1
|
Noseda R, Bedussi F, Panchaud A, Ceschi A. Safety of Monoclonal Antibodies Inhibiting PCSK9 in Pregnancy: Disproportionality Analysis in VigiBase®. Clin Pharmacol Ther 2024; 116:346-350. [PMID: 38637956 DOI: 10.1002/cpt.3269] [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: 12/18/2023] [Accepted: 03/23/2024] [Indexed: 04/20/2024]
Abstract
Safety data on the use of monoclonal antibodies inhibiting proprotein convertase subtilisin/kexin type 9 in pregnancy are scarce. This study queried VigiBase®, the World Health Organization global pharmacovigilance database, to search for signals of disproportionate reporting for pregnancy outcomes with alirocumab and evolocumab. As of November 22, 2023, there were 45 safety reports of exposure to evolocumab (N = 31) and alirocumab (N = 14) in pregnancy. Most of them originated from Europe (N = 25, 55.6%) and were more frequently reported by healthcare professionals (N = 35, 77.8%). Median patient age was 37 years (25th-75th percentiles; 32-41 years). Drug exposure occurred during pregnancy in 36 (80.0%) safety reports, via paternal exposure during pregnancy in four (8.9%), during lactation in three (6.7%), and in two safety reports the time of drug exposure remained unknown. Twenty safety reports (57.8%) merely reported drug exposure, while 19 (42.2%) also reported pregnancy outcomes, however, without specific maternal toxicities or patterns of birth defects. Spontaneous abortion was reported in eight safety reports without representing a signal of disproportionate reporting compared with either the full database (reporting odds ratio, ROR, 0.06 95% confidence interval, CI 0.03-0.12) or statins (ROR 0.16, 95% CI 0.08-0.32). In conclusion, this study showed that, currently, there are no signals of increased reporting of spontaneous abortion with alirocumab and evolocumab compared with the full database and statins in VigiBase®. Notwithstanding, lack of disproportionality is not synonymous with safety and, as disproportionality analyses depend on the number of safety reports that progressively accumulate in VigiBase®, they should be repeated at regular intervals to confirm the results of the present study.
Collapse
Affiliation(s)
- Roberta Noseda
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Francesca Bedussi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Alice Panchaud
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Alessandro Ceschi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Clinical Trial Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
2
|
Stellmach C, Hopff SM, Jaenisch T, Nunes de Miranda SM, Rinaldi E. Creation of Standardized Common Data Elements for Diagnostic Tests in Infectious Disease Studies: Semantic and Syntactic Mapping. J Med Internet Res 2024; 26:e50049. [PMID: 38857066 PMCID: PMC11196918 DOI: 10.2196/50049] [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: 06/19/2023] [Revised: 10/10/2023] [Accepted: 01/18/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND It is necessary to harmonize and standardize data variables used in case report forms (CRFs) of clinical studies to facilitate the merging and sharing of the collected patient data across several clinical studies. This is particularly true for clinical studies that focus on infectious diseases. Public health may be highly dependent on the findings of such studies. Hence, there is an elevated urgency to generate meaningful, reliable insights, ideally based on a high sample number and quality data. The implementation of core data elements and the incorporation of interoperability standards can facilitate the creation of harmonized clinical data sets. OBJECTIVE This study's objective was to compare, harmonize, and standardize variables focused on diagnostic tests used as part of CRFs in 6 international clinical studies of infectious diseases in order to, ultimately, then make available the panstudy common data elements (CDEs) for ongoing and future studies to foster interoperability and comparability of collected data across trials. METHODS We reviewed and compared the metadata that comprised the CRFs used for data collection in and across all 6 infectious disease studies under consideration in order to identify CDEs. We examined the availability of international semantic standard codes within the Systemized Nomenclature of Medicine - Clinical Terms, the National Cancer Institute Thesaurus, and the Logical Observation Identifiers Names and Codes system for the unambiguous representation of diagnostic testing information that makes up the CDEs. We then proposed 2 data models that incorporate semantic and syntactic standards for the identified CDEs. RESULTS Of 216 variables that were considered in the scope of the analysis, we identified 11 CDEs to describe diagnostic tests (in particular, serology and sequencing) for infectious diseases: viral lineage/clade; test date, type, performer, and manufacturer; target gene; quantitative and qualitative results; and specimen identifier, type, and collection date. CONCLUSIONS The identification of CDEs for infectious diseases is the first step in facilitating the exchange and possible merging of a subset of data across clinical studies (and with that, large research projects) for possible shared analysis to increase the power of findings. The path to harmonization and standardization of clinical study data in the interest of interoperability can be paved in 2 ways. First, a map to standard terminologies ensures that each data element's (variable's) definition is unambiguous and that it has a single, unique interpretation across studies. Second, the exchange of these data is assisted by "wrapping" them in a standard exchange format, such as Fast Health care Interoperability Resources or the Clinical Data Interchange Standards Consortium's Clinical Data Acquisition Standards Harmonization Model.
Collapse
Affiliation(s)
- Caroline Stellmach
- Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sina Marie Hopff
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Department I of Internal Medicine, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Thomas Jaenisch
- Heidelberg Institut für Global Health, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Susana Marina Nunes de Miranda
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Department I of Internal Medicine, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Eugenia Rinaldi
- Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
3
|
Favre G, Richardson JL, Moore A, Geissbühler Y, Jehl V, Oliver A, Shechtman S, Diav-Citrin O, Berlin M, De Haan T, Baud D, Panchaud A, Mor A, Sabidó M, de Souza S, Chambers C, van Rijt-Weetink YRJ, van Puijenbroek EP, Yates LM, Girardin F, Stellfeld M, Winterfeld U. Improving Data Collection in Pregnancy Safety Studies: Towards Standardisation of Data Elements in Pregnancy Reports from Public and Private Partners, A Contribution from the ConcePTION Project. Drug Saf 2024; 47:227-236. [PMID: 38114757 PMCID: PMC10874316 DOI: 10.1007/s40264-023-01384-3] [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: 11/15/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION AND OBJECTIVE The ConcePTION project aims to improve the way medication use during pregnancy is studied. This includes exploring the possibility of developing a distributed data processing and analysis infrastructure using a common data model that could form a foundational platform for future surveillance and research. A prerequisite would be that data from various data access providers (DAPs) can be harmonised according to an agreed set of standard rules concerning the structure and content of the data. To do so, a reference framework of core data elements (CDEs) recommended for primary data studies on drug safety during pregnancy was previously developed. The aim of this study was to assess the ability of several public and private DAPs using different primary data sources focusing on multiple sclerosis, as a pilot, to map their respective data variables and definitions with the CDE recommendations framework. METHODS Four pregnancy registries (Gilenya, Novartis; Aubagio, Sanofi; the Organization of Teratology Information Specialists [OTIS]; Aubagio, Sanofi; the Dutch Pregnancy Drug Register, Lareb), two enhanced pharmacovigilance programmes (Gilenya PRIM, Novartis; MAPLE-MS, Merck Healthcare KGaA) and four Teratology Information Services (UK TIS, Jerusalem TIS, Zerifin TIS, Swiss TIS) participated in the study. The ConcePTION primary data source CDE includes 51 items covering administrative functions, the description of pregnancy, maternal medical history, maternal illnesses arising in pregnancy, delivery details, and pregnancy and infant outcomes. For each variable in the CDE, the DAPs identified whether their variables were: identical to the one mentioned in the CDE; derived; similar but with a divergent definition; or not available. RESULTS The majority of the DAP data variables were either directly taken (85%, n = 305/357, range 73-94% between DAPs) or derived by combining different variables (12%, n = 42/357, range 0-24% between DAPs) to conform to the CDE variables and definitions. For very few of the DAP variables, alignment with the CDE items was not possible, either because of divergent definitions (1%, n = 3/357, range 0-2% between DAPs) or because the variables were not available (2%, n = 7/357, range 0-4% between DAPs). CONCLUSIONS Data access providers participating in this study presented a very high proportion of variables matching the CDE items, indicating that alignment of definitions and harmonisation of data analysis by different stakeholders to accelerate and strengthen pregnancy pharmacovigilance safety data analyses could be feasible.
Collapse
Affiliation(s)
- Guillaume Favre
- Swiss Teratology Information Service and Clinical Pharmacology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jonathan L Richardson
- UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Health and Society, Newcastle upon Tyne, UK
| | | | | | | | - Alison Oliver
- UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Svetlana Shechtman
- The Israeli Teratology Information Service, Ministry of Health, Jerusalem, Israel
| | - Orna Diav-Citrin
- The Israeli Teratology Information Service, Ministry of Health, Jerusalem, Israel
| | - Maya Berlin
- Clinical Pharmacology and Toxicology Unit, Drug Consultation Center, Shamir Medical Center (Assaf Harofeh), Affiliated with the Sackler Faculty of Medicine, Zerifin TIS, Tel Aviv University, Tel Aviv, Israel
| | - Tal De Haan
- Clinical Pharmacology and Toxicology Unit, Drug Consultation Center, Shamir Medical Center (Assaf Harofeh), Affiliated with the Sackler Faculty of Medicine, Zerifin TIS, Tel Aviv University, Tel Aviv, Israel
| | - David Baud
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alice Panchaud
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anil Mor
- Epidemiology and Benefit Risk, Sanofi, North York, ON, Canada
| | | | | | - Christina Chambers
- Organization of Teratology Information Specialists (OTIS), University of California San Diego, San Diego, CA, USA
| | | | | | - Laura M Yates
- Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- KRISP, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - François Girardin
- Swiss Teratology Information Service and Clinical Pharmacology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Ursula Winterfeld
- Swiss Teratology Information Service and Clinical Pharmacology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| |
Collapse
|
4
|
Obara T. Directions for perinatal pharmacoepidemiology studies in Japan. Congenit Anom (Kyoto) 2024; 64:4-5. [PMID: 38163674 DOI: 10.1111/cga.12549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Taku Obara
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Division of Molecular Epidemiology, Graduate School of Medicine, Tohoku University, Sendai, Japan
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Japan
| |
Collapse
|
5
|
Bromley RL, Bickle Graz M, Bluett-Duncan M, Chambers C, Damkier P, Dietrich K, Dolk H, Grant K, Mattson S, Meador KJ, Nordeng H, Oberlander TF, Ornoy A, Revet A, Richardson J, Rovet J, Schuler-Faccini L, Smearman E, Simms V, Vorhees C, Wide K, Wood A, Yates L, Ystrom E, Supraja TA, Adams J. Expert consensus on neurodevelopmental outcomes in pregnancy pharmacovigilance studies. Front Pharmacol 2023; 14:1094698. [PMID: 37332344 PMCID: PMC10270323 DOI: 10.3389/fphar.2023.1094698] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
Background: Exposure in utero to certain medications can disrupt processes of fetal development, including brain development, leading to a continuum of neurodevelopmental difficulties. Recognizing the deficiency of neurodevelopmental investigations within pregnancy pharmacovigilance, an international Neurodevelopmental Expert Working Group was convened to achieve consensus regarding the core neurodevelopmental outcomes, optimization of methodological approaches and barriers to conducting pregnancy pharmacovigilance studies with neurodevelopmental outcomes. Methods: A modified Delphi study was undertaken based on stakeholder and expert input. Stakeholders (patient, pharmaceutical, academic and regulatory) were invited to define topics, pertaining to neurodevelopmental investigations in medication-exposed pregnancies. Experts were identified for their experience regarding neurodevelopmental outcomes following medicinal, substances of misuse or environmental exposures in utero. Two questionnaire rounds and a virtual discussion meeting were used to explore expert opinion on the topics identified by the stakeholders. Results: Twenty-five experts, from 13 countries and professionally diverse backgrounds took part in the development of 11 recommendations. The recommendations focus on the importance of neurodevelopment as a core feature of pregnancy pharmacovigilance, the timing of study initiation and a core set of distinct but interrelated neurodevelopmental skills or diagnoses which require investigation. Studies should start in infancy with an extended period of investigation into adolescence, with more frequent sampling during rapid periods of development. Additionally, recommendations are made regarding optimal approach to neurodevelopmental outcome measurement, comparator groups, exposure factors, a core set of confounding and mediating variables, attrition, reporting of results and the required improvements in funding for potential later emerging effects. Different study designs will be required depending on the specific neurodevelopmental outcome type under investigation and whether the medicine in question is newly approved or already in widespread use. Conclusion: An improved focus on neurodevelopmental outcomes is required within pregnancy pharmacovigilance. These expert recommendations should be met across a complementary set of studies which converge to form a comprehensive set of evidence regarding neurodevelopmental outcomes in pregnancy pharmacovigilance.
Collapse
Affiliation(s)
- R. L. Bromley
- Division of Neuroscience, Faculty of Medicine, School of Biological Sciences, Biology and Health, University of Manchester, Manchester, United Kingdom
- Royal Manchester Children’s Hospital, Manchester Academic Sciences Park, Manchester, United Kingdom
| | - M. Bickle Graz
- Neonatology, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - M. Bluett-Duncan
- Division of Neuroscience, Faculty of Medicine, School of Biological Sciences, Biology and Health, University of Manchester, Manchester, United Kingdom
| | - C. Chambers
- Division of Environmental Science and Health, Department of Pediatrics, University of California San Diego School of Medicine, San Diego, CA, United States
| | - P. Damkier
- Department of Clinical Pharmacology, Odense University Hospital, Denmark and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - K. Dietrich
- Department of Environmental and Public Health Sciences, Division of Epidemiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - H. Dolk
- Maternal, Fetal and Infant Research Unit, Faculty of Life and Health Sciences, Ulster University, Coleraine, United Kingdom
| | - K. Grant
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States
| | - S. Mattson
- Center for Behavioral Teratology, San Diego State University, San Diego, CA, United States
| | - K. J. Meador
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, United States
| | - H. Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - T. F. Oberlander
- Department Pediatrics and School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - A. Ornoy
- Hebrew University Hadassah Medical School, Adelson School of Medicine, Ariel University, Jerusalem, Israel
| | - A. Revet
- INSERM University of Toulouse 3, Toulouse, France
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France
| | - J. Richardson
- UK Teratology Information Service, Newcastle, United Kingdom
| | - J. Rovet
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| | - L. Schuler-Faccini
- Genetics Department, Hospital de Clinicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - E. Smearman
- Department of Surgery, Emory University, Atlanta, GA, United States
| | - V. Simms
- School of Psychology, Faculty of Life and Health Sciences, Ulster University, Coleraine, United Kingdom
| | - C. Vorhees
- Department of Pediatrics, Division of Neurology, University of Cincinnati College of Medicine and Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - K. Wide
- Department of Pediatrics, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - A. Wood
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
| | - L. Yates
- Northern Genetics Service, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
- KRISP, University of KwaZulu-Natal, Durban, South Africa
| | - E. Ystrom
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - T. A. Supraja
- National Institute of Mental Health and Neurosciences NIMHANS, Bangalore, Karnataka, India
| | - J. Adams
- Department of Psychology, University of Massachusetts Boston, Boston, MA, United States
| |
Collapse
|