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Kim HJ, Yoon JH, Park YH. Long-term hepatobiliary disorder associated with trastuzumab emtansine pharmacovigilance study using the FDA Adverse Event Reporting System database. Sci Rep 2024; 14:19587. [PMID: 39179667 PMCID: PMC11343769 DOI: 10.1038/s41598-024-69614-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 08/07/2024] [Indexed: 08/26/2024] Open
Abstract
Trastuzumab emtansine (T-DM1) is widely utilized as a second-line and subsequent treatment for metastatic HER2+ breast cancer and has shown promise in early breast cancer treatment, particularly in adjuvant settings for residual disease after neoadjuvant chemotherapy. However, concerns have arisen regarding long-term hepatic adverse drug reactions (ADRs) not identified in clinical trials. We investigated potential safety signals of T-DM1 in hepatobiliary disorders and the time-to-onset of ADRs using the FDA Adverse Event Reporting System (FAERS) database. Suspected ADRs were extracted and divided into two groups: T-DM1 (N = 3387) and other drugs (N = 11,833,701). Potential signal for T-DM1 in hepatobiliary disorder were identified (reporting odds ratio [ROR] = 5.66, 95% confidence interval [CI] = 5.11-6.27; information component [IC] = 2.35, 95% Credibility Interval [Crl] = 2.18-2.51). A breast cancer indicated subgroup analysis (2519 T-DM1; 172,329 other drugs) also identified a potential safety signal (ROR = 3.28, 95% CI = 2.92-3.68; IC = 1.53, 95%CrI = 1.35-1.71). The median time-to-onset for T-DM1-associated hepatobiliary disorders was 41 days. For prolonged and chronic hepatobiliary disorders, median times were 322.5 and 301.5 days, respectively. These findings highlight the need for further research to inform clinical decisions on optimal T-DM1 treatment duration, balancing benefits with potential adverse reactions.
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Affiliation(s)
- Hyo Jung Kim
- Department of Digital Health, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Republic of Korea
- Center of Research Resource Standardization, Research Institution for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jeong-Hwa Yoon
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Republic of Korea
- Medical Big Data Research Center, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Yeon Hee Park
- Samsung Advanced Institute for Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.
- Division of Hematology-Oncology, Department of Medicine, Breast Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro Gangnam-gu, Seoul, 06351, Republic of Korea.
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Taylor LG, Kürzinger ML, Hermans R, Enshaeifar S, Dwan B, Chhikara P, Li X, Thummisetti S, Colas S, Duverne M, Juhaeri J. Considerations for practical use of tree-based scan statistics for signal detection using electronic healthcare data: a case study with insulin glargine. Expert Opin Drug Saf 2024:1-11. [PMID: 39162331 DOI: 10.1080/14740338.2024.2393274] [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: 02/15/2024] [Accepted: 07/29/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND Hypothesis-free signal detection (HFSD) methods such as tree-based scan statistics (TBSS) applied to longitudinal electronic healthcare data (EHD) are increasingly used in safety monitoring. However, challenges may arise in interpreting HFSD results alongside results from disproportionality analysis of spontaneous reporting. RESEARCH DESIGN AND METHODS Using the anti-diabetes drug insulin glargine (Lantus®) we apply two different tree-based scan designs using TreeScan™ software on retrospective EHD and compare the results to one another as well as to results from a disproportionality analysis using SRD. RESULTS The self-controlled tree temporal scan method produced the larger number of alerts relative to propensity-score matched approach; however, far fewer alerts were observed when analyses were limited to EHD in inpatient/emergency room settings only. Very few reference adverse events were observed using TBSS methods on EHD relative to disproportionality methods in SRD. CONCLUSION Differences in detected alerts between TBSS methods and between TBSS and disproportionality analysis of SRD are likely attributable to differences in data, comparator, and study design. Our results suggest that HFDS methods like TBSS applied to EHD may complement more traditional approaches such as disproportionality analysis of SRD to provide a more complete picture of product safety in the post-approval setting.
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Affiliation(s)
| | | | | | | | | | | | - Xinyu Li
- Sanofi, Epidemiology and Benefit-Risk, PSPV, Bridgewater, MA, USA
| | | | - Sandrine Colas
- Sanofi Epidemiology and Benefit-Risk, PSPV, Toronto, Canada
| | | | - Juhaeri Juhaeri
- Sanofi, Epidemiology and Benefit-Risk, PSPV, Bridgewater, MA, USA
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Goldman A, Galper BEL, Druyan A, Grossman C, Sharif K, Shechtman L, Moshkovits Y, Lahat A, Ben-Zvi I. Adverse cardiovascular events in rheumatoid arthritis patients treated with JAK inhibitors: An analysis of postmarketing spontaneous safety reports. Semin Arthritis Rheum 2024; 67:152461. [PMID: 38772185 DOI: 10.1016/j.semarthrit.2024.152461] [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: 03/06/2024] [Revised: 04/14/2024] [Accepted: 04/29/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVES The ORAL Surveillance trial, a postmarketing safety clinical trial, found an increased risk of adverse cardiovascular events and venous thromboembolism (VTE) in patients treated with Janus Kinase (JAK) inhibitors compared to tumor necrosis factor (TNF) inhibitors. However, additional studies yielded mixed results and data on other JAK inhibitors are limited. METHODS A retrospective, pharmacovigilance study using the FDA adverse event reporting system (FAERS) to assess reporting of adverse cardiovascular events following treatment with JAK inhibitors in rheumatoid arthritis (RA) patients between January 2015 and June 2023. To identify disproportionately increased reporting, an adjusted reporting odds ratio (adj.ROR) was calculated with a multivariable logistic regression model. RESULTS We identified safety reports of 75,407 RA patients treated with JAK inhibitors (tofacitinib, n = 52,181; upadacitinib, n = 21,006; baricitinib, n = 2,220) and 303,278 patients treated with biologic disease-modifying antirheumatic drugs (bDMARDs; TNF inhibitors, rituximab, and tocilizumab). The mean age was 61.2(±12) and 59.0(±13), respectively; 82 % and 81 % were women. Compared to bDMARDs, JAK inhibitors were associated with an increased reporting of VTE [n = 1,393, adj.ROR=2.11 (1.97-2.25)], stroke [n = 973, adj.ROR=1.25 (1.16-1.34)], ischemic heart disease [IHD, n = 999, adj.ROR=1.23 (1.13-1.33)], peripheral edema [n = 2699, adj.ROR=1.22 (1.17-1.28)], and tachyarrhythmias [n = 370, adj.ROR=1.15 (1.00-1.33)]. Most of the events occurred in the first year after treatment initiation. When different JAK inhibitors were compared, VTE, stroke, and IHD were more frequently reported with upadacitinib and baricitinib than tofacitinib. When stratified by age category, all safety signals were statistically significant in patients aged≤65 years. CONCLUSION In this global postmarketing study, JAK inhibitors are associated with increased reporting of VTE, stroke, IHD, and tachyarrhythmias. These adverse events were reported following all JAK inhibitors that were studied, suggesting a class effect.
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Affiliation(s)
- Adam Goldman
- Department of Internal Medicine F, Sheba Medical Center, Ramat-Gan, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; The Sheba Talpiot Medical Leadership Program, Sheba Medical Center, Ramat-Gan, Israel
| | | | - Amit Druyan
- Department of Internal Medicine F, Sheba Medical Center, Ramat-Gan, Israel; School of Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel‑Aviv, Israel
| | - Chagai Grossman
- Department of Internal Medicine F, Sheba Medical Center, Ramat-Gan, Israel; School of Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel‑Aviv, Israel
| | - Kassem Sharif
- School of Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel‑Aviv, Israel; Department of Gastroenterology, Sheba Medical Center, Ramat-Gan, Israel
| | - Liran Shechtman
- Department of Critical Care Medicine, Sunnybrook Hospital, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada
| | - Yonatan Moshkovits
- Department of Internal Medicine F, Sheba Medical Center, Ramat-Gan, Israel; School of Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel‑Aviv, Israel
| | - Adi Lahat
- School of Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel‑Aviv, Israel; Department of Gastroenterology, Sheba Medical Center, Ramat-Gan, Israel
| | - Ilan Ben-Zvi
- Department of Internal Medicine F, Sheba Medical Center, Ramat-Gan, Israel; The Sheba Talpiot Medical Leadership Program, Sheba Medical Center, Ramat-Gan, Israel; School of Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel‑Aviv, Israel.
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Gravel CA, Bai W, Douros A. Comparators in Pharmacovigilance: A Quasi-Quantification Bias Analysis. Drug Saf 2024; 47:809-819. [PMID: 38703312 PMCID: PMC11286628 DOI: 10.1007/s40264-024-01433-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND AND OBJECTIVE It is unclear which comparator is the most appropriate for bias reduction in disproportionality analyses based on spontaneous reports. We conducted a quasi-quantitative bias analysis using two well-studied drug-event combinations to assess how different comparators influence the directionality of bias in pharmacovigilance. METHODS We used the US Food and Drug Administration Adverse Event Reporting System focusing on two drug-event combinations with a propensity for stimulated reporting: rivaroxaban and hepatotoxicity, and canagliflozin and acute kidney injury. We assessed the directionality of three disproportionality analysis estimates (reporting odds ratio, proportional reporting ratio, information component) using one unrestricted comparator (full data) and two restricted comparators (active comparator, active comparator with class exclusion). Analyses were conducted within two calendar time periods, defined based on external events (approval of direct oral anticoagulants, Food and Drug Administration safety warning on acute kidney injury with sodium-glucose cotransporter 2 inhibitors) hypothesized to alter reporting rates. RESULTS There were no false-positive signals for rivaroxaban and hepatotoxicity irrespective of the comparator. Restricting to the initial post-approval period led to false-positive signals, with restricted comparators performing worse. There were false-positive signals for canagliflozin and acute kidney injury, with restricted comparators performing better. Restricting to the period before the Food and Drug Administration warning weakened the false-positive signal for canagliflozin and acute kidney injury across comparators. CONCLUSIONS We could not identify a consistent and predictable pattern to the directionality of disproportionality analysis estimates with specific comparators. Calendar time-based restrictions anchored on relevant external events had a considerable impact.
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Affiliation(s)
- Christopher A Gravel
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, OΝ, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, ON, Canada
- Data Literacy Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - William Bai
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, OΝ, Canada
| | - Antonios Douros
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, OΝ, Canada.
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
- Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany.
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Alrasheed MA, Alamer KA, Albishi M, Alsuhibani AA, Almohammed OA, Alwhaibi A, Almajed AN, Guo JJ. Descriptive Analysis of Adverse Events Reported for New Multiple Myeloma Medications Using FDA Adverse Event Reporting System (FAERS) Databases from 2015 to 2022. Pharmaceuticals (Basel) 2024; 17:815. [PMID: 39065666 PMCID: PMC11279559 DOI: 10.3390/ph17070815] [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: 05/08/2024] [Revised: 06/09/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND New multiple myeloma (MM) medications have revolutionized the treatment landscape, but they are also associated with a range of adverse events (AEs). This study aims to provide a comprehensive overview of AEs reported for four new MM medications: daratumumab, ixazomib, elotuzumab, and panobinostat. METHODS This study uses a descriptive retrospective approach to analyze the FDA Adverse Event Reporting System (FAERS) from 2015 to 2022. It includes variables like medication names, report details, patient demographics, adverse events, and reporter types. The initial dataset consists of over 3700 adverse events, which are categorized into 21 groups for clarity and comparison. RESULTS The FAERS database revealed 367,756 adverse events (AEs) associated with novel multiple myeloma drugs from 2015-2022. Ixazomib had the highest number of reported AEs with 206,243 reports, followed by daratumumab with 98,872 reports, then elotuzumab with 26,193 AEs. Ixazomib's AE reports increased dramatically over the study period, rising approximately 51-fold from 1183 in 2015 to 60,835 in 2022. Of the medications studied, ixazomib also recorded the highest number of deaths (24,206), followed by daratumumab (11,624), panobinostat (7227), and elotuzumab (3349). The majority of AEs occurred in patients aged 55-64 and 65-74 years. CONCLUSIONS Ixazomib, a new MM medication, had the highest number of AEs reported. Also, it has the highest rate of reported deaths compared to other new MM medications. Clinicians should be aware of the potential AEs associated with this medication and further research is needed to understand the reasons for the high number of AEs and to develop mitigation strategies. More attention should also be paid to the safety of new multiple myeloma medications in younger patients.
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Affiliation(s)
- Marwan A. Alrasheed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (M.A.); (O.A.A.); (A.A.)
| | - Khalid A. Alamer
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia;
| | - Mashael Albishi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (M.A.); (O.A.A.); (A.A.)
| | - Abdulrahman A. Alsuhibani
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah 51452, Saudi Arabia;
| | - Omar A. Almohammed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (M.A.); (O.A.A.); (A.A.)
| | - Abdulrahman Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (M.A.); (O.A.A.); (A.A.)
| | - Abdullah N. Almajed
- Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Centre, MBC 11, P.O. Box 3354, Riyadh 11211, Saudi Arabia;
| | - Jeff J. Guo
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH 45267, USA;
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Sayed A, Munir M, Poliner M, Sughra S, Epperla N, Addison D. Response to: Correspondence on 'Cardiovascular toxicities associated with bispecific T-cell engager therapy' by Noguchi et al. J Immunother Cancer 2024; 12:e009300. [PMID: 38649282 PMCID: PMC11043767 DOI: 10.1136/jitc-2024-009300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 04/25/2024] Open
Affiliation(s)
- Ahmed Sayed
- Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Malak Munir
- Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Michael Poliner
- The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Sana Sughra
- The Ohio State University Medical Center, Columbus, Ohio, USA
| | | | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Division of Cancer Control and Prevention, The Ohio State University James Cancer Hospital, Columbus, Ohio, USA
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Hirai R, Uesawa Y. Analysis of Opioid-Related Adverse Events in Japan Using FAERS Database. Pharmaceuticals (Basel) 2023; 16:1541. [PMID: 38004407 PMCID: PMC10675800 DOI: 10.3390/ph16111541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023] Open
Abstract
Adverse events associated with opioid use in palliative care have been extensively studied. However, predicting the occurrence of adverse events based on the specific opioid used remains difficult. This study aimed to comprehensively analyze the adverse events related to µ-opioid receptor stimulation of opioids approved in Japan and investigate the tendencies of adverse event occurrence among different opioids. We utilized the FDA Adverse Event Reporting System database to extract reported adverse events for opioids approved in Japan. Cluster analysis was performed on reporting odds ratios (RORs) of adverse event names among opioids to visualize relationships between opioids and adverse events, facilitating a comparative study of their classifications. We calculated the RORs of adverse events for the target opioids. Cluster analysis based on these RORs resulted in five broad clusters based on the reported adverse events: i.e., strong opioids, weak opioids, loperamide, tapentadol, and remifentanil. This study provides a comprehensive classification of the association between μ-opioid-receptor-stimulating opioids and adverse events.
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Affiliation(s)
| | - Yoshihiro Uesawa
- Department of Medical Molecular Informatics, Meiji Pharmaceutical University, Tokyo 204-8588, Japan
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Montes-Grajales D, Garcia-Serna R, Mestres J. Impact of the COVID-19 pandemic on the spontaneous reporting and signal detection of adverse drug events. Sci Rep 2023; 13:18817. [PMID: 37914862 PMCID: PMC10620227 DOI: 10.1038/s41598-023-46275-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/30/2023] [Indexed: 11/03/2023] Open
Abstract
External factors severely affecting in a short period of time the spontaneous reporting of adverse events (AEs) can significantly impact drug safety signal detection. Coronavirus disease 2019 (COVID-19) represented an enormous challenge for health systems, with over 767 million cases and massive vaccination campaigns involving over 70% of the worldwide population. This study investigates the potential masking effect on certain AEs caused by the substantial increase in reports solely related to COVID-19 vaccines within various spontaneous reporting systems (SRSs). Three SRSs were used to monitor AEs reporting before and during the pandemic, namely, the World Health Organisation (WHO) global individual case safety reports database (VigiBase®), the United States Food and Drug Administration Adverse Event Reporting System (FAERS) and the Japanese Adverse Drug Event Report database (JADER). Findings revealed a sudden over-reporting of 35 AEs (≥ 200%) during the pandemic, with an increment of the RRF value in 2021 of at least double the RRF reported in 2020. This translates into a substantial reduction in signals of disproportionate reporting (SDR) due to the massive inclusion of COVID-19 vaccine reports. To mitigate the masking effect of COVID-19 vaccines in post-marketing SRS analyses, we recommend utilizing COVID-19-corrected versions for a more accurate assessment.
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Affiliation(s)
- Diana Montes-Grajales
- Chemotargets SL, Parc Científic de Barcelona, Baldiri Reixac 4 (TR-03), 08028, Barcelona, Catalonia, Spain
| | - Ricard Garcia-Serna
- Chemotargets SL, Parc Científic de Barcelona, Baldiri Reixac 4 (TR-03), 08028, Barcelona, Catalonia, Spain
| | - Jordi Mestres
- Chemotargets SL, Parc Científic de Barcelona, Baldiri Reixac 4 (TR-03), 08028, Barcelona, Catalonia, Spain.
- Institut de Quimica Computacional i Catalisi, Facultat de Ciencies, Universitat de Girona, Maria Aurelia Capmany 69, 17003, Girona, Catalonia, Spain.
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Dimakos J, Cui Y, Platt RW, Renoux C, Filion KB, Douros A. Pharmacologic Heterogeneity and Risk of Severe Hypoglycemia with Concomitant Use of Sulfonylureas and DPP-4 Inhibitors: Population-Based Cohort Study. Clin Pharmacol Ther 2023; 114:712-720. [PMID: 37326010 DOI: 10.1002/cpt.2975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023]
Abstract
Dipeptidyl peptidase-4 inhibitors (DPP-4i) interact with sulfonylureas to increase their risk of hypoglycemia. Our population-based study assessed whether intraclass pharmacologic heterogeneity among sulfonylureas (long- vs. short-acting) and DPP-4i (peptidomimetic vs. non-peptidomimetic) modifies this interaction. We conducted a cohort study using the UK's Clinical Practice Research Datalink Aurum linked to hospitalization and vital statistics data. We assembled a cohort of patients initiating sulfonylureas (2007-2020). Using a time-varying exposure definition, we assessed the risk of severe hypoglycemia (hospitalization with or death due to hypoglycemia) associated with (i) concomitant use of long-acting sulfonylureas (glimepiride and glibenclamide) with DPP-4i compared with concomitant use of short-acting sulfonylureas (gliclazide and glipizide) with DPP-4i; and (ii) concomitant use of sulfonylureas with peptidomimetic DPP-4i (saxagliptin and vildagliptin) compared with concomitant use of sulfonylureas with non-peptidomimetic DPP-4i (sitagliptin, linagliptin, and alogliptin). Time-dependent Cox models estimated confounder-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). Our cohort included 196,138 sulfonylurea initiators. During a median follow-up of 6 years, 8,576 events of severe hypoglycemia occurred. Compared with concomitant use of short-acting sulfonylureas with DPP-4i, concomitant use of long-acting sulfonylureas with DPP-4i was not associated with the risk of severe hypoglycemia (adjusted HR: 0.87, 95% CI: 0.65-1.16). Compared with concomitant use of sulfonylureas with non-peptidomimetic DPP-4i, concomitant use of sulfonylureas with peptidomimetic DPP-4i was also not associated with the risk of severe hypoglycemia (HR: 0.96, 95% CI: 0.76-1.22). Intra-class pharmacologic heterogeneity did not modify the association between concomitant use of sulfonylureas (short- vs. long-acting) and DPP-4i (peptidomimetic vs. non-peptidomimetic) and the risk of severe hypoglycemia.
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Affiliation(s)
- Jenny Dimakos
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ying Cui
- Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, Quebec, Canada
| | - Robert W Platt
- Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Christel Renoux
- Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Kristian B Filion
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Antonios Douros
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Choudhury A, Singh PA, Bajwa N, Dash S, Bisht P. Pharmacovigilance of herbal medicines: Concerns and future prospects. JOURNAL OF ETHNOPHARMACOLOGY 2023; 309:116383. [PMID: 36918049 DOI: 10.1016/j.jep.2023.116383] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The use of herbal medicines for prophylaxis, prevention, and treatment of various ailments is rising throughout the world because they are thought to be safer than allopathic treatments, which they are. However, several investigations have documented the toxicity and adverse drug reactions (ADR) of certain formulations and botanicals if not consumed wisely. AIM OF THE STUDY The goal of the current study is to address herbal medication pharmacovigilance (PV) modeling and related considerations for improved patient safety. Also, focus is laid on the comprehensive and critical analysis of the current state of PV for herbal medications at the national and international levels. MATERIALS AND METHODS Targeted review also known as focused literature review methodology was utilized for exploring the data from various scientific platforms such as Science Direct, Wiley Online Library, Springer, PubMed, Google Scholar using "pharmacovigilance, herbal medicine, traditional medicine, ADR, under reporting, herb toxicity, herb interactions" as keywords along with standard literature pertaining to herbal medicines that is published by the WHO and other international and national organizations etc. The botanical names mentioned in the present article were authenticated using World Flora Online database. RESULTS The historical developments paving the way for PV in regulatory setup were also discussed, along with various criteria's for monitoring herbal medicine, ADR of herbs, phytoconstituents, and traditional medicines, herb-drug interactions, modes of reporting ADR, databases for reporting ADR's, provisions of PV in regulatory framework of different nations, challenges and way forward in PV are discussed in detail advocating a robust drug safety ecosystem for herbal medicines. CONCLUSION Despite recent efforts to encourage the reporting of suspected ADRs linked to herbal medicines, such as expanding the programme and adding community pharmacists and other healthcare professionals as recognized reporters, the number of herbal ADR reports received by the regulatory bodies remains comparatively low. Since users often do not seek professional advice or report if they have side effects, under-reporting, is anticipated to be significant for herbal medications. There are inadequate quality control methods, poor regulatory oversight considering herbs used in food and botanicals, and unregulated distribution channels. In addition, botanical identity, traceability of herbs, ecological concerns, over-the-counter (OTC) herbal medicines, patient-physicians barriers requires special focus by the regulatory bodies for improved global safety of herbal medicines.
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Affiliation(s)
- Abinash Choudhury
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Preet Amol Singh
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India.
| | - Neha Bajwa
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Subhransu Dash
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Preeti Bisht
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
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Hsieh MHC, Liang HY, Tsai CY, Tseng YT, Chao PH, Huang WI, Chen WW, Lin SJ, Lai ECC. A New Drug Safety Signal Detection and Triage System Integrating Sequence Symmetry Analysis and Tree-Based Scan Statistics with Longitudinal Data. Clin Epidemiol 2023; 15:91-107. [PMID: 36699647 PMCID: PMC9868282 DOI: 10.2147/clep.s395922] [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: 11/02/2022] [Accepted: 12/14/2022] [Indexed: 01/19/2023] Open
Abstract
Purpose Development and evaluation of a drug-safety signal detection system integrating data-mining tools in longitudinal data is essential. This study aimed to construct a new triage system using longitudinal data for drug-safety signal detection, integrating data-mining tools, and evaluate adaptability of such system. Patients and Methods Based on relevant guidelines and structural frameworks in Taiwan's pharmacovigilance system, we constructed a triage system integrating sequence symmetry analysis (SSA) and tree-based scan statistics (TreeScan) as data-mining tools for detecting safety signals. We conducted an exploratory analysis utilizing Taiwan's National Health Insurance Database and selecting two drug classes (sodium-glucose co-transporter-2 inhibitors (SGLT2i) and non-fluorinated quinolones (NFQ)) as chronic and episodic treatment respectively, as examples to test feasibility of the system. Results Under the proposed system, either cohort-based or self-controlled mining with SSA and TreeScan was selected, based on whether the screened drug had an appropriate comparator. All detected alerts were further classified as known adverse drug reactions (ADRs), events related to other causes or potential signals from the triage algorithm, building on existing drug labels and clinical judgement. Exploratory analysis revealed greater numbers of signals for NFQ with a relatively low proportion of known ADRs; most were related to indication, patient characteristics or bias. No safety signals were found. By contrast, most SGLT2i signals were known ADRs or events related to patient characteristics. Four were potential signals warranting further investigation. Conclusion The proposed system facilitated active and systematic screening to detect and classify potential safety signals. Countries with real-world longitudinal data could adopt it to streamline drug-safety surveillance.
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Affiliation(s)
- Miyuki Hsing-Chun Hsieh
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Taiwan Drug Relief Foundation (TDRF), Taipei, Taiwan
| | | | | | - Yu-Ting Tseng
- Taiwan Drug Relief Foundation (TDRF), Taipei, Taiwan
| | - Pi-Hui Chao
- Taiwan Drug Relief Foundation (TDRF), Taipei, Taiwan
| | - Wei-I Huang
- Taiwan Drug Relief Foundation (TDRF), Taipei, Taiwan
| | - Wen-Wen Chen
- Taiwan Drug Relief Foundation (TDRF), Taipei, Taiwan
| | - Swu-Jane Lin
- Department of Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Edward Chia-Cheng Lai
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Correspondence: Edward Chia-Cheng Lai, Email
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12
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Yavne Y, Amar Shamir R, Shapiro M, Shepshelovich D. Evaluating the Impact of Black Box Warning Updates on the Reporting of Drug-Related Adverse Events: a Cross Sectional Study of the FAERS Database. Expert Opin Drug Saf 2023; 22:463-468. [PMID: 36683587 DOI: 10.1080/14740338.2023.2172160] [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: 09/07/2022] [Accepted: 12/16/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND The Food and Drug Administration (FDA)'s Adverse Event Reporting System (FAERS) is a post-marketing surveillance system which relies on spontaneous reports of adverse drug reactions (ADRs). Our objective was to evaluate how black box warning (BBW) updates impact ADR reporting rates. RESEARCH DESIGN AND METHODS We searched MEDWATCH for all BBW updates issued between January 2014 and December 2016 and categorized them as new, major, and minor. Rates of relevant ADR reports from the FAERS database in the 4 years preceding and following a BBW update were assessed among the different BBW categories. RESULTS Forty BBW updates were included (16 major, 3 new, and 21 minor). A meaningful increase in the proportion of relevant ADRs of all ADRs reported following BBW updates was documented for 53% of new or major updates and 24% of minor updates (p = 0.06). The median percentage of reported relevant ADRs increased by 5% following new and major BBW updates and decreased by 30% following minor BBW updates (p = 0.3). CONCLUSIONS Reporting of adverse events to the FAERS database is affected by the severity and timing of related BBW updates, highlighting the drawbacks of spontaneous reporting systems. Regulators should promote proactive pharmacovigilance strategies to cope with these limitations.
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Affiliation(s)
- Yarden Yavne
- Department of Medicine 'T,' Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reut Amar Shamir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Shapiro
- Department of Medicine 'T,' Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Shepshelovich
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medicine 'D,' Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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13
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Carter RR, Chum AP, Sanchez R, Guha A, Dey AK, Reinbolt R, Kim L, Otchere P, Oppong‐Nkrumah O, Abraham WT, Lustberg M, Addison D. Hypertensive events after the initiation of contemporary cancer therapies for breast cancer control. Cancer Med 2023; 12:297-305. [PMID: 35633055 PMCID: PMC9844596 DOI: 10.1002/cam4.4862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 05/03/2022] [Accepted: 05/11/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Contemporary therapies improve breast cancer (BC) outcomes. Yet, many of these therapies have been increasingly linked with serious cardiotoxicity, including reports of profound hypertension. Yet, the incidence, predictors, and impacts of these events are largely unknown. METHODS Leveraging two large U.S.-based registries, the National Inpatient Sample (NIS) and the Food and Drug Administration Adverse Event Reporting System (FAERS) databases, we assessed the incidence, factors, and outcomes of hypertensive events among BC patients from 2007 to 2015. Differences in baseline characteristics, hypertension-related discharges, and complications were examined over time. Further, we performed a disproportionality analysis using reporting-odds-ratios (ROR) to determine the association between individual BC drugs and hypertensive events. Utilizing an ROR cutoff of >1.0, we quantified associations by drug-class, and individual drugs with the likelihood of excess hypertension. RESULTS Overall, there were 5,464,401 BC-admissions, of which 46,989 (0.8%) presented with hypertension. Hypertensive BC patients were older, and saw initially increased in-hospital mortality, which equilibrated over time. The mean incidence of hypertension-related admissions was 732 per 100,000 among BC patients, versus 96 per 100,000 among non-cancer patients (RR 7.71, p < 0.001). Moreover, in FAERS, those with hypertension versus other BC-treatment side-effects were more frequently hospitalized (40.1% vs. 36.7%, p < 0.001), and were most commonly associated with chemotherapy (45.9%). Outside of Eribulin (ROR 3.36; 95% CI 1.37-8.22), no specific drug was associated with a higher reporting of hypertension; however, collectively BC drugs were associated with a higher odds of hypertension (ROR 1.66; 95% CI 1.09-2.53). CONCLUSIONS BC therapies are associated with a substantial increase in limiting hypertension.
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Affiliation(s)
- Rebecca R. Carter
- Cardio‐Oncology Program, Division of CardiologyOhio State UniversityColumbusOhioUSA
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST)Ohio State UniversityColumbusOhioUSA
| | - Aaron P. Chum
- Cardio‐Oncology Program, Division of CardiologyOhio State UniversityColumbusOhioUSA
| | - Reynaldo Sanchez
- Cardio‐Oncology Program, Division of CardiologyOhio State UniversityColumbusOhioUSA
| | - Avirup Guha
- Cardio‐Oncology Program, Division of CardiologyOhio State UniversityColumbusOhioUSA
- Harrington Heart and Vascular InstituteCase Western Reserve UniversityClevelandOhioUSA
| | - Amit K. Dey
- National Heart Lung and Blood InstituteBethesdaMarylandUSA
| | - Raquel Reinbolt
- Solove Research InstituteThe Ohio State University Comprehensive Cancer Center – James Cancer HospitalColumbusOhioUSA
| | - Lisa Kim
- Cardio‐Oncology Program, Division of CardiologyOhio State UniversityColumbusOhioUSA
| | - Prince Otchere
- Cardio‐Oncology Program, Division of CardiologyOhio State UniversityColumbusOhioUSA
| | - Oduro Oppong‐Nkrumah
- Cardio‐Oncology Program, Division of CardiologyOhio State UniversityColumbusOhioUSA
| | - William T. Abraham
- Cardio‐Oncology Program, Division of CardiologyOhio State UniversityColumbusOhioUSA
| | - Maryam Lustberg
- Solove Research InstituteThe Ohio State University Comprehensive Cancer Center – James Cancer HospitalColumbusOhioUSA
| | - Daniel Addison
- Cardio‐Oncology Program, Division of CardiologyOhio State UniversityColumbusOhioUSA
- Cancer Control Program, Department of MedicineOhio State University Comprehensive Cancer CenterColumbusOhioUSA
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Latack KR, Morocco E, Nguyen BT, Dancz C. Re: Sze et al-"Adverse Events for Overactive Bladder Medications From a Public Federal Database". UROGYNECOLOGY (HAGERSTOWN, MD.) 2022; 28:793-794. [PMID: 36288119 DOI: 10.1097/spv.0000000000001245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Kyle Richard Latack
- From the Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Elise Morocco
- Department of Obstetrics and Gynecology, Univeristy of Southern California, Los Angeles, CA
| | - Brian Trung Nguyen
- Department of Obstetrics and Gynecology, Univeristy of Southern California, Los Angeles, CA
| | - Christina Dancz
- Department of Obstetrics and Gynecology, Univeristy of Southern California, Los Angeles, CA
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Ruggiero R, Balzano N, Di Napoli R, Mascolo A, Berrino PM, Rafaniello C, Sportiello L, Rossi F, Capuano A. Capillary leak syndrome following COVID-19 vaccination: Data from the European pharmacovigilance database Eudravigilance. Front Immunol 2022; 13:956825. [PMID: 36177033 PMCID: PMC9513245 DOI: 10.3389/fimmu.2022.956825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Capillary leak syndrome (CLS) emerged as new adverse event after immunization (AEFI) associated to COVID-19 vaccination. CLS is a rare condition characterized by increased capillary permeability, resulting in hypoalbuminemia, hypotension, and edema mainly in the upper and lower limbs. Our pharmacovigilance study aims to evaluate the CLS onset following receipt of COVID-19 mRNA vaccines (mRNA-1273 and BNT162b2) compared to viral vector vaccines (Ad26.COV2-S and ChAdOx1-SARS-COV-2). We carried a cross-sectional study using all Individual Case Safety Reports (ICSRs) reporting a COVID-19 vaccine as suspected drug and CLS as AEFI, which were collected in the pharmacovigilance database EudraVigilance from January 1st, 2021, to January 14th, 2022. We applied the Reporting Odds Ratio (ROR) 95% CI for the disproportionality analysis. During our study period, CLS was described as AEFI in 84 out of 1,357,962 ICRs reporting a vaccine COVID-19 as suspected drug and collected in the EV database. Overall, the ICSR reported by CLS were mainly related to the viral vector COVID-19(ChAdOx1-SARS-COV-2 = 36; Ad26.COV2-S = 9). The mRNA COVID-19 vaccines were reported in 39 ICSRs (BNT162b2 =33; mRNA-1273 =6). Majority of ICSRs were reported by healthcare professionals (71.4%). Majority of the patients were adult (58.3%) and the female gender accounted in more than 65% of ICSRs referred both to classes vaccines. In particular, women were more represented in ICSRs referred to mRNA-1273 (83.3%) and to ChAdOx1-SARS-COV-2 (72.2%). The CLS outcome was more frequently favorable in mRNA ICSRs (33,3%) than the viral vector ones (13.3%). Among the ICSRs reporting CLS with unfavorable outcome, we found also 9 fatal cases (BNT162b2 = 1; ChAdOx1-SARS-COV-2 = 4; Ad26.COV2-S = 4). From disproportionality analysis emerged a lower CLS reporting probability after vaccination with mRNA vaccines compared to viral vector-based ones (ROR 0.5, 95% CI 0.3–0.7; p <0.001).Our findings, even if subject to the limitations of spontaneous reporting systems, suggest a small but statistically significant safety concern for CLS following receipt of COVID-19 viral vector vaccines, in particular with Ad26.COV2-S. Cytokine-release following T-cell activation could be involved in CLS occurrence, but a precise mechanism has been not yet identified. COVID-19 vaccines remain attentive as possible triggers of CLS.
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Affiliation(s)
- Rosanna Ruggiero
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania “L. Vanvitelli”, Naples, Italy
- Department of Experimental Medicine – Section of Pharmacology “L. Donatelli”, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Nunzia Balzano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania “L. Vanvitelli”, Naples, Italy
- Department of Experimental Medicine – Section of Pharmacology “L. Donatelli”, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Raffaella Di Napoli
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania “L. Vanvitelli”, Naples, Italy
- Department of Experimental Medicine – Section of Pharmacology “L. Donatelli”, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Annamaria Mascolo
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania “L. Vanvitelli”, Naples, Italy
- Department of Experimental Medicine – Section of Pharmacology “L. Donatelli”, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Pasquale Maria Berrino
- Department of Specialized Medicine, Diagnostic and Experimental, University of Bologna “Alma Mater Studiorum”, Bologna, Italy
| | - Concetta Rafaniello
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania “L. Vanvitelli”, Naples, Italy
- Department of Experimental Medicine – Section of Pharmacology “L. Donatelli”, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Liberata Sportiello
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania “L. Vanvitelli”, Naples, Italy
- Department of Experimental Medicine – Section of Pharmacology “L. Donatelli”, University of Campania “L. Vanvitelli”, Naples, Italy
- *Correspondence: Liberata Sportiello,
| | - Francesco Rossi
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania “L. Vanvitelli”, Naples, Italy
- Department of Experimental Medicine – Section of Pharmacology “L. Donatelli”, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania “L. Vanvitelli”, Naples, Italy
- Department of Experimental Medicine – Section of Pharmacology “L. Donatelli”, University of Campania “L. Vanvitelli”, Naples, Italy
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16
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Katsuhara Y, Ikeda S. Signal Detection of Acute Renal Failure Following the Use of SGLT-2 Inhibitors: Stratified Analysis and Time Trend Analysis in Japan and the United States. Biol Pharm Bull 2022; 45:1077-1083. [DOI: 10.1248/bpb.b22-00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yukari Katsuhara
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare
| | - Shunya Ikeda
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare
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17
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Raschi E, Fusaroli M, Massari F, Mollica V, Repaci A, Ardizzoni A, Poluzzi E, Pagotto U, Di Dalmazi G. The Changing Face of Drug-induced Adrenal Insufficiency in the Food and Drug Administration Adverse Event Reporting System. J Clin Endocrinol Metab 2022; 107:e3107-e3114. [PMID: 35704533 PMCID: PMC9282361 DOI: 10.1210/clinem/dgac359] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Indexed: 12/18/2022]
Abstract
CONTEXT Adrenal insufficiency (AI) is a life-threatening condition complicating heterogeneous disorders across various disciplines, with challenging diagnosis and a notable drug-induced component. OBJECTIVE This work aimed to describe the spectrum of drug-induced AI through adverse drug event reports received by the US Food and Drug Administration (FDA). METHODS A retrospective disproportionality analysis reporting trends of drug-induced AI was conducted on the FDA Adverse Event Reporting System (FAERS) (> 15 000 000 reports since 2004). AE reports were extracted from FAERS over the past 2 decades. Interventions included cases containing any of the preferred terms in the Medical Dictionary for Regulatory Activities describing AI, and signals of disproportionate reporting for drugs recorded in 10 or more cases as primary suspect. RESULTS We identified 8496 cases of AI: 97.5% serious, 41.1% requiring hospitalization. AI showed an exponential increase throughout the years, with 5282 (62.2%) cases in 2015 to 2020. We identified 56 compounds associated with substantial disproportionality: glucocorticoids (N = 1971), monoclonal antibodies (N = 1644, of which N = 1330 were associated with immune checkpoint inhibitors-ICIs), hormone therapy (N = 291), anti-infectives (N = 252), drugs for hypercortisolism or adrenocortical cancer diagnosis/treatment (N = 169), and protein kinase inhibitors (N = 138). Cases of AI by glucocorticoids were stable in each 5-year period (22%-27%), whereas those by monoclonal antibodies, largely ICIs, peaked from 13% in 2010 to 2015 to 33% in 2015 to 2020. CONCLUSION We provide a comprehensive insight into the evolution of drug-induced AI, highlighting the heterogeneous spectrum of culprit drug classes and the emerging increased reporting of ICIs. We claim for the urgent identification of predictive factors for drug-induced AI, and the establishment of screening and educational protocols for patients and caregivers.
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Affiliation(s)
- Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum–University of Bologna, Bologna 40138, Italy
| | - Michele Fusaroli
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum–University of Bologna, Bologna 40138, Italy
| | - Francesco Massari
- Medical Oncology Unit, IRCCS Azienda Ospedaliero–Universitaria di Bologna, Bologna 40138, Italy
| | - Veronica Mollica
- Medical Oncology Unit, IRCCS Azienda Ospedaliero–Universitaria di Bologna, Bologna 40138, Italy
| | - Andrea Repaci
- Division of Endocrinology and Diabetes Prevention and Care Unit, IRCCS Azienda Ospedaliero–Universitaria di Bologna, Bologna 40138, Italy
| | - Andrea Ardizzoni
- Medical Oncology Unit, IRCCS Azienda Ospedaliero–Universitaria di Bologna, Bologna 40138, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, Policlinico S. Orsola-Malpighi, Alma Mater Studiorum–University of Bologna, Bologna 40138, Italy
| | - Elisabetta Poluzzi
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum–University of Bologna, Bologna 40138, Italy
| | - Uberto Pagotto
- Division of Endocrinology and Diabetes Prevention and Care Unit, IRCCS Azienda Ospedaliero–Universitaria di Bologna, Bologna 40138, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum–University of Bologna, Bologna 40138, Italy
| | - Guido Di Dalmazi
- Correspondence: Guido Di Dalmazi, MD, Division of Endocrinology and Diabetes Prevention and Care Unit, IRCCS Azienda Ospedaliero–Universitaria di Bologna, Department of Medical and Surgical Sciences, Alma Mater Studiorum–University of Bologna, via Massarenti, 9, 40138 Bologna, Italy.
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18
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Are finasteride-related penile curvature/Peyronie's disease Adverse Event Reports worthy of further clinical investigation? Disproportionality analysis based on both the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) pharmacovigilance databases. Int J Impot Res 2022:10.1038/s41443-022-00568-2. [PMID: 35513712 DOI: 10.1038/s41443-022-00568-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 01/22/2022] [Accepted: 03/22/2022] [Indexed: 11/09/2022]
Abstract
A limited number of studies have described patients on finasteride showing findings which were consistent with Peyronie's disease (PD). We aimed to detect a pharmacovigilance signal of possible association between finasteride and PD-related clinical features. The Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database was queried to identify the ten drugs which were associated the most with the adverse drug reactions (ADRs) recorded as "penile curvature" and/or "Peyronie's disease". A similar analysis, including the same drugs, was carried out for the EMA (European Medicines Agency) EudraVigilance (EV) database. Descriptive data have been analyzed, and Proportional Reporting Ratios (PRRs) have been computed against the other nine drugs of the database. Overall, 860 reports of "penile curvature" and/or "Peyronie's disease", were identified in the FAERS database, 214 of which (24.9%) were associated with finasteride. Most reports (56.9%) were submitted by healthcare professionals. Where a treatment-indication was stated, the vast majority of reports (176/210; 83.8%) were associated with androgenetic alopecia. The outcome of most ADRs was "serious" (82.2%), with 96 ADRs resulting in levels of permanent disability. For 97/214 individual cases, penile curvature/PD reports were not part of a syndromic cluster suggestive of post-finasteride syndrome (PFS). The PRR resulted 6.6 (95% CI: 5.6-7.8) and 11.8 (95% CI: 9.08-15.33), respectively, in the FAERS and in the EV databases. Notwithstanding the related limitations and biasing factors of pharmacovigilance studies based on spontaneous reporting, the PRR values here identified should be interpreted as strong signals of disproportionality. These findings, per se, are however not useful to confirm any causal association. Clinical studies are needed to investigate on the possible role for finasteride in causing PD-related clinical features, an hypothesis which remains highly speculative due to the very questionable quality of present data.
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Marwitz KK, Noureldin M. A descriptive analysis of concomitant opioid and benzodiazepine medication use and associated adverse drug events in United States adults between 2009 and 2018. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 5:100130. [PMID: 35478505 PMCID: PMC9031034 DOI: 10.1016/j.rcsop.2022.100130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/24/2022] [Accepted: 03/16/2022] [Indexed: 12/04/2022] Open
Abstract
Background In 2016, the Centers for Disease Control and Prevention (CDC) published guidelines for prescribing opioids for chronic pain in response to the opioid epidemic and recommended avoiding concomitant use of opioid and benzodiazepine medications whenever possible. However, based on a recent report, 16% of overdose deaths involving opioids also involved benzodiazepines. Objective The objectives of this study were to examine 1) trends in concomitant opioid and benzodiazepine usage and factors associated with utilization 2) and related adverse event reporting before and after the publication of CDC chronic pain prescribing guidelines. Methods This study employed a retrospective data analysis of the National Health and Nutrition Examination Survey (NHANES) and FDA Adverse Event Reporting System (FAERS) databases between 2009 and 2018. Descriptive statistics and logistic regression were used to examine characteristics and temporal trends in people taking or reporting adverse events with opioid, benzodiazepine, and both medications. Results Among those taking an opioid medication, 19.7% were also taking a benzodiazepine within the same 30 days. Characteristics for those who reported taking both medications together include being female, non-Hispanic White, being middle aged, and having a lower household income. Concomitant medication use rose between 2009 and 2016 and declined in 2017-2018. Among FAERS reports examined with an opioid suspect medication, 17.9% also included a benzodiazepine suspect medication. Over time, there was an increase in identified FAERS reports involving concomitant opioid and benzodiazepine medications. Conclusions Concomitant opioid and benzodiazepine use was detected in a small but notable proportion of NHANES survey participants and FAERS reports between 2009 and 2018. Further research examining causal associations between opioids, benzodiazepines, and identified social risk factors are needed to inform prescribing and to best tailor public health interventions to address physical and mental illness safely and effectively across the population.
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Affiliation(s)
- Kathryn K. Marwitz
- Manchester University College of Pharmacy, Natural & Health Sciences, 10627 Diebold Road, Fort Wayne, IN 46845, United States of America
| | - Marwa Noureldin
- Manchester University College of Pharmacy, Natural & Health Sciences, 10627 Diebold Road, Fort Wayne, IN 46845, United States of America
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Saengmearnuparp T, Lojanapiwat B, Chattipakorn N, Chattipakorn S. The connection of 5-alpha reductase inhibitors to the development of depression. Biomed Pharmacother 2021; 143:112100. [PMID: 34479019 DOI: 10.1016/j.biopha.2021.112100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
Recent literature connects 5-alpha reductase inhibitors (5-ARIs) with neuropsychiatric adverse effects. Several clinical studies have indicated that former 5-ARIs users had a higher incidence of depressive symptoms and neuropsychiatric side effects than non-users. However, the underlying mechanisms involved in the depression in former 5-ARIs patients, a condition known as "post finasteride syndrome (PFS)", are not thoroughly understood. This review aims to summarize and discuss the association between 5-ARIs and depression as well as possible mechanisms. We used PubMed search terms including "depression", "depressive symptoms", "MDD", "anxiety", or "suicidal idea", and "5-alpha reductase inhibitors", "finasteride", "dutasteride", "5-ARIs". All relevant articles from in vivo and clinical studies from 2002 to 2021 were carefully reviewed. Any contradictory findings were included and debated. The potential mechanisms that link 5-ARIs and depression include alteration in neuroactive steroids, dopaminergic dysfunction, reduced hippocampal neurogenesis, increased neuroinflammation, alteration of the HPA axis, and epigenetic modifications. From this review, we hope to provide information for future studies based on animal experiments, and potential therapeutic strategies for depressive patients with PFS.
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Affiliation(s)
| | - Bannakij Lojanapiwat
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Nipon Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Siriporn Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai 50200, Thailand; Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand.
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Ding X, Mower J, Subramanian D, Cohen T. Augmenting aer2vec: Enriching distributed representations of adverse event report data with orthographic and lexical information. J Biomed Inform 2021; 119:103833. [PMID: 34111555 DOI: 10.1016/j.jbi.2021.103833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/10/2021] [Accepted: 06/02/2021] [Indexed: 11/29/2022]
Abstract
Adverse Drug Events (ADEs) are prevalent, costly, and sometimes preventable. Post-marketing drug surveillance aims to monitor ADEs that occur after a drug is released to market. Reports of such ADEs are aggregated by reporting systems, such as the Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS). In this paper, we consider the topic of how best to represent data derived from reports in FAERS for the purpose of detecting post-marketing surveillance signals, in order to inform regulatory decision making. In our previous work, we developed aer2vec, a method for deriving distributed representations (concept embeddings) of drugs and side effects from ADE reports, establishing the utility of distributional information for pharmacovigilance signal detection. In this paper, we advance this line of research further by evaluating the utility of encoding orthographic and lexical information. We do so by adapting two Natural Language Processing methods, subword embedding and vector retrofitting, which were developed to encode such information into word embeddings. Models were compared for their ability to distinguish between positive and negative examples in a set of manually curated drug/ADE relationships, with both aer2vec enhancements offering advantages in performances over baseline models, and best performance obtained when retrofitting and subword embeddings were applied in concert. In addition, this work demonstrates that models leveraging distributed representations do not require extensive manual preprocessing to perform well on this pharmacovigilance signal detection task, and may even benefit from information that would otherwise be lost during the normalization and standardization process.
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Affiliation(s)
- Xiruo Ding
- Department of Biomedical Informatics & Medical Education, University of Washington, Seattle, WA, USA.
| | - Justin Mower
- Department of Computer Science, Rice University, Houston, TX, USA.
| | | | - Trevor Cohen
- Department of Biomedical Informatics & Medical Education, University of Washington, Seattle, WA, USA.
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22
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Dörks M, Jobski K, Hoffmann F, Douros A. Global COVID-19 pandemic and reporting behavior - An analysis of the Food and Drug Administration adverse events reporting system. Pharmacoepidemiol Drug Saf 2021; 30:707-715. [PMID: 33650210 PMCID: PMC8012989 DOI: 10.1002/pds.5217] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/18/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To describe the characteristics of adverse event reporting in the United States (US) Food and Drug Administration Adverse Event Reporting System (FAERS) before and after the outbreak of the COVID-19 pandemic. METHODS We included all FAERS reports from the US and Canada from November 7, 2019 to July 15, 2020 and divided the study period into three equal time intervals (pre-pandemic, first pandemic, second pandemic). We focused on methotrexate, a broadly used drug unrelated to COVID-19, and (hydroxy)chloroquine, another broadly used drug implicated in COVID-19 treatment. Using descriptive statistics, we compared reporting characteristics before and after the COVID-19 outbreak. RESULTS During the study period, 366 998 cases (60% female, median age: 59 years) were submitted to FAERS. The daily median number of reports (1796 in the pre-pandemic, 1810 in the second pandemic time interval) and other characteristics remained stable. The daily median number of reports for methotrexate decreased from 28 in the pre-pandemic to 15 in the second pandemic time interval, with no considerable differences in other characteristics. The daily median number of reports for (hydroxy)chloroquine increased slightly from 1 in the pre-pandemic to 3 in the second pandemic time interval, while there were also changes in the demographics of cases and an increase in the proportion of cases reported by health professionals. CONCLUSIONS The overall reporting to FAERS did not change after the outbreak of the COVID-19 pandemic. However, some stimulated reporting was observed for (hydroxy)chloroquine, highlighting the need for caution when conducting pharmacovigilance analyses with substances related to COVID-19.
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Affiliation(s)
- Michael Dörks
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Kathrin Jobski
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Antonios Douros
- Departments of Medicine and Epidemiology, McGill University, Montreal, Quebec, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute - Jewish General Hospital, Montreal, Quebec, Canada.,Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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23
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Moore TJ, Morrow RL, Dormuth CR, Mintzes B. US Food and Drug Administration Safety Advisories and Reporting to the Adverse Event Reporting System (FAERS). Pharmaceut Med 2021; 34:135-140. [PMID: 32180152 DOI: 10.1007/s40290-020-00329-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The US Food and Drug Administration (FDA) and other major regulators regularly issue safety advisories about licensed drugs with new adverse effects that have been documented through observational studies, clinical trials, and spontaneously reported adverse drug events. OBJECTIVE To assess the possible effects of a representative group of FDA Drug Safety Communications on the reporting of the specific adverse effect featured in the advisory on new cases reported to the FDA Adverse Event Reporting System (FAERS). METHODS We examined 16 FDA Drug Safety Communications issued from 2010 to 2015 that had not previously been the focus of advisories from regulators in the UK, Canada, or Australia. We compared the reports of the adverse effect in the 8 calendar quarters preceding the advisory and in the 4 quarters following. We measured change in reporting frequency by calculating the event reporting odds ratio (ROR) for the post-warning compared to the pre-warning periods. We defined a credible association of the advisory with increased reporting as a ROR ≥ 2.0 and p value of < 0.05 by Fisher's Exact Test. RESULTS We found statistically significant increased reporting for 4/16 advisories with RORs that ranged from 3.9 to 40.6. Three advisories had smaller but still statistically significant increases that were less than the ROR ≥ 2.0 threshold. For 7 advisories, we found no statistically significant changes in reporting. CONCLUSIONS No consistent pattern or effect was found on spontaneous reporting following these safety advisories. After results were available, we observed that some cases with the largest reporting increase also involved substantial numbers of legal claims. Changes in adverse event reporting following a warning need to be evaluated on a case-by-case basis.
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Affiliation(s)
- Thomas J Moore
- Institute for Safe Medication Practices, 916 Prince Street, Suite 102, Alexandria, VA, 22314, USA.
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA.
| | - Richard L Morrow
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Colin R Dormuth
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Barbara Mintzes
- Faculty of Medicine and Health, University of Sidney Charles Perkins Center and School of Pharmacy, Sydney, Australia
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24
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Nguyen DD, Marchese M, Cone EB, Paciotti M, Basaria S, Bhojani N, Trinh QD. Investigation of Suicidality and Psychological Adverse Events in Patients Treated With Finasteride. JAMA Dermatol 2021; 157:35-42. [PMID: 33175100 PMCID: PMC7658800 DOI: 10.1001/jamadermatol.2020.3385] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance There is ongoing controversy about the adverse events of finasteride, a drug used in the management of alopecia and benign prostatic hyperplasia (BPH). In 2012, reports started emerging on men who had used finasteride and either attempted or completed suicide. Objective To investigate the association of suicidality (ideation, attempt, and completed suicide) and psychological adverse events (depression and anxiety) with finasteride use. Design, Setting, and Participants This pharmacovigilance case-noncase study used disproportionality analysis (case-noncase design) to detect signals of adverse reaction of interest reported with finasteride in VigiBase, the World Health Organization's global database of individual case safety reports. To explore the strength of association, the reporting odds ratio (ROR), a surrogate measure of association used in disproportionality analysis, was used. Extensive sensitivity analyses included stratifying by indication (BPH and alopecia) and age (≤45 and >45 years); comparing finasteride signals with those of drugs with different mechanisms but used for similar indications (minoxidil for alopecia and tamsulosin hydrochloride for BPH); comparing finasteride with a drug with a similar mechanism of action and adverse event profile (dutasteride); and comparing reports of suicidality before and after 2012. Data were obtained in June 2019 and analyzed from January 25 to February 28, 2020. Exposures Reported finasteride use. Main Outcomes and Measures Suicidality and psychological adverse events. Results VigiBase contained 356 reports of suicidality and 2926 reports of psychological adverse events (total of 3282 adverse events of interest) in finasteride users (3206 male [98.9%]; 615 of 868 [70.9%] with data available aged 18-44 years). A significant disproportionality signal for suicidality (ROR, 1.63; 95% CI, 1.47-1.81) and psychological adverse events (ROR, 4.33; 95% CI, 4.17-4.49) in finasteride was identified. In sensitivity analyses, younger patients (ROR, 3.47; 95% CI, 2.90-4.15) and those with alopecia (ROR, 2.06; 95% CI, 1.81-2.34) had significant disproportionality signals for increased suicidality; such signals were not detected in older patients with BPH. Sensitivity analyses also showed that the reports of these adverse events significantly increased after 2012 (ROR, 2.13; 95% CI, 1.91-2.39). Conclusions and Relevance In this pharmacovigilance case-noncase study, significant RORs of suicidality and psychological adverse events were associated with finasteride use in patients younger than 45 years who used finasteride for alopecia. The sensitivity analyses suggest that these disproportional signals of adverse events may be due to stimulated reporting and/or younger patients being more vulnerable to finasteride's adverse effects.
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Affiliation(s)
- David-Dan Nguyen
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts,Faculty of Medicine, McGill University, Montreal, Québec, Canada
| | - Maya Marchese
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eugene B. Cone
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marco Paciotti
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shehzad Basaria
- Research Program in Men’s Health: Aging and Metabolism, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montreal, Québec, Canada
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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25
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Peng L, Stebbing J, Wang YJ. Reply to letter to the editor: baricitinib and toxicity is a rare occurrence. Expert Opin Drug Saf 2020; 19:1371-1372. [PMID: 32804556 DOI: 10.1080/14740338.2020.1812192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ling Peng
- Department of Radiotherapy, the First Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou, Zhejiang Province, China
| | - Justin Stebbing
- Division of Cancer, Department of Surgery and Cancer, Imperial College London , London, UK
| | - Ying-Jie Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou, Zhejiang, China
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26
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Rosenberg M, Sheehan S, Zhou E, Pinnow E, Burnell J, Romine M, Dal Pan G. FDA postmarketing safety labeling changes: What have we learned since 2010 about impacts on prescribing rates, drug utilization, and treatment outcomes. Pharmacoepidemiol Drug Saf 2020; 29:1022-1029. [PMID: 32790031 DOI: 10.1002/pds.5073] [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: 09/04/2019] [Revised: 03/25/2020] [Accepted: 06/02/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE Prior literature reviews have identified gaps in understanding of how postmarketing safety labeling changes and related FDA communications impact key clinical and behavioral outcomes. We conducted a review of newly published studies on this topic to determine what new evidence exists and to identify which gaps may still remain. We believe that this information can support FDA as it develops and implements future risk communication approaches. METHODS We searched PubMed and Embase for studies published between January 1, 2010, and August 7, 2017 that examined the impact of labeling changes or associated FDA safety-related communications. For each study, we extracted information on research design and findings for key clinical outcomes and behaviors. We also conducted a ROBINS-I review to identify potential for bias in the research design of each study. RESULTS We found that the estimated impacts of FDA labeling changes on several key outcomes-including adverse events-varied. Labeling changes also yielded unintended consequences on drug prescribing in some cases, despite low provider adherence. Finally, some studies we reviewed exhibited potential for bias due to confounding, among other factors. CONCLUSIONS The new studies we reviewed contain many of the same limitations identified in previously published reviews. While there are several challenges to conducting this research there is substantial room for improvement in the quality of the evidence base. More information, particularly with respect to the types of populations and medications affected by labeling changes, is needed to support the development of more effective and targeted safety communications.
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Affiliation(s)
| | - Sarah Sheehan
- Duke-Margolis Center for Health Policy, Washington, DC, USA
| | - Esther Zhou
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Ellen Pinnow
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Morgan Romine
- Duke-Margolis Center for Health Policy, Washington, DC, USA
| | - Gerald Dal Pan
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
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27
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Isotretinoin-Induced Delusional Disorder, Somatic Subtype. Case Rep Dermatol Med 2020; 2020:8853167. [PMID: 32774942 PMCID: PMC7399729 DOI: 10.1155/2020/8853167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 11/30/2022] Open
Abstract
Isotretinoin, an active form of vitamin A, is the drug of last resort for the treatment of severe acne. Depression, suicidal ideation, and psychosis are among the most well-documented psychiatric side effects. Here, we report a case of isotretinoin-induced psychosis, which was diagnosed as delusional disorder somatic subtype, in a young male in the absence of any prodromal symptoms, previous psychiatric history, or family history of mental illness. The onset of psychosis was in the context of a dosage increase from 40 mg/day to 80 mg/day. Isotretinoin was discontinued, and the patient showed improvement on low-dose quetiapine.
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28
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Neha R, Subeesh V, Beulah E, Gouri N, Maheswari E. Existence of Notoriety Bias in FDA Adverse Event Reporting System Database and Its Impact on Signal Strength. Hosp Pharm 2019; 56:152-158. [PMID: 34024922 DOI: 10.1177/0018578719882323] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Notoriety bias is defined as "a selection bias in which a case has a greater chance of being reported if the subject is exposed to the studied factor known to cause, thought to cause, or likely to cause the event of interest." This study aimed to determine the existence of notoriety bias in the FDA Adverse Event Reporting System (FAERS) database and estimate the impact of potential notoriety bias induced by safety alerts on signal estimation using disproportionality analysis. Methods: Publicly available FAERS data were downloaded and used for analysis. Thirty-one drugs which had label change/safety alert issued by FDA from 2009 to 2013 were considered. These drugs were reviewed 4 quarters before and after the safety alert notification for the existence of notoriety bias. The impact of notoriety bias induced by safety alerts was analyzed by comparing the signal strength using reporting odds ratio (ROR) and proportional reporting ratio (PRR), 2 years before and after the safety alert. Wilcoxon signed rank test was used to determine whether there were a statistically significant difference before and after the safety alert. Results: There was increased reporting for 11 drugs after the safety alert/label change by the FDA. The reporting of 20 drugs decreased or remained unchanged after the safety alert/label change by the FDA. Wilcoxon signed rank test showed that there is no statistically significant difference with respect to the number of reports before and after the safety alert (P = .330, Z = -0.974). Fourteen (45.16%) drugs had an increase in ROR, while 17 (54.83%) drugs had a decrease in ROR after safety alert issued by FDA (P = .953, Z = -0.059). Fourteen (45.16%) drugs had an increase in PRR, while 17 (54.83%) drugs had a decrease in PRR after safety alert issued by the FDA (P = .914, Z = -0.108). Conclusion: Although few FDA safety alert/warnings had a strong and immediate impact, many had no impact on reporting of AE and signal strength. This study found that overreporting due to notoriety bias does not exist in the FAERS database and the overall disproportionality in signal estimates is not altered by the safety alert.
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Affiliation(s)
- Reddy Neha
- Department of Pharmacy Practice, M. S. Ramaiah University of Applied Sciences, Bengaluru, India
| | - Viswam Subeesh
- Department of Pharmacy Practice, M. S. Ramaiah University of Applied Sciences, Bengaluru, India
| | - Elsa Beulah
- Department of Pharmacy Practice, M. S. Ramaiah University of Applied Sciences, Bengaluru, India
| | - Nair Gouri
- Department of Pharmacology, M. S. Ramaiah University of Applied Sciences, Bengaluru, India
| | - Eswaran Maheswari
- Department of Pharmacy Practice, M. S. Ramaiah University of Applied Sciences, Bengaluru, India
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29
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Duprey MS, Al-Qadheeb NS, O'Donnell N, Hoffman KB, Weinstock J, Madias C, Dimbil M, Devlin JW. Serious Cardiovascular Adverse Events Reported with Intravenous Sedatives: A Retrospective Analysis of the MedWatch Adverse Event Reporting System. Drugs Real World Outcomes 2019; 6:141-149. [PMID: 31399842 PMCID: PMC6702539 DOI: 10.1007/s40801-019-00161-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Serious cardiovascular adverse events (SCAEs) associated with intravenous sedatives remain poorly characterized. OBJECTIVE The objective of this study was to compare SCAE incidence, types, and mortality between intravenous benzodiazepines (i.e., diazepam, lorazepam, and midazolam), dexmedetomidine, and propofol in the USA over 8 years regardless of the clinical setting where it was administered. METHODS The Food and Drug Administration's MedWatch Adverse Event Reporting System was searched between 2004 and 2011 using the Evidex® platform from Advera Health Analytics, Inc. to identify all reports that included one or more of ten different SCAEs (package insert incidence ≥ 1%) and where an intravenous benzodiazepine, dexmedetomidine, or propofol was the primary suspected drug. RESULTS Among the 2326 Food and Drug Administration's MedWatch Adverse Event Reporting System cases reported, 394 (16.9%) were related to a SCAE. The presence of a SCAE (vs. a non-SCAE) is associated with higher mortality (34 vs. 8%, p < 0.001). The percentage of cases with one or more SCAE, the case mortality rate (%), and the incidence of each SCAE (per 106 days of sedative exposure), respectively, were benzodiazepines (14, 26, 13) [diazepam (13, 23, 31); lorazepam (15, 43, 14); midazolam (14, 20, 11)]; dexmedetomidine (40, 15, 13); and propofol (17, 39, 7). Propofol (vs. either a benzodiazepine or dexmedetomidine) was associated with more total SCAEs (268 vs. 126, p < 0.001) but a lower incidence (per 106 days of sedative exposure) of SCAE (7 vs. 13, p = 0.0001) and cardiac arrest [6.3 (benzodiazepine) vs. 6.7 (dexmedetomidine) vs. 1.4 (propofol), p < 0.0001]. CONCLUSIONS Serious cardiac adverse events account for nearly one-fifth of intravenous sedative Food and Drug Administration's MedWatch Adverse Event Reporting System reports. These SCAEs appear to be associated with greater mortality than non-cardiac serious adverse events. Serious cardiac events may be more prevalent with either benzodiazepines or dexmedetomidine than propofol.
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Affiliation(s)
- Matthew S Duprey
- Northeastern University School of Pharmacy, 360 Huntington Ave, 140 TF R216, Boston, MA, 02115, USA
| | - Nada S Al-Qadheeb
- Department of Critical Care, Hafer Al Batin Central Hospital, Qurtubah, Hafar Al Batin, Saudi Arabia
| | | | | | | | | | - Mo Dimbil
- Advera Health Analytics, Inc., Santa Rosa, CA, USA
| | - John W Devlin
- Northeastern University School of Pharmacy, 360 Huntington Ave, 140 TF R216, Boston, MA, 02115, USA. .,Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA, USA.
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30
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Bersoff-Matcha SJ, Chamberlain C, Cao C, Kortepeter C, Chong WH. Fournier Gangrene Associated With Sodium-Glucose Cotransporter-2 Inhibitors: A Review of Spontaneous Postmarketing Cases. Ann Intern Med 2019; 170:764-769. [PMID: 31060053 DOI: 10.7326/m19-0085] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Use of sodium-glucose cotransporter-2 (SGLT2) inhibitors has been associated with Fournier gangrene (FG), a rare urologic emergency characterized by necrotizing infection of the external genitalia, perineum, and perianal region. OBJECTIVE To describe and compare reported cases of FG in diabetic adults receiving treatment with SGLT2 inhibitors or other antiglycemic agents. DESIGN Descriptive case series. SETTING U.S. Food and Drug Administration (FDA) Adverse Event Reporting System and published case reports. PATIENTS Adults receiving SGLT2 inhibitors or other antiglycemic agents. MEASUREMENTS Clinical and laboratory data. RESULTS The FDA identified 55 unique cases of FG in patients receiving SGLT2 inhibitors between 1 March 2013 and 31 January 2019. The patients ranged in age from 33 to 87 years; 39 were men, and 16 were women. Time to onset after initiation of SGLT2-inhibitor therapy ranged from 5 days to 49 months. All patients had surgical debridement and were severely ill. Reported complications included diabetic ketoacidosis (n = 8), sepsis or septic shock (n = 9), and acute kidney injury (n = 4). Eight patients had fecal diversion surgery, 2 patients developed necrotizing fasciitis of a lower extremity that required amputation, and 1 patient required a lower-extremity bypass procedure because of gangrenous toes. Three patients died. For comparison, the FDA identified 19 FG cases associated with other antiglycemic agents between 1984 and 31 January 2019: metformin (n = 8), insulin glargine (n = 6), short-acting insulin (n = 2), sitagliptin plus metformin (n = 2), and dulaglutide (n = 1). These patients ranged in age from 42 to 79 years; 12 were men, and 7 were women. Two patients died. LIMITATION Inability to establish causality or incidence, variable quality of reports, possible underreporting, and confounding by indication. CONCLUSION FG is a newly identified safety concern in patients receiving SGLT2 inhibitors. Physicians prescribing these agents should be aware of this possible complication and have a high index of suspicion to recognize it in its early stages. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Susan J Bersoff-Matcha
- U.S. Food and Drug Administration, Silver Spring, Maryland (S.J.B., C.C., C.C., C.K., W.H.C.)
| | - Christine Chamberlain
- U.S. Food and Drug Administration, Silver Spring, Maryland (S.J.B., C.C., C.C., C.K., W.H.C.)
| | - Christian Cao
- U.S. Food and Drug Administration, Silver Spring, Maryland (S.J.B., C.C., C.C., C.K., W.H.C.)
| | - Cindy Kortepeter
- U.S. Food and Drug Administration, Silver Spring, Maryland (S.J.B., C.C., C.C., C.K., W.H.C.)
| | - William H Chong
- U.S. Food and Drug Administration, Silver Spring, Maryland (S.J.B., C.C., C.C., C.K., W.H.C.)
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31
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Liebling DB, Cordova E, Deng G, McKoy JM. Pharmacovigilance of Alternative Medications in the Cancer Setting. Cancer Treat Res 2019; 171:37-45. [PMID: 30552655 DOI: 10.1007/978-3-319-43896-2_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
With the increase in utilization of alternative medications to manage cancer treatment-related side effects, pharmacovigilance of alternative drug therapies, specifically herbal supplements, has become of increasing importance in the oncologic setting. This chapter focuses on the pharmacovigilance of herbal supplements in the setting of cancer drug therapy and explores national and international drug policies that have been employed to mitigate adverse herbal supplement events (AHEs). This chapter examines common drug-herbal supplement interactions, discusses the mechanisms behind these interactions, and investigates several common pharmacovigilance reporting methods clinicians can use to report adverse events. This chapter will also describe policies and strategies that can be employed to monitor use of these alternative drug therapies, and examines global harmonization efforts to reduce AHEs in the cancer setting. The safety of herbal medicines has emerged as an international public health priority, and we explore how oncology providers may directly apply the knowledge garnered herein to help guide their clinical management of oncology patients utilizing alternative medications.
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Affiliation(s)
- Dustin B Liebling
- Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA.
| | - Emmanuel Cordova
- Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Gary Deng
- Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - June M McKoy
- Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
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32
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Antonazzo IC, Poluzzi E, Forcesi E, Riise T, Bjornevik K, Baldin E, Muratori L, De Ponti F, Raschi E. Liver injury with drugs used for multiple sclerosis: A contemporary analysis of the FDA Adverse Event Reporting System. Mult Scler 2018; 25:1633-1640. [DOI: 10.1177/1352458518799598] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Drug-induced liver injury (DILI) has been observed in patients with multiple sclerosis (MS), raising concerns on the liver safety of MS drugs. Objective: To describe DILI events with MS drugs by analyzing the FDA Adverse Event Reporting System. Methods: DILI reports were extracted and classified in overall liver injury (OLI), including asymptomatic elevation of liver enzymes, and severe liver injury (SLI). We performed disproportionality analysis by calculating adjusted reporting odds ratios (RORs) with 95% confidence interval (CI) and case-by-case evaluation for concomitant drugs with hepatotoxic potential. Results: Fampridine showed statistically significant ROR for both OLI and SLI, whereas teriflunomide and fingolimod generated solid disproportionality (ROR > 2) only for OLI (ROR, 2.31; 95% CI, 2.12–2.52; and 2.53; 2.40–2.66, respectively). Among monoclonal antibodies, only alemtuzumab generated higher-than-expected ROR for OLI (1.34; 1.09–1.65). We also detected the expected hepatotoxic potential of beta interferon and mitoxantrone. Concomitant reporting of hepatotoxic drugs ranged from 26% (dimethyl fumarate) to 90% (mitoxantrone). Conclusion: These real-world pharmacovigilance findings suggest that DILI might be a common feature of MS drugs and call for (1) formal population-based study to verify the risk of fampridine and (2) awareness by clinicians, who should assess the possible responsibility of MS drugs when they diagnose DILI.
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Affiliation(s)
- Ippazio Cosimo Antonazzo
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Elisabetta Poluzzi
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Emanuele Forcesi
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Trond Riise
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Kjetil Bjornevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway/Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elisa Baldin
- Epidemiology and Biostatistics Service, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Luigi Muratori
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy/ Center for the Study and Treatment of the Autoimmune Diseases of the Liver and Biliary System, Policlinico di Sant’Orsola, Bologna, Italy
| | - Fabrizio De Ponti
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Baksh SN, McAdams-DeMarco M, Segal JB, Alexander GC. Cardiovascular safety signals with dipeptidyl peptidase-4 inhibitors: A disproportionality analysis among high-risk patients. Pharmacoepidemiol Drug Saf 2018; 27:660-667. [PMID: 29655237 PMCID: PMC6727842 DOI: 10.1002/pds.4437] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 03/12/2018] [Accepted: 03/13/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE In 2008, the US Food and Drug Administration (FDA) issued Draft Guidance on investigating cardiovascular risk with oral diabetic drugs, including dipeptidyl peptidase-4 inhibitors (DPP-4i). In 2014, underpowered, post hoc analyses of clinical trials suggested an increased risk of heart failure with the use of these products. As such, we assessed disproportionate reporting of major adverse cardiac events (MACE) among reports for DPP-4i submitted to the FDA Adverse Event Reporting System (FAERS) from 2006 to 2015. METHODS We assessed the empirical Bayes geometric mean (EBGM) and its lower bound (EB05) of the relative reporting ratio for MACE among DPP-4i reports in the full FAERS database and in a subset of reports limited to cardiovascular and diabetic drugs. We then compared the EB05 in these 2 analyses and calculated the percent positive agreement for signals of disproportional reporting (SDRs) involving MACE. RESULTS Of 180.3 million adverse event reports, 13.4 million were for diabetic and cardiovascular drugs. In the cardiovascular subset, there was an SDR for heart failure with linagliptin (EB05 = 2782.47) and saxagliptin (EB05 = 2.40), myocardial infarction with alogliptin (EB05 = 290.11), and cerebral infarction with sitagliptin (EB05 = 2.80). Of the 14 MACE, 8 had a percent positive agreement ≥50% for an SDR in both analyses. Overall, the cardiovascular subset elicited 11 more SDRs for DPP-4i than the full dataset. CONCLUSIONS Postmarketing surveillance of DPP-4i through FAERS suggest increased reporting of MACE, supporting the current FDA warning of heart failure risk. This suggests the need for additional longitudinal, observational research into the association of DPP-4i and other MACE.
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Affiliation(s)
- Sheriza N Baksh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA
| | - Mara McAdams-DeMarco
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA
| | - Jodi B Segal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA
- Center for Health Services and Outcomes Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - G Caleb Alexander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
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Raschi E, Poluzzi E, Salvo F, Pariente A, De Ponti F, Marchesini G, Moretti U. Pharmacovigilance of sodium-glucose co-transporter-2 inhibitors: What a clinician should know on disproportionality analysis of spontaneous reporting systems. Nutr Metab Cardiovasc Dis 2018; 28:533-542. [PMID: 29625780 DOI: 10.1016/j.numecd.2018.02.014] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/21/2018] [Accepted: 02/21/2018] [Indexed: 10/17/2022]
Abstract
Sodium-glucose co-transporter-2 inhibitors (SGLT2-Is) have consistently demonstrated a clinically significant reduction of cardiovascular mortality. However, their safety in clinical practice is still incompletely characterized, and post-marketing monitoring is required considering the expected increase in clinical use. Different analyses of international spontaneous reporting systems, known as disproportionality analyses (DAs), have highlighted the occurrence of ketoacidosis, amputations, acute renal failure and skin toxicity. In this viewpoint, we critically appraise these pharmacovigilance data on SGLT2-Is, with the aim of supporting clinicians in proper interpretation of these studies, and discussing their risk-benefit profile. To this aim, we offer a broad perspective on basic technical aspects subtending DAs of spontaneous reporting databases (describing peculiarities of the Food and Drug Administration Adverse Event Reporting System), their common and evolving uses, key pitfalls in presenting study results (in terms of "risk" or "association") and relevant strategies to account for major confounders. This will also facilitate reviewers and editors in proper evaluation of DAs, and prompt pharmacovigilance experts in converging towards a set of minimum requirements in standardization of design, performance and reporting of DAs. A consensus on quality assessment of DAs will finally establish their transferability to clinical practice. It is anticipated that DAs cannot be used per se as a standalone approach to assess a drug-related risk and cannot replace clinical judgment in the individual patient.
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Affiliation(s)
- E Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - E Poluzzi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - F Salvo
- University of Bordeaux, U657, 33000, Bordeaux, France; INSERM U657, 33000, Bordeaux, France; CIC Bordeaux CICI1401, 33000, Bordeaux, France
| | - A Pariente
- University of Bordeaux, U657, 33000, Bordeaux, France; INSERM U657, 33000, Bordeaux, France; CIC Bordeaux CICI1401, 33000, Bordeaux, France
| | - F De Ponti
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - G Marchesini
- Unit of Metabolic Diseases & Clinical Dietetics, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - U Moretti
- Department of Public Health and Community Medicine, University of Verona, Verona, Italy
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Toki T, Ono S. Spontaneous Reporting on Adverse Events by Consumers in the United States: An Analysis of the Food and Drug Administration Adverse Event Reporting System Database. Drugs Real World Outcomes 2018; 5:117-128. [PMID: 29725886 PMCID: PMC5984610 DOI: 10.1007/s40801-018-0134-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Voluntary reports on adverse events (AEs) submitted by consumers have been facilitated through the MedWatch program in the United States (US), but few studies have described the characteristics of voluntary reports. OBJECTIVE The aim of this study was to reveal the characteristics of current voluntary reports on AEs reported by consumers and healthcare professionals. METHODS We performed analysis on voluntary reports of AEs in the US Food and Drug Administration AE Reporting System (FAERS) database submitted in 2016. We compared reports by consumers with those by healthcare professionals. RESULTS The number of voluntary reports by consumers has increased since 2013 in the US. Reports by consumers were different from ones by health professionals in several important aspects such as demographics and outcomes of patients, AEs, and suspect drugs. The proportion of reports on female patients and on disability as a patient outcome were higher in reports by consumers than in those by healthcare professionals. Consumers more frequently reported concomitant drugs compared with healthcare professionals. Time to report varied among the occupations and depending on seriousness of outcomes. CONCLUSIONS Our analysis of voluntary AE reports in the US FAERS database has shown that voluntary reports tended to include AEs related to subjective symptoms, as in some previous studies on patient reporting in the EU. Voluntary reports by consumers seemed to be different from ones by healthcare professionals in important aspects including demographics and reporting behaviors. These findings suggest that the heterogeneities should be addressed appropriately in using spontaneous reports.
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Affiliation(s)
- Tadashi Toki
- Laboratory of Pharmaceutical Regulation and Sciences, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shunsuke Ono
- Laboratory of Pharmaceutical Regulation and Sciences, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
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Madigan D, Shin J. Drospirenone-containing oral contraceptives and venous thromboembolism: an analysis of the FAERS database. Open Access J Contracept 2018; 9:29-32. [PMID: 29720882 PMCID: PMC5919164 DOI: 10.2147/oajc.s161737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Substantial evidence suggests that drospirenone-containing oral contraceptives may cause a higher risk of venous thrombotic events than earlier-generation oral contraceptives. Methods To gain insight into recent real-world implications, we conducted an analysis using the US Food and Drug Administration’s Adverse Event Reporting System. Results Venous thrombotic events continue to be reported at a much higher rate with drospirenone-containing oral contraceptives than the general background. The disproportionality has been rising since 2010. The same behavior is not seen with levonorgestrel-containing oral contraceptives. Conclusion Our results are consistent with decreased physician and patient awareness of risks associated with drospirenone-containing oral contraceptives.
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Affiliation(s)
- David Madigan
- Department of Statistics, Columbia University, New York, NY, USA
| | - Jennifer Shin
- Department of Statistics, Columbia University, New York, NY, USA
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Gawron AJ, Bielefeldt K. Risk of Pancreatitis Following Treatment of Irritable Bowel Syndrome With Eluxadoline. Clin Gastroenterol Hepatol 2018; 16:378-384.e2. [PMID: 28804032 DOI: 10.1016/j.cgh.2017.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/01/2017] [Accepted: 08/04/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The Food and Drug Administration approved eluxadoline for the treatment of diarrhea-predominant irritable bowel syndrome despite cases of pancreatitis in early stage trials. We investigated the frequency of pancreatitis attributed to eluxadoline in postmarketing surveillance. METHODS We extracted reports on eluxadoline submitted to the Federal Adverse Event Reporting System from January through September 2016. We collected data on patient age and sex, event date, reporting entity (consumer, physician, pharmacist, legal worker, or other), medications, dosages, presumed role in the event (coinciding, primary, or secondary suspect), treatment indication, and outcome (death, life threatening, hospitalization, disability, or other).We compared data for eluxadoline with data from antidiarrheals, oxycodone, and rifaximin using the κ2 test, Kruskal-Wallis rank test, and analysis of variance; findings with P < .05 were considered statistically significant. RESULTS Pancreatitis accounted for 16.4% of the 597 reports of adverse events linked to eluxadoline; 53 cases required hospitalization. Pancreatitis was listed as treatment complication of other agents in significantly lower proportions of cases (loperamide, 0.3%; diphenoxylate, 0.4%; oxycodone, 0.2%; rifaximin, 0.5%), with 75% of these submissions not considering the agent as causal. CONCLUSIONS In an analysis of reports on eluxadoline submitted to the Federal Adverse Event Reporting System, we confirmed a previously reported risk of pancreatitis associated with eluxadoline. The need for hospitalization in at least half of these instances and a recent report of 2 fatalities should prompt reassessments of the agent's risk-benefit ratio.
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Affiliation(s)
- Andrew J Gawron
- Gastroenterology Section, George E. Wahlen VA Medical Center, Salt Lake City, Utah; Division of Gastroenterology, Hepatology, and Nutrition, University of Utah, Salt Lake City, Utah; Salt Lake City Specialty Care Center of Innovation, Salt Lake City, Utah
| | - Klaus Bielefeldt
- Gastroenterology Section, George E. Wahlen VA Medical Center, Salt Lake City, Utah.
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Hashiguchi M, Maruyama J, Shimizu M, Takahashi D, Shiga T. Risk Factor for Diabetes Mellitus and High Blood Glucose With HMG-CoA Reductase Inhibitors Using a Postmarketing Surveillance Database in Japan. Clin Pharmacol Drug Dev 2018; 7:800-810. [PMID: 29462515 DOI: 10.1002/cpdd.444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/02/2018] [Indexed: 11/11/2022]
Abstract
To investigate whether 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor (statin) use is associated with an increased risk of diabetes mellitus and hyperglycemia, we performed a nested case-control study using a postmarketing surveillance database in Japan. The database cohort included 26,849 cases of statin use and 5308 cases of other lipid-lowering drug use in patients with hyperlipidemia. Participants received at least 1 type of statin, had a clear medication history of statin use, and had no complications of diabetes mellitus. Cases were defined as onset of diabetes mellitus or hyperglycemia during statin intake. For each case, 20 controls were randomly selected and matched by time point. The factors associated with an increased risk of diabetes mellitus and hyperglycemia during statin intake examined included sex, age, body mass index, statin use duration, complications, concomitant medication, and clinical laboratory tests. Statin-associated diabetes mellitus or hyperglycemia was identified based on abnormal elevation of blood glucose concentrations beyond the reference range. A total of 19,868 patients met the inclusion criteria, of whom 24 were patients in the case group. Two complicating factors, fatty liver (adjusted odds ratio 16.10) and hyperuricemia (adjusted odds ratio 28.96), were extracted for onset of diabetes mellitus or hyperglycemia. Nonalcoholic fatty liver was associated with diabetes mellitus, obesity, and insulin resistance, and hyperuricemia was associated with lifestyle. This study suggested that the onset of diabetes mellitus or hyperglycemia might be increased with statin use in patients with complications of fatty liver and hyperuricemia.
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Affiliation(s)
- Masayuki Hashiguchi
- Division for Evaluation and Analysis of Drug Information, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Junya Maruyama
- Division for Evaluation and Analysis of Drug Information, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Mikiko Shimizu
- Department of Hygienic Chemistry, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Daichi Takahashi
- Division for Evaluation and Analysis of Drug Information, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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Sarangdhar M, Tabar S, Schmidt C, Kushwaha A, Shah K, Dahlquist JE, Jegga AG, Aronow BJ. Data mining differential clinical outcomes associated with drug regimens using adverse event reporting data. Nat Biotechnol 2018; 34:697-700. [PMID: 27404875 DOI: 10.1038/nbt.3623] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Mayur Sarangdhar
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Scott Tabar
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Charles Schmidt
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Akash Kushwaha
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Krish Shah
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jeanine E Dahlquist
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Anil G Jegga
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Bruce J Aronow
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Clinical and Translational Sciences Program, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Thota P, Thota A, Medhi B, Sidhu S, Kumar P, Selvan VK, Singh GN. Drug safety alerts of pharmacovigilance programme of India: A scope for targeted spontaneous reporting in India. Perspect Clin Res 2018; 9:51-55. [PMID: 29430420 PMCID: PMC5799955 DOI: 10.4103/picr.picr_29_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The National Coordination Centre-Pharmacovigilance Programme of India (NCC-PvPI), Indian Pharmacopoeia Commission works under the aegis of Ministry of Health and Family Welfare, Government of India. It promotes patient safety in India and also supports postmarketing surveillance programs. Currently, almost hundred thousand case reports are submitted to NCC-PvPI each year through its 250 ADR Monitoring Centers (AMCs) located across India, and India is the one of the top ten contributor countries under WHO-Uppsala Monitoring Centre since 2012 and start issuing drug safety alerts from March 2016. AIM This study aims to highlight the drug safety alerts issued by NCC-PvPI from March 2016 to June 2017 and urgent need for further monitoring by adopting targeted spontaneous reporting (TSR) methodology at AMCs and its impact on the NCC's drug safety database, i.e., VigiFlow in India. METHODOLOGY A retrospective analysis was done for the reported unlisted ADRs by various AMCs to PvPI through VigiFlow, i.e., individual case safety report (ICSR) management system at NCC, where these unlisted drug-ADR combinations considered and issued as drug safety alerts for further reporting these to NCC, if any detected at healthcare settings during routine clinical practice by healthcare professionals. RESULTS From July 2011 to June 2017, NCC-PvPI was collated 250,787 ICSRs and contributed to WHO international drug safety database, i.e., VigiBase, from these ICSRs; NCC-PvPI was issued 56 drug safety alerts from March 2016 to June 2017. CONCLUSION In India, spontaneous reporting of ADRs existed since 1998 under passive surveillance method, but there is an urgent need to initiate TSR, which is a complementary method to spontaneous reporting on these drug safety alerts for further regulatory action by Central Drugs Standard Control Organization.
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Affiliation(s)
- Prasad Thota
- Department of Life Sciences, IKG Punjab Technical University, Jalandhar, Punjab, India
| | - Anusha Thota
- Indian Pharmacopoeia Commission, Ghaziabad, Uttar Pradesh, India
| | - Bikash Medhi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shabir Sidhu
- Department of Life Sciences, IKG Punjab Technical University, Jalandhar, Punjab, India
| | - Pramod Kumar
- Indian Pharmacopoeia Commission, Ghaziabad, Uttar Pradesh, India
| | - V. Kalai Selvan
- Indian Pharmacopoeia Commission, Ghaziabad, Uttar Pradesh, India
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Svendsen K, Halvorsen KH, Vorren S, Samdal H, Garcia B. Adverse drug reaction reporting: how can drug consumption information add to analyses using spontaneous reports? Eur J Clin Pharmacol 2017; 74:497-504. [DOI: 10.1007/s00228-017-2396-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 12/04/2017] [Indexed: 11/29/2022]
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Raschi E, Parisotto M, Forcesi E, La Placa M, Marchesini G, De Ponti F, Poluzzi E. Adverse events with sodium-glucose co-transporter-2 inhibitors: A global analysis of international spontaneous reporting systems. Nutr Metab Cardiovasc Dis 2017; 27:1098-1107. [PMID: 29174026 DOI: 10.1016/j.numecd.2017.10.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/19/2017] [Accepted: 10/06/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIMS We assessed post-marketing safety of sodium-glucose co-transporter-2 inhibitors (SGLT2-Is) by analyzing adverse events (AEs) reported in international pharmacovigilance databases. METHODS AND RESULTS Eudravigilance, WHO-Vigibase (as of Feb 25, 2017) and the FDA Adverse Event Reporting System (FAERS, from 2004 to 2016 second quarter) were queried to extract AEs recording SGLT2-Is as suspect. Disproportionality analyses (case/non-case method) were performed in FAERS by calculating the reporting odds ratios (RORs) from System Organ Classes (SOCs) to Preferred Terms (PTs) (precise clinical entities). Potential signals were defined by statistically-significant ROR (lower limit of the 95% confidence interval - LL95%CI - >1) undetected by literature analysis (as of December 2016). SGLT2-Is were recorded in 7972, 19,775, 11,137 reports (Eudravigilance, WHO-Vigibase and FAERS, respectively); in FAERS, statistically significant ROR emerged for the following SOCs: "infections and infestations" (N = 2162; LL95%CI = 3.25), "metabolism and nutrition disorders" (2278; 1.36), "renal and urinary disorders" (1665; 2.31), "reproductive system and breast disorders" (471; 4.85), "skin and subcutaneous tissue disorders" (1136; 1.52). Skin toxicity emerged as potential signal (e.g., rash, photosensitivity, urticaria as PTs), both for SGLT2-Is as a class and as individual drugs. Severe adverse skin events (81 reports, 7% of the skin cases) mainly occurred in females aged 18-65 using SGLT2-Is as single antidiabetic regimen. CONCLUSION Among antidiabetics, SGLT2-Is are associated with higher reporting of infections, metabolism, renal and reproductive AEs, corroborating clinical trial evidence. Their large reporting patterns and the unexpected signal of skin toxicity justify active vigilance by clinicians and "real-time" monitoring by pharmacovigilance experts.
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Affiliation(s)
- E Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - M Parisotto
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - E Forcesi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - M La Placa
- Dermatology Division, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - G Marchesini
- Unit of Metabolic Diseases & Clinical Dietetics, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - F De Ponti
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - E Poluzzi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
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Perlman A, Heyman SN, Matok I, Stokar J, Muszkat M, Szalat A. Acute renal failure with sodium-glucose-cotransporter-2 inhibitors: Analysis of the FDA adverse event report system database. Nutr Metab Cardiovasc Dis 2017; 27:1108-1113. [PMID: 29174031 DOI: 10.1016/j.numecd.2017.10.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/03/2017] [Accepted: 10/06/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Sodium-glucose-cotransporter-2 (SGLT2) inhibitors have recently been approved for the treatment of type II diabetes mellitus (T2DM). It has been proposed that these agents could induce acute renal failure (ARF) under certain conditions. This study aimed to evaluate the association between SGLT2-inhibitors and ARF in the FDA adverse event report system (FAERS) database. METHODS AND RESULTS We analyzed adverse event cases submitted to FAERS between January 2013 and September 2016. ARF cases were identified using a structured medical query. Medications were identified using both brand and generic names. During the period evaluated, 18,915 reports (out of a total of 3,832,015 registered in FAERS) involved the use of SGLT2-inhibitors. SGLT2-inhibitors were reportedly associated with ARF in 1224 of these cases (6.4%), and were defined as the "primary" or "secondary" cause of the adverse event in 96.8% of these cases. The proportion of reports with ARF among reports with SGLT2 inhibitor was almost three-fold higher compared to reports without these drugs (ROR 2.88, 95% CI 2.71-3.05, p < 0.001). The proportion of ARF reports among cases with SGLT2-inhibitors was significantly greater than the proportion of ARF among cases with T2DM without SGLT2-inhibitors (ROR 1.68, 95% CI 1.57-1.8, p < 0.001). Among the SGLT2-inhibitors, canagliflozin was associated with a higher proportion of reports of renal failure (7.3%), compared to empagliflozin and dapagliflozin (4.7% and 4.8% respectively, p < 0.001). CONCLUSION SGLT2-inhibitors are associated with an increase in the proportion of reports of ARF compared to other medications. SGLT2-inhibitor agents may differ from one another in their respective risk for ARF.
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Affiliation(s)
- A Perlman
- Department of Internal Medicine, Hadassah University Hospital, Jerusalem, Israel; Division of Clinical Pharmacy, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Israel.
| | - S N Heyman
- Department of Internal Medicine, Hadassah University Hospital, Jerusalem, Israel
| | - I Matok
- Division of Clinical Pharmacy, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Israel
| | - J Stokar
- Department of Internal Medicine, Hadassah University Hospital, Jerusalem, Israel
| | - M Muszkat
- Department of Internal Medicine, Hadassah University Hospital, Jerusalem, Israel
| | - A Szalat
- Department of Internal Medicine, Hadassah University Hospital, Jerusalem, Israel
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Maciejewski M, Lounkine E, Whitebread S, Farmer P, DuMouchel W, Shoichet BK, Urban L. Reverse translation of adverse event reports paves the way for de-risking preclinical off-targets. eLife 2017; 6. [PMID: 28786378 PMCID: PMC5548487 DOI: 10.7554/elife.25818] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 07/04/2017] [Indexed: 01/06/2023] Open
Abstract
The Food and Drug Administration Adverse Event Reporting System (FAERS) remains the primary source for post-marketing pharmacovigilance. The system is largely un-curated, unstandardized, and lacks a method for linking drugs to the chemical structures of their active ingredients, increasing noise and artefactual trends. To address these problems, we mapped drugs to their ingredients and used natural language processing to classify and correlate drug events. Our analysis exposed key idiosyncrasies in FAERS, for example reports of thalidomide causing a deadly ADR when used against myeloma, a likely result of the disease itself; multiplications of the same report, unjustifiably increasing its importance; correlation of reported ADRs with public events, regulatory announcements, and with publications. Comparing the pharmacological, pharmacokinetic, and clinical ADR profiles of methylphenidate, aripiprazole, and risperidone, and of kinase drugs targeting the VEGF receptor, demonstrates how underlying molecular mechanisms can emerge from ADR co-analysis. The precautions and methods we describe may enable investigators to avoid confounding chemistry-based associations and reporting biases in FAERS, and illustrate how comparative analysis of ADRs can reveal underlying mechanisms. DOI:http://dx.doi.org/10.7554/eLife.25818.001 New treatments are tested in clinical trials before they are licensed for use in patients, but until the drugs are available for prescribing it’s not always possible to identify every side effect. When the drugs enter the clinic, they might be prescribed to patients with multiple medical conditions, or combined with other treatments. The drugs may also be taken for longer periods of time than tested in trials. It is therefore common for new adverse reactions to emerge after a drug is in widespread use. The FDA Adverse Event Reporting System (FAERS) is a surveillance system used in the United States for reporting drug side effects after new treatments have been licensed. Healthcare professionals and patients can submit reports to the database, logging the adverse drug reactions that they have experienced. FAERS currently contains over 8.5 million entries, and is growing all the time. However, Maciejewski et al. show that the database has several shortcomings that are reducing its usefulness. For instance, on average any given drug will have 16 different names in the system; this makes it challenging to group all of the reported side effects so that trends and patterns can be correctly seen. To address this first problem, Maciejewski et al. grouped together drugs according to their active ingredients, rather than their name. This made it much easier to account for subsequent, and more crucial conflating factors such as multiple reports for the same adverse event and patient, or cases where adverse reactions were confused with the diseases that the drugs are trying to treat. For example, diabetes was listed as a side effect for drugs used to treat diabetes. Building on this cleaned-up dataset, Maciejewski et al. monitored how adverse event signals evolve over time and uncovered biases that were hard to see otherwise. For example, side-effects were reported more often when drugs were in the news. More strikingly, this bias affected not only the drug in question, but also other drugs that acted in the same way or on the same molecular target. The computational method developed by Maciejewski et al. allows the data in FAERS to be combined and corrected, making easier to evaluate the safety of different medicines. The link between adverse side effects and the molecular targets of the drug, via the ingredient’s chemical structure, furthermore makes it possible to analyze such clinical data reliably by using chemical and genetic information. In the future, this method could also help to identify previously unknown side effects and the biological mechanisms behind them. This could help researchers to develop new drugs with improved side effect profiles. DOI:http://dx.doi.org/10.7554/eLife.25818.002
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Affiliation(s)
| | - Eugen Lounkine
- Novartis Institutes for Biomedical Research, Cambridge, United States
| | - Steven Whitebread
- Novartis Institutes for Biomedical Research, Cambridge, United States
| | - Pierre Farmer
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - William DuMouchel
- Oracle Health Sciences, Oracle Health Sciences, Burlington, United States
| | | | - Laszlo Urban
- Novartis Institutes for Biomedical Research, Cambridge, United States
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Fadini GP, Bonora BM, Avogaro A. SGLT2 inhibitors and diabetic ketoacidosis: data from the FDA Adverse Event Reporting System. Diabetologia 2017; 60:1385-1389. [PMID: 28500396 DOI: 10.1007/s00125-017-4301-8] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 04/11/2017] [Indexed: 12/11/2022]
Abstract
AIMS/HYPOTHESIS Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are indicated for the treatment of type 2 diabetes and may also improve glucose control in type 1 diabetes. In 2015, regulatory agencies warned that SGLT2i may favour diabetic ketoacidosis (DKA). We provide a detailed analysis of DKA reports in which an SGLT2i was listed among suspect or concomitant drugs in the US Food and Drug Administration Adverse Event Reporting System (FAERS). METHODS We first analysed the entire public FAERS up to September (third quarter [Q3]) 2016 to extract the number of reports, background indications and concomitant medications, and to calculate proportional reporting ratios (PRRs) and safety signals. We then mined single FAERS files from the first quarter (Q1) of 2014 to 2016 Q3 to obtain detailed information on DKA reports. RESULTS The FAERS database contains >2500 DKA reports in which SGLT2i are listed as suspect or concomitant drugs. The PRR of DKA in reports including vs those not including an SGLT2i and having a diabetes indication was 7.9 (95% CI 7.5, 8.4) and was higher for type 1 diabetes. Several concomitant conditions were less prevalent in DKA reports with SGLT2i vs DKA reports filed for other drugs. A detailed analysis of 2397 DKA reports for SGLT2i from 2014 Q1 to 2016 Q3 revealed a predominance of women, an extremely wide range of age and body weight, and a highly variable duration of SGLT2i treatment before onset of DKA. In 37 individuals (1.54%), DKA was fatal. CONCLUSIONS/INTERPRETATION Based on the profile of these reports, SGLT2i-associated DKA may not be limited to any particular demographic or comorbid subpopulation and can occur at any duration of SGLT2i use. DATA AVAILABILITY A list of FDA reports analysed in the study is available in the figshare repository, 10.6084/m9.figshare.4903211 . Other data are available from the corresponding author on reasonable request.
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Affiliation(s)
- Gian Paolo Fadini
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
| | | | - Angelo Avogaro
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
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Aggarwal N. Local anesthetics systemic toxicity association with exparel (bupivacaine liposome)- a pharmacovigilance evaluation. Expert Opin Drug Saf 2017; 17:581-587. [DOI: 10.1080/14740338.2017.1335304] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Nitish Aggarwal
- Ohio State University Wexner Medical Center, Columbus, OH, USA
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Moro P, Baumblatt J, Lewis P, Cragan J, Tepper N, Cano M. Surveillance of Adverse Events After Seasonal Influenza Vaccination in Pregnant Women and Their Infants in the Vaccine Adverse Event Reporting System, July 2010-May 2016. Drug Saf 2017; 40:145-152. [PMID: 27988883 PMCID: PMC6602065 DOI: 10.1007/s40264-016-0482-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Routine immunization of pregnant women with seasonal inactivated influenza vaccines (IIVs) is recommended in all trimesters of pregnancy. A review of the Vaccine Adverse Event Reporting System (VAERS) during 1990-2009 did not find any unexpected patterns of pregnancy complications or fetal outcomes after administration of IIV or live attenuated influenza vaccines (LAIVs). During the 2009-2010 pandemic influenza A (H1N1) vaccination campaign, a study noted that the number of VAERS reports from pregnant women who received the H1N1 2009 inactivated monovalent vaccine (n = 288) increased compared with 1990-2009 seasonal IIV pregnancy reports (n = 148). OBJECTIVES The objective of this study was to assess the safety of seasonal influenza vaccines in pregnant women and their infants whose reports were submitted to VAERS during 2010-2016. METHODS We searched VAERS for US reports of adverse events (AEs) in pregnant women who received IIV or LAIV from 1 July 2010 through 6 May 2016. Clinicians reviewed reports and available medical records and assigned a primary clinical category for each report. Reports were coded as serious based on the Code of Federal Regulations. RESULTS We identified 671 reports after seasonal influenza vaccines administered to pregnant women: 544 after IIV and 127 after LAIV. Serious events occurred among 61 (11.2%) reports following IIV and one (0.8%) report following LAIV. No deaths were reported. Among reports with trimester information (n = 296), IIV was administered during the first trimester in 116 (39.2%). Among IIV reports, the most frequent pregnancy-specific AE was spontaneous abortion in 62 (11.4%) reports, followed by stillbirth in ten (1.8%) and preterm delivery in six (1.1%). The most common non-pregnancy-specific AEs were injection-site reactions (55 [10.1%]). Neonatal or infant outcomes were reported in 22 (4.0%) reports, seven of which had major birth defects of different types and no neonatal deaths. CONCLUSION As in 2009-2010, no new or unexpected patterns in maternal or fetal outcomes were observed during 2010-2016.
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Affiliation(s)
- Pedro Moro
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd, MS D26, Atlanta, GA, 30329, USA.
| | - Jane Baumblatt
- Division of Epidemiology, Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Paige Lewis
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd, MS D26, Atlanta, GA, 30329, USA
| | - Janet Cragan
- Birth Defects Branch, Division of Congenital and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities (NCBDDD), CDC, Atlanta, GA, USA
| | - Naomi Tepper
- Women's Health and Fertility Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), CDC, Atlanta, GA, USA
| | - Maria Cano
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd, MS D26, Atlanta, GA, 30329, USA
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Li H, Shi Q. Drugs and Diseases Interacting with Cigarette Smoking in US Prescription Drug Labelling. Clin Pharmacokinet 2016; 54:493-501. [PMID: 25701380 DOI: 10.1007/s40262-015-0246-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The US Food and Drug Administration (FDA) draft guidance for industry on drug interaction studies recommends, but does not mandate, that both cigarette smokers and non-smokers can be used to study drug metabolism in clinical trials, and that important results related to smoking should be included in drug labelling to guide medication usage. This study aimed to provide a comprehensive review of drugs or diseases interacting with smoking, as presented in all US drug labelling. The 62,857 drug labels deposited in the FDA Online Label Repository were searched using the keywords 'smoke', 'smoker(s)', 'smoking', 'tobacco' and 'cigarette(s)' on 19 June 2014. The resultant records were refined to include only human prescription drug labelling, for manual examination. For 188 single-active-ingredient drugs and 36 multiple-active-ingredient drugs, the labelling was found to contain smoking-related information. The pharmacokinetics of 29 and 21 single-active-ingredient drugs were affected and unaffected, respectively, by smoking. For the remaining drugs, the provided information related to smoking affecting efficacy, safety or diseases but not pharmacokinetics. Depending on the nature of specific drugs, the perturbation in pharmacokinetic parameters in smokers ranged from 13 to 500%, in comparison with non-smokers. Dosage modifications in smokers are necessary for four drugs and may be necessary for six drugs, but are unnecessary for seven drugs although the pharmacokinetic parameters of four of them are affected by smoking. Cigarette smoking is a risk factor for 16 types of diseases or adverse drug reactions. For one single-active-ingredient contraceptive drug and 10 multiple-active-ingredient contraceptive drugs, a black box warning (the FDA's strongest safety warning) is included in the labelling for increased risks of heart attacks and strokes in female smokers, and "women are strongly advised not to smoke" when using these drugs. This study presents the first comprehensive overview of cigarette smoking interacting with drugs and/or diseases, as presented in US drug labelling.
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Affiliation(s)
- Haibo Li
- Department of Microbiology, Nantong Center for Disease Control and Prevention, 189 South Gongnong Road, Nantong, 226007, Jiangsu, China
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Hashiguchi M, Imai S, Uehara K, Maruyama J, Shimizu M, Mochizuki M. Factors Affecting the Timing of Signal Detection of Adverse Drug Reactions. PLoS One 2015; 10:e0144263. [PMID: 26641634 PMCID: PMC4671724 DOI: 10.1371/journal.pone.0144263] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 11/16/2015] [Indexed: 11/18/2022] Open
Abstract
We investigated factors affecting the timing of signal detection by comparing variations in reporting time of known and unknown ADRs after initial drug release in the USA. Data on adverse event reactions (AERs) submitted to U.S. FDA was used. Six ADRs associated with 6 drugs (rosuvastatin, aripiprazole, teriparatide, telithromycin, exenatide, varenicline) were investigated: Changes in the proportional reporting ratio, reporting odds ratio, and information component as indexes of signal detection were followed every 3 months after each drugs release, and the time for detection of signals was investigated. The time for the detection of signal to be detected after drug release in the USA was 2-10 months for known ADRs and 19-44 months for unknown ones. The median lag time for known and unknown ADRs was 99.0-122.5 days and 185.5-306.0 days, respectively. When the FDA released advisory information on rare but potentially serious health risks of an unknown ADR, the time lag to report from the onset of ADRs to the FDA was shorter. This study suggested that one factor affecting signal detection time is whether an ADR was known or unknown at release.
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Affiliation(s)
- Masayuki Hashiguchi
- Division for Evaluation and Analysis of Drug Information, Faculty of Pharmacy, Keio University, Shibakoen, Minato-ku, Tokyo, Japan
- * E-mail:
| | - Shungo Imai
- Division for Evaluation and Analysis of Drug Information, Faculty of Pharmacy, Keio University, Shibakoen, Minato-ku, Tokyo, Japan
| | - Keiko Uehara
- Japan Pharmaceutical Information Center (JAPIC), Shibuya, Shibuya-ku, Tokyo, Japan
| | - Junya Maruyama
- Division for Evaluation and Analysis of Drug Information, Faculty of Pharmacy, Keio University, Shibakoen, Minato-ku, Tokyo, Japan
| | - Mikiko Shimizu
- Department of Hygienic Chemistry, Faculty of Pharmacy, Keio University, Shibakoen, Minato-ku, Tokyo, Japan
| | - Mayumi Mochizuki
- Division for Evaluation and Analysis of Drug Information, Faculty of Pharmacy, Keio University, Shibakoen, Minato-ku, Tokyo, Japan
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