The Impact of Litigation-Associated Reports on Signal Identification in the US FDA's Adverse Event Reporting System

Characterization of Pediatric Reports in the US Food and Drug Administration Adverse Event Reporting System from 2010-2020: A Cross-Sectional Study

INTRODUCTION

The Food and Drug Administration Adverse Event Reporting System (FAERS) is a database of adverse event (AE) and medication error reports for drugs and therapeutic biologics. Examining trends of reported individual case safety reports (ICSRs) provides context for evaluating safety concerns.

OBJECTIVE

Characterize pediatric FAERS ICSRs and compare trends (1) to adult reports; (2) within pediatric subgroups.

METHODS

This cross-sectional study examined FAERS ICSRs received between January 1, 2010, through December 31, 2020. Stratified age bands were neonates, infants, younger children, older children, adolescents, and adults. We characterized groups by patient demographic information, suspect products, AEs, and reporter type.

RESULTS

From 2010 to 2020, there were 11,258,995 FAERS ICSRs; 3.1% described pediatric patients. Compared to adults, pediatric ICSRs had higher proportions of all serious outcomes except death. Within pediatric subgroups, neonates had the highest proportions of serious outcomes (96.2%) compared to infants, younger children, older children, and adolescents (79.8%, 67.9%, 59.5%, and 52.7%, respectively). Younger pediatric age groups were more likely to have weight information than older age groups but were less likely to include gender information. The most frequently reported AE was off label use for pediatrics and drug ineffective for adults. Products and AEs reported also differed among pediatric subgroups. Neonates, infants, and adolescents had entirely distinct sets of top five product-event combinations.

CONCLUSION

Pediatric ICSRs represent a minority of FAERS reports but have distinctly different attributes relative to adult ICSRs. Reporting trends also vary within pediatric subgroups, which highlights the need for unique considerations for pediatric safety surveillance.

A descriptive analysis of concomitant opioid and benzodiazepine medication use and associated adverse drug events in United States adults between 2009 and 2018

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.

An Evaluation of Postmarketing Reports with an Outcome of Death in the US FDA Adverse Event Reporting System

INTRODUCTION

Adverse reactions with an outcome of death are inherently important for pharmacovigilance organizations to evaluate. Prior efforts to systematically evaluate individual case safety reports (ICSRs) with an outcome of death have been limited to high-level summaries.

OBJECTIVE

The aim of this study was to characterize ICSRs with an outcome of death contained in the US FDA Adverse Event Reporting System (FAERS) database.

METHODS

All ICSRs received through 31 December 2017 reporting an outcome of death were characterized by patient demographics, suspect product(s), adverse events, and reporter type. Using the ICSR's narrative and reporter information, we classified ICSRs by source to include those from industry-sponsored programs, poison control centers, specialty pharmacies, and litigation. Additionally, a random sample of ICSRs was evaluated for completeness of structured data fields and manually reviewed for the availability of key information in the narrative (i.e. cause of death, medical history, and causality assessment).

RESULTS

Overall, 1,053,716 ICSRs with a death outcome were received in the study period. Ten medications treating conditions for malignancies, pain, and kidney disease accounted for nearly 20% of all fatal ICSRs. ICSRs originating from industry-sponsored programs, poison control centers, litigation, and specialty pharmacies accounted for 14%, 6.5%, 5.0%, and 3.3% of all fatal ICSRs, respectively. ICSRs in which the only adverse event coded was 'death' were more likely to be missing structured data and less likely to include key information in the narrative.

CONCLUSION

Understanding the origins and characteristics of ICSRs with an outcome of death supports meaningful evaluations and interpretations of FAERS data. A wide variability in ICSR quality exists, even in those reports with the most serious outcome.