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Bahri P, Genov G, Arlett P, Šarinić VM, Korakianiti E, Nolte A, Huber M, Straus SMJM. The STAR Compass to Guide Future Pharmacovigilance Based on a 10-Year Review of the Strengthened EU System. Drug Saf 2024; 47:941-956. [PMID: 38987419 PMCID: PMC11399220 DOI: 10.1007/s40264-024-01451-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 07/12/2024]
Abstract
This article reflects on the 2010 pharmacovigilance legislation of the European Union (EU). Its legislative aim of better patient and public health protection through new responsibilities for pharmaceutical companies and regulatory bodies is considered to have been achieved and is well supported by the good pharmacovigilance practices 'EU-GVP'. For future progress, we set out a vision for high-quality pharmacovigilance in a world of ongoing medical, technological and social changes. To deliver this vision, four principles are proposed to guide actions for further progressing the EU pharmacovigilance system: synergistic interactions with healthcare systems; trustworthy evidence for regulatory decisions; adaptive process efficiency; and readiness for emergency situations (the 'STAR principles'). Like a compass, these principles should guide actions for building capacity, technology and methods; improving regulatory processes; and expanding policies, frameworks and research agendas. Fit for the future, the EU system should achieve further improved outputs in terms of safe, effective and trusted use of medicines and positive health outcomes within patient-centred healthcare.
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Affiliation(s)
- Priya Bahri
- European Medicines Agency (EMA), Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands.
| | - Georgy Genov
- European Medicines Agency (EMA), Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
| | - Peter Arlett
- European Medicines Agency (EMA), Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
| | - Viola Macolić Šarinić
- European Medicines Agency (EMA), Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
| | - Evdokia Korakianiti
- European Medicines Agency (EMA), Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
| | - Alexis Nolte
- European Medicines Agency (EMA), Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
| | - Martin Huber
- Federal Institute for Drugs and Medical Devices, Bonn, Germany
- EMA Pharmacovigilance and Risk Assessment Committee, Amsterdam, The Netherlands
| | - Sabine M J M Straus
- EMA Pharmacovigilance and Risk Assessment Committee, Amsterdam, The Netherlands
- Medicines Evaluation Board, Utrecht, The Netherlands
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2
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Mahaux O, Powell G, Haguinet F, Sobczak P, Saini N, Barry A, Mustafa A, Bate A. Identifying Safety Subgroups at Risk: Assessing the Agreement Between Statistical Alerting and Patient Subgroup Risk. Drug Saf 2023; 46:601-614. [PMID: 37131012 PMCID: PMC10153776 DOI: 10.1007/s40264-023-01306-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Identifying individual characteristics or underlying conditions linked to adverse drug reactions (ADRs) can help optimise the benefit-risk ratio for individuals. A systematic evaluation of statistical methods to identify subgroups potentially at risk using spontaneous ADR report datasets is lacking. OBJECTIVES In this study, we aimed to assess concordance between subgroup disproportionality scores and European Medicines Agency Pharmacovigilance Risk Assessment Committee (PRAC) discussions of potential subgroup risk. METHODS The subgroup disproportionality method described by Sandberg et al., and variants, were applied to statistically screen for subgroups at potential increased risk of ADRs, using data from the US FDA Adverse Event Reporting System (FAERS) cumulative from 2004 to quarter 2 2021. The reference set used to assess concordance was manually extracted from PRAC minutes from 2015 to 2019. Mentions of subgroups presenting potential differentiated risk and overlapping with the Sandberg method were included. RESULTS Twenty-seven PRAC subgroup examples representing 1719 subgroup drug-event combinations (DECs) in FAERS were included. Using the Sandberg methodology, 2 of the 27 could be detected (one for age and one for sex). No subgroup examples for pregnancy and underlying condition were detected. With a methodological variant, 14 of 27 examples could be detected. CONCLUSIONS We observed low concordance between subgroup disproportionality scores and PRAC discussions of potential subgroup risk. Subgroup analyses performed better for age and sex, while for covariates not well-captured in FAERS, such as underlying condition and pregnancy, additional data sources should be considered.
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Affiliation(s)
- Olivia Mahaux
- Safety Innovation and Analytics, GSK, Wavre, Belgium.
| | - Greg Powell
- Safety Innovation and Analytics, GSK, Durham, NC, USA
| | | | | | - Namrata Saini
- Safety Evaluation and Risk Management, GSK, Bangalore, India
| | - Allen Barry
- University of North Carolina, Chapel Hill, NC, USA
| | | | - Andrew Bate
- Safety Innovation and Analytics, GSK, London, UK
- London School of Hygiene and Tropical Medicine, University of London, London, UK
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3
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Pathak R, Catalan-Matamoros D. Can Twitter posts serve as early indicators for potential safety signals? A retrospective analysis. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2023; 34:41-61. [PMID: 35491804 DOI: 10.3233/jrs-210024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND As Twitter has gained significant popularity, tweets can serve as large pool of readily available data to estimate the adverse events (AEs) of medications. OBJECTIVE This study evaluated whether tweets were an early indicator for potential safety warnings. Additionally, the trend of AEs posted on Twitter was compared with AEs from the Yellow Card system in the United Kingdom. METHODS English Tweets for 35 drug-event pairs for the period 2017-2019, two years prior to the date of EMA Pharmacovigilance Risk Assessment Committee (PRAC) meeting, were collected. Both signal and non-signal AEs were manually identified and encoded using the MedDRA dictionary. AEs from Yellow Card were also gathered for the same period. Descriptive and inferential statistical analysis was conducted using Fisher's exact test to assess the distribution and proportion of AEs from the two data sources. RESULTS Of the total 61,661 English tweets, 1,411 had negative or neutral sentiment and mention of at least one AE. Tweets for 15 out of the 35 drugs (42.9%) contained AEs associated with the signals. On pooling data from Twitter and Yellow Card, 24 out of 35 drug-event pairs (68.6%) were identified prior to the respective PRAC meetings. Both data sources showed similar distribution of AEs based on seriousness, however, the distribution based on labelling was divergent. CONCLUSION Twitter cannot be used in isolation for signal detection in current pharmacovigilance (PV) systems. However, it can be used in combination with traditional PV systems for early signal detection, as it can provide a holistic drug safety profile.
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Affiliation(s)
- Revati Pathak
- UC3M Medialab, Department of Communication and Media Studies, University Carlos III of Madrid, Madrid, Spain.,Eu2P Programme, University of Bordeaux, Bordeaux, France
| | - Daniel Catalan-Matamoros
- UC3M Medialab, Department of Communication and Media Studies, University Carlos III of Madrid, Madrid, Spain.,Eu2P Programme, University of Bordeaux, Bordeaux, France.,Health Research Centre, University of Almeria, Almeria, Spain
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4
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Pandemic vaccines: a formidable challenge for pharmacovigilance. Nat Rev Drug Discov 2023; 22:1-2. [PMID: 36307650 DOI: 10.1038/d41573-022-00178-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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5
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Waschbusch M, Rodriguez L, Brueckner A, Lee KJ, Li X, Mokliatchouk O, Tremmel L, Yuan SS. Global Landscape of Benefit-Risk Considerations for Medicinal Products: Current State and Future Directions. Pharmaceut Med 2022; 36:201-213. [PMID: 35780471 DOI: 10.1007/s40290-022-00435-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 11/24/2022]
Abstract
In the last decade there has been a significant increase in the literature discussing the use of benefit-risk methods in medical product (including devices) development. Government agencies, medical product industry groups, academia, and collaborative consortia have extensively discussed the advantages of structured benefit-risk assessments. However, the abundance of information has not resulted in a consistent way to utilize these findings in medical product development. Guidelines and papers on methods, even though well structured, have not led to a firm consensus on a clear and consistent approach. This paper summarizes the global landscape of benefit-risk considerations for product- or program-level decisions from available literature and regulatory guidance, providing the perspectives of three stakeholder groups-regulators, collaborative groups and consortia, and patients. The paper identifies key themes, potential impact on benefit-risk assessments, and significant future trends.
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Affiliation(s)
- Max Waschbusch
- Global Clinical Safety and Pharmacovigilance, CSL Behring, King of Prussia, PA, USA.
| | - Lisa Rodriguez
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Kerry Jo Lee
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Xuefeng Li
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Lothar Tremmel
- Quantitative Sciences and Reporting, CSL Behring, King of Prussia, PA, USA
| | - Shuai S Yuan
- Oncology Statistics, GlaxoSmithKline Plc, Upper Province, PA, USA
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6
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Bloem LT, Karomi M, Hoekman J, van der Elst ME, Leufkens HGM, Klungel OH, Mantel-Teeuwisse AK. Comprehensive evaluation of post-approval regulatory actions during the drug lifecycle - a focus on benefits and risks. Expert Opin Drug Saf 2021; 20:1433-1442. [PMID: 34263667 DOI: 10.1080/14740338.2021.1952981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Prior studies investigated regulatory actions that reflected a negative impact on drug risks. We aimed to evaluate occurrence of regulatory actions that reflected a negative or positive impact on benefits or risks, as well as relations between them.Research design and methods: We followed EMA-approved innovative drugs from approval (2009-2010) until July 2020 or withdrawal to identify regulatory actions. We assessed these for impact on benefits or risks and relations between actions. Additionally, we scrutinized drug lifecycles for time-variant characteristics that may contribute to specific patterns of regulatory actions.Results: We identified 14 letters and 361 label updates for 40 drugs. Of the label updates, 85 (24%) reflected a positive impact, mostly concerning indications, and 276 (76%) a negative impact, mostly adverse drug reactions. Many updates (54%) occurred simultaneously with other updates, also if these reflected a different impact. Furthermore, levels of patient exposure, innovativeness, needs for regulatory learning and unexpected risks may contribute to patterns of regulatory actions.Conclusions: Almost a quarter of regulatory actions reflected a positive impact on benefits and risks. Also, simultaneous learning about benefits and risks suggests an important role for drug development in risk characterization. These findings may impact regulatory analyses and decision-making.
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Affiliation(s)
- Lourens T Bloem
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Pharmacovigilance department, Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | - Mariana Karomi
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jarno Hoekman
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Pharmacovigilance department, Innovation Studies, Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands
| | - Menno E van der Elst
- Pharmacovigilance department, Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | - Hubert G M Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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7
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Miljković N, van Overbeeke E, Godman B, Kovačević M, Anastasi A, Bochenek T, Huys I, Miljković B. Practical Implications From European Hospital Pharmacists on Prospective Risk Assessment for Medicine Shortages. Front Med (Lausanne) 2020; 7:407. [PMID: 32850907 PMCID: PMC7419473 DOI: 10.3389/fmed.2020.00407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/29/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aimed to obtain a comprehensive overview on the perception, attitudes, and experience of European pharmacists with prospective risk assessment procedures in everyday practice, as well as to identify challenges and solutions. This is a follow-up study to the surveys on prospective risk assessment previously carried out within the COST Action 15105 among pharmacists across Europe. Methodology: In-depth interviews were performed using an interview guide comprising 25 questions. Interviews were transcribed ad verbatim and imported into NVivo 10 for framework analysis. In NVivo, the interviews were coded through assigning text segments to a responding code from a coding tree, covering the full content of the interviews. Coded text segments were then charted into a matrix, and analyzed by interpreting all text segments per code. Results: In total, 18 interviews were conducted. From the framework analysis, 6 codes and 12 sub-codes emerged. Overall, despite citing specific issues pertaining to its implementation, the interviewees considered multi-stakeholder and multi-disciplinary prospective risk assessment to be essential. While healthcare professionals reported being aware of the importance of risk assessment, they cited insufficient knowledge and skills to be a major obstacle in everyday practice. They also reported inadequate IT support since a paper-based system is still widely in use, thereby complicating data extraction to carry out prospective risk assessment. Conclusion: While prospective risk assessment was found to be valuable, interviewees also found it to be a resource-intensive and time-consuming process. Due to resource constraints, it may not be possible or desirable to conduct prospective risk assessment for every shortage. However, for critical-essential drugs, it is crucial to have a ready-to-use substitute based on risk assessment. Moreover, potential risks of substitutes on patient health should be identified before a shortage occurs and the substitute is dispensed as an alternative.
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Affiliation(s)
- Nenad Miljković
- Hospital Pharmacy Department, Institute of Orthopaedic Surgery "Banjica", University of Belgrade, Belgrade, Serbia
| | | | - Brian Godman
- Division of Clinical Pharmacology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, United Kingdom.,Department of Public Health and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Milena Kovačević
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Alison Anastasi
- Central Procurement and Supplies Unit, The Malta Ministry for Health, San Gwann, Malta
| | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Branislava Miljković
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade, Belgrade, Serbia
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8
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Gini R, Sturkenboom MCJ, Sultana J, Cave A, Landi A, Pacurariu A, Roberto G, Schink T, Candore G, Slattery J, Trifirò G. Different Strategies to Execute Multi-Database Studies for Medicines Surveillance in Real-World Setting: A Reflection on the European Model. Clin Pharmacol Ther 2020; 108:228-235. [PMID: 32243569 PMCID: PMC7484985 DOI: 10.1002/cpt.1833] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/13/2020] [Indexed: 12/18/2022]
Abstract
Although postmarketing studies conducted in population-based databases often contain information on patients in the order of millions, they can still be underpowered if outcomes or exposure of interest is rare, or the interest is in subgroup effects. Combining several databases might provide the statistical power needed. A multi-database study (MDS) uses at least two healthcare databases, which are not linked with each other at an individual person level, with analyses carried out in parallel across each database applying a common study protocol. Although many MDSs have been performed in Europe in the past 10 years, there is a lack of clarity on the peculiarities and implications of the existing strategies to conduct them. In this review, we identify four strategies to execute MDSs, classified according to specific choices in the execution: (A) local analyses, where data are extracted and analyzed locally, with programs developed by each site; (B) sharing of raw data, where raw data are locally extracted and transferred without analysis to a central partner, where all the data are pooled and analyzed; (C) use of a common data model with study-specific data, where study-specific data are locally extracted, loaded into a common data model, and processed locally with centrally developed programs; and (D) use of general common data model, where all local data are extracted and loaded into a common data model, prior to and independent of any study protocol, and protocols are incorporated in centrally developed programs that run locally. We illustrate differences between strategies and analyze potential implications.
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Affiliation(s)
- Rona Gini
- Agenzia regionale di sanità della ToscanaFlorenceItaly
| | | | | | - Alison Cave
- European Medicines AgencyAmsterdamThe Netherlands
| | - Annalisa Landi
- Fondazione per la Ricerca Farmacologica Gianni Benzi OnlusValenzanoItaly
- Teddy European Network of Excellence for Paediatric Clinical ResearchPaviaItaly
| | | | | | - Tania Schink
- Leibniz Institute for Prevention Research and EpidemiologyBremenGermany
| | | | - Jim Slattery
- European Medicines AgencyAmsterdamThe Netherlands
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional ImagingUniversità di MessinaMessinaItaly
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9
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Moseley J, Vamvakas S, Berntgen M, Cave A, Kurz X, Arlett P, Acha V, Bennett S, Cohet C, Corriol-Rohou S, Du Four E, Lamoril C, Langeneckert A, Koban M, Pasté M, Sandler S, Van Baelen K, Cangini A, García S, Obach M, Gimenez Garcia E, Varela Lema L, Jauhonen HM, Rannanheimo P, Morrison D, Van De Casteele M, Strömgren A, Viberg A, Makady A, Guilhaume C. Regulatory and health technology assessment advice on postlicensing and postlaunch evidence generation is a foundation for lifecycle data collection for medicines. Br J Clin Pharmacol 2020; 86:1034-1051. [PMID: 32162368 PMCID: PMC7256124 DOI: 10.1111/bcp.14279] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/30/2020] [Accepted: 02/13/2020] [Indexed: 12/13/2022] Open
Abstract
The understanding of the benefit risk profile, and relative effectiveness of a new medicinal product, are initially established in a circumscribed patient population through clinical trials. There may be uncertainties associated with the new medicinal product that cannot be, or do not need to be resolved before launch. Postlicensing or postlaunch evidence generation (PLEG) is a term for evidence generated after the licensure or launch of a medicinal product to address these remaining uncertainties. PLEG is thus part of the continuum of evidence development for a medicinal product, complementing earlier evidence, facilitating further elucidation of a product's benefit/risk profile, value proposition, and/or exploring broader aspects of disease management and provision of healthcare. PLEG plays a role in regulatory decision making, not only in the European Union but also in other jurisdictions including the USA and Japan. PLEG is also relevant for downstream decision‐making by health technology assessment bodies and payers. PLEG comprises studies of different designs, based on data collected in observational or experimental settings. Experience to date in the European Union has indicated a need for improvements in PLEG. Improvements in design and research efficiency of PLEG could be addressed through more systematic pursuance of Scientific Advice on PLEG with single or multiple decision makers. To date, limited information has been available on the rationale, process or timing for seeking PLEG advice from regulators or health technology assessment bodies. This article sets out to address these issues and to encourage further uptake of PLEG advice.
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Affiliation(s)
- Jane Moseley
- European Medicines Agency (EMA), The Netherlands
| | | | | | - Alison Cave
- European Medicines Agency (EMA), The Netherlands
| | - Xavier Kurz
- European Medicines Agency (EMA), The Netherlands
| | - Peter Arlett
- European Medicines Agency (EMA), The Netherlands
| | - Virginia Acha
- MSD, UK.,European Federation of Pharmaceutical Industries and Associations (EFPIA), Luxembourg
| | - Simon Bennett
- European Federation of Pharmaceutical Industries and Associations (EFPIA), Luxembourg.,Biogen, UK
| | - Catherine Cohet
- European Federation of Pharmaceutical Industries and Associations (EFPIA), Luxembourg.,GSK, Belgium
| | - Solange Corriol-Rohou
- European Federation of Pharmaceutical Industries and Associations (EFPIA), Luxembourg.,AstraZeneca, France
| | - Emma Du Four
- European Federation of Pharmaceutical Industries and Associations (EFPIA), Luxembourg.,Abbvie, UK
| | - Christelle Lamoril
- European Federation of Pharmaceutical Industries and Associations (EFPIA), Luxembourg.,Sanofi, France
| | - Anja Langeneckert
- European Federation of Pharmaceutical Industries and Associations (EFPIA), Luxembourg.,F-Hoffmann La Roche, Switzerland
| | - Maren Koban
- European Federation of Pharmaceutical Industries and Associations (EFPIA), Luxembourg.,Merck KGaA Darmstadt, Germany
| | - Muriel Pasté
- European Federation of Pharmaceutical Industries and Associations (EFPIA), Luxembourg.,GSK, Belgium
| | - Susan Sandler
- European Federation of Pharmaceutical Industries and Associations (EFPIA), Luxembourg.,Janssen Pharmaceutical Companies of Johnson & Johnson, Belgium
| | - Karin Van Baelen
- European Federation of Pharmaceutical Industries and Associations (EFPIA), Luxembourg.,Janssen Pharmaceutical Companies of Johnson & Johnson, Belgium
| | - Agnese Cangini
- Agenzia Italiana del Farmaco (AIFA, Italian Medicines Agency), Italy.,European Union Network for Health technology assessment (EUnetHTA), The Netherlands
| | - Sonia García
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,Agencia Española de Medicamentos y Productos Sanitarios (AEMPS, Spanish Medicines agency), Spain
| | - Mercè Obach
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS, Agency for Health Quality and Assessment of Catalonia), Spain.,Catalan Healthcare Service (Catsalut), Spain
| | - Emmanuel Gimenez Garcia
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS, Agency for Health Quality and Assessment of Catalonia), Spain
| | - Leonor Varela Lema
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,Galician Agency for Health Knowledge Management (avalia-t; ACIS), Spain
| | - Hanna-Mari Jauhonen
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,Finnish Medicines Agency (FIMEA), Finland
| | - Piia Rannanheimo
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,Finnish Medicines Agency (FIMEA), Finland
| | - Deborah Morrison
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,National Institute for Health and Care Excellence (NICE), UK
| | - Marc Van De Casteele
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,Rijksinstituut voor Ziekte- en Invaliditeitsverzekering/Institut national d'assurance maladie-invalidité (RIZIV-INAMI, National Institute for Health and Disability Insurance), Belgium
| | - Anna Strömgren
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,Tandvårds-Läkemedelförmånsverket (TLV, Dental and Pharmaceutical Benefits Agency), Sweden
| | - Anders Viberg
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,Tandvårds-Läkemedelförmånsverket (TLV, Dental and Pharmaceutical Benefits Agency), Sweden
| | - Amr Makady
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,Zorginstituut Nederland (ZIN, National Health Care Institute), The Netherlands
| | - Chantal Guilhaume
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,Haute Autorité de Santé, (HAS, French National Authority for Health), France
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10
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Arlett P. Measuring the impact of risk communications: Robust analytical approaches are key. Br J Clin Pharmacol 2020; 86:635-636. [PMID: 32064646 PMCID: PMC7098862 DOI: 10.1111/bcp.14222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Peter Arlett
- Pharmacovigilance and Epidemiology DepartmentEuropean Medicines AgencyAmsterdamThe Netherlands
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11
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Farcas A, Balcescu T, Anghel L, Bucsa C, Mogoșan C. A description of medicines-related safety issues evaluated through a referral procedure at the EU level after 2012. Expert Opin Drug Saf 2020; 19:755-762. [PMID: 32186202 DOI: 10.1080/14740338.2020.1744561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Important drug safety issues are evaluated through a referral procedure in the EU by the Pharmacovigilance Risk Assessment Committee (PRAC) within the European Medicines Agency. We aim to describe all safety-related referrals assessed by the PRAC by June 2019. METHODS Publicly available data on safety issues assessed through referral procedures that reached a final decision during July 2012-June 2019 were identified, analyzed and classified according to predefined criteria. RESULTS Fifty-one safety issues were assessed by PRAC for 45 medicines/combinations/therapeutic classes during this timeframe. Referrals were initiated mostly by the European Commission (16) and France (8). Nine medicines were authorized in the last five years, the rest being well-established drugs. In four cases (flupirtine, hydroxyethyl-starch, valproate, codeine) PRAC re-assessed the same risks as previous recommendations have not been effective. Post-referral recommendations consisted of updates of the summary of product characteristics and package leaflet (42), Direct Healthcare Professional Communication (32), and other additional risk minimization measures (RMMs). Withdrawal was recommended for seven active substances. CONCLUSIONS PRAC recommended routine or additional RMMs for most referrals. Complete withdrawal of a drug or withdrawal of certain pharmaceutical forms or concentrations was advised only when the risk could not be managed by RMMs.
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Affiliation(s)
- Andreea Farcas
- Drug Information Research Center, "Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj-Napoca, Romania
| | - Teodora Balcescu
- Drug Information Research Center, "Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj-Napoca, Romania
| | - Laura Anghel
- Drug Information Research Center, "Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj-Napoca, Romania
| | - Camelia Bucsa
- Drug Information Research Center, "Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj-Napoca, Romania
| | - Cristina Mogoșan
- Drug Information Research Center, "Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj-Napoca, Romania
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12
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Drug Safety Issues Covered by Lay Media: A Cohort Study of Direct Healthcare Provider Communications Sent between 2001 and 2015 in The Netherlands. Drug Saf 2020; 43:677-690. [PMID: 32212054 PMCID: PMC7305079 DOI: 10.1007/s40264-020-00922-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Some drug safety issues communicated through direct healthcare professional communications (DHPCs) receive substantial media coverage, while others do not. Objectives The objective of this study was to assess the extent of coverage of drug safety issues that have been communicated through DHPCs in newspapers and social media. A secondary aim was to explore which determinants may be associated with media coverage. Methods Newspaper articles covering drug safety issues communicated through 387 DHPCs published between 2001 and 2015 were retrieved from LexisNexis Academic™. Social media postings were retrieved from Coosto™ for drugs included in 220 DHPCs published between 2010 and 2015. Coverage of DHPCs by newspapers and social media was assessed during the 2-month and 14-day time periods following issuance of the DHPC, respectively. Multivariate logistic regression was used to assess potential DHPC- and drug-related determinants of media coverage. Results 41 (10.6%) DHPC safety issues were covered in newspaper articles. Newspaper coverage was associated with drugs without a specialist indication [adjusted odds ratio 5.32; 95% confidence interval (2.64–10.73)]. Negative associations were seen for time since market approval [3–5 years 0.30; (0.11–0.82), 6–11 years 0.18; (0.06–0.58)] and year of the DHPC [0.88; (0.81–0.96)]. In the social media, 180 (81.8%) drugs mentioned in 220 DHPCs were covered. Social media coverage was associated with drugs without a specialist indication [6.92; (1.56–30.64)], and for DHPCs communicating clinical safety issues [5.46; (2.03–14.66)]. Conclusions Newspapers covered a small proportion of DHPC safety issues only. Most drugs mentioned in DHPCs were covered in social media. Coverage in both media were higher for drugs without a specialist indication. Electronic supplementary material The online version of this article (10.1007/s40264-020-00922-7) contains supplementary material, which is available to authorized users.
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Flynn R, Hedenmalm K, Murray-Thomas T, Pacurariu A, Arlett P, Shepherd H, Myles P, Kurz X. Ability of Primary Care Health Databases to Assess Medicinal Products Discussed by the European Union Pharmacovigilance Risk Assessment Committee. Clin Pharmacol Ther 2020; 107:957-965. [PMID: 31955404 PMCID: PMC7158204 DOI: 10.1002/cpt.1775] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/23/2019] [Indexed: 12/17/2022]
Abstract
This study measured the exposure to different categories of medicinal products discussed by the European Union (EU) Pharmacovigilance Risk Assessment Committee from September to November 2018 in four electronic primary care health databases: IQVIA Medical Research Data‐UK, IQVIA Medical Research Data‐France, IQVIA Medical Research Data‐Germany, and Clinical Practice Research Datalink Aurum, in the entire lifespan of each database until August 31, 2018. The assessment of 83 centrally authorized products and 45 nationally authorized products showed that coverage was better for products marketed for longer duration and worse for orphan drugs. The ability to detect associations against hypothetical comparators was better for more common events and for larger effect sizes. Coverage of advanced therapies was worse for those typically administered in a specialized rather than primary care setting. This study shows that to enable better informed regulatory decisions there is a need to access complementary data sources, particularly capturing secondary care prescribing.
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Affiliation(s)
- Robert Flynn
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, Amsterdam, The Netherlands.,Medicines Monitoring Unit (MEMO), Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Karin Hedenmalm
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, Amsterdam, The Netherlands
| | - Tarita Murray-Thomas
- Clinical Practice Research Datalink (CPRD), Medicines and Healthcare Products Regulatory Agency (MHRA), London, UK
| | - Alexandra Pacurariu
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, Amsterdam, The Netherlands
| | - Peter Arlett
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, Amsterdam, The Netherlands
| | - Hilary Shepherd
- Clinical Practice Research Datalink (CPRD), Medicines and Healthcare Products Regulatory Agency (MHRA), London, UK
| | - Puja Myles
- Clinical Practice Research Datalink (CPRD), Medicines and Healthcare Products Regulatory Agency (MHRA), London, UK
| | - Xavier Kurz
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, Amsterdam, The Netherlands
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14
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Potts J, Genov G, Segec A, Raine J, Straus S, Arlett P. Improving the Safety of Medicines in the European Union: From Signals to Action. Clin Pharmacol Ther 2019; 107:521-529. [PMID: 31621897 PMCID: PMC7027976 DOI: 10.1002/cpt.1678] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/13/2019] [Indexed: 11/11/2022]
Abstract
Pharmacovigilance and risk minimization must be planned during drug development and forms a critical part of the regulator's decision on whether a medicinal product can be authorized. Pharmacovigilance systems should ensure proactive monitoring of all authorized medicines throughout their lifecycle in clinical use. Signal detection and management are core activities in pharmacovigilance, rapidly delivering new information on the safety of medicines in real-world use which helps to fill knowledge gaps. The first 6 years of the European Union (EU) signal management system resulted in 453 recommendations issued by the Pharmacovigilance Risk Assessment Committee (PRAC), of which more than half were for drug labeling changes. The EU pharmacovigilance network has demonstrated its ability to detect and evaluate new drug safety signals. This has resulted in new warnings to guide the safe and effective use of medicines in Europe.
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Affiliation(s)
- Joanne Potts
- Pharmacovigilance and Epidemiology Department, European Medicines Agency (EMA), Amsterdam, The Netherlands
| | - Georgy Genov
- Pharmacovigilance and Epidemiology Department, European Medicines Agency (EMA), Amsterdam, The Netherlands
| | - Andrej Segec
- Pharmacovigilance and Epidemiology Department, European Medicines Agency (EMA), Amsterdam, The Netherlands
| | - June Raine
- Medicines and Healthcare Products Regulatory Agency (MHRA), London, UK
| | - Sabine Straus
- Medicines Evaluation Board (MEB), Utrecht, The Netherlands.,EMA Pharmacovigilance Risk Assessment Committee (PRAC), Amsterdam, The Netherlands
| | - Peter Arlett
- Pharmacovigilance and Epidemiology Department, European Medicines Agency (EMA), Amsterdam, The Netherlands
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15
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Hedenmalm K, Blake K, Donegan K, Macia MA, Gil M, Williams J, Montero D, Candore G, Morales D, Kurz X, Arlett P. A European multicentre drug utilisation study of the impact of regulatory measures on prescribing of codeine for pain in children. Pharmacoepidemiol Drug Saf 2019; 28:1086-1096. [PMID: 31219227 PMCID: PMC6771637 DOI: 10.1002/pds.4836] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/01/2019] [Accepted: 04/23/2019] [Indexed: 12/19/2022]
Abstract
Purpose In June 2013, following recommendations from the World Health Organization (WHO) and Food and Drug Administration (FDA), the European Medicines Agency agreed updates to the codeine product information regarding use for pain in children younger than 12 years and children undergoing tonsillectomy or adenoidectomy (TA) for obstructive sleep apnoea. This study was conducted to (a) assess effectiveness of these measures on codeine prescribing in the “real‐world” setting and (b) test feasibility of a study using a common protocol by regulators with access to databases. Methods The study was performed using BIFAP (Spain), CPRD (UK), and IMS® Disease Analyzer (France and Germany) databases. Prescribers included general practitioners (GPs) (France and UK), GPs and paediatricians together (Spain), and GPs, paediatricians, and ear, nose, and throat (ENT) specialists separately (Germany). Between January 2010 and June 2015, prevalence of codeine prescribing was obtained every 6 months, and a time series analysis (joinpoint) was performed. Codeine prescribing within ±30 days of TA was also identified. Furthermore, doses, durations, and prior prescribing of other analgesics were investigated. Results Over the 5‐year period, codeine prescribing decreased in children younger than 12 years (by 84% in France and Spain, 44% in GP practices in Germany, and 33% in the United Kingdom). The temporal pattern was compatible with the regulatory intervention in France and the United Kingdom, whereas a decrease throughout the study period was seen in Germany and Spain. Decreased prescribing associated with TA was suggested in ENT practices in Germany. Conclusions Codeine prescribing for children decreased in line with introduced regulatory measures. Multidatabase studies assessing impact of measures by EU regulators are feasible.
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Affiliation(s)
- Karin Hedenmalm
- Business, Data and Analytics Department, European Medicines Agency, London, UK
| | - Kevin Blake
- Specialised Scientific Disciplines Department, European Medicines Agency, London, UK
| | - Katherine Donegan
- Vigilance and Risk Management of Medicines, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Miguel-Angel Macia
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices, Madrid, Spain
| | - Miguel Gil
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices, Madrid, Spain
| | - Julie Williams
- Pharmacovigilance and Risk Management Planning, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Dolores Montero
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices, Madrid, Spain.,Spanish Medicines & Medical Devices Agency (Agencia Española de Medicamentos y Productos Sanitarios), Madrid, Spain
| | - Gianmario Candore
- Business, Data and Analytics Department, European Medicines Agency, London, UK
| | - Daniel Morales
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK
| | - Xavier Kurz
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK
| | - Peter Arlett
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK
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16
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Eichler H, Bloechl‐Daum B, Broich K, Kyrle PA, Oderkirk J, Rasi G, Santos Ivo R, Schuurman A, Senderovitz T, Slawomirski L, Wenzl M, Paris V. Data Rich, Information Poor: Can We Use Electronic Health Records to Create a Learning Healthcare System for Pharmaceuticals? Clin Pharmacol Ther 2019; 105:912-922. [PMID: 30178490 PMCID: PMC6587701 DOI: 10.1002/cpt.1226] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/14/2018] [Indexed: 12/16/2022]
Abstract
Judicious use of real-world data (RWD) is expected to make all steps in the development and use of pharmaceuticals more effective and efficient, including research and development, regulatory decision making, health technology assessment, pricing, and reimbursement decisions and treatment. A "learning healthcare system" based on electronic health records and other routinely collected data will be required to harness the full potential of RWD to complement evidence based on randomized controlled trials. We describe and illustrate with examples the growing demand for a learning healthcare system; we contrast the exigencies of an efficient pharmaceutical ecosystem in the future with current deficiencies highlighted in recently published Organisation for Economic Co-operation and Development (OECD) reports; and we reflect on the steps necessary to enable the transition from healthcare data to actionable information. A coordinated effort from all stakeholders and international cooperation will be required to increase the speed of implementation of the learning healthcare system, to everybody's benefit.
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Affiliation(s)
| | | | - Karl Broich
- Federal Institute for Drugs and Medical DevicesBonnGermany
| | | | - Jillian Oderkirk
- Organisation for Economic Co‐operation and DevelopmentParisFrance
| | | | - Rui Santos Ivo
- National Authority of Medicines and Health ProductsLisbonPortugal
| | - Ad Schuurman
- National Health Care InstituteDiemenThe Netherlands
| | | | - Luke Slawomirski
- Organisation for Economic Co‐operation and DevelopmentParisFrance
| | - Martin Wenzl
- Organisation for Economic Co‐operation and DevelopmentParisFrance
| | - Valerie Paris
- Organisation for Economic Co‐operation and DevelopmentParisFrance
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17
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Farcaş A, Măhălean A, Bulik NB, Leucuta D, Mogoșan C. New safety signals assessed by the Pharmacovigilance Risk Assessment Committee at EU level in 2014-2017. Expert Rev Clin Pharmacol 2018; 11:1045-1051. [PMID: 30269618 DOI: 10.1080/17512433.2018.1526676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Safety monitoring of all drugs throughout their entire life cycle is mandatory in order to protect the public health. Our objective was to describe all new safety signals assessed at EU level by the Pharmacovigilance Risk Assessment Committee (PRAC). METHODS Publicly available data on signals assessment from PRAC meeting minutes for the period January 2014-November 2017 were analyzed and classified. RESULTS A total of 239 new signals for 194 drugs/drug combinations/therapeutic classes were evaluated by PRAC. A total of 154 signals were triggered by spontaneous reporting, 31 by literature case reports, and 26 by observational studies. In 188 signals, the drugs involved were authorized for more than 5 years. The drug classes for which most signals were detected were antineoplastic/immunomodulators (n = 75), anti-infectives (n = 34), and drugs acting on the nervous system (n = 27). Signals were triggered for drug interactions (n = 15), in utero exposure (n = 7), medication errors (n = 6), and for different disorders, among which the skin/subcutaneous tissue disorders were more common. PRAC recommendations consisted in label updates (n = 86), in Direct Healthcare Professional Communications (n = 17), and in eight recommendations for a more complex evaluation through referral procedures. CONCLUSIONS Most new signals assessed were triggered by spontaneous reporting and led to routine risk minimization measures, such as updating the product information.
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Affiliation(s)
- Andrea Farcaş
- a Drug Information Research Center , "Iuliu Haţieganu" University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Andreea Măhălean
- a Drug Information Research Center , "Iuliu Haţieganu" University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Noémi Beátrix Bulik
- a Drug Information Research Center , "Iuliu Haţieganu" University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Daniel Leucuta
- b Medical Informatics and Biostatistics Department , "Iuliu Haţieganu" University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Cristina Mogoșan
- a Drug Information Research Center , "Iuliu Haţieganu" University of Medicine and Pharmacy , Cluj-Napoca , Romania
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18
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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.
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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
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19
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Jonker CJ, van den Berg HM, Kwa MS, Hoes AW, Mol PG. Registries supporting new drug applications. Pharmacoepidemiol Drug Saf 2017; 26:1451-1457. [PMID: 28983992 PMCID: PMC5725674 DOI: 10.1002/pds.4332] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 08/28/2017] [Accepted: 09/08/2017] [Indexed: 11/07/2022]
Abstract
PURPOSE Knowledge of the benefits and risks of new drugs is incomplete at the time of marketing approval. Registries offer the possibility for additional, post-approval, data collection. For all new drugs, which were approved in the European Union between 2007 and 2010, we reviewed the frequency, the type, and the reason for requiring a registry. METHODS The European Public Assessment Reports, published on the website of the European Medicine Agency, were reviewed for drugs approved by the Committee for Medicinal Products for Human Use. We searched for key characteristics of these drugs, including therapeutic area (ATC1 level), level of innovation (the score is an algorithm based on availability of treatment and therapeutic effect), and procedural characteristics. In addition, we identified if these registries were defined by disease (disease registry) or exposure to a single drug (drug registry). RESULTS Out of 116 new drugs approved in the predefined period, for 43 (37%), 1 to 6 registry studies were identified, with a total of 73 registries. Of these 46 were disease registries and 27 (single) drug registries. For 9 drugs, the registry was a specific obligation imposed by the regulators. The level of innovation and the orphan status of the drugs were determinants positively predicting post-approval registries (OR 10.3 [95% CI 1.0-103.9] and OR 2.8 [95% CI 1.0-7.5], respectively). CONCLUSIONS The majority of registries required by regulators are existing disease registries. Registries are an important and frequently used tool for post-approval data collection for orphan and innovative drugs.
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Affiliation(s)
- Carla J. Jonker
- Dutch Medicines Evaluation Board (CBG‐MEB)UtrechtThe Netherlands
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - H. Marijke van den Berg
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Marcel S.G. Kwa
- Dutch Medicines Evaluation Board (CBG‐MEB)UtrechtThe Netherlands
| | - Arno W. Hoes
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Peter G.M. Mol
- Dutch Medicines Evaluation Board (CBG‐MEB)UtrechtThe Netherlands
- Department of Clinical Pharmacy and PharmacologyUniversity Medical Center GroningenGroningenThe Netherlands
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20
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Vaitaitis GM, Waid DM, Yussman MG, Wagner DH. CD40-mediated signalling influences trafficking, T-cell receptor expression, and T-cell pathogenesis, in the NOD model of type 1 diabetes. Immunology 2017; 152:243-254. [PMID: 28542921 DOI: 10.1111/imm.12761] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 04/27/2017] [Accepted: 05/08/2017] [Indexed: 12/23/2022] Open
Abstract
CD40 plays a critical role in the pathogenesis of type 1 diabetes (T1D). The mechanism of action, however, is undetermined, probably because CD40 expression has been grossly underestimated. CD40 is expressed on numerous cell types that now include T cells and pancreatic β cells. CD40+ CD4+ cells [T helper type 40 (TH40)] prove highly pathogenic in NOD mice and in translational human T1D studies. We generated BDC2.5.CD40-/- and re-derived NOD.CD154-/- mice to better understand the CD40 mechanism of action. Fully functional CD40 expression is required not only for T1D development but also for insulitis. In NOD mice, TH40 cell expansion in pancreatic lymph nodes occurs before insulitis and demonstrates an activated phenotype compared with conventional CD4+ cells, apparently regardless of antigen specificity. TH40 T-cell receptor (TCR) usage demonstrates increases in several Vα and Vβ species, particularly Vα3.2+ that arise early and are sustained throughout disease development. TH40 cells isolated from diabetic pancreas demonstrate a relatively broad TCR repertoire rather than restricted clonal expansions. The expansion of the Vα/Vβ species associated with diabetes depends upon CD40 signalling; NOD.CD154-/- mice do not expand the same TCR species. Finally, CD40-mediated signals significantly increase pro-inflammatory Th1- and Th17-associated cytokines whereas CD28 co-stimulus alternatively promotes regulatory cytokines.
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Affiliation(s)
- Gisela M Vaitaitis
- The Webb-Waring Center, The University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Dan M Waid
- The Webb-Waring Center, The University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Martin G Yussman
- The Webb-Waring Center, The University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - David H Wagner
- The Webb-Waring Center, The University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Division of Pulmonary Sciences and Critical Care, Department of Medicine, The University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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21
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Cohet C, Rosillon D, Willame C, Haguinet F, Marenne MN, Fontaine S, Buyse H, Bauchau V, Baril L. Challenges in conducting post-authorisation safety studies (PASS): A vaccine manufacturer's view. Vaccine 2017; 35:3041-3049. [PMID: 28465097 DOI: 10.1016/j.vaccine.2017.04.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/13/2017] [Accepted: 04/20/2017] [Indexed: 12/23/2022]
Abstract
Post-authorisation safety studies (PASS) of vaccines assess or quantify the risk of adverse events following immunisation that were not identified or could not be estimated pre-licensure. The aim of this perspective paper is to describe the authors' experience in the design and conduct of twelve PASS that contributed to the evaluation of the benefit-risk of vaccines in real-world settings. We describe challenges and learnings from selected PASS of rotavirus, malaria, influenza, human papillomavirus and measles-mumps-rubella-varicella vaccines that assessed or identified potential or theoretical risks, which may lead to changes to risk management plans and/or to label updates. Study settings include the use of large healthcare databases and de novo data collection. PASS methodology is influenced by the background incidence of the outcome of interest, vaccine uptake, availability and quality of data sources, identification of the at-risk population and of suitable comparators, availability of validated case definitions, and the frequent need for case ascertainment in large databases. Challenges include the requirement for valid exposure and outcome data, identification of, and access to, adequate data sources, and mitigating limitations including bias and confounding. Assessing feasibility is becoming a key step to confirm that study objectives can be met in a timely manner. PASS provide critical information for regulators, public health agencies, vaccine manufacturers and ultimately, individuals. Collaborative approaches and synergistic efforts between vaccine manufacturers and key stakeholders, such as regulatory and public health agencies, are needed to facilitate access to data, and to drive optimal study design and implementation, with the aim of generating robust evidence.
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22
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Engel P, Almas MF, De Bruin ML, Starzyk K, Blackburn S, Dreyer NA. Lessons learned on the design and the conduct of Post-Authorization Safety Studies: review of 3 years of PRAC oversight. Br J Clin Pharmacol 2016; 83:884-893. [PMID: 27780289 DOI: 10.1111/bcp.13165] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/18/2016] [Accepted: 10/23/2016] [Indexed: 01/03/2023] Open
Abstract
AIMS To describe and characterize the first cohort of Post-Authorization Safety Study (PASS) protocols reviewed under the recent European pharmacovigilance legislation. METHODS A systematic approach was used to compile all publicly available information on PASS protocols and assessments submitted from July 2012 to July 2015 from Pharmacovigilance Risk Assessment Committee (PRAC) minutes, European Medicines Agency (EMA) and European Network of Pharmacovigilance and Pharmacoepidemiology (ENCePP) webpages. RESULTS During the study period, 189 different PASS protocols were submitted to the PRAC, half of which were entered in the ENCePP electronic register of post-authorization studies (EU-PAS) by July 2015. Those protocols were assessed during 353 PRAC reviews. The EMA published only 31% of the PRAC feedback, of which the main concerns were study design (37%) and feasibility (30%). Among the 189 PASS, slightly more involved primary data capture (58%). PASS assessing drug utilization mainly leveraged secondary data sources (58%). The majority of the PASS did not include a comparator (65%) and 35% of PASS also evaluated clinical effectiveness endpoints. CONCLUSIONS To the best of our knowledge this is the first comprehensive review of three years of PASS protocols submitted under the new pharmacovigilance legislation. Our results show that both EMA and PASS sponsors could respectively increase the availability of protocol assessments and documents in the EU-PAS. Protocol content review and the high number of PRAC comments related to methodological issues and feasibility concerns should raise awareness among PASS stakeholders to design more thoughtful studies according to pharmacoepidemiological principles and existing guidelines.
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Affiliation(s)
- Pierre Engel
- Real-World Insights, QuintilesIMS, Saint Ouen, France
| | | | - Marieke Louise De Bruin
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands.,Copenhagen Centre for Regulatory Science (CORS), University of Copenhagen, Denmark
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23
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Mühlbauer B. [Adaptive licensing - a threat to patient safety?]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2016; 112 Suppl 1:S34-S37. [PMID: 27320027 DOI: 10.1016/j.zefq.2016.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In 2014, a pilot project of the European licensing authority EMA was launched to explore new ways to license medicinal products. The intention of this project is to open up gradual ("adaptive") licensing pathways, with pharmaceutical developing preparations gaining market authorization on the basis of clearly lower-level evidence of effectiveness and risk of damage than before. Their market authorization shall, initially, be restricted, for example, to subpopulations of patients or to selected indications. When new data from subsequent become available, the extension of the authorization shall follow in a stepwise manner. Data from investigations using less valid methodology shall also find consideration, such as, for example data from uncontrolled studies. The experience with accelerated market access, which is already being offered by several drug authorities, may give rise to concerns about the use of procedures that keep drugs with a negative benefit-risk relation for the patients in the market for many years - apart from the costs for the healthcare system. It is unacceptable that manufacturers will be exempt from (strict) liability for these adaptively licensed pharmaceuticals. If patients suffer damage from taking these medications, they cannot even expect material compensation.
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Affiliation(s)
- Bernd Mühlbauer
- Institut für Pharmakologie, Gesundheit Nord GmbH, Bremen, Germany.
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24
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Bouvy JC, Huinink L, De Bruin ML. Benefit-risk reassessment of medicines: a retrospective analysis of all safety-related referral procedures in Europe during 2001-2012. Pharmacoepidemiol Drug Saf 2016; 25:1004-14. [DOI: 10.1002/pds.4011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/04/2016] [Accepted: 03/19/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Jacoline C. Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science; Utrecht University; Utrecht The Netherlands
- Institute for Medical Technology Assessment (iMTA), Faculty of Health, Policy and Management; Erasmus University Rotterdam; Rotterdam The Netherlands
| | - Lotte Huinink
- Institute for Medical Technology Assessment (iMTA), Faculty of Health, Policy and Management; Erasmus University Rotterdam; Rotterdam The Netherlands
| | - Marie L. De Bruin
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science; Utrecht University; Utrecht The Netherlands
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Laroche ML, Batz A, Géniaux H, Féchant C, Merle L, Maison P. La pharmacovigilance européenne : place du Comité pour l’évaluation des risques en matière de pharmacovigilance (Pharmacovigilance Risk Assessment Committee – PRAC) dans l’organisation et le processus décisionnel. Therapie 2016. [DOI: 10.1016/j.therap.2015.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pinheiro L, Blake K, Januskiene J, Yue QY, Arlett P. Geographical variation in reporting Interstitial Lung Disease as an adverse drug reaction: findings from an European Medicines Agency analysis of reports in EudraVigilance. Pharmacoepidemiol Drug Saf 2016; 25:705-12. [PMID: 27004571 DOI: 10.1002/pds.3998] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/17/2016] [Accepted: 02/21/2016] [Indexed: 01/14/2023]
Abstract
PURPOSE Clinically, interstitial lung disease (ILD) is a heterogeneous group of over 150 respiratory disorders. In the context of its signal evaluation work, the European Medicines Agency's (EMA) Pharmacovigilance Risk Assessment Committee (PRAC) has seen geographic clustering of case reports of ILD from Japan. To explore this further, EudraVigilance (EV), the EMA's database of adverse drug reactions (ADRs), was analysed. The results have been used to inform on implications for pharmacovigilance including signal detection and evaluation activities. METHODS EV was queried for reports of respiratory ADRs coded using MedDRA for the period 1994-2014 for all medicinal products. Descriptive statistics and non-parametric (chi-square) independence tests were produced to compare reporting of ILD from Japan versus the rest of the world. RESULTS As of 31 December 2014, there were 26 551 case reports of ILD in EV of which 17 526 (66%) originated in Japan. The reporting rate of ILD for Japan has been consistently higher over the period. The odds that a case report from Japan in EV refers to ILD is OR = 20.7, 95% CI 20.2, 21.3 (p < 0.001), compared to OR = 0.60, 95% CI 0.54, 0.67 (p < 0.001) for pulmonary fibrosis. CONCLUSIONS A geographic imbalance between Japan and the rest of the world in reporting respiratory ADRs as ILD is confirmed. Consequently, the PRAC has developed approaches to address this in relation to signals of ILD it assesses to allow for more targeted risk minimisation including updates to the product information in the EU setting. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Luis Pinheiro
- European Medicines Agency, Inspections and Human Medicines Pharmacovigilance Division, London, United Kingdom of Great Britain and Northern Ireland
| | - Kevin Blake
- European Medicines Agency, Inspections and Human Medicines Pharmacovigilance Division, London, United Kingdom of Great Britain and Northern Ireland
| | - Justina Januskiene
- European Medicines Agency, Inspections and Human Medicines Pharmacovigilance Division, London, United Kingdom of Great Britain and Northern Ireland
| | - Qun-Ying Yue
- Läkemedelsverket (Medical Product Agency Sweden), Pharmacovigilance, Uppsala, Sweden
| | - Peter Arlett
- European Medicines Agency, Inspections and Human Medicines Pharmacovigilance Division, London, United Kingdom of Great Britain and Northern Ireland
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Laroche ML, Batz A, Géniaux H, Féchant C, Merle L, Maison P. Pharmacovigilance in Europe: Place of the Pharmacovigilance Risk Assessment Committee (PRAC) in organisation and decisional processes. Therapie 2016; 71:161-9. [PMID: 27080834 DOI: 10.1016/j.therap.2016.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/16/2015] [Indexed: 11/28/2022]
Abstract
The new European legislation that came into force in July 2012 reinforced the organisation of pharmacovigilance by setting up a committee in charge of risk assessment for medicines, the Pharmacovigilance Risk Assessment Committee (PRAC). The PRAC has a remit covering the assessment of all aspects of the safety and the risk management of medicinal products for human use in the European Union. It deals with issues regarding pharmacovigilance signals, the periodic evaluation of benefit/risk reports from marketing authorization holders (MAH), risk management plans, post-marketing studies, variations or renewals of marketing authorisations, management of under surveillance drugs lists, inspections for pharmacovigilance reasons and audits of pharmacovigilance systems. The PRAC works with the pharmacovigilance systems of the European Member States, which draw up evaluation reports. These evaluations are circulated and discussed by Member States so as to issue recommendations, which serve as a basis for other European medicines committees, the Committee for Medicinal Products for Human Use (CHMP) or the Coordination Group for Mutual Recognition and Decentralised Procedures-Human (CMDh) which then give their opinion. The final decision, which applies to all Member States and to the concerned MAH, lies with the European Commission (EC). This decisional procedure thus rests on coordination involving the PRAC, the CHMP, the CMDh, the EC, the Member States and the pharmaceutical companies. In the 3 years from July 2012, the PRAC has processed nearly 4500 procedures and is still facing an increasing workload.
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Affiliation(s)
- Marie-Laure Laroche
- Centre régional de pharmacovigilance, de pharmacoépidémiologie et d'information sur les médicaments, CHU de Limoges, 87042 Limoges, France; Faculté de médecine, université de Limoges, 87042 Limoges, France.
| | - Arnaud Batz
- Direction de la surveillance, Agence nationale de sécurité du médicament et des produits de santé (ANSM), 93285 Saint-Denis, France
| | - Hélène Géniaux
- Centre régional de pharmacovigilance, de pharmacoépidémiologie et d'information sur les médicaments, CHU de Limoges, 87042 Limoges, France; Faculté de médecine, université de Limoges, 87042 Limoges, France
| | - Corinne Féchant
- Direction de la surveillance, Agence nationale de sécurité du médicament et des produits de santé (ANSM), 93285 Saint-Denis, France
| | - Louis Merle
- Centre régional de pharmacovigilance, de pharmacoépidémiologie et d'information sur les médicaments, CHU de Limoges, 87042 Limoges, France; Faculté de médecine, université de Limoges, 87042 Limoges, France
| | - Patrick Maison
- Direction de la surveillance, Agence nationale de sécurité du médicament et des produits de santé (ANSM), 93285 Saint-Denis, France
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Dal Pan GJ, Arlett PR. The US Food and Drug Administration-European Medicines Agency collaboration in pharmacovigilance: common objectives and common challenges. Drug Saf 2015; 38:13-5. [PMID: 25539878 DOI: 10.1007/s40264-014-0259-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
On 19 February 2014, the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) announced the formation of a cluster on pharmacovigilance topics. The cluster is designed to complement, and not replace, other international activities in this field. It builds upon years of interactions between the two agencies. The creation of the cluster formalizes this longstanding and productive relationship and facilitates more systematic exchange of information and expertise.
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Jullian S, Jaskiewicz L, Pfannkuche HJ, Parker J, Lalande-Luesink I, Lewis DJ, Close P. Aggregate analysis of regulatory authority assessors' comments to improve the quality of periodic safety update reports. Pharmacoepidemiol Drug Saf 2015; 24:971-9. [PMID: 26175055 DOI: 10.1002/pds.3818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 05/07/2015] [Accepted: 05/27/2015] [Indexed: 11/11/2022]
Abstract
PURPOSE Marketing authorization holders (MAHs) are expected to provide high-quality periodic safety update reports (PSURs) on their pharmaceutical products to health authorities (HAs). We present a novel instrument aiming at improving quality of PSURs based on standardized analysis of PSUR assessment reports (ARs) received from the European Union HAs across products and therapeutic areas. METHODS All HA comments were classified into one of three categories: "Request for regulatory actions," "Request for medical and scientific information," or "Data deficiencies." The comments were graded according to their impact on patients' safety, the drug's benefit-risk profile, and the MAH's pharmacovigilance system. RESULTS A total of 476 comments were identified through the analysis of 63 PSUR HA ARs received in 2013 and 2014; 47 (10%) were classified as "Requests for regulatory actions," 309 (65%) as "Requests for medical and scientific information," and 118 (25%) comments were related to "Data deficiencies." The most frequent comments were requests for labeling changes (35 HA comments in 19 ARs). The aggregate analysis revealed commonly raised issues and prompted changes of the MAH's procedures related to the preparation of PSURs. CONCLUSION The authors believe that this novel instrument based on the evaluation of PSUR HA ARs serves as a valuable mechanism to enhance the quality of PSURs and decisions about optimization of the use of the products and, therefore, contributes to improve further the MAH's pharmacovigilance system and patient safety.
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Affiliation(s)
- Sandra Jullian
- Drug Safety and Epidemiology, Novartis Pharma AG, Basel, Switzerland
| | - Lukasz Jaskiewicz
- Drug Safety and Epidemiology, Novartis Pharma AG, Basel, Switzerland
| | | | - Jeremy Parker
- Drug Safety and Epidemiology, Novartis Pharma AG, Basel, Switzerland
| | | | - David J Lewis
- Drug Safety and Epidemiology, Novartis Pharma AG, Basel, Switzerland.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, England
| | - Philippe Close
- European Qualified Person for Pharmacovigilance, Novartis Pharma Produktions GmbH, Wehr, Germany.,Chief Medical Office, Novartis Pharma AG, Basel, Switzerland
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Pacurariu AC, Coloma PM, van Haren A, Genov G, Sturkenboom MCJM, Straus SMJM. A description of signals during the first 18 months of the EMA pharmacovigilance risk assessment committee. Drug Saf 2015; 37:1059-66. [PMID: 25398646 DOI: 10.1007/s40264-014-0240-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVE New pharmacovigilance legislation in the European Union has underlined the importance of signal management, giving the European Medicines Agency's newly established Pharmacovigilance Risk Assessment Committee (PRAC) the mandate to oversee all aspects of the use of medicinal products including detection, assessment, minimization, and communication relating to the risk of adverse reactions. In this study, we describe the signals as brought to the PRAC during the first 18 months of its operation and the ensuing regulatory actions. METHODS Data were collected from publicly available sources, for the period July 2012-December 2013, classified according to predefined rules, and described using the appropriate descriptive statistics. Suspected adverse drug reactions were categorized into the Medical Dictionary for Regulatory Affairs and drug names were mapped to the Anatomical Therapeutic Chemical codes. RESULTS During the study period, 125 signals concerning 96 medicinal products were discussed by the PRAC. The majority of signals were triggered by spontaneous reports (62%) and the median drug age (since marketing authorization) for drugs that prompted a signal was 12 years, significantly less compared with drugs that had no signal within the same period (20 years). The mean time until a decision was reached by the PRAC was 75 days (median 30 days, range 0-273) with 43% of all decisions taken during the first meeting. The decisions to start a referral and to send a direct healthcare professional communication took the least amount of time [54 days (median 27 days, range 0-186) and 51 days (median 0 days, range 0-153)]. CONCLUSIONS The importance of spontaneous reporting in signal detection and monitoring of safety issues throughout the entire life cycle of a medicinal product is confirmed in this study. The amount of time a drug has been on the market is correlated with the number of signals detected. The PRAC decision-making process seems efficient particularly with respect to serious concerns; its role in improving signal prioritization and real-time signal management will be further clarified in its subsequent years of operation.
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Affiliation(s)
- Alexandra C Pacurariu
- Department of Medical Informatics, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Arlett P, Postigo R, Janssen H, Spooner A. Periodic Benefit-Risk Evaluation Report: A European Union Regulatory Perspective. Pharmaceut Med 2014. [DOI: 10.1007/s40290-014-0071-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Thompson A, Komparic A, Smith MJ. Ethical considerations in post-market-approval monitoring and regulation of vaccines. Vaccine 2014; 32:7171-4. [PMID: 25454882 DOI: 10.1016/j.vaccine.2014.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 09/21/2014] [Accepted: 10/03/2014] [Indexed: 11/18/2022]
Abstract
The objective of this paper is to identify and articulate ethical considerations to help guide decision-making around the regulation and monitoring of vaccines post-licensure. While these considerations are not intended to be an exhaustive account of the ethical concerns, they can facilitate the explicit examination of ethical issues in this context. We identify the protection of public from harm as the primary consideration, and identify others that help in the discharging of this governmental obligation. Others include: transparency, a publicly acceptable risk-benefit profile, public trust, minimization of stigma, and special obligations to vulnerable populations. Regulators and researchers can use these ethical considerations to help enhance their reasoning and to improve the accountability of their decision-making. These considerations can be used to inform rational deliberations about how to balance the obligation to protect the public from harm with other relevant considerations such as the need to be transparent, while taking into account the contextual features of the situation. Further research and debate on the relevance and refinement of these ethical considerations is desirable.
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Affiliation(s)
- Alison Thompson
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, Canada M5S 3M2; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, Canada M5T 3M7; University of Toronto Joint Centre for Bioethics, 155 College Street, Toronto, ON, Canada M5T 3M7.
| | - Ana Komparic
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, Canada M5S 3M2; University of Toronto Joint Centre for Bioethics, 155 College Street, Toronto, ON, Canada M5T 3M7.
| | - Maxwell J Smith
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, Canada M5T 3M7; University of Toronto Joint Centre for Bioethics, 155 College Street, Toronto, ON, Canada M5T 3M7.
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Risk Management Plans as a Tool for Proactive Pharmacovigilance: A Cohort Study of Newly Approved Drugs in Europe. Clin Pharmacol Ther 2014; 96:723-31. [DOI: 10.1038/clpt.2014.184] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/12/2014] [Indexed: 12/28/2022]
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