3
|
Pariente A, Micallef J, Lahouegue A, Molimard M, Auffret M, Chouchana L, Denis B, Faillie JL, Grandvuillemin A, Letinier L, Pierron E, Pons C, Pujade I, Rubino H, Salvo F. What place for intelligent automation and artificial intelligence to preserve and strengthen vigilance expertise in the face of increasing declarations? Therapie 2023; 78:131-143. [PMID: 36572627 DOI: 10.1016/j.therap.2022.11.004] [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: 11/27/2022]
Abstract
In 2018, the "Ateliers de Giens" (Giens Workshops) devoted a workshop to artificial intelligence (AI) and led its experts to confirm the potential contribution and theoretical benefit of AI in clinical research, pharmacovigilance, and in improving the efficiency of care. The 2022 workshop is a continuation of this reflection on AI and intelligent automation (IA) by focusing on its contribution to pharmacovigilance and the applications and tasks could be optimized to preserve and strengthen medical and pharmacological expertise in pharmacovigilance. The evolution of pharmacovigilance work is characterized by many tasks with low added value, a growing volume of pharmacovigilance reporting of suspected side effects, and a scarcity of medical staff with expertise in clinical pharmacology and pharmacovigilance and human resources to support this growing need. Together, these parameters contribute to an embolization of the pharmacovigilance system at risk of missing its primary mission: to identify and characterize a risk or even a health alert on a drug. The participants of the workshop (representatives of the Regional Pharmacovigilance Centres (CRPV), the French National Agency for Safety of Medicinal Products (ANSM), patients, the pharmaceutical industry, or start-ups working in the development of AI in the field of medicine) shared their experiences, their pilot projects and their expectations on the expected potential, theoretical or proven, AI and IA. This work has made it possible to identify the needs and challenges that AI or IA represent, in the current or future modes of organization of pharmacovigilance activities. This approach led to the development of a SWOT matrix (strengths, weaknesses, opportunities, threats), a basis for reflection to identify critical points and consider four main recommendations: (1) preserve and develop business expertise in pharmacovigilance (including research and development in methods) with the integration of new technologies; (2) improve the quality of pharmacovigilance reports; (3) adapt technical and regulatory means; (4) implement a development strategy for AI and IA tools at the service of expertise.
Collapse
Affiliation(s)
- Antoine Pariente
- Univ. Bordeaux, Inserm, BPH, U1219, Equipe AHeaD, 33000 Bordeaux, France; CHU de Bordeaux, service de Pharmacologie Médicale, 33000 Bordeaux, France.
| | - Joëlle Micallef
- AMU INS Inserm 1106, centre régional de pharmacovigilance, pharmacologie clinique, APHM, 13005 Marseille, France
| | - Amir Lahouegue
- Pharmacovigilance et information médicale, AstraZeneca, 92400 Courbevoie, France
| | - Mathieu Molimard
- Univ. Bordeaux, Inserm, BPH, U1219, Equipe AHeaD, 33000 Bordeaux, France; CHU de Bordeaux, service de Pharmacologie Médicale, 33000 Bordeaux, France
| | - Marine Auffret
- Service hospitalo-universitaire de pharmacotoxicologie, centre régional de pharmacovigilance, hospices civils de Lyon, UMR CNRS 5558, université de Lyon 1, 69000 Lyon, France
| | - Laurent Chouchana
- Service de pharmacologie, centre-université Paris Cité, centre régional de pharmacovigilance, hôpital Cochin, AP-HP, 75014 Paris, France
| | - Bernard Denis
- Formation recherche, union francophone patients partenaire, 75012 Paris, France
| | - Jean Luc Faillie
- Inserm, département de pharmacologie médicale et toxicologie, centre régional de pharmacovigilance, institut Desbrest d'épidémiologie et de santé publique, CHU de Montpellier, université Montpellier, 34090 Montpellier, France
| | | | | | - Evelyne Pierron
- Agence nationale de sécurité du médicament et des produits de santé (ANSM), 93285 Saint-Denis, France
| | | | | | - Heather Rubino
- Pfizer, Inc, 235, East 42nd Street, NYC, NY, 10007 New York, USA
| | - Francesco Salvo
- Univ. Bordeaux, Inserm, BPH, U1219, Equipe AHeaD, 33000 Bordeaux, France; CHU de Bordeaux, service de Pharmacologie Médicale, 33000 Bordeaux, France
| |
Collapse
|
4
|
Ouldali N, Bagheri H, Salvo F, Antona D, Pariente A, Leblanc C, Tebacher M, Micallef J, Levy C, Cohen R, Javouhey E, Bader-Meunier B, Ovaert C, Renolleau S, Hentgen V, Kone-Paut I, Deschamps N, De Pontual L, Iriart X, Guen CGL, Angoulvant F, Belot A. Hyper inflammatory syndrome following COVID-19 mRNA vaccine in children: A national post-authorization pharmacovigilance study. THE LANCET REGIONAL HEALTH. EUROPE 2022; 17:100393. [PMID: 35505833 PMCID: PMC9051933 DOI: 10.1016/j.lanepe.2022.100393] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Multisystem inflammatory syndrome in children (MIS-C) is the most severe clinical entity associated with pediatric SARS-CoV-2 infection with a putative role of the spike protein into the immune system activation. Whether COVID-19 mRNA vaccine can induce this complication in children is unknown. We aimed to assess the risk of hyper-inflammatory syndrome following COVID-19 mRNA vaccine in children. Methods We conducted a post-authorization national population-based surveillance using the French enhanced pharmacovigilance surveillance system for COVID-19 vaccines. All cases of suspected hyper-inflammatory syndrome following COVID-19 mRNA vaccine in 12-17-year-old children between June 15th, 2021 and January 1st, 2022, were reported. Cases were reviewed according to WHO criteria for MIS-C. The reporting rate of this syndrome was compared to the MIS-C rate per 1,000,000 12-17-year-old children infected by SARS-CoV-2. Findings Up to January 2022, 8,113,058 COVID-19 mRNA vaccine doses were administered to 4,079,234 12-17-year-old children. Among them, 12 presented a hyper-inflammatory syndrome with multisystemic involvement. Main clinical features included male predominance (10/12, 83%), cardiac involvement (10/12, 83%), digestive symptoms (10/12, 83%), coagulopathy (7/12, 58%), cytolytic hepatitis (6/12, 50%), and shock (5/12, 42%). 4/12 (33%) required intensive care unit transfer, and 3/12 (25%) hemodynamic support. All cases recovered. In eight cases, no evidence of previous SARS-CoV-2 infection was found. The reporting rate was 1.5 (95%CI [0.8; 2.6]) per 1,000,000 doses injected, i.e. 2.9 (95%CI [1.5; 5.1]) per 1,000,000 12-17-year-old vaccinated children. As a comparison, 113 MIS-C (95%CI [95; 135]) occurred per 1,000,000 12-17-year-old children infected by SARS-CoV-2. Interpretation Very few cases of hyper-inflammatory syndrome with multi-organ involvement occurred following COVID-19 mRNA vaccine in 12-17-year-old children. The low reporting rate of this syndrome, compared to the rate of post-SARS-CoV-2 MIS-C in the same age-group, largely supports the vaccination in a context of an important circulation of SARS-CoV-2. Funding ESPID Fellowship Award; Grandir-Fonds de Solidarité Pour L'enfance.
Collapse
Affiliation(s)
- Naïm Ouldali
- Assistance Publique-Hôpitaux de Paris, Department of general paediatrics, paediatric infectious disease and internal medicine, Robert Debré university hospital, Université de Paris, Paris, France
- Infectious Diseases Division, CHU Sainte Justine - Montreal University, Montreal, Quebec, Canada
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
- Université de Paris, INSERM UMR 1123, ECEVE, Paris, France
| | - Haleh Bagheri
- Department of Medical and Clinical Pharmacology, Regional Pharmacovigilance Center, CIC 1436, Toulouse University Hospital, France
| | - Francesco Salvo
- INSERM, BPH, U1219, Team Pharmacoepidemiology, Université de Bordeaux, 33000 Bordeaux, France
- Pole de Santé Publique, Service de Pharmacologie Médicale, Regional pharmacovigilance center of Bordeaux, CHU de Bordeaux, 33000 Bordeaux, France
| | - Denise Antona
- Santé Publique France, Agence nationale de Santé publique, Saint-Maurice, France
| | - Antoine Pariente
- Team Pharmacoepidemiology, U1219 BPH Research Center, Bordeaux University, INSERM, Bordeaux, France
| | - Claire Leblanc
- Assistance Publique-Hôpitaux de Paris, Department of general paediatrics, paediatric infectious disease and internal medicine, Robert Debré university hospital, Université de Paris, Paris, France
| | - Martine Tebacher
- Regional pharmacovigilance center of Strasbourg, HUS, Strasbourg, France
| | - Joëlle Micallef
- Marseille University hospital, Clinical pharmacology department Regional Pharmacovigilance Center of Marseille, France
- Aix-Marseille University, INSERM UMR 1106, Marseille, France
| | - Corinne Levy
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
- Centre Hospitalier Intercommunal, Research Center, Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Robert Cohen
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
- Centre Hospitalier Intercommunal, Research Center, Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Etienne Javouhey
- Hospices Civils de Lyon, Paediatric Intensive Care Unit, Hopital Femme, Mère Enfant, University of Lyon, Bron, France
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression", University Claude Bernard Lyon 1, Hospices Civils of Lyon, Lyon, France
| | - Brigitte Bader-Meunier
- Department of Paediatric Hematology-Immunology and Rheumatology, Necker-Enfants Malades Hospital, AP-HP, Paris, France, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France
- Laboratory of Immunogenetics of Paediatric Autoimmunity, Imagine Institute, Paris University, Inserm U 1163, Paris, France
| | - Caroline Ovaert
- Department of Pediatric Cardiology, Hôpital Timone Enfant, AP-HM, Marseille, France
- Aix-Marseille University, MMG, INSERM, Marseille, France
| | - Sylvain Renolleau
- Pediatric Intensive Care Unit, Necker Hospital, AP-HP, Paris University, Paris, France
- Paris University, Paris EA7323, France
| | - Veronique Hentgen
- General Pediatrics department, Versailles Hospital, Paris, France
- CEREMAIA (French reference center for auto-inflammatory diseases and inflammatory amyloidosis), Paris, France
| | - Isabelle Kone-Paut
- CEREMAIA (French reference center for auto-inflammatory diseases and inflammatory amyloidosis), Paris, France
- Pediatric Rheumatology Department, Bicêtre Hospital, APHP, University of Paris Saclay, Kremlin Bicêtre, France
| | - Nina Deschamps
- General Pediatrics department, Saint-Malo Hospital, Saint-Malo, France
| | - Loïc De Pontual
- General Pediatrics and Pediatric emergency department, Jean Verdier Hospital, Bondy, France
| | - Xavier Iriart
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital, Pessac, France
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, Pessac, France
- INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Christelle Gras-Le Guen
- Department of Pediatric Emergency Care, Nantes University Hospital, Nantes F-44000, France
- Obstetrical, Perinatal and Pediatric Epidemiology Research team, Center of Research in Epidemiology and Statistics, Université de Paris, INSERM, Paris F-75004, France
- Inserm CIC 1413, Nantes University Hospital, Nantes F-44000, France
| | - François Angoulvant
- Assistance Publique-Hôpitaux de Paris, Department of general paediatrics, paediatric infectious disease and internal medicine, Robert Debré university hospital, Université de Paris, Paris, France
- INSERM, Centre de Recherche des Cordeliers, UMRS 1138, Sorbonne Université, Université de Paris, Paris, France
| | - Alexandre Belot
- Hospices Civils de Lyon, Paediatric Nephrology, Rheumatology, Dermatology, Hopital Femme, Mère Enfant and Centre International de Recherche en Infectiologie / INSERM U1111, Bron, France
- National Reference Center for Rheumatic and AutoImmune and Systemic Diseases in Children (RAISE), Lyon, France
- International Center of Research in Infectiology, Lyon University, INSERM U1111, CNRS UMR 5308, ENS, UCBL, 69007 Lyon, France
| | - “French Covid-19 Paediatric Inflammation Consortium”£ and the “French Pharmacovigilance network”*
- Assistance Publique-Hôpitaux de Paris, Department of general paediatrics, paediatric infectious disease and internal medicine, Robert Debré university hospital, Université de Paris, Paris, France
- Infectious Diseases Division, CHU Sainte Justine - Montreal University, Montreal, Quebec, Canada
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
- Université de Paris, INSERM UMR 1123, ECEVE, Paris, France
- Department of Medical and Clinical Pharmacology, Regional Pharmacovigilance Center, CIC 1436, Toulouse University Hospital, France
- INSERM, BPH, U1219, Team Pharmacoepidemiology, Université de Bordeaux, 33000 Bordeaux, France
- Pole de Santé Publique, Service de Pharmacologie Médicale, Regional pharmacovigilance center of Bordeaux, CHU de Bordeaux, 33000 Bordeaux, France
- Santé Publique France, Agence nationale de Santé publique, Saint-Maurice, France
- Team Pharmacoepidemiology, U1219 BPH Research Center, Bordeaux University, INSERM, Bordeaux, France
- Regional pharmacovigilance center of Strasbourg, HUS, Strasbourg, France
- Marseille University hospital, Clinical pharmacology department Regional Pharmacovigilance Center of Marseille, France
- Aix-Marseille University, INSERM UMR 1106, Marseille, France
- Centre Hospitalier Intercommunal, Research Center, Université Paris Est, IMRB-GRC GEMINI, Créteil, France
- Hospices Civils de Lyon, Paediatric Intensive Care Unit, Hopital Femme, Mère Enfant, University of Lyon, Bron, France
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression", University Claude Bernard Lyon 1, Hospices Civils of Lyon, Lyon, France
- Department of Paediatric Hematology-Immunology and Rheumatology, Necker-Enfants Malades Hospital, AP-HP, Paris, France, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France
- Laboratory of Immunogenetics of Paediatric Autoimmunity, Imagine Institute, Paris University, Inserm U 1163, Paris, France
- Department of Pediatric Cardiology, Hôpital Timone Enfant, AP-HM, Marseille, France
- Aix-Marseille University, MMG, INSERM, Marseille, France
- Pediatric Intensive Care Unit, Necker Hospital, AP-HP, Paris University, Paris, France
- Paris University, Paris EA7323, France
- General Pediatrics department, Versailles Hospital, Paris, France
- CEREMAIA (French reference center for auto-inflammatory diseases and inflammatory amyloidosis), Paris, France
- Pediatric Rheumatology Department, Bicêtre Hospital, APHP, University of Paris Saclay, Kremlin Bicêtre, France
- General Pediatrics department, Saint-Malo Hospital, Saint-Malo, France
- General Pediatrics and Pediatric emergency department, Jean Verdier Hospital, Bondy, France
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital, Pessac, France
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, Pessac, France
- INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
- Department of Pediatric Emergency Care, Nantes University Hospital, Nantes F-44000, France
- Obstetrical, Perinatal and Pediatric Epidemiology Research team, Center of Research in Epidemiology and Statistics, Université de Paris, INSERM, Paris F-75004, France
- Inserm CIC 1413, Nantes University Hospital, Nantes F-44000, France
- INSERM, Centre de Recherche des Cordeliers, UMRS 1138, Sorbonne Université, Université de Paris, Paris, France
- Hospices Civils de Lyon, Paediatric Nephrology, Rheumatology, Dermatology, Hopital Femme, Mère Enfant and Centre International de Recherche en Infectiologie / INSERM U1111, Bron, France
- National Reference Center for Rheumatic and AutoImmune and Systemic Diseases in Children (RAISE), Lyon, France
- International Center of Research in Infectiology, Lyon University, INSERM U1111, CNRS UMR 5308, ENS, UCBL, 69007 Lyon, France
| |
Collapse
|
5
|
Lacroix C, Salvo F, Gras-Champel V, Gautier S, Massy N, Valnet-Rabier MB, Grandvuillemin A, Mounier C, Benkebil M, Pariente A, Jonville-Béra AP, Micallef J. French organization for the pharmacovigilance of COVID-19 vaccines: A major challenge. Therapie 2021; 76:297-303. [PMID: 34059351 PMCID: PMC8103768 DOI: 10.1016/j.therap.2021.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/22/2021] [Indexed: 12/30/2022]
Abstract
In this special issue, we present the main highlights of the first weeks of pharmacovigilance monitoring of coronavirus disease 2019 (COVID-19) vaccines in this unprecedented situation in France: the deployment of a vaccination during an epidemic period with the aim of vaccinating the entire population and the intense pharmacovigilance and surveillance of these vaccines still under conditional marketing authorizations. In this unprecedented situation, the cross approach and interaction between the French pharmacovigilance network and French National Agency for the Safety of Medicines and Health Products (ANSM) has been optimized to provide a real-time safety related to COVID-19 vaccines. Every week, pair of regional pharmacovigilance centers gathered safety data from the French pharmacovigilance network, to acutely expertise all the adverse drug reactions (ADRs) reported with each COVID-19 vaccine within a direct circuit with ANSM. Results of this expertise are presented and discussed with ANSM in order to raise safety signals and take appropriate measures if necessary. These reports are then published online. At the 25th of March 2021, more than 9 815 000 doses were injected and 20,265 ADRs were reported, mostly non-serious (76%). Several potential or confirmed signals were raised at the european level for those vaccines and others ADRs are under special attentions. This underlines the adaptiveness of the French pharmacovigilance system to both the identification of new patient profiles experiencing ADRs and the evolution of the vaccine strategy. Such an efficiency is necessary to manage a careful and acute surveillance of these new COVID-19 vaccines for and to face the pandemic at the same time.
Collapse
Affiliation(s)
- Clémence Lacroix
- Centre régional de pharmacovigilance et d'information sur le médicament, service de pharmacologie clinique et pharmacovigilance, Aix Marseille Université, AP-HM, hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite 13009, Marseille, France
| | - Francesco Salvo
- University Bordeaux, Inserm, BPH, U1219, Team Pharmacoepidemiology, 33000 Bordeaux, France; CHU de Bordeaux, pôle de santé publique, service de pharmacologie médicale, centre régional de pharmacovigilance et d'information sur le médicament de Bordeaux, 33076 Bordeaux, France
| | - Valérie Gras-Champel
- Centre régional de pharmacovigilance, service de pharmacologie clinique, CHU Amiens-Picardie, 80054 Amiens, France
| | - Sophie Gautier
- Centre régional de pharmacovigilance Lille, service de pharmacologie clinique, CHU Lille, université de Lille, 59045 Lille, France
| | - Nathalie Massy
- Centre régional de pharmacovigilance, service de pharmacologie clinique, CHU de Rouen, 76031 Rouen, France
| | - Marie-Blanche Valnet-Rabier
- Centre régional de pharmacovigilance Franche Comté, service de pharmacologie clinique, CHU de Besançon, 25030 Besançon, France
| | - Aurélie Grandvuillemin
- Centre régional de pharmacovigilance, service de vigilances, qualité, risques, centre hospitalier universitaire de Dijon-Bourgogne, université de Bourgogne, 21079 Dijon, France
| | - Céline Mounier
- Agence nationale de sécurité du médicament et des produits de santé, Direction de la surveillance, 93200 Saint-Denis, France
| | - Mehdi Benkebil
- Agence nationale de sécurité du médicament et des produits de santé, Direction de la surveillance, 93200 Saint-Denis, France
| | - Antoine Pariente
- University Bordeaux, Inserm, BPH, U1219, Team Pharmacoepidemiology, 33000 Bordeaux, France
| | - Annie-Pierre Jonville-Béra
- Centre régional de pharmacovigilance et d'information sur le médicament, service de pharmacosurveillance, CHU de Tours, 37044 Tours, France
| | - Joëlle Micallef
- Centre régional de pharmacovigilance et d'information sur le médicament, service de pharmacologie clinique et pharmacovigilance, Aix Marseille Université, AP-HM, hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite 13009, Marseille, France.
| |
Collapse
|