1
|
DeFrank JT, McCormack L, West SL, Lefebvre C, Burrus O. Unintended Effects of Communicating About Drug Safety Issues: A Critical Review of the Literature. Drug Saf 2019; 42:1125-1134. [PMID: 31152320 DOI: 10.1007/s40264-019-00840-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Communications about the safety and effectiveness of human drugs can influence patients' and prescribers' perceptions and behaviors, which in turn can affect the public's health more broadly. We conducted a critical review of the literature on the unintended effects from communicating information to the public about safety issues with prescription and over-the-counter drugs. We searched PubMed for peer-reviewed studies published from 1990 to 2017 where study authors reported probable unintended effects of communicating drug safety. The types of communications included in these studies were news reports, direct-to-consumer advertisements, and those released by government agencies. Among the 26 studies identified, the most commonly reported unintended effects were decreased drug use or discontinuation. Other unintended effects included spillover to populations not targeted by the communications (e.g., discontinuation of antidepressants among adults following communications concerning use among youth), shifts in clinical diagnoses (e.g., fewer diagnoses of depression), increased use of alternative therapies, and other undesirable behaviors (e.g., possible increased suicide attempts because antidepressants were discontinued). Limitations to the literature include the inability to establish causation or to isolate the effects of multiple communication sources and messages. Further, because the intended effect of many communications was not known, our study was limited by challenges in defining some effects as unintended. Most studies used health insurer claims data to identify unintended effects of communications, which provide an incomplete picture; few used self-reported or other methodologies that could help illuminate the reasons underlying the effects observed in the claims data. Best practices for communicating about the potential benefits and harms of drugs in a manner that minimizes negative unintended effects are needed to protect and improve public health.
Collapse
Affiliation(s)
- Jessica T DeFrank
- Center for Communication Science, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, PO Box 12194, NC, USA.
| | - Lauren McCormack
- Center for Communication Science, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, PO Box 12194, NC, USA
| | - Suzanne L West
- Center for Communication Science, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, PO Box 12194, NC, USA
| | - Craig Lefebvre
- Center for Communication Science, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, PO Box 12194, NC, USA
| | - Olivia Burrus
- Center for Communication Science, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, PO Box 12194, NC, USA
| |
Collapse
|
2
|
Goedecke T, Morales DR, Pacurariu A, Kurz X. Measuring the impact of medicines regulatory interventions - Systematic review and methodological considerations. Br J Clin Pharmacol 2018; 84:419-433. [PMID: 29105853 PMCID: PMC5809349 DOI: 10.1111/bcp.13469] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/24/2017] [Accepted: 10/31/2017] [Indexed: 12/20/2022] Open
Abstract
AIMS Evaluating the public health impact of regulatory interventions is important but there is currently no common methodological approach to guide this evaluation. This systematic review provides a descriptive overview of the analytical methods for impact research. METHODS We searched MEDLINE and EMBASE for articles with an empirical analysis evaluating the impact of European Union or non-European Union regulatory actions to safeguard public health published until March 2017. References from systematic reviews and articles from other known sources were added. Regulatory interventions, data sources, outcomes of interest, methodology and key findings were extracted. RESULTS From 1246 screened articles, 229 were eligible for full-text review and 153 articles in English language were included in the descriptive analysis. Over a third of articles studied analgesics and antidepressants. Interventions most frequently evaluated are regulatory safety communications (28.8%), black box warnings (23.5%) and direct healthcare professional communications (10.5%); 55% of studies measured changes in drug utilization patterns, 27% evaluated health outcomes, and 18% targeted knowledge, behaviour or changes in clinical practice. Unintended consequences like switching therapies or spill-over effects were rarely evaluated. Two-thirds used before-after time series and 15.7% before-after cross-sectional study designs. Various analytical approaches were applied including interrupted time series regression (31.4%), simple descriptive analysis (28.8%) and descriptive analysis with significance tests (23.5%). CONCLUSION Whilst impact evaluation of pharmacovigilance and product-specific regulatory interventions is increasing, the marked heterogeneity in study conduct and reporting highlights the need for scientific guidance to ensure robust methodologies are applied and systematic dissemination of results occurs.
Collapse
Affiliation(s)
- Thomas Goedecke
- Pharmacovigilance and Epidemiology Department, Inspections Human Medicines Pharmacovigilance and Committees DivisionEuropean Medicines Agency (EMA)LondonE14 5EUUK
| | - Daniel R. Morales
- Pharmacovigilance and Epidemiology Department, Inspections Human Medicines Pharmacovigilance and Committees DivisionEuropean Medicines Agency (EMA)LondonE14 5EUUK
- Division of Population Health SciencesUniversity of DundeeDundeeDD2 4BFUK
| | - Alexandra Pacurariu
- Pharmacovigilance and Epidemiology Department, Inspections Human Medicines Pharmacovigilance and Committees DivisionEuropean Medicines Agency (EMA)LondonE14 5EUUK
- Dutch Medicines Evaluation Board3531AHUtrechtThe Netherlands
| | - Xavier Kurz
- Pharmacovigilance and Epidemiology Department, Inspections Human Medicines Pharmacovigilance and Committees DivisionEuropean Medicines Agency (EMA)LondonE14 5EUUK
| |
Collapse
|
3
|
Eworuke E, Popat V, Moeny DG. Bone mineral density testing, and bisphosphonate and oestrogen prescribing associated with depot medroxyprogesterone acetate utilization-The impact of the boxed warning. J Clin Pharm Ther 2017; 42:483-494. [PMID: 28543135 DOI: 10.1111/jcpt.12561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 04/24/2017] [Indexed: 11/26/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Depot medroxyprogesterone acetate (DMPA) prevents follicular maturation and ovulation, resulting in oestrogen deficiency. Oestrogen deficiency is particularly concerning as it is associated with decreases in bone mineral density (BMD) or bone mass. Widespread use of concurrent oestrogen or bisphosphonates with DMPA has been observed in a previous single-centre US study. The authors also reported that more than half of obstetrician-gynaecologists ordered BMD testing solely due to DMPA. The small sample size of the survey, potential for volunteer bias and recall bias limit the utility of this study. Given the study limitations, we sought to examine the trends of concurrent bone mineral density (BMD) testing, and bisphosphonate (BPA) and oral oestrogen-only (EST) prescribing during depot medroxyprogesterone (DMPA) use in a large administrative database. METHODS From IMS Health LifeLink™ database (2001-2013), we identified DMPA and combined hormonal contraceptive (CHC) users as women with no contraceptive claim 6 months before and after the defined episode. We examined concurrent use as the proportion of BPA or EST claims and concurrent therapy days during contraception use. We also determined the proportion of users who had a concurrent BMD test by calendar year. RESULTS We identified 203 477 DMPA episodes associated with 600 BPA and 7060 EST claims and 1 297 806 CHC episodes associated with 2792 BPA and 145 600 EST claims. Most concurrent BPA use overlapped with 10% or less of the DMPA episode, whereas most concurrent BPA use overlapped with >90%-100% of CHC episode. No difference was noted with concurrent EST use. Concurrent BMD testing was higher among DMPA users (0.68%) compared to CHC users (0.11%). Across calendar year, BMD testing peaked in 2004 and declined steadily to the baseline. Most DMPA concurrent BPA (69.3%) users had a BMD test. CONCLUSION Our findings indicate the absence of BST or EST use solely due to DMPA initiation and present alternative explanations. Published research and publicity leading to the final implementation of the boxed warning in 2004 may explain observed trends for BMD testing. The majority of patients who had a BMD test ordered were also receiving bisphosphonates, suggesting high-risk fracture status or appropriate monitoring.
Collapse
Affiliation(s)
- E Eworuke
- Division of Epidemiology II, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - V Popat
- Office of New Drugs, Immediate Office, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - D G Moeny
- Division of Epidemiology II, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| |
Collapse
|
4
|
Eworuke E, Lee JY, Soule L, Popat V, Moeny DG. The impact of the boxed warning on the duration of use for depot medroxprogesterone acetate. Pharmacoepidemiol Drug Saf 2017; 26:827-836. [DOI: 10.1002/pds.4227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Efe Eworuke
- Division of Epidemiology II, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology; Center for Drug Evaluation and Research, Food and Drug Administration; Silver Spring MA USA
| | - Joo-Yeon Lee
- Division of Biometrics VII, Office of Biostatistics; Center for Drug Evaluation and Research, Food and Drug Administration; Silver Spring MA USA
| | - Lisa Soule
- Division of Bone, Reproductive, and Urologic Products; Office of New Drugs, Center for Drug Evaluation and Research, Food and Drug Administration; Silver Spring MA USA
| | - Vaishali Popat
- Office of New Drugs, Immediate Office; Center for Drug Evaluation and Research, Food and Drug Administration; Silver Spring MA USA
| | - David G. Moeny
- Division of Epidemiology II, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology; Center for Drug Evaluation and Research, Food and Drug Administration; Silver Spring MA USA
| |
Collapse
|
5
|
Kaunitz AM, Peipert JF, Grimes DA. Injectable contraception: issues and opportunities. Contraception 2014; 89:331-4. [DOI: 10.1016/j.contraception.2014.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/25/2014] [Accepted: 03/26/2014] [Indexed: 12/26/2022]
|
6
|
Dusetzina SB, Higashi AS, Dorsey ER, Conti R, Huskamp HA, Zhu S, Garfield CF, Alexander GC. Impact of FDA drug risk communications on health care utilization and health behaviors: a systematic review. Med Care 2012; 50:466-78. [PMID: 22266704 PMCID: PMC3342472 DOI: 10.1097/mlr.0b013e318245a160] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To review literature on the impact of The Food and Drug Administration (FDA) drug risk communications on medication utilization, health care services use, and health outcomes. DATA SOURCES The authors searched MEDLINE and the Web of Science for manuscripts published between January 1990 and November 2010 that included terms related to drug utilization, the FDA, and advisories or warnings. We manually searched bibliographies and works citing selected articles and consulted with experts to guide study selection. STUDY SELECTION Studies were included if they involved an empirical analysis evaluating the impact of an FDA risk communication. DATA EXTRACTION We extracted the drug(s) analyzed, relevant FDA communication(s), data source, analytical method, and main outcome(s) assessed. RESULTS Of the 1432 records screened, 49 studies were included. These studies covered 16 medicines or therapeutic classes; one third examined communications regarding antidepressants. Most used medical or pharmacy claims and a few rigorously examined patient-provider communication, decision making, or risk perceptions. Advisories recommending increased clinical or laboratory monitoring generally led to decreased drug use, but only modest, short-term increases in monitoring. Communications targeting specific subpopulations often spilled over to other groups. Repeated or sequential advisories tended to have larger but delayed effects and decreased incident more than prevalent use. Drug-specific warnings were associated with particularly large decreases in utilization, although the magnitude of substitution within therapeutic classes varied across clinical contexts. CONCLUSIONS Although some FDA drug risk communications had immediate and strong impacts, many had either delayed or had no impact on health care utilization or health behaviors. These data demonstrate the complexity of using risk communication to improve the quality and safety of prescription drug use, and suggest the importance of continued assessments of the effect of future advisories and label changes. Identifying factors that are associated with rapid and sustained responses to risk communications will be important for informing future risk communication efforts.
Collapse
Affiliation(s)
- Stacie B. Dusetzina
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Ashley S. Higashi
- Department of Medicine, University of Chicago Hospitals, Chicago, Illinois
| | - E. Ray Dorsey
- Department of Neurology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Rena Conti
- Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois
- Department of Pediatrics, University of Chicago Hospitals, Chicago, Illinois
| | - Haiden A. Huskamp
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Shu Zhu
- Department of Medicine, University of Chicago Hospitals, Chicago, Illinois
| | - Craig F. Garfield
- Department of Pediatrics, NorthShore University Health System, Evanston, Illinois
| | - G. Caleb Alexander
- Department of Medicine, University of Chicago Hospitals, Chicago, Illinois
- Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois
- Department of Pharmacy Practice, University of Illinois at Chicago School of Pharmacy, Chicago, Illinois
| |
Collapse
|
7
|
Viola AS, Castro S, Bahamondes MV, Fernandes A, Viola CF, Bahamondes L. A cross-sectional study of the forearm bone mineral density in long-term current users of the injectable contraceptive depot medroxyprogesterone acetate. Contraception 2011; 84:e31-7. [DOI: 10.1016/j.contraception.2011.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 06/27/2011] [Accepted: 06/27/2011] [Indexed: 10/17/2022]
|
8
|
Kaunitz AM, Grimes DA. Removing the black box warning for depot medroxyprogesterone acetate. Contraception 2011; 84:212-3. [DOI: 10.1016/j.contraception.2011.01.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 01/10/2011] [Indexed: 11/17/2022]
|
9
|
Abstract
Combination hormonal contraception and progestin-only contraception (including depot medroxyprogesterone acetate [DMPA]) are effective and convenient forms of reversible contraception that millions of women use worldwide. In recent years, observations of reduced bone mineral density in current users of these methods have led to concerns that this hormone-induced bone loss might translate into long-term increased fracture risk. Special focus has been placed on adolescent users who have not yet attained their peak bone mass as well as perimenopausal users. In 2004, the FDA added a black box warning to DMPA package labeling warning of the risk of significant bone loss and cautioning against long-term use (> 2 years). This article reviews evidence on the use of hormonal contraception and its effect on bone density in adolescent, premenopausal, and perimenopausal populations. Recommendations from reproductive healthcare organizations are reviewed and clinical recommendations are provided.
Collapse
MESH Headings
- Adolescent
- Adult
- Bone Density/drug effects
- Contraceptive Agents, Female/administration & dosage
- Contraceptive Agents, Female/adverse effects
- Contraceptive Agents, Female/therapeutic use
- Contraceptives, Oral, Combined/adverse effects
- Contraceptives, Oral, Combined/therapeutic use
- Contraceptives, Oral, Hormonal/adverse effects
- Contraceptives, Oral, Hormonal/therapeutic use
- Female
- Fractures, Bone/chemically induced
- Fractures, Bone/epidemiology
- Humans
- Lactation
- Perimenopause
- Practice Guidelines as Topic
- Risk Factors
- Young Adult
Collapse
Affiliation(s)
- Michelle M Isley
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, USA.
| | | |
Collapse
|
10
|
Renner RM, Edelman AB, Kaunitz AM. Depot Medroxyprogesterone Acetate Contraceptive Injections and Skeletal Health. WOMENS HEALTH 2010; 6:339-42. [DOI: 10.2217/whe.10.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
11
|
|
12
|
Current world literature. Curr Opin Obstet Gynecol 2009; 21:450-5. [PMID: 19724169 DOI: 10.1097/gco.0b013e3283317d6c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Kaunitz AM, Darney PD, Ross D, Wolter KD, Speroff L. Subcutaneous DMPA vs. intramuscular DMPA: a 2-year randomized study of contraceptive efficacy and bone mineral density. Contraception 2009; 80:7-17. [PMID: 19501210 DOI: 10.1016/j.contraception.2009.02.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 02/05/2009] [Accepted: 02/05/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND A formulation of depot medroxyprogesterone acetate (DMPA) has been developed that allows subcutaneous injection (104 mg/0.65 mL; DMPA-SC) and achieves highly effective contraception with a similar tolerability profile to intramuscular DMPA (150 mg/mL; DMPA-IM). STUDY DESIGN This randomized, evaluator-blinded study was designed to compare efficacy, safety, and user satisfaction in women receiving DMPA-SC (n=266) or DMPA-IM (n=268) for 2 years with an option to continue for a third year. The primary objectives were to evaluate bone mineral density (BMD) changes and contraceptive efficacy after 2 years. RESULTS A total of 225 women completed the first 2 years of this study (DMPA-SC, n=116; DMPA-IM, n=109). After 2 years of DMPA use, BMD loss was marginally smaller in the DMPA-SC group than in the DMPA-IM group at both the total hip (-3.3% and -3.6%, respectively) and lumbar spine (-4.3% and -5.0%, respectively). In those women who received DMPA during the third year, there were no statistically significant differences in BMD loss between DMPA-SC and DMPA-IM groups at the end of Year 3. Recovery of BMD was observed in the small subpopulation of women who had discontinued DMPA-SC or DMPA-IM after the second year. The 2-year treatment-failure cumulative pregnancy rate was 0% in the DMPA-SC group and 0.8% (95% confidence interval, 0.00-2.37%) in the DMPA-IM group (life-table method). Adverse events were similar in the two groups except that injection site reactions were more common in the DMPA-SC group. CONCLUSION DMPA-SC is an effective and well-tolerated contraceptive option, providing comparable efficacy and BMD safety to DMPA-IM.
Collapse
Affiliation(s)
- Andrew M Kaunitz
- Department of Obstetrics and Gynecology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 32209, USA.
| | | | | | | | | |
Collapse
|