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Mathevula H, Schellack N, Orubu S, Godman B, Matlala M. Off-Label and Unlicenced Medicine Use among Hospitalised Children in South Africa: Practice and Policy Implications. PHARMACY 2023; 11:174. [PMID: 37987384 PMCID: PMC10661306 DOI: 10.3390/pharmacy11060174] [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: 09/14/2023] [Revised: 10/25/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Information regarding off-label and unlicensed medicine use among South African children is limited. This is a concern as the prescribing of off-label and unlicensed medicines can lead to issues of effectiveness and safety as well as raise liability issues in the event of adverse events. This potentially exposes physicians to legal penalties. Consequently, we sought to determine the prevalence of off-label and unlicensed medicine use among paediatric patients in South Africa to provide future direction. METHODS This study retrospectively examined the use of medicine in a point-prevalence survey study (PPS) involving paediatric patients aged (0-2 years) admitted to selected public hospitals in Gauteng Province, South Africa. Data were collected per hospital over two days between February 2022 and July 2022. Demographics, duration of treatment, diagnosis, and medicines prescribed were collected from patient medical records using a mobile application. Prescribed medicines were reviewed against the medicine formularies and other databases to assess their appropriateness. RESULTS From three academic hospitals, 184 patient records were reviewed. A total of 592 medicines were dispensed, of which 379 (64.0%) were licensed and 213 (36.0%) were used off-label/unlicensed for paediatric patients 0-2 years of age. The most prevalent off-label and unlicensed medicines were multivitamins (n = 32, 15.0%) and ampicillin injections (n = 15, 7.0%). CONCLUSION The frequency of unlicensed and off-label medicine prescribing shown in this study is consistent with the literature and can be considered high. This practice can pose a risk because it adversely affects patients if not properly regulated. Attention is needed to ensure future high-quality, safe, and effective use of medicines.
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Affiliation(s)
- Hlayiseka Mathevula
- School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Pretoria 0204, South Africa; (B.G.); (M.M.)
| | - Natalie Schellack
- Department of Pharmacology, University of Pretoria, Pretoria 0084, South Africa;
| | - Samuel Orubu
- Pharmacy Department, Niger Delta University, Yenagoa P.O. BOX 72, Nigeria;
- Global Strategy Lab, York University, Toronto, ON 4700, Canada
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Pretoria 0204, South Africa; (B.G.); (M.M.)
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow G4 0RE, UK
| | - Moliehi Matlala
- School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Pretoria 0204, South Africa; (B.G.); (M.M.)
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Alcântara TDS, Carvalho GAC, Sanchez JM, Ramos SF, Cunha LC, Araújo-Neto FDC, Valença-Feitosa F, Silvestre CC, Lyra Junior DPD. Quality indicators of hospitalized children influenced by clinical pharmacist services: A systematic review. Res Social Adm Pharm 2023; 19:1315-1330. [PMID: 37442709 DOI: 10.1016/j.sapharm.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/31/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Care for children who are hospitalized can be optimized if the pharmacist, in conjunction with the multidisciplinary team, promotes the rational use of medicines. In this sense, the evaluation of the quality of these clinical services through indicators is important in the planning, decision making of pharmacists and managers of these services. OBJECTIVE To characterize which health indicators were influenced by the pharmaceutical clinical services for the care of children in hospitals. METHODS A systematic review was performed. The search for data was made on the bases: Cochrane, Embase, Lilacs, Pubmed and Web of Science. Then, the search included studies in which evaluated the impact of pharmaceutical clinical services on clinical, economic and humanistic outcomes. RESULTS The search resulted in 11 included studies. In this review, four pharmaceutical clinical services were found: pharmacotherapy review, multiprofessional team interventions, antimicrobial stewardship program and pharmaceutical services at discharge hospital. The most influenced outcome indicators were length of hospital stay, with average time in the group that received the pharmacotherapy review service, and interventions multiprofessional team with a 6.45-day vs. 10.83 days in the control group; hospital readmissions with a significant reduction of non-scheduled readmission of 30 days in the ntimicrobial stewardship program; reduction of hospital costs and caregiver satisfaction. CONCLUSION In this study, we can highlight that pharmacotherapy review, multiprofessional team interventions and Antimicrobial Stewardship Program that significantly reduced the clinical results of length of hospital stay and hospital readmission, as well as a significant reduction of hospital costs.
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Affiliation(s)
- Thaciana Dos Santos Alcântara
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | | | - Júlia Mirão Sanchez
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Sheila Feitosa Ramos
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Luiza Correia Cunha
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Fernando de Castro Araújo-Neto
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Fernanda Valença-Feitosa
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Carina Carvalho Silvestre
- Department of Pharmacy, Life Sciences Institute, Federal University of Juiz de Fora, Campus Governador Valadares, Brazil.
| | - Divaldo Pereira de Lyra Junior
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
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Bedard P, Winsor GL, Garlock ES, Azad MB, Becker AB, Mandhane PJ, Moraes TJ, Sears MR, Turvey SE, Subbarao P, Brinkman FSL, Kozyrskyj AL. From Prescription Drugs to Natural Health Products: Medication Use in Canadian Infants. CHILDREN 2022; 9:children9101475. [PMID: 36291411 PMCID: PMC9600175 DOI: 10.3390/children9101475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/28/2022]
Abstract
Limited data exist on pharmaceutical product use by infants, although available data suggests higher prevalence of use among children under 12 months of age. We conducted a descriptive study of 3050 infants recruited in the CHILD Cohort Study, a prospective, multicenter, longitudinal cohort following children from pregnancy through childhood. Parents were surveyed for use of prescription and over-the-counter drugs, and natural health products (NHPs, including homeopathic products and vitamins) at 3, 6, and 12 months after delivery. By one year of age, 96.0% of children had taken at least one pharmaceutical product. Among 307 reported products, 32 were given to at least 1% of cohort infants. Vitamin D, acetaminophen, ibuprofen, topical hydrocortisone, amoxicillin, and nystatin were the most common medications and natural health products (NHPs) received, with 8/32 of the most frequently used products being NHPs. Overall, 14.7% of pharmaceutical products administered to children were off-label and 35.8% were NHPs or products without a Drug Identification Number (DIN). The use of over-the-counter medications and NHPs is common and off-label use of drugs is frequent, even in the first year of life. This study highlights the importance of conducting studies on medication use in infants, and of infant medication use monitoring by healthcare providers.
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Affiliation(s)
- Pascal Bedard
- Department of Pharmacy, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
| | - Geoffrey L. Winsor
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Emma S. Garlock
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Meghan B. Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Allan B. Becker
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
| | - Piush J. Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Theo J. Moraes
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Malcolm R. Sears
- Department of Medicine, McMaster University, Hamilton, ON L8P 1H6, Canada
| | - Stuart E. Turvey
- Department of Pediatrics, BC Children’s Hospital and The University of British Columbia, Vancouver, BC V6H 0B3, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Fiona S. L. Brinkman
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
- Correspondence: (F.S.L.B.); (A.L.K.)
| | - Anita L. Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Correspondence: (F.S.L.B.); (A.L.K.)
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Nyengerai T, Phohole M, Iqaba N, Kinge CW, Gori E, Moyo K, Chasela C. Quality of service and continuous quality improvement in voluntary medical male circumcision programme across four provinces in South Africa: Longitudinal and cross-sectional programme data. PLoS One 2021; 16:e0254850. [PMID: 34351933 PMCID: PMC8341521 DOI: 10.1371/journal.pone.0254850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 07/03/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Recent studies in the Sub-Saharan countries in Africa have indicated gaps and challenges for voluntary medical male circumcision (VMMC) quality of service. Less has focused on the changes in quality of service after implementation of continuous quality improvement (CQI) action plans. This study aimed to evaluate the impact of coaching, provision of standard operating procedures (SOPS) and guidelines, mentoring and on-site in-service training in improving quality of VMMC services across four Right to Care (RTC) supported provinces in South Africa. METHOD This was a pre- and post-interventional study on RTC supported VMMC sites from July 2018 to October 2019. All RTC-supported sites that were assessed at baseline and post-intervention were included in the study. Data for baseline CQI assessment and re-assessments was collected using a standardized National Department of Health (NDoH) CQI assessment tool for VMMC services from routine RTC facility level VMMC programme data. Quality improvement support was provided through a combination of coaching, provision of standard operating procedures and guidelines, mentoring and on-site in-service training on quality improvement planning and implementation. The main outcome measure was quality of service. A paired sample t-test was used to compare the difference in mean quality of service scores before and after CQI implementation by quality standard. RESULTS A total of 40 health facilities were assessed at both baseline and after CQI support visits. Results showed significant increases for the overall changes in quality of service after CQI support intervention of 12% for infection prevention (95%CI: 7-17; p<0.001) and 8% for male circumcision surgical procedure, (95%CI: 3-13; p<0.01). Similarly, individual counselling, and HIV testing increased by 14%, (95%CI: 7-20; p<0.001), group counselling, registration and communication by 8%, (95%CI: 3-14; p<0.001), and 35% for monitoring and evaluation, (95%CI: 28-42; p<0.001). In addition, there were significant increases for management systems of 29%, (95%CI: 22-35; p<0.001), leadership and planning 23%, (95%CI: 13-34; p<0.001%) and supplies, equipment, environment and emergency 5%, (95%CI: 1-9; p<0.01). The overall quality of service performance across provinces increased by 18% (95%CI: 14-21; p<0.001). CONCLUSION The overall quality of service performance across provinces was significantly improved after implementation of CQI support intervention program. Regular visits and intensive CQI support are required for sites that will be performing below quality standards.
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Affiliation(s)
- Tawanda Nyengerai
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Motshana Phohole
- Voluntary Medical Male Circumcision (VMMC) Programme, Right to Care, Johannesburg, Gauteng, South Africa
| | - Nelson Iqaba
- Voluntary Medical Male Circumcision (VMMC) Programme, Right to Care, Johannesburg, Gauteng, South Africa
| | - Constance Wose Kinge
- Department of Implementation Science, Right to Care, Johannesburg, Gauteng, South Africa
| | - Elizabeth Gori
- Department of Pre-Clinical Veterinary Science, University of Zimbabwe, Harare, Zimbabwe
| | - Khumbulani Moyo
- Voluntary Medical Male Circumcision (VMMC) Programme, Right to Care, Johannesburg, Gauteng, South Africa
| | - Charles Chasela
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Department of Implementation Science, Right to Care, Johannesburg, Gauteng, South Africa
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5
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Carvalho IV, de Sousa VM, Visacri MB, Quintanilha JCF, de Souza CM, Ambrósio RFL, Reis MCD, de Queiroz RA, Mazzola PG, Galvao TF, Moriel P. Adverse Drug Event-Related Admissions to a Pediatric Emergency Unit. Pediatr Emerg Care 2021; 37:e152-e158. [PMID: 30106866 DOI: 10.1097/pec.0000000000001582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The objectives of this study were to analyze adverse drug events (ADEs) related to admissions to a pediatric emergency unit and to identify the associated risk factors. METHODS This was a prospective study. Demographic data and details of medications were collected for each patient admitted. Case studies were performed by clinical pharmacists and the clinical team to discuss whether the admission was due to an ADE and to characterize the ADE. Multivariate logistic regression was used for statistical analysis. RESULTS In total, 1708 pediatric patients were included in this study. Adverse drug events were the cause of hospital admission in 12.3% of the studied population. The majority of patients presenting with an ADE were in the age group of 0 to 5 years (61.6%), had a mean ± SD age of 4.9 ± 3.9 years, were female (51.2%), were Caucasian (72.0%), and had infectious disorders (49.3%). High frequencies of medication errors (68.8%), use of drugs to treat respiratory disorders (27.7%), and ADEs of mild severity (75.3%) were reported. The risk of being admitted to the pediatric emergency unit for any ADE increased in cases of neurological (odds ratio [OR], 4.63; 95% confidence interval [CI], 2.38-8.99), dermatological (OR, 3.16; 95% CI, 1.93-5.18), and respiratory (OR, 3.02; 95% CI, 1.89-4.83) disorders. CONCLUSIONS A high frequency of ADE-related admissions to the pediatric emergency unit was observed. The risk of being admitted to the pediatric emergency unit for any ADE increased in cases of neurological, dermatological, and respiratory disorders. Clinical pharmacists play an important role in the identification of ADEs and the education of child caregivers and health care providers concerning pediatric medication.
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Affiliation(s)
| | | | | | | | | | | | - Marcelo Conrado Dos Reis
- Pediatric Emergency Unit, Hospital of Clinics, University of Campinas, Campinas, São Paulo, Brazil
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6
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Baan EJ, de Smet VA, Hoeve CE, Pacurariu AC, Sturkenboom MCJM, de Jongste JC, Janssens HM, Verhamme KMC. Exploratory Study of Signals for Asthma Drugs in Children, Using the EudraVigilance Database of Spontaneous Reports. Drug Saf 2020; 43:7-16. [PMID: 31617080 PMCID: PMC6965046 DOI: 10.1007/s40264-019-00870-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction As asthma medications are frequently prescribed for children, knowledge of the safety of these drugs in the paediatric population is important. Although spontaneous reports cannot be used to prove causality of adverse events, they are important in the detection of safety signals. Objective Our objective was to provide an overview of adverse drug events associated with asthma medications in children from a spontaneous reports database and to identify new signals. Methods Spontaneous reports concerning asthma drugs were obtained from EudraVigilance, the European Medicine Agency’s database for suspected adverse drug reactions. For each drug–event combination, we calculated the proportional reporting ratio (PRR) in the study period 2011–2017. Signals in children (aged 0–17 years) were compared with signals in the whole population. Analyses were repeated for different age categories, by sex and by therapeutic area. Results In total, 372,345 reports in children resulted in 385 different signals concerning asthma therapy. The largest group consisted of psychiatric events (65 signals). Only 30 signals were new, with seven, including herpes viral infections, associated with omalizumab. Stratification by age, sex and therapeutic area provided additional new signals, such as hypertrichoses with budesonide and encephalopathies with theophylline. Of all signals in children, 60 (16%) did not appear in the whole population. Conclusions The majority of signals regarding asthma therapy in children were already known, but we also identified new signals. We showed that signals can be masked if age stratification is not conducted. Further exploration is needed to investigate the risk and causality of the newly found signals. Electronic supplementary material The online version of this article (10.1007/s40264-019-00870-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Esmé J Baan
- Department of Medical Informatics, Erasmus Medical Centre, Erasmus University, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands.
| | | | - Christina E Hoeve
- Department of Medical Informatics, Erasmus Medical Centre, Erasmus University, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands
| | - Alexandra C Pacurariu
- Department of Medical Informatics, Erasmus Medical Centre, Erasmus University, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands
| | | | - Johan C de Jongste
- Department of Pediatrics/Respiratory Medicine, Erasmus University/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Hettie M Janssens
- Department of Pediatrics/Respiratory Medicine, Erasmus University/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Katia M C Verhamme
- Department of Medical Informatics, Erasmus Medical Centre, Erasmus University, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands.,Department of Pharmacy, Ghent University Hospital, Ghent, Belgium.,Department of Infection Control and Epidemiology, OLV Hospital, Aalst, Belgium
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7
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Abstract
OBJECTIVES (1) Systematically assemble, analyse and synthesise published evidence on causes of prescribing error in children. (2) Present results to a multidisciplinary group of paediatric prescribing stakeholders to validate findings and establish how causative factors lead to errors in practice. DESIGN Scoping review using Arksey and O'Malley's framework, including stakeholder consultation; qualitative evidence synthesis. METHODS We followed the six scoping review stages. (1) Research question-the research question was 'What is known about causes of prescribing error in children?' (2) Search strategy-we searched MEDLINE, EMBASE, CINAHL (from inception to February 2018), grey literature and reference lists of included studies. (3) Article selection-all published evidence contributing information on the causes of prescribing error in children was eligible for inclusion. We included review articles as secondary evidence to broaden understanding. (4) Charting data-results were collated in a custom data charting form. (5) Reporting results-we summarised article characteristics, extracted causal evidence and thematically synthesised findings. (6) Stakeholder consultation-results were presented to a multidisciplinary focus group of six prescribing stakeholders to establish validity, relevance and mechanisms by which causes lead to errors in practice. RESULTS 68 articles were included. We identified six main causes of prescribing errors: children's fundamental differences led to individualised dosing and calculations; off-licence prescribing; medication formulations; communication with children; and experience working with children. Primary evidence clarifying causes was lacking. CONCLUSIONS Specific factors complicate prescribing for children and increase risk of errors. Primary research is needed to confirm and elaborate these causes of error. In the meantime, this review uses existing evidence to make provisional paediatric-specific recommendations for policy, practice and education.
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Affiliation(s)
- Richard L Conn
- Centre for Medical Education, Queen's University Belfast School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
- Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Orla Kearney
- Queen's University Belfast School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | - Mary P Tully
- Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester Academic Health Sciences Centre, Manchester, UK
| | - Michael D Shields
- Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
- Centre for Experimental Medicine, The Institute for Health Sciences, Queen's University Belfast, Belfast, UK
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
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8
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Star K, Sandberg L, Bergvall T, Choonara I, Caduff-Janosa P, Edwards IR. Paediatric safety signals identified in VigiBase: Methods and results from Uppsala Monitoring Centre. Pharmacoepidemiol Drug Saf 2019; 28:680-689. [PMID: 30767342 PMCID: PMC6594230 DOI: 10.1002/pds.4734] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 10/01/2018] [Accepted: 12/10/2018] [Indexed: 12/01/2022]
Abstract
Purpose The purpose of this study is to uncover previously unrecognised risks of medicines in paediatric pharmacovigilance reports and thereby advance a safer use of medicines in paediatrics. Methods Individual case safety reports (ICSRs) with ages less than 18 years were retrieved from VigiBase, the World Health Organization (WHO) global database of ICSRs, in September 2014. The reports were grouped according to the following age spans: 0 to 27 days; 28 days to 23 months; 2 to 11 years; and 12 to 17 years. vigiRank, a data‐driven predictive model for emerging safety signals, was used to prioritise the list of drug events by age groups. The list was manually assessed, and potential signals were identified to undergo in‐depth assessment to determine whether a signal should be communicated. Results A total of 472 drug‐event pairs by paediatric age groups were the subject of an initial manual assessment. Twenty‐seven drug events from the two older age groups were classified as potential signals. An in‐depth assessment resulted in eight signals, of which one concerned harm in connection with off‐label use of dextromethorphan and another with accidental overdose of olanzapine by young children, and the remaining signals referred to potentially new causal associations for atomoxetine (two signals), temozolamide, deferasirox, levetiracetam, and desloratadine that could be relevant also for adults. Conclusions Clinically relevant signals were uncovered in VigiBase by using vigiRank applied to paediatric age groups. Further refinement of the methodology is needed to identify signals in reports with ages under 2 years and to capture signals specific to the paediatric population as a risk group.
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Affiliation(s)
- Kristina Star
- Research Section, Uppsala Monitoring Centre, Uppsala, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Lovisa Sandberg
- Research Section, Uppsala Monitoring Centre, Uppsala, Sweden
| | - Tomas Bergvall
- Research Section, Uppsala Monitoring Centre, Uppsala, Sweden
| | - Imti Choonara
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK
| | | | - I Ralph Edwards
- Research Section, Uppsala Monitoring Centre, Uppsala, Sweden
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9
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Drug-induced gambling disorder: A not so rare but underreported condition. Psychiatry Res 2018; 269:593-595. [PMID: 30205352 DOI: 10.1016/j.psychres.2018.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/11/2018] [Accepted: 09/03/2018] [Indexed: 01/13/2023]
Abstract
The widespread use of dopaminergic agents for the treatment of Parkinson's disease has revealed the presence of gambling disorder (GD) as an uncommon, but serious, adverse reaction to these agents. We describe the main characteristics of drug-induced GD reports received by the Spanish Pharmacovigilance System during the period from 1983 to 2016. Fifteen reports of GD have been identified. Dopaminergic agonists, especially pramipexole, are the main drugs involved in inducing GD. Physicians prescribing these drugs should warn patients and families about this disorder. Knowledge of this disorder will encourage early diagnosis, treatment, and reporting of this clinically and socially relevant disorder.
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10
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Agoro OO, Kibira SW, Freeman JV, Fraser HSF. Barriers to the success of an electronic pharmacovigilance reporting system in Kenya: an evaluation three years post implementation. J Am Med Inform Assoc 2018; 25:627-634. [PMID: 29040656 PMCID: PMC6664850 DOI: 10.1093/jamia/ocx102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/07/2017] [Accepted: 09/01/2017] [Indexed: 11/13/2022] Open
Abstract
Objective Electronic pharmacovigilance reporting systems are being implemented in many developing countries in an effort to improve reporting rates. This study sought to establish the factors that acted as barriers to the success of an electronic pharmacovigilance reporting system in Kenya 3 years after its implementation. Materials and Methods Factors that could act as barriers to using electronic reporting systems were identified in a review of literature and then used to develop a survey questionnaire that was administered to pharmacists working in government hospitals in 6 counties in Kenya. Results The survey was completed by 103 out of the 115 targeted pharmacists (89.5%) and included free-text comments. The key factors identified as barriers were: unavailable, unreliable, or expensive Internet access; challenges associated with a hybrid system of paper and electronic reporting tools; and system usability issues. Coordination challenges at the national pharmacovigilance center and changes in the structure of health management in the country also had an impact on the success of the electronic reporting system. Discussion Different personal, organizational, infrastructural, and reporting system factors affect the success of electronic reporting systems in different ways, depending on the context. Context-specific formative evaluations are useful in establishing the performance of electronic reporting systems to identify problems and ensure that they achieve the desired objectives. Conclusion While several factors hindered the optimal use of the electronic pharmacovigilance reporting system in Kenya, all were considered modifiable. Effort should be directed toward tackling the identified issues in order to facilitate use and improve pharmacovigilance reporting rates.
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Affiliation(s)
- Oscar O Agoro
- Ministry of Health, Medical Department, Nairobi, Kenya
| | | | - Jenny V Freeman
- Yorkshire Centre for Health Informatics, University of Leeds, Leeds, UK
| | - Hamish S F Fraser
- Yorkshire Centre for Health Informatics, University of Leeds, Leeds, UK
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11
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Czaja AS, Ross ME, Liu W, Fiks AG, Localio R, Wasserman RC, Grundmeier RW, Adams WG. Electronic health record (EHR) based postmarketing surveillance of adverse events associated with pediatric off-label medication use: A case study of short-acting beta-2 agonists and arrhythmias. Pharmacoepidemiol Drug Saf 2018; 27:815-822. [PMID: 29806185 DOI: 10.1002/pds.4562] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/23/2018] [Accepted: 05/01/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Use electronic health record (EHR) data to (1) estimate the risk of arrhythmia associated with inhaled short-acting beta-2 agonists (SABA) in pediatric patients and (2) determine whether risk varied by on-label versus off-label prescribing. METHODS Retrospective cohort study of 335 041 children ≤18 years using EHR primary care data from 2 pediatric health systems (2011-2013). A series of monthly pseudotrials were created, using propensity score methodology to balance baseline characteristics between SABA-exposed (identified by prescription) and SABA-unexposed children. Association between SABA and subsequent arrhythmia for each health system was estimated through pooled logistic regression with separate estimates for children initiating under and over 4 years old (off-label and on-label, respectively). RESULTS Eleven percent of the cohort received a SABA prescription, 57% occurred under the age of 4 years (off-label). During the follow-up period, there were 283 first arrhythmia events, most commonly atrial tachyarrhythmias and premature ventricular/atrial contractions. In 1 health system, adjusted risk for arrhythmia was increased among exposed children (OR 1.89, 95% CI 1.31-2.73) without evidence of interaction between label status and risk. The absolute adjusted rate difference was 3.6/10 000 person-years of SABA exposure. The association between SABA exposure and arrhythmias was less strong in the second system (OR 1.26, 95% CI 0.30-5.33). CONCLUSION Using EHR data, we could estimate the risk of a rare event associated with medication use and determine difference in risk related to on-label versus off-label status. These findings support the value of EHR-based data for postmarketing drug studies in the pediatric population.
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Affiliation(s)
- Angela S Czaja
- Department of Pediatrics, Critical Care, University of Colorado School of Medicine, Aurora, CO, USA.,Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michelle E Ross
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Weiwei Liu
- Pediatric Research in Office Settings, American Academy of Pediatrics, Itasca, IL, USA
| | - Alexander G Fiks
- Pediatric Research in Office Settings, American Academy of Pediatrics, Itasca, IL, USA.,Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Russell Localio
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard C Wasserman
- Pediatric Research in Office Settings, American Academy of Pediatrics, Itasca, IL, USA.,Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Robert W Grundmeier
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - William G Adams
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
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Bouquet É, Star K, Jonville-Béra AP, Durrieu G. Pharmacovigilance in pediatrics. Therapie 2018; 73:171-180. [DOI: 10.1016/j.therap.2017.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 11/15/2017] [Indexed: 12/20/2022]
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Drug Safety Monitoring in Children: Performance of Signal Detection Algorithms and Impact of Age Stratification. Drug Saf 2017; 39:873-81. [PMID: 27255487 PMCID: PMC4982893 DOI: 10.1007/s40264-016-0433-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Spontaneous reports of suspected adverse drug reactions (ADRs) can be analyzed to yield additional drug safety evidence for the pediatric population. Signal detection algorithms (SDAs) are required for these analyses; however, the performance of SDAs in the pediatric population specifically is unknown. We tested the performance of two SDAs on pediatric data from the US FDA Adverse Event Reporting System (FAERS) and investigated the impact of age stratification and age adjustment on the performance of SDAs. METHODS We tested the performance of two established SDAs: the proportional reporting ratio (PRR) and the empirical Bayes geometric mean (EBGM) on a pediatric dataset from FAERS (2004-2012). We compared the performance of the SDAs with a published pediatric-specific reference set by calculating diagnostic test-related statistics, including the area under the curve (AUC) of receiver operating characteristics. Impact of age stratification and age-adjustment on the performance of the SDAs was assessed. Age adjustment was performed by pooling (Mantel-Hanszel) stratum-specific estimates. RESULTS A total of 115,674 pediatric reports (patients aged 0-18 years) comprising 893,587 drug-event combinations (DECs) were analysed. Crude values of the AUC were similar for both SDAs: 0.731 (PRR) and 0.745 (EBGM). Stratification unmasked four DECs, e.g., 'ibuprofen and thrombocytopenia'. Age adjustment did not improve performance. CONCLUSION The performance of the two tested SDAs was similar in the pediatric population. Age adjustment does not improve performance and is therefore not recommended to be performed routinely. Stratification can reveal new associations, and therefore is recommended when either drug use is age-specific or when an age-specific risk is suspected.
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Crawford C, Anderson M, Cooper G, Jackson G, Thompson J, Vale A, Thomas SHL, Eddleston M, Bateman DN. Overdose in young children treated with anti-reflux medications: Poisons enquiry evidence of excess 10-fold dosing errors with ranitidine. Hum Exp Toxicol 2017; 37:343-349. [DOI: 10.1177/0960327117705430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- C Crawford
- National Poisons Information Service – Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - M Anderson
- National Poisons Information Service – Newcastle, Regional Drugs & Therapeutics Centre, Newcastle upon Tyne, UK
| | - G Cooper
- National Poisons Information Service – Cardiff, University Hospital Llandough, Cardiff, UK
| | - G Jackson
- National Poisons Information Service – Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - J Thompson
- National Poisons Information Service – Cardiff, University Hospital Llandough, Cardiff, UK
| | - A Vale
- National Poisons Information Service – Birmingham, City Hospital, Birmingham, UK
| | - SHL Thomas
- National Poisons Information Service – Newcastle, Regional Drugs & Therapeutics Centre, Newcastle upon Tyne, UK
| | - M Eddleston
- National Poisons Information Service – Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
- Pharmacology, Toxicology, & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - DN Bateman
- Pharmacology, Toxicology, & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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15
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[Adverse drug reactions in neonates hospitalized in neonatal intensive care units in Barranquilla, Colombia]. BIOMEDICA 2017; 37:33-42. [PMID: 28527264 DOI: 10.7705/biomedica.v37i1.3192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/23/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The appearance of adverse drug reactions in neonates is an important issue due to the lack of drug safety data. OBJECTIVE To identify the behavior of adverse drug reactions (ADR) in hospitalized neonates at two intensive care units in Barranquilla, Colombia. MATERIALS AND METHODS We conducted a cross-sectional prospective descriptive study based on patientcentered intensive pharmacosurveillance. We followed up and monitored the appearance of ADRs for six months. We used Naranjo's algorithm to assess causality, modified Hartwig and Siegel assessment scale to establish severity and Schumock and Thornton criteria to determine ADR preventability. RESULTS We detected 123 adverse drug reactions in 78 neonates of the 284 monitored. The cumulative incidence of ADRs was 27.4% (78/284); incidence density was 30.60 ADRs per 1,000 patients/day (78/2,549). The most affected organ system was the digestive (33.6%). Systemic anti-infective drugs were the most involved pharmacological group. Most of the ADRs were mild (58.5%), 83% were classified as probable, 16.2% as possible and 0.8% as definite. CONCLUSIONS ADR incidence was high in newborns, and it increased in preterm infants (less than 38 weeks of age).
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Kaguelidou F, Beau-Salinas F, Jonville-Bera AP, Jacqz-Aigrain E. Neonatal adverse drug reactions: an analysis of reports to the French pharmacovigilance database. Br J Clin Pharmacol 2016; 82:1058-68. [PMID: 27276109 DOI: 10.1111/bcp.13034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 05/23/2016] [Accepted: 06/06/2016] [Indexed: 11/30/2022] Open
Abstract
AIM Term and preterm neonates are at high risk for serious adverse drug reactions (ADRs). METHODS A descriptive study of reports registered in the French pharmacovigilance database from 1986 to 2012 were obtained. All reports concerning neonates (≤1 month of life) with direct drug exposure were retrieved. Characteristics of the reports, including reported ADR(s), drug(s) and the causality assessment using the French causality assessment method, were described. RESULTS A total of 1688 reports were analyzed and more than half of them were classified as serious (n = 995). Median age at ADR occurrence was 9 days. Overall, 3127 ADRs were described in these reports in relation to 2238 suspect/interacting drugs. The most commonly reported system organ classes (SOCs) were injury, poisoning and procedural complications (16%), general disorders and administration site conditions (12.5%) and blood and lymphatic system disorders (12%). In the majority of ADRs reported (73%), infants fully recovered and less than 4% of neonates deceased as a consequence of the reported ADR. One out of five ADRs was associated with drug administration errors. Therapeutic classes commonly incriminated were anti-infectives, nervous system and alimentary tract drugs. Substances most frequently related to serious ADRs were zidovudine, ibuprofen and nevirapine. Among the 10 most frequently encountered drug-ADR pairs, two substances were mainly implicated, zidovudine in haematological adverse reactions and phytomenadione in maladministrations. CONCLUSIONS Anti-infective drugs, mainly antiretroviral therapy, account for the majority of ADRs reported in neonates. The specific issue of drug maladministration and medication errors remains to be addressed in neonates.
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Affiliation(s)
- Florentia Kaguelidou
- EA 08, University of Paris Diderot, Sorbonne Paris Cité, F-75010, Paris. .,Inserm, CIC 1426, F-75019, Paris. .,Department of Pediatric Pharmacology and Pharmacogenetics, AP-HP, Hôpital Robert Debré, F-75019, Paris.
| | - Frédérique Beau-Salinas
- CHRU of Tours, Department of Clinical Pharmacology, Regional Centre of Pharmacovigilance, F-37 044, Tours, France
| | - Annie Pierre Jonville-Bera
- CHRU of Tours, Department of Clinical Pharmacology, Regional Centre of Pharmacovigilance, F-37 044, Tours, France
| | - Evelyne Jacqz-Aigrain
- EA 08, University of Paris Diderot, Sorbonne Paris Cité, F-75010, Paris.,Inserm, CIC 1426, F-75019, Paris.,Department of Pediatric Pharmacology and Pharmacogenetics, AP-HP, Hôpital Robert Debré, F-75019, Paris
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Palmaro A, Bissuel R, Renaud N, Durrieu G, Escourrou B, Oustric S, Montastruc JL, Lapeyre-Mestre M. Off-label prescribing in pediatric outpatients. Pediatrics 2015; 135:49-58. [PMID: 25511119 DOI: 10.1542/peds.2014-0764] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To study the characteristics of off-label prescribing and adverse drug reaction (ADR) occurrence in a sample of pediatric outpatients treated by general practitioners. METHODS A survey on pediatric drug prescribing was implemented in 46 general practices in southwestern France. All consecutive patients aged 0 to 16 years were included. Patient characteristics, reasons for consultation, and drug prescribed (including indications) were collected. ADRs occurring ≤10 days after the date of consultation were recorded by the general practitioners (spontaneous notification). Off-label prescription was defined as prescribing outside the specifications of the Summary of Product Characteristics. RESULTS Among the 2313 children seen between March 8, 2011 and July 31, 2011, 1960 were exposed to ≥1 prescribed drug. Mean age was 5.6 years, with a gender ratio of 1.1. Among children with prescriptions, 37.6% (n = 736) were exposed to ≥1 off-label prescription and 6.7% (n = 132) to ≥1 unlicensed drug. Off-label prescribing involved an unapproved indication in 56.4% of cases (n = 416), a lower dosage (26.5%, n = 195) or higher dosage (19.5%, n = 144) than specified, age not labeled (7.2%, n = 53), incorrect route of administration (3.5%, n = 26), and contraindication (0.3%, n = 2). A total of 23 ADRs were reported (1.5% of patients with off-label prescriptions). ADR occurrence was not significantly related to off-label drug prescribing. CONCLUSIONS Despite the numerous initiatives implemented for promoting rational medicine use in children, the prevalence of off-label prescription in outpatient pediatric practice remains high.
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Affiliation(s)
- Aurore Palmaro
- Laboratoire de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Equipe de Pharmacoépidémiologie, INSERM U1027, Centre Hospitalier Universitaire, Faculté de Médecine, Université de Toulouse, France; and
| | - Raphael Bissuel
- Département Universitaire de Médecine Générale des Facultés de Médecine de Toulouse, France
| | - Nicholas Renaud
- Laboratoire de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Equipe de Pharmacoépidémiologie, INSERM U1027, Centre Hospitalier Universitaire, Faculté de Médecine, Université de Toulouse, France; and
| | - Geneviève Durrieu
- Laboratoire de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Equipe de Pharmacoépidémiologie, INSERM U1027, Centre Hospitalier Universitaire, Faculté de Médecine, Université de Toulouse, France; and
| | - Brigitte Escourrou
- Département Universitaire de Médecine Générale des Facultés de Médecine de Toulouse, France
| | - Stephane Oustric
- Département Universitaire de Médecine Générale des Facultés de Médecine de Toulouse, France
| | - Jean-Louis Montastruc
- Laboratoire de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Equipe de Pharmacoépidémiologie, INSERM U1027, Centre Hospitalier Universitaire, Faculté de Médecine, Université de Toulouse, France; and
| | - Maryse Lapeyre-Mestre
- Laboratoire de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Equipe de Pharmacoépidémiologie, INSERM U1027, Centre Hospitalier Universitaire, Faculté de Médecine, Université de Toulouse, France; and
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Carnovale C, Brusadelli T, Zuccotti G, Beretta S, Sullo MG, Capuano A, Rossi F, Moschini M, Mugelli A, Vannacci A, Laterza M, Clementi E, Radice S. The importance of monitoring adverse drug reactions in pediatric patients: the results of a national surveillance program in Italy. Expert Opin Drug Saf 2014; 13 Suppl 1:S1-8. [DOI: 10.1517/14740338.2014.928692] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Pharmacovigilance reports of drug-related harms in children should include details on age- and drug-specific factors. DRUGS & THERAPY PERSPECTIVES 2014. [DOI: 10.1007/s40267-014-0127-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Blake KV, Zaccaria C, Domergue F, La Mache E, Saint-Raymond A, Hidalgo-Simon A. Comparison between paediatric and adult suspected adverse drug reactions reported to the European medicines agency: implications for pharmacovigilance. Paediatr Drugs 2014; 16:309-19. [PMID: 24898717 DOI: 10.1007/s40272-014-0076-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Databases systematically collecting reports of suspected adverse drug reactions (ADRs) are a cornerstone of pharmacovigilance in that they provide on-going large-scale surveillance in the 'real-world' setting. Several studies have provided data on ADRs in children reported to national databases. EudraVigilance (EV) is the European Medicines Agency's (EMA) web-based system for reporting and evaluating suspected ADRs. Due to requirements on pharmaceutical companies to report ADRs that originate both inside and outside Europe, the data in EudraVigilance are global in nature. As such, it is potentially a rich source of information for paediatric pharmacovigilance. AIM The present study sought to provide a descriptive overview comparing ADRs involving children and adolescents aged less than 18 years with those involving adults reported to EudraVigilance across national boundaries. The results will serve as a baseline to explore whether lessons can be learned for paediatric pharmacovigilance. METHODS All ADR reports received in EudraVigilance up to 13 June 2013 were analysed for overall numbers, age, gender, and geographic origin. Accurate age was determined when reported in valid format or calculated from the interval between date of birth and the reaction start date. The nature of the ADRs and the most frequently reported drug substances and drug event combinations were evaluated using Medical Dictionary for Regulatory Activities (MedDRA) 'preferred terms' (PTs) and 'system organ classes' (SOCs). The distribution over time of reported paediatric ADRs was also analysed. RESULTS As of 13 June 2013, EudraVigilance contained 3,291,593 spontaneous reports, for 75.9 % of which accurate age was determined; 11.2 % of these were paediatric reports. Paediatric ADRs were more common than those in adults under the MedDRA SOCs 'general and administration site', 'nervous system', 'skin and subcutaneous' and 'infections and infestations'. For children, the three most frequently reported MedDRA PTs, i.e. pyrexia, vomiting and convulsion (13, 6 and 4 % of reports, respectively), accounted for a greater proportion of reports than the corresponding top three in adults, i.e. nausea, dyspnoea and pyrexia (4, 4 and 3 % of reports, respectively). The 20 most reported active substances (12 of which are vaccines) together accounted for 52 % of paediatric reports as compared with 28 % of adult reports. CONCLUSIONS The present study applied a first-time approach to one of the largest databases worldwide of reported ADRs. It confirmed that reports of reactions in children were different to those in adults, not only in terms of reactions and drugs involved but also more concentrated around limited sets of reaction types and drugs. The possible causal association between a medicine or vaccine and the suspected ADR was not formally assessed in this study since the study analysed the characteristics of reported ADRs that were suspected and therefore not proven. However, the findings may help to identify pharmacovigilance activities that should be strengthened to reduce the burden of ADRs in children.
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Affiliation(s)
- Kevin V Blake
- European Medicines Agency, 7 Westferry Circus, Canary Wharf, London, E14 4HB, UK,
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Abstract
INTRODUCTION Retapamulin, a topical pleuromutilin that selectively inhibits bacterial protein synthesis, is approved for treatment of impetigo and secondarily infected traumatic lesions in adults and in children older than 9 months of age. OBJECTIVE A 5-year study was conducted to monitor prescription use in children younger than 9 months of age. METHODS Annual prescription events were monitored in the UK Clinical Practice Research Datalink (CPRD) and the Clinformatics™ DataMart Multiplan (IMPACT), a product of OptumInsight Life Sciences, Inc. (Eden Prairie, MN, USA), from the USA. RESULTS In the CPRD, of 148 prescriptions, three (2 %) were identified in children aged less than 9 months between years 2008 and 2011. In IMPACT, of 59,210 claims for retapamulin in children, 1,951 (3.3 %) were categorized as definitive, or uncertain for, less than 9 months of age between 2007 and 2011. CONCLUSION Retapamulin prescription events in children aged less than 9 months were relatively low compared with other recent estimations of off-label pediatric medicines. Our report provides a framework for future investigations and discussions that may facilitate off-label reporting schemes and promote pediatric drug safety.
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