New South Wales, Australia
| | - Duong T Tran
- Centre for Big Data Research in Health (CBDRH), University of New South Wales, Sydney, New South Wales, Australia
| | - Debra Kennedy
- Royal Hospital for Women, MotherSafe, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health (CBDRH), University of New South Wales, Sydney, New South Wales, Australia
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13
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Wood ME, Andrade SE, Toh S. Safe Expectations: Current State and Future Directions for Medication Safety in Pregnancy Research. Clin Ther 2019; 41:2467-2476. [PMID: 31563392 PMCID: PMC6917855 DOI: 10.1016/j.clinthera.2019.08.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/30/2019] [Accepted: 08/22/2019] [Indexed: 12/14/2022]
Abstract
Medication use in pregnancy is common, but information about the safety of most medications in pregnant women or their infants is limited. In the absence of data from randomized clinical trials to guide decisions made by regulators, clinicians, and patients, we often have to rely on well-designed observational studies to generate valid evidence about the benefits and risks of medications in pregnancy. Spontaneous reporting, primary case-control and cohort studies, pregnancy exposure registries, and electronic health data have been used extensively for studying medication safety in pregnancy. This article discusses these data sources, their strengths and limitations, and possible strategies and approaches to mitigating limitations when planning studies or interpreting findings from the literature. Strategies discussed include combining data sources across institutional or national borders, developing and using more sophisticated study designs, and taking advantage of existing analytic methods for more complex data structures, such as time-varying exposure or unmeasured confounding. Finally, we make recommendations for study designs that aid in better risk-related communication.
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Affiliation(s)
- Mollie E Wood
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Susan E Andrade
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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14
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Mott K, Reichman ME, Toh S, Kieswetter C, Haffenreffer K, Andrade SE. Use of Antidiabetic drugs during pregnancy among U.S. women with Livebirth deliveries in the Mini-Sentinel system. BMC Pregnancy Childbirth 2019; 19:441. [PMID: 31775682 PMCID: PMC6880378 DOI: 10.1186/s12884-019-2609-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 11/18/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND As the prevalence of diabetes mellitus increases in the population, the exposure to antidiabetic drugs (ADDs) during pregnancies is expected to grow, as has been seen over the last decade. The objective of this study was to estimate the prevalence of ADD use during pregnancy among women in the Mini-Sentinel Distributed Database (MSDD) who delivered a liveborn infant. METHODS We identified qualifying livebirth pregnancies among women aged 10 to 54 years in the MSDD from 2001 to 2013. ADD use was estimated using outpatient pharmacy dispensing claims and days-supplied among three cohorts: all livebirth pregnancies, pregnancies among women with pre-existing diabetes, and pregnancies among women without prior ADD use. RESULTS Among the 1.9 million pregnancies in the MSDD that resulted in a livebirth from 2001 to 2013, 4.4% were exposed to an ADD. Of the 15,606 pregnancies (0.8%) with pre-existing diabetes, 92.8% were also exposed during the pregnancy period. The most commonly used product in these pregnancies was insulin (75.6% of pregnancies). In contrast, in pregnancies of women without prior ADD use, the most commonly used products were glyburide and insulin, and most of these users were diagnosed with gestational diabetes. CONCLUSIONS Patterns of ADD use during pregnancy described here, along with changes in disease incidence and management, highlight the importance of continuing surveillance of ADD utilization patterns and examining the safety and effectiveness of these products in pregnancy.
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Affiliation(s)
- Katrina Mott
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA.
| | - Marsha E Reichman
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Caren Kieswetter
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Katherine Haffenreffer
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Susan E Andrade
- Meyers Primary Care Institute (Fallon Community Health Plan, Reliant Medical Group, and University of Massachusetts Medical School), Worcester, MA, USA
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15
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Daniel C, Serre P, Orlova N, Bréant S, Paris N, Griffon N. Initializing a hospital-wide data quality program. The AP-HP experience. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 181:104804. [PMID: 30497872 DOI: 10.1016/j.cmpb.2018.10.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/09/2018] [Accepted: 10/26/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Data Quality (DQ) programs are recognized as a critical aspect of new-generation research platforms using electronic health record (EHR) data for building Learning Healthcare Systems. The AP-HP Clinical Data Repository aggregates EHR data from 37 hospitals to enable large-scale research and secondary data analysis. This paper describes the DQ program currently in place at AP-HP and the lessons learned from two DQ campaigns initiated in 2017. MATERIALS AND METHODS As part of the AP-HP DQ program, two domains - patient identification (PI) and healthcare services (HS) - were selected for conducting DQ campaigns consisting of 5 phases: defining the scope, measuring, analyzing, improving and controlling DQ. Semi-automated DQ profiling was conducted in two data sets - the PI data set containing 8.8 M patients and the HS data set containing 13,099 consultation agendas and 2122 care units. Seventeen DQ measures were defined and DQ issues were classified using a unified DQ reporting framework. For each domain, actions plans were defined for improving and monitoring prioritized DQ issues. RESULTS Eleven identified DQ issues (8 for the PI data set and 3 for the HS data set) were categorized into completeness (n = 6), conformance (n = 3) and plausibility (n = 2) DQ issues. DQ issues were caused by errors from data originators, ETL issues or limitations of the EHR data entry tool. The action plans included sixteen actions (9 for the PI domain and 7 for the HS domain). Though only partial implementation, the DQ campaigns already resulted in significant improvement of DQ measures. CONCLUSION DQ assessments of hospital information systems are largely unpublished. The preliminary results of two DQ campaigns conducted at AP-HP illustrate the benefit of the engagement into a DQ program. The adoption of a unified DQ reporting framework enables the communication of DQ findings in a well-defined manner with a shared vocabulary. Dedicated tooling is needed to automate and extend the scope of the generic DQ program. Specific DQ checks will be additionally defined on a per-study basis to evaluate whether EHR data fits for specific uses.
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Affiliation(s)
- Christel Daniel
- DSI WIND, AP-HP, Paris, France; INSERM, U1142, LIMICS, F-75006, Paris, France; Sorbonne Universités, Paris, France.
| | | | | | | | | | - Nicolas Griffon
- DSI WIND, AP-HP, Paris, France; INSERM, U1142, LIMICS, F-75006, Paris, France; Sorbonne Universités, Paris, France
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16
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Marić I, Winn VD, Borisenko E, Weber KA, Wong RJ, Aziz N, Blumenfeld YJ, El-Sayed YY, Stevenson DK, Shaw GM. Data-driven queries between medications and spontaneous preterm birth among 2.5 million pregnancies. Birth Defects Res 2019; 111:1145-1153. [PMID: 31433567 PMCID: PMC11199711 DOI: 10.1002/bdr2.1580] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/31/2019] [Accepted: 08/05/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Our goal was to develop an approach that can systematically identify potential associations between medication prescribed in pregnancy and spontaneous preterm birth (sPTB) by mining large administrative "claims" databases containing hundreds of medications. One such association that we illustrate emerged with antiviral medications used for herpes treatment. METHODS IBM MarketScan® databases (2007-2016) were used. A pregnancy cohort was established using International Classification of Diseases (ICD-9/10) codes. Multiple hypothesis testing and the Benjamini-Hochberg procedure that limited false discovery rate at 5% revealed, among 863 medications, five that showed odds ratios (ORs) <1. The statistically strongest was an association between antivirals and sPTB that we illustrate as a real example of our approach, specifically for treatment of genital herpes (GH). Three groups of women were identified based on diagnosis of GH and treatment during the first 36 weeks of pregnancy: (a) GH without treatment; (b) GH treated with antivirals; (c) no GH or treatment. RESULTS We identified 2,538,255 deliveries. 0.98% women had a diagnosis of GH. Among them, 60.0% received antiviral treatment. Women with treated GH had OR < 1, (OR [95% CI] = 0.91 [0.85, 0.98]). In contrast, women with untreated GH had a small increased risk of sPTB (OR [95% CI] =1.22 [1.14, 1.32]). CONCLUSIONS Data-driven approaches can effectively generate new hypotheses on associations between medications and sPTB. This analysis led us to examine the association with GH treatment. While unknown confounders may impact these findings, our results indicate that women with untreated GH have a modest increased risk of sPTB.
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Affiliation(s)
- Ivana Marić
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Virginia D. Winn
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Kari A. Weber
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Ronald J. Wong
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Natali Aziz
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Yair J. Blumenfeld
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Yasser Y. El-Sayed
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - David K. Stevenson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Gary M. Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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17
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MacDonald SC, Cohen JM, Panchaud A, McElrath TF, Huybrechts KF, Hernández-Díaz S. Identifying pregnancies in insurance claims data: Methods and application to retinoid teratogenic surveillance. Pharmacoepidemiol Drug Saf 2019; 28:1211-1221. [PMID: 31328328 PMCID: PMC6830505 DOI: 10.1002/pds.4794] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 04/05/2019] [Accepted: 04/09/2019] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of the study is to develop an algorithm to identify pregnancies in administrative databases and apply it to assess pregnancy rates and outcomes in women prescribed isotretinoin or tretinoin. METHODS Using the 2011 to 2015 Truven Health MarketScan Database, we identified pregnancies, including losses and terminations. In a cohort design, nonpregnant women filling a prescription for isotretinoin or tretinoin were matched to five women without either prescription. Women were followed for 365 days or until conception, medication discontinuation, or enrollment discontinuation ("prescription episode"). Rates of pregnancy, risks of pregnancy losses, and prevalence of infant malformations at birth were assessed by exposure. RESULTS We identified 2 179 192 livebirths, 8434 stillbirths, 2521 mixed births, 415 110 spontaneous abortions, 124 556 elective terminations, and 8974 unspecified abortions. There were 86 834 isotretinoin and 973 587 tretinoin episodes, matched to 5 302 105 unexposed women. Pregnancy rates were 3 (isotretinoin), 19 (tretinoin), and 34 (unexposed) per 1000 person-years. Risk of spontaneous pregnancy losses were similar; however, terminations were more common in the isotretinoin-exposed (28% [95% CI: 21%-36%]) than the tretinoin-exposed (10% [95% CI: 9%-11%]) or unexposed pregnancies (6%). Malformations occurred in 4.5% (95% CI: 3.5%-5.6%) of the tretinoin-exposed pregnancies and 4.2% of the unexposed pregnancies (adjusted odds ratio: 1.16 [95% CI: 0.85-1.58]); isotretinoin-exposed births were too few to assess malformations. CONCLUSIONS Administrative databases can complement risk evaluation and mitigation strategies (REMS) for known teratogens and contribute to safety surveillance for other medications. Here, isotretinoin-exposed pregnancy rates were low, but existent, and many pregnancies were terminated. Tretinoin exposure was not associated with a meaningfully elevated risk of losses or malformations as compared with unexposed pregnancies.
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Affiliation(s)
- Sarah C MacDonald
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jacqueline M Cohen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Alice Panchaud
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Thomas F McElrath
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sonia Hernández-Díaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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18
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Bird ST, Gelperin K, Sahin L, Bleich KB, Fazio-Eynullayeva E, Woods C, Radden E, Greene P, McCloskey C, Johnson T, Shinde M, Krefting I. First-Trimester Exposure to Gadolinium-based Contrast Agents: A Utilization Study of 4.6 Million U.S. Pregnancies. Radiology 2019; 293:193-200. [PMID: 31429682 DOI: 10.1148/radiol.2019190563] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BackgroundThe safety of gadolinium-based contrast agent (GBCA) exposure during pregnancy has not been established, and the use of GBCAs during pregnancy is not recommended unless it is essential to the health of the woman or fetus.PurposeTo examine the prevalence of GBCA exposure in a large sample of pregnancies resulting in a live birth.Materials and MethodsThe Sentinel Distributed Database was used to retrospectively identify U.S. pregnancies that resulted in live births between 2006 and 2017 from 16 data partners. The main outcome was the prevalence of MRI procedures with and without GBCAs, sorted by anatomic location and trimester, among pregnant and matched comparator women.ResultsAmong 4 692 744 pregnancies resulting in a live birth, we identified 6879 exposures to GBCAs in 5457 pregnancies, representing one contrast-enhanced MRI examination per 860 pregnancies (0.12% of all pregnancies). Most contrast-enhanced MRI examinations were performed in the head (n = 3499), although pelvic and abdominal MRI constituted 22.3% (n = 1536) of all contrast-enhanced MRI examinations during pregnancy. The majority (70.2%) of GBCA exposures occurred during the first trimester, with a 4.3-fold greater prevalence compared with that in the second trimester and a 5.1-fold greater prevalence compared with that in the third trimester.ConclusionThis study identified higher rates of gadolinium-based contrast agent (GBCA) exposure during the first few weeks of pregnancy compared with the later weeks of pregnancy, suggesting inadvertent exposure to GBCAs might occur before pregnancy is recognized.© RSNA, 2019Online supplemental material is available for this article.See also the editorial by Kallmes and Watson in this issue.
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Affiliation(s)
- Steven T Bird
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| | - Kate Gelperin
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| | - Leyla Sahin
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| | - Karen B Bleich
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| | - Elnara Fazio-Eynullayeva
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| | - Corinne Woods
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| | - Erica Radden
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| | - Patty Greene
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| | - Carolyn McCloskey
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| | - Tamara Johnson
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| | - Mayura Shinde
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| | - Ira Krefting
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
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Huybrechts KF, Bateman BT, Hernández-Díaz S. Use of real-world evidence from healthcare utilization data to evaluate drug safety during pregnancy. Pharmacoepidemiol Drug Saf 2019; 28:906-922. [PMID: 31074570 PMCID: PMC6823105 DOI: 10.1002/pds.4789] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Because preapproval clinical trials typically exclude pregnant women, the evidence on drug safety during pregnancy required to inform drug labeling must come from postapproval controlled observational studies. Common designs have included pregnancy registries and case-control studies. Recently, pregnancy cohorts nested within healthcare utilization databases are increasingly being used. Despite clear advantages, these databases share some important limitations that may threaten the validity of studies emerging from them. METHODS This paper describes the distinctive methodological aspects of conducting drug safety studies in healthcare utilization databases with special emphasis on design and analytic approaches to minimize biases. RESULTS We describe considerations for study design, cohort definition, and follow-up. We then address issues related to exposure ascertainment based on prescription fills, including the importance of the etiologically relevant window and of properly accounting for preterm births. This is followed by a discussion of advantages and challenges when ascertaining maternal and infant outcomes based on secondary data. We then explore useful approaches to address confounding within the context of pregnancy research and of the potential for selection bias when restricting the cohort to live births. Finally, we consider issues related to external validity and statistical significance. The examples are mainly drawn from a pregnancy cohort nested in the Medicaid Analytic Extract. CONCLUSIONS The approaches presented provide guidance regarding the important methodological considerations that need to be attended to in order to generate valid, minimally biased risk when using large healthcare utilization databases for drug safety surveillance in pregnancy.
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Affiliation(s)
- Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sonia Hernández-Díaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Eworuke E, Panucci G, Goulding M, Neuner R, Toh S. Use of tumor necrosis factor-alpha inhibitors during pregnancy among women who delivered live born infants. Pharmacoepidemiol Drug Saf 2018; 28:296-304. [PMID: 30430682 DOI: 10.1002/pds.4695] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 08/21/2018] [Accepted: 10/10/2018] [Indexed: 11/11/2022]
Abstract
PURPOSE To describe the use of tumor necrosis factor-alpha inhibitors (TNFis) among pregnancies ending in a live birth and with a diagnosis of ankylosing spondylitis (AS), Crohn's disease (CD), juvenile idiopathic arthritis (JIA), psoriasis (PsO), psoriatic arthritis (PsA), rheumatoid arthritis (RA), or ulcerative colitis (UC). METHODS We identified pregnancies among women aged 15 to 54 years between 01/01/2004 and 09/30/2015 from 16 health plans participating in Sentinel. We inferred indication using ICD-9-CM codes in the 183-day period before conception. We assessed proportion of infliximab, etanercept, adalimumab, certolizumab pegol, and golimumab by calendar year, indication, and maternal age, and compared them to proportions in an age-matched, indication-matched, and date-matched non-pregnant cohort. RESULTS Among 19 681 pregnancies with at least one chronic inflammatory condition, 2990 (15.2%) received a TNFi. In both pregnancies and matched non-pregnant cohort, TNFi use was highest (34.4%; 55.8%) for PsA patients and lowest (6.2%; 13.4%) for PsO patients. Etanercept was most frequently used among AS/JIA/PsA/PsO/RA patients, while infliximab was the preferred TNFi for CD/UC patients. Except for infliximab and certolizumab, TNFi use during pregnancy decreased after the first trimester. Pregnancies among older pregnant women (45-54 years) were more likely to be treated compared with the matched non-pregnant cohort. CONCLUSION There was a preference for etanercept among pregnancies with AS/JIA/PsA/PsO/RA, despite the availability of other TNFis. Decline in TNFi use after the first trimester may be related to the desire to reduce TNFis transplacental transfer and to minimize infection risk to the fetus or baby associated with live vaccine immunizations after birth.
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Affiliation(s)
- Efe Eworuke
- Division of Epidemiology II, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Genna Panucci
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Margie Goulding
- Division of Epidemiology II, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Rosemarie Neuner
- Division of Pulmonary, Allergy and Rheumatology Products, Office of New Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Sengwee Toh
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Li J, Panucci G, Moeny D, Liu W, Maro JC, Toh S, Huang TY. Association of Risk for Venous Thromboembolism With Use of Low-Dose Extended- and Continuous-Cycle Combined Oral Contraceptives: A Safety Study Using the Sentinel Distributed Database. JAMA Intern Med 2018; 178:1482-1488. [PMID: 30285041 PMCID: PMC6248208 DOI: 10.1001/jamainternmed.2018.4251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Continuous/extended cyclic estrogen use (84/7 or 365/0 days cycles) in combined oral contraceptives (COCs) could potentially expose women to an increased cumulative dose of estrogen, compared with traditional cyclic regimens (21/7 days cycle), and may increase the risk for venous thromboembolism (VTE). OBJECTIVE To determine, while holding the progestogen type constant, whether the risk for VTE is higher with use of continuous/extended COCs than with cyclic COCs among women who initiated a COC containing ethinyl estradiol and levonorgestrel. DESIGN, SETTING, AND PARTICIPANTS Incident user retrospective cohort study of primarily commercially insured US population identified from the Sentinel Distributed Database. Participants were women aged 18 to 50 years at the time of initiating a study COC between May 2007 and September 2015. Using a propensity score approach and Cox proportional hazards regression models, we estimated the hazard ratios of VTE overall and separately by ethinyl estradiol dose and age groups. EXPOSURES Initiation of continuous/extended or traditional cyclic COCs containing ethinyl estradiol or levonorgestrel of any dose. MAIN OUTCOMES AND MEASURES First VTE hospitalization that occurred during the study follow-up, identified by an inpatient International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code of 415.1, 415.1x, 453, 453.x, or 453.xx. RESULTS We identified 210 691 initiators of continuous/extended COCs (mean [SD] age, 30.4 [8.6] years) and 522 316 initiators of cyclic COCs (mean [SD] age, 28.8 [8.3] years), with a mean of 0.7 person-years at risk among continuous/extended and cyclic users. Baseline cardiovascular and metabolic conditions (7.2% vs 4.7%), gynecological conditions (39.7% vs 32.3%), and health services utilization were slightly higher among continuous/extended cyclic than cyclic COC users. Propensity score matching decreased the hazard ratio estimates from 1.84 (95% CI, 1.53-2.21) to 1.32 (95% CI, 1.07-1.64) for continuous/extended use compared with cyclic COC use. The absolute risk difference (0.27 per 1000 persons) and the incidence rate difference (0.35 cases per 1000 person-years [1.44 vs 1.09 cases per 1000 person-years]) between the 2 propensity score-matched cohorts remained low, which may not translate into a clinically significant risk differences between cyclic and noncyclic estrogen use. CONCLUSIONS AND RELEVANCE Holding the progestogen type constant (levonorgestrel), we observed a slightly elevated VTE risk in association with continuous/extended COC use when compared with cyclic COC use. However, due to the small absolute risk difference and potential residual confounding, our findings did not show strong evidence supporting a VTE risk difference between continuous/extended and cyclic COC use.
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Affiliation(s)
- Jie Li
- Division of Epidemiology, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Genna Panucci
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - David Moeny
- Division of Epidemiology, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Wei Liu
- Division of Epidemiology, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Judith C Maro
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Ting-Ying Huang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Enrollment and Retention in 34 United States Pregnancy Registries Contrasted with the Manufacturer's Capture of Spontaneous Reports for Exposed Pregnancies. Drug Saf 2018; 41:87-94. [PMID: 28840499 DOI: 10.1007/s40264-017-0591-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Pregnancy registries and spontaneous reports are essential pharmacovigilance tools to evaluate drug safety during pregnancy. OBJECTIVES The aim of this study was to evaluate postmarket capture of exposed pregnancies. METHODS Pregnancy registries for drugs and biologics were identified in a systematic review. Through a standardized questionnaire, manufacturers provided information on (1) pregnancy registry enrollment and retention, and (2) worldwide receipt of spontaneous reports for exposed pregnancies. A validated algorithm for live-birth pregnancies allowed calculation of exposure rates per 100,000 live births using claims data. RESULTS Among 34 products with a pregnancy registry, median (interquartile range) registry enrollment was 36 pregnancies (5-258) and median spontaneous report capture was 450 pregnancies (89-1192). Products used in >20/100,000 live births had a median registry enrollment of 490 pregnancies and median capture of 1061 spontaneously reported exposed pregnancies. Lower median registry enrollment and spontaneous report capture was observed for products used in 0.5-20/100,000 live births (36 from registries, 541 spontaneous reports) and <0.5/100,000 live births (3 from registries, 41 spontaneous reports). Among 24 registries enrolling ≥10 pregnancies, median capture of pregnancy outcomes (e.g. live birth, spontaneous abortion) was 83.9%. For 19 registries enrolling ≥10 infants, the median proportion of infants achieving protocol-specified follow-up was 89.9% for up to 4 weeks post-birth, 75.0% for 1-5 months, and 57.1% for ≥6 months. CONCLUSIONS Relatively higher product utilization among pregnant women predicted greater pregnancy registry enrollment. For products rarely used during pregnancy, registry enrollment was low and differences in registry enrollment compared with worldwide spontaneous report receipt were most pronounced. Products with very low utilization levels during pregnancy may require a combination of worldwide pharmacovigilance, pregnancy registries, and additional study methods to achieve adequate surveillance.
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Yusuf A, Chia V, Xue F, Mikol DD, Bollinger L, Cangialose C. Use of existing electronic health care databases to evaluate medication safety in pregnancy: Triptan exposure in pregnancy as a case study. Pharmacoepidemiol Drug Saf 2018; 27:1309-1315. [PMID: 30240072 PMCID: PMC6586074 DOI: 10.1002/pds.4658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 05/25/2018] [Accepted: 08/18/2018] [Indexed: 12/04/2022]
Abstract
Purpose The recent expansion of electronic health and medical record systems may present an opportunity to generate robust post‐approval safety data and obviate the limitations of prospective pregnancy exposure registries. We examined and compared, over the same time frame, the outcomes of triptan exposure in pregnancy using (1) a retrospective claims database and (2) a previously completed pregnancy registry. Methods Using the Marketscan database, the risk of major birth defects was ascertained in live‐born infants whose birth mothers were exposed to sumatriptan, naratriptan, or sumatriptan/naproxen during pregnancy. The frequencies of outcomes observed were compared with the findings of the 16‐year sumatriptan, naratripan, and sumatriptan/naproxen prospective pregnancy registry. Results About 5120 pregnancies were identified in the retrospective claims cohort in contrast to 617 included in the prospective registry during the same time frame. The proportion of major birth defects among first‐semester sumatriptan exposures was 4.0%, which is exactly the same as the proportion of major birth defects reported for first‐semester sumatriptan exposures in the registry. There were very few non‐livebirth outcomes in both the claims analyses and registry. Conclusions These results confirm broad agreement between the database analysis and the registry regarding the safety of triptans during pregnancy. Of note, the number of triptan‐exposed pregnancies identified in this large US database was about 7‐fold that included in the prospective registry over the same time frame. The findings of this study support an approach of using existing health care database (s) in the post‐approval assessment of medication exposure in pregnancy.
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Affiliation(s)
| | | | - Fei Xue
- Amgen, Inc., Thousand Oaks, CA, USA
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Illoh OA, Toh S, Andrade SE, Hampp C, Sahin L, Gelperin K, Taylor L, Bird ST. Utilization of drugs with pregnancy exposure registries during pregnancy. Pharmacoepidemiol Drug Saf 2018. [DOI: 10.1002/pds.4409] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Onyekachukwu A. Illoh
- Office of Surveillance and Epidemiology; Center for Drug Evaluation and Research, Food and Drug Administration; Silver Spring MD USA
| | - Sengwee Toh
- Department of Population Medicine; Harvard Medical School and Harvard Pilgrim Health Care Institute; Boston MA USA
| | - Susan E. Andrade
- Meyers Primary Care Institute; University of Massachusetts Medical School; Worcester MA USA
| | - Christian Hampp
- Office of Surveillance and Epidemiology; Center for Drug Evaluation and Research, Food and Drug Administration; Silver Spring MD USA
| | - Leyla Sahin
- Office of New Drugs; Center for Drug Evaluation and Research, Food and Drug Administration; Silver Spring MD USA
| | - Kate Gelperin
- Office of Surveillance and Epidemiology; Center for Drug Evaluation and Research, Food and Drug Administration; Silver Spring MD USA
| | - Lockwood Taylor
- Office of Surveillance and Epidemiology; Center for Drug Evaluation and Research, Food and Drug Administration; Silver Spring MD USA
| | - Steven T. Bird
- Office of Surveillance and Epidemiology; Center for Drug Evaluation and Research, Food and Drug Administration; Silver Spring MD USA
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Ailes EC, Simeone RM, Dawson AL, Petersen EE, Gilboa SM. Using insurance claims data to identify and estimate critical periods in pregnancy: An application to antidepressants. ACTA ACUST UNITED AC 2017; 106:927-934. [PMID: 27891779 DOI: 10.1002/bdra.23573] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/07/2016] [Accepted: 09/09/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Health insurance claims are a rich data source to examine medication use in pregnancy. Our objective was to identify pregnant women, their pregnancy outcomes, and date of their last menstrual period (LMP), and to estimate antidepressant dispensations in pregnancy. METHODS From a literature search, we identified diagnosis and procedure codes indicating the end of a pregnancy. Using Truven Health MarketScan® Commercial Claims and Encounters Databases, we identified all inpatient admissions and outpatient service claims with these codes. We developed an algorithm to assign: (1) pregnancy outcome (ectopic pregnancy, induced or spontaneous abortion, live birth, or stillbirth), and (2) estimated gestational age, to each inpatient or outpatient visit. For each pregnancy outcome, we estimated the LMP as the admission (for inpatient visits) or service (for outpatient visits) date minus the gestational age. To differentiate visits associated with separate pregnancies, we required ≥ 2 months between one pregnancy outcomes and the LMP of the next pregnancy. We used this algorithm to identify pregnancies in 2013 and to estimate the proportion of women who filled a prescription for an antidepressant from an outpatient pharmacy at various time points in pregnancy. RESULTS We identified 488,887 pregnancies in 2013; 79% resulted in a live birth. A prescription for an antidepressant was filled in 6.2% of pregnancies. Dispensations varied throughout pregnancy and were lowest (3.1%) during the second trimester. CONCLUSION This work will inform future efforts to estimate medication dispensations during critical periods of preconception, interconception, and pregnancy using health insurance claims data. Birth Defects Research (Part A) 106:927-934, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Elizabeth C Ailes
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Regina M Simeone
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - April L Dawson
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Emily E Petersen
- National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Suzanne M Gilboa
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
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Capó-Lugo CE, Kho AN, O'Dwyer LC, Rosenman MB. Data Sharing and Data Registries in Physical Medicine and Rehabilitation. PM R 2017; 9:S59-S74. [PMID: 28527505 DOI: 10.1016/j.pmrj.2017.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/04/2017] [Accepted: 04/06/2017] [Indexed: 11/26/2022]
Abstract
The field of physical medicine & rehabilitation (PM&R), along with all the disciplines it encompasses, has evolved rapidly in the past 50 years. The number of controlled trials, systematic reviews, and meta-analyses in PM&R increased 5-fold from 1998 to 2013. In recent years, professional, private, and governmental institutions have identified the need to track function and functional status across providers and settings of care and on a larger scale. Because function and functional status are key aspects of PM&R, access to and sharing of reliable data will have an important impact on clinical practice. We reviewed the current landscape of PM&R databases and data repositories, the clinical applicability and practice implications of data sharing, and challenges and future directions. We included articles that (1) addressed any aspect of function, disability, or participation; (2) focused on recovery or maintenance of any function; and (3) used data repositories or research databases. We identified 398 articles that cited 244 data sources. The data sources included 66 data repositories and 179 research databases. We categorized the data sources based on their purposes and uses, geographic distribution, and other characteristics. This study collates the range of databases, data repositories, and data-sharing mechanisms that have been used in PM&R internationally. In recent years, these data sources have provided significant information for the field, especially at the population-health level. Implications and future directions for data sources also are discussed.
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Affiliation(s)
- Carmen E Capó-Lugo
- Center for Education in Health Sciences, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair St, 20th Floor, Chicago, IL 60611(∗).
| | - Abel N Kho
- Center for Health Information Partnerships, Institute for Public Health and Medicine and Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL(†)
| | - Linda C O'Dwyer
- Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University, Chicago, IL(‡)
| | - Marc B Rosenman
- Center for Health Information Partnerships, Institute for Public Health and Medicine and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL(§)
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Andrade SE, Bérard A, Nordeng HME, Wood ME, van Gelder MMHJ, Toh S. Administrative Claims Data Versus Augmented Pregnancy Data for the Study of Pharmaceutical Treatments in Pregnancy. CURR EPIDEMIOL REP 2017; 4:106-116. [PMID: 29399433 PMCID: PMC5780544 DOI: 10.1007/s40471-017-0104-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Purpose of Review Administrative claims databases, which collect reimbursement-related information generated from healthcare encounters, are increasingly used to evaluate medication safety in pregnancy. We reviewed the strengths and limitations of claims-only databases and how other data sources may be used to improve the accuracy and completeness of information critical for studying medication safety in pregnancy. Recent Findings Research on medication safety in pregnancy requires information on pregnancy episodes, mother-infant linkage, medication exposure, gestational age, maternal and birth outcomes, confounding factors, and (in some studies) long-term follow-up data. Claims data reliably identifies live births and possibly other pregnancies. It allows mother-infant linkage and has prospectively collected prescription medication information. Its diagnosis and procedure information allows estimation of gestational age. It captures maternal medical conditions but generally has incomplete data on reproductive and lifestyle factors. It has information on certain, typically short-term maternal and infant outcomes that may require chart review confirmation. Other data sources including electronic health records and birth registries can augment claims data or be analyzed alone. Interviews, surveys, or biological samples provide additional information. Nationwide and regional birth and pregnancy registries, such as those in several European and North American countries, generally contain more complete information essential for pregnancy research compared to claims-only databases. Summary Claims data offers several advantages in medication safety in pregnancy research. Its limitations can be partially addressed by linking it with other data sources or supplementing with primary data collection. Rigorous assessment of data quality and completeness is recommended regardless of data sources.
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Affiliation(s)
- Susan E Andrade
- 1Meyers Primary Care Institute, Fallon Community Health Plan, Reliant Medical Group, University of Massachusetts Medical School, 425 North Lake Avenue, Worcester, MA 01605 USA
| | - Anick Bérard
- 2Faculty of Pharmacy, and CHU Ste-Justine Research Center, University of Montreal, 3175 Côte-Ste-Catherine, Montreal, QC H3T 1C5 Canada
| | - Hedvig M E Nordeng
- 3Pharmacoepidemiology and Drug Safety Research Group, School of Pharmacy, PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, P.O. Box 1068, Blindern, 0316 Oslo, Norway.,4Department of Child Health, Norwegian Institute of Public Health, P.O. Box 4404 Nydalen, 0403 Oslo, Norway
| | - Mollie E Wood
- 3Pharmacoepidemiology and Drug Safety Research Group, School of Pharmacy, PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, P.O. Box 1068, Blindern, 0316 Oslo, Norway
| | - Marleen M H J van Gelder
- 5Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.,6Radboud REshape Innovation Center, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Sengwee Toh
- 7Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA 02215 USA
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Use of selective serotonin reuptake inhibitors (SSRIs) in women delivering liveborn infants and other women of child-bearing age within the U.S. Food and Drug Administration's Mini-Sentinel program. Arch Womens Ment Health 2016; 19:969-977. [PMID: 27178125 DOI: 10.1007/s00737-016-0637-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/30/2016] [Indexed: 10/21/2022]
Abstract
This study was conducted in order to assess the prevalence of use of selective serotonin reuptake inhibitors (SSRIs) among pregnant women delivering a liveborn infant in the USA. A retrospective study was conducted using the automated databases of 15 health-care systems participating in the Mini-Sentinel program. Diagnosis and procedure codes were used to identify women ages 10 to 54 years delivering a liveborn infant between April 2001 and December 2013. A comparison group of age- and date-matched women without live births was identified. The frequency of use of SSRIs was identified from outpatient dispensing data. Among the 1,895,519 liveborn deliveries, 113,689 women (6.0 %) were exposed to an SSRI during pregnancy during the period 2001-2013; 5.4 % were exposed to an SSRI during 2013. During the corresponding time period, 10.5 % of the age- and date-matched cohort of women without live births was exposed to an SSRI, with 10.1 % exposed to an SSRI during 2013. The most common agents dispensed during pregnancy were sertraline (n = 48,678), fluoxetine (n = 28,983), and citalopram (n = 20,591). Among those women exposed to an SSRI during pregnancy, 53.8 % had a diagnosis of depression and 37.3 % had a diagnosis of an anxiety disorder during pregnancy or within 180 days prior to pregnancy. Our finding that 6 % of women with live births were prescribed SSRIs during pregnancy highlights the importance of understanding the differential effects of these medications and other therapeutic options on the developing fetus and on the pregnant women.
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