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Bahri P, Bowring G, Edwards BD, Anton C, Aronson JK, Caro-Rojas A, Hugman BPJ, Mol PG, Trifirò G, Ilic K, Daghfous R, Fermont I, Furlan G, Gaissmaier W, Geer MI, Hartigan-Go KY, Houÿez F, Neth H, Norgela G, Oppamayun Y, Raynor DKT, Bouhlel M, Santoro F, Sultana J. Communicating for the Safe Use of Medicines: Progress and Directions for the 2020s Promoted by the Special Interest Group of the International Society of Pharmacovigilance. Drug Saf 2023; 46:517-532. [PMID: 37219785 DOI: 10.1007/s40264-023-01285-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 05/24/2023]
Affiliation(s)
- Priya Bahri
- Special Interest Group on Medicinal Product Risk Communication of the International Society of Pharmacovigilance (ISoP CommSIG), Geneva, Switzerland.
- European Medicines Agency (EMA) (Coordinator of the ISoP CommSIG in Her Personal Capacity), Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands.
| | - Geoffrey Bowring
- Special Interest Group on Medicinal Product Risk Communication of the International Society of Pharmacovigilance (ISoP CommSIG), Geneva, Switzerland
- Uppsala Monitoring Centre (UMC), Uppsala, Sweden
| | - Brian D Edwards
- Special Interest Group on Medicinal Product Risk Communication of the International Society of Pharmacovigilance (ISoP CommSIG), Geneva, Switzerland
- Husoteria Ltd, Ashtead, UK
| | - Christopher Anton
- Special Interest Group on Medicinal Product Risk Communication of the International Society of Pharmacovigilance (ISoP CommSIG), Geneva, Switzerland
- West Midlands Centre for Adverse Drug Reactions, City Hospital, Birmingham, UK
| | - Jeffrey K Aronson
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Angela Caro-Rojas
- Special Interest Group on Medicinal Product Risk Communication of the International Society of Pharmacovigilance (ISoP CommSIG), Geneva, Switzerland
- Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Peter G Mol
- Special Interest Group on Medicinal Product Risk Communication of the International Society of Pharmacovigilance (ISoP CommSIG), Geneva, Switzerland
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, The Netherlands
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Katarina Ilic
- Special Interest Group on Medicinal Product Risk Communication of the International Society of Pharmacovigilance (ISoP CommSIG), Geneva, Switzerland
- Takeda, Cambridge, MA, USA
| | - Riadh Daghfous
- Tunisian National Centre of Pharmacovigilance, Tunis, Tunisia
| | - Irene Fermont
- Israel Society for Medication and Vaccine Safety (ERANIM), Jerusalem, Israel
| | - Giovanni Furlan
- Special Interest Group on Medicinal Product Risk Communication of the International Society of Pharmacovigilance (ISoP CommSIG), Geneva, Switzerland
- Pfizer s.r.l., Safety Surveillance and Risk Management, Milan, Italy
| | - Wolfgang Gaissmaier
- Department of Psychology, Social Psychology and Decision Sciences, University of Konstanz, Konstanz, Germany
| | - Mohammad Ishaq Geer
- Department of Pharmaceutical Sciences, University of Kashmir, Srinagar, India
| | - Kenneth Y Hartigan-Go
- Special Interest Group on Medicinal Product Risk Communication of the International Society of Pharmacovigilance (ISoP CommSIG), Geneva, Switzerland
- School of Government, Ateneo De Manila University, Quezon City, Philippines
| | - François Houÿez
- European Organisation for Rare Diseases (EURORDIS), Paris, France
| | - Hansjörg Neth
- Department of Psychology, Social Psychology and Decision Sciences, University of Konstanz, Konstanz, Germany
| | | | - Yaowares Oppamayun
- Thai Food and Drug Administration, Health Product Vigilance Center, Bangkok, Thailand
| | | | - Mehdi Bouhlel
- Tunisian National Centre of Pharmacovigilance, Tunis, Tunisia
- Department of Pharmacology, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | | | - Janet Sultana
- Pharmacy Department, Mater Dei Hospital, Msida, Malta
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Crisafulli S, Khan Z, Karatas Y, Tuccori M, Trifirò G. An overview of methodological flaws of real-world studies investigating drug safety in the post-marketing setting. Expert Opin Drug Saf 2023; 22:373-380. [PMID: 37243676 DOI: 10.1080/14740338.2023.2219892] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/07/2023] [Accepted: 05/26/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION The evaluation of the post-marketing safety profile of drugs is a continuous monitoring process for approved and marketed medicines and it is crucial for detecting new adverse drug reactions. As such, real-world studies are essential to complement pre-marketing evidence with information concerning drug risk-benefit profile and use in wider patient populations and they have a great potential to support post-marketing drug safety evaluations. AREAS COVERED A detailed description of the main limitations of real-world data sources (i.e. claims databases, electronic healthcare records, drug/disease registers and spontaneous reporting system databases) and of the main methodological challenges of real-world studies in generating real-world evidence is provided. EXPERT OPINION Real-world evidence biases can be ascribed to both the methodological approach and the specific limitations of the different real-world data sources used to carry out the study. As such, it is crucial to characterize the quality of real-world data, by establishing guidelines and best practices for the assessment of data fitness for purpose. On the other hand, it is important that real-world studies are conducted using a rigorous methodology, aimed at minimizing the risk of bias.
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Affiliation(s)
| | - Zakir Khan
- Faculty of Medicines, Department of Medical Pharmacology Çukurova University, Sarıçam, Adana, Türkiye
| | - Yusuf Karatas
- Faculty of Medicines, Department of Medical Pharmacology Çukurova University, Sarıçam, Adana, Türkiye
- Pharmacovigilance Specialist, Faculty of Medicines, Balcali Hospital, Sarıçam, Adana, Türkiye
| | - Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Unit of Adverse Drug Reaction Monitoring, University Hospital of Pisa, Pisa, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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3
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Fife D, Blacketer C, Knight K, Weaver J. Stroke Risk Among Non-Elderly Users of Haloperidol or First-Generation Antipsychotics vs Second-Generation Antipsychotics: A Cohort Study from a US Health Insurance Claims Database. Drugs Real World Outcomes 2021; 8:481-496. [PMID: 34109564 PMCID: PMC8605955 DOI: 10.1007/s40801-021-00267-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background Previous studies have reported an increased risk of stroke in patients taking antipsychotics. However, most of these studies have been conducted in the elderly population. Objective We estimated stroke risk in new users of any first-generation antipsychotic or haloperidol, vs second-generation antipsychotics among patients aged 18–64 years without a recent dementia diagnosis and, separately, regardless of a recent dementia diagnosis. Methods Data were obtained from IBM MarketScan® Commercial Database (1 January, 2001–31 December, 2017). Among new users without a recent dementia diagnosis, stroke risk for first-generation antipsychotics (FGAw/oD cohort) or haloperidol (HALw/oD cohort) was compared with second-generation antipsychotics (SGAw/oD cohort). A similar comparison was conducted among new users regardless of dementia diagnosis: first-generation antipsychotics (FGA cohort) or haloperidol (HAL cohort) vs second-generation antipsychotics (SGA cohort). Crude incident stroke rates within each cohort were determined. For hazard ratios, three propensity score matching strategies were used: unadjusted (crude), Sentinel propensity score strategy, and large-scale regularized regression model (adapted propensity score strategy). Results Each cohort included ≥12,000 patients. The incident rates for stroke per 1000 person-years were 3.10 (FGAw/oD), 5.99 (HALw/oD), 0.85 (SGAw/oD), 3.14 (FGA), 6.12 (HAL), and 0.90 (SGA). Pre-planned analysis with adapted propensity score strategy matching yielded calibrated hazard ratios for stroke: FGAw/oD vs SGAw/oD: 2.05 (calibrated confidence interval 1.13–3.89); HALw/oD vs SGAw/oD: 2.47 (1.14–5.48), FGA vs SGA: 1.64 (0.94–2.97), and HAL vs SGA: 1.98 (0.99–4.00). A post-hoc sensitivity analysis to address potential bias introduced by the 2015 change from the International Classification of Diseases, Ninth Revision to the International Classification of Diseases, Tenth Revision yielded calibrated hazard ratios for FGAw/oD vs SGAw/oD: 1.59 (0.87–3.01), HALw/oD vs SGAw/oD: 2.79 (1.24–6.42), FGA vs SGA: 1.41 (0.79–2.62), and HAL vs SGA: 3.47 (1.63–7.92). Conclusions Among adults aged ≤64 years, without a recent dementia diagnosis, stroke risk is higher among those exposed to haloperidol compared with those exposed to second-generation antipsychotics. Supplementary Information The online version contains supplementary material available at 10.1007/s40801-021-00267-2.
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Affiliation(s)
- Daniel Fife
- Department of Epidemiology, Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA.
| | - Clair Blacketer
- Department of Epidemiology, Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Karl Knight
- Established Products, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - James Weaver
- Department of Epidemiology, Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
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Butler D, Vucic K, Straus S, Cupelli A, Micallef B, Serracino-Inglott A, Borg JJ. Regulatory experience of handling Risk Management Plans (RMPs) for medicinal products in the EU. Expert Opin Drug Saf 2021; 20:815-826. [PMID: 33843379 DOI: 10.1080/14740338.2021.1909569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Risk Management Plans (RMPs) aim to optimize a medicinal product's benefit/risk balance for the individual patient and the target population. Despite differences in regulatory RMP requirements between jurisdictions worldwide, their ultimate aim is to protect public health.Areas covered: The review presents findings of different RMP requirements by different regulatory authorities and additional risk minimization measures (issued between January 2010 and December 2018) indicate how RMPs and additional risk minimization measures translate into actions to protect public health within the European Union (EU) member states and worldwide. Areas covered also include the different International Council for Harmonization (ICH) regional requirements of RMPs by the different regulatory authorities as well as data regarding the number of RMP assessments carried out by the EMA, FDA and Japan, and number of safety communications issued in Malta (taken as an example of a typical small EU member state) and in the United States of America (USA).Expert opinion: The EU legislation adopted in 2010 required RMPs to be included in all new applications for medicinal products in the EU, both for EU centrally authorized and nationally authorized medicinal products. Lessons learnt by EU regulators during this process are discussed in this review.
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Affiliation(s)
- Dianne Butler
- Medicines Authority, San Ġwann, Malta.,European Medicines Agency, Amsterdam, The Netherlands
| | | | - Sabine Straus
- European Medicines Agency, Amsterdam, The Netherlands.,Medicines Evaluation Board, Utrecht, The Netherlands
| | - Amelia Cupelli
- European Medicines Agency, Amsterdam, The Netherlands.,Italian Medicines Agency (AIFA), Rome, Italy
| | - Benjamin Micallef
- Medicines Authority, San Ġwann, Malta.,European Medicines Agency, Amsterdam, The Netherlands
| | - Anthony Serracino-Inglott
- Medicines Authority, San Ġwann, Malta.,Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - John-Joseph Borg
- Medicines Authority, San Ġwann, Malta.,European Medicines Agency, Amsterdam, The Netherlands.,Department of Biology, University of Tor Vergata, Rome, Italy
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Morales DR, Macfarlane T, MacDonald TM, Hallas J, Ernst MT, Herings RMC, Smits E, Overbeek JA, Mitchell L, Morant S, Mackenzie I, Doney ASF, Robertson C, Bennie M, Wei L, Nicholson L, Morris C, Flynn RWF. Impact of EMA regulatory label changes on hydroxyzine initiation, discontinuation and switching to other medicines in Denmark, Scotland, England and the Netherlands: An interrupted time series regression analysis. Pharmacoepidemiol Drug Saf 2021; 30:482-491. [PMID: 33386650 DOI: 10.1002/pds.5191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 12/11/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Hydroxyzine is indicated for the management of anxiety, skin and sleep disorders. In 2015, the European Medicines Agency (EMA) concluded that hydroxyzine was pro-arrhythmogenic and changes to the product information were implemented in Europe. This study aimed to evaluate their impact in Denmark, Scotland, England and the Netherlands. METHOD Quarterly time series analyses measuring hydroxyzine initiation, discontinuation, and switching to other antihistamines, benzodiazepines and antidepressants in Denmark, England, Scotland and the Netherlands from 2009 to 2018. Data were analysed using interrupted time series regression. RESULTS Hydroxyzine initiation in quarter one 2010 in Denmark, Scotland, England and the Netherlands per 100 000 was: 23.5, 91.5, 35.9 and 34.4 respectively. Regulatory action was associated with a significant: immediate fall in hydroxyzine initiation per 100 000 in England (-12.05, 95%CI -18.47 to -5.63) and Scotland (-19.01, 95%CI -26.99 to -11.02); change to a negative trend in hydroxyzine initiation per 100 000/quarter in England (-1.72, 95%CI -2.69 to -0.75) and Scotland (-2.38, 95%CI -3.32 to -1.44). Regulatory action was associated with a significant: immediate rise in hydroxyzine discontinuation per 100 000 in England (3850, 95%CI 440-7240). No consistent changes were observed in the Netherlands or Denmark. Regulatory action was associated with no switching to other antihistamines, benzodiazepines or antidepressants following hydroxyzine discontinuation in any country. CONCLUSION The 2015 EMA regulatory action was associated with heterogeneous impact with reductions in hydroxyzine initiation varying by country. There was limited impact on discontinuation with no strong evidence suggesting unintended consequences of major switching to other antihistamines, benzodiazepines or antidepressants.
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Affiliation(s)
- Daniel R Morales
- MEMO Research, University of Dundee, Dundee, UK.,Department of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | | | | | - Jesper Hallas
- Department of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Martin Thomsen Ernst
- Department of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Elisabeth Smits
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | | | | | | | | | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Marion Bennie
- Strathclyde Onstitute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Li Wei
- School of Pharmacy, University College London, London, UK
| | - Lizzie Nicholson
- Electronic Data Research and Innovation Service, NHS National Services Scotland, Edinburgh, UK
| | - Carole Morris
- Electronic Data Research and Innovation Service, NHS National Services Scotland, Edinburgh, UK
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7
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Abstract
INTRODUCTION Understanding how patients of all ages perceive the benefits and risks of medical treatments is vitally important. Yet, the role of older age on pharmaceutical benefit-risk perceptions has hardly been empirically investigated as a central focus of study. OBJECTIVE This study tested the generalizability of recent pilot findings to explore benefit-risk perception age differences between adults aged 65 years old and over (older group) and those aged 18-64 years old (younger group). METHODS An online survey representative for age, sex, and education was conducted in Ohio, USA (N = 1520) and Germany (N = 1536). A combination of benefit, risk, and affect questions measured respondents' perceptions of 18 medicines, tests, vaccines, and procedures. Further questions investigated general perceptions of side effects and effectiveness, as well as respondents' reliance on different sources of medicines information. RESULTS Clear age differences were found that strongly support recent pilot findings. Older adults perceived prescription medicines significantly more positively than their younger counterparts. They had significantly higher benefit and lower risk perceptions for most, but not all, medical treatments investigated. Older adults' benefit-risk perceptions were more strongly correlated with positive/negative affect, that is, their positive/negative experiences and feelings of "goodness" or "badness" they associated with each medical treatment investigated. They also perceived doctors and pharmacists as more competent and trustworthy. Contrary to popular belief, both age groups ranked their reliance on 15 different medical (e.g. doctors), societal (e.g. social media), industry (e.g. pharmaceutical company websites), and governmental (e.g. regulatory agencies) sources of medicines information remarkably similarly. CONCLUSION Age has an important role in patients' pharmaceutical benefit-risk perceptions. Findings show that, when designing messages, benefit-risk communicators should incorporate age differences. This includes older patients' positive perceptions of pharmaceuticals, greater reliance on affect, and information seeking versus scanning behaviour. Field experiments are now needed to test the effectiveness of such changes for improving benefit-risk communication practice.
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