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de Vogel S, Seeger JD, Arana A, Margulis AV, McQuay LJ, Perez-Gutthann S, Hallas J, Kristiansen NS, Linder M, Odsbu I, Suehs B, Xu Y, Uribe C, Appenteng K, Robinson NJ. Lessons learned from a multi-data source research collaboration: The mirabegron post-authorization safety study program. Pharmacoepidemiol Drug Saf 2024; 33:e5799. [PMID: 38680102 DOI: 10.1002/pds.5799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/07/2024] [Accepted: 04/04/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Many factors contribute to developing and conducting a successful multi-data source, non-interventional, post-authorization safety study (NI-PASS) for submission to multiple health authorities. Such studies are often large undertakings; evaluating and sharing lessons learned can provide useful insights to others considering similar studies. OBJECTIVES We discuss challenges and key methodological and organizational factors that led to the delivery of a successful post-marketing requirement (PMR)/PASS program investigating the risk of cardiovascular and cancer events among users of mirabegron, an oral medication for the treatment of overactive bladder. RESULTS We provide context and share learnings, including sections on research program collaboration, scientific transparency, organizational approach, mitigation of uncertainty around potential delays, validity of study outcomes, selection of data sources and optimizing patient numbers, choice of comparator groups and enhancing precision of estimates of associations, potential confounding and generalizability of study findings, and interpretation of results. CONCLUSIONS This large PMR/PASS program was a long-term commitment from all parties and benefited from an effective coordinating center and extensive scientific interactions across research partners, scientific advisory board, study sponsor, and health authorities, and delivered useful learnings related to the design and organization of multi-data source NI-PASS.
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Affiliation(s)
- Stefan de Vogel
- Pharmacovigilance, Astellas Pharma B.V., Leiden, The Netherlands
| | | | | | | | - Lisa J McQuay
- Epidemiology, RTI Health Solutions, Research Triangle Park, Durham, North Carolina, USA
| | | | - Jesper Hallas
- Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Marie Linder
- Medicine, Centre for Pharmacoepidemiology, Karolinska Institutet, Solna, Sweden
| | - Ingvild Odsbu
- Medicine, Centre for Pharmacoepidemiology, Karolinska Institutet, Solna, Sweden
| | - Brandon Suehs
- Health Economics and Outcomes Research, Humana Healthcare Research, Louisville, Kentucky, USA
| | - Yihua Xu
- Health Economics and Outcomes Research, Humana Healthcare Research, Louisville, Kentucky, USA
| | - Claudia Uribe
- Health Economics and Outcomes Research, Humana Healthcare Research, Louisville, Kentucky, USA
| | - Kwame Appenteng
- Pharmacovigilance, Astellas Pharma US, Northbrook, Illinois, USA
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Axfors C, Patel CJ, Ioannidis JPA. Published registry-based pharmacoepidemiologic associations show limited concordance with agnostic medication-wide analyses. J Clin Epidemiol 2023; 160:33-45. [PMID: 37224981 DOI: 10.1016/j.jclinepi.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/13/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To assess how the results of published national registry-based pharmacoepidemiology studies (where select associations are of interest) compare with an agnostic medication-wide approach (where all possible drug associations are tested). STUDY DESIGN AND SETTING We systematically searched for publications that reported drug associations with any, breast, colon/colorectal, or prostate cancer in the Swedish Prescribed Drug Registry. Results were compared against a previously performed agnostic medication-wide study on the same registry. PROTOCOL https://osf.io/kqj8n. RESULTS Most published studies (25/32) investigated previously reported associations. 421/913 (46%) associations had statistically significant results. 134 of the 162 unique drug-cancer associations could be paired with 70 associations in the agnostic study (corresponding drug categories and cancer types). Published studies reported smaller effect sizes and absolute effect sizes than the agnostic study, and generally used more adjustments. Agnostic analyses were less likely to report statistically significant protective associations (based on a multiplicity-corrected threshold) than their paired associations in published studies (McNemar odds ratio 0.13, P = 0.0022). Among 162 published associations, 36 (22%) showed increased risk signal and 25 (15%) protective signal at P < 0.05, while for agnostic associations, 237 (11%) showed increased risk signal and 108 (5%) protective signal at a multiplicity-corrected threshold. Associations belonging to drug categories targeted by individual published studies vs. nontargeted had smaller average effect sizes; smaller P values; and more frequent risk signals. CONCLUSION Published pharmacoepidemiology studies using a national registry addressed mostly previously proposed associations, were mostly "negative", and showed only modest concordance with their respective agnostic analyses in the same registry.
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Affiliation(s)
- Cathrine Axfors
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA; Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Chirag J Patel
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - John P A Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA; Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, Stanford University, Stanford, CA, USA
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Kristensen KB, Friis S, Lund LC, Hallas J, Cardwell CR, Andreassen BK, Habel LA, Pottegård A. Identification of Drug-Cancer Associations: A Nationwide Screening Study. CANCER RESEARCH COMMUNICATIONS 2022; 2:552-560. [PMID: 36923552 PMCID: PMC10010324 DOI: 10.1158/2767-9764.crc-22-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/24/2022] [Accepted: 06/09/2022] [Indexed: 11/16/2022]
Abstract
The main tool in drug safety monitoring, spontaneous reporting of adverse effects, is unlikely to detect delayed adverse drug effects including cancer. Hypothesis-free screening studies based on administrative data could improve ongoing drug safety monitoring. Using Danish health registries, we conducted a series of case-control studies by identifying individuals with incident cancer in Denmark from 2001 to 2018, matching each case with 10 population controls on age, sex, and calendar time. ORs were estimated using conditional logistic regression accounting for matching factors, educational level, and selected comorbidities. A total of 13,577 drug-cancer associations were examined for individual drugs and 8,996 for drug classes. We reviewed 274 drug-cancer pairs where an association with high use and a cumulative dose-response pattern was present. We classified 65 associations as not readily attributable to bias of which 20 were established as carcinogens by the International Agency for Research on Cancer and the remaining 45 associations may warrant further study. The screening program identified drugs with known carcinogenic effects and highlighted a number of drugs that were not established as carcinogens and warrant further study. The effect estimates in this study should be interpreted cautiously and will need confirmation targeted epidemiologic and translational studies. Significance This study provides a screening tool for drug carcinogenicity aimed at hypothesis generation and explorative purposes. As such, the study may help to identify drugs with unknown carcinogenic effects and, ultimately, improve drug safety as part of the ongoing safety monitoring of drugs.
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Affiliation(s)
- Kasper Bruun Kristensen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Søren Friis
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Lars Christian Lund
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Hallas
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Chris R. Cardwell
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | | | - Laurel A. Habel
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Anton Pottegård
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Krhut J, Skugarevská B, Míka D, Lund L, Zvara P. Clinical Utility of β3-Adrenoreceptor Agonists for the Treatment of Overactive Bladder: A Review of the Evidence and Current Recommendations. Res Rep Urol 2022; 14:167-175. [PMID: 35502186 PMCID: PMC9056051 DOI: 10.2147/rru.s309144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/03/2022] [Indexed: 11/29/2022] Open
Abstract
This nonsystematic review provides a summary of current evidence on the use of β3-adrenoreceptor agonists (β3-ARAs) for the treatment for lower urinary tract symptoms. Soon after their discovery in 1989, β3-ARs were identified as a predominant adrenoreceptor subtype in the human urinary bladder. Although it is widely believed that β3-ARAs cause detrusor relaxation, the effect on bladder afferent signaling likely plays an important role in their mechanism of action as well. In 2011 and 2012, mirabegron was approved for clinical use in overactive bladder (OAB) patients. Pooled analysis of data from prospective randomized studies on >60,000 OAB patients showed that when compared to placebo, mirabegron was superior with respect to reducing the frequency, number, and severity of urgency episodes, number of incontinence episodes and increasing dry rate, but not in reduction of nocturia episodes. The only side effect showing significantly higher incidence than placebo was nasopharyngitis. Mirabegron is approved for OAB treatment in all age-groups and in pediatric patients with neurogenic bladder. Vibegron is another β3-ARA approved for OAB treatment in the US and Japan. Several large, multicenter, double-blind, randomized trials have documented statistically significant superiority of vibegron over placebo on all efficacy end points. Other β3-ARAs are being developed; however, to date none has been introduced to clinical use. All β3-ARAs provide efficacy similar to anticholinergics. They have a favorable safety profile and are well tolerated. Due to their different mechanisms of action, combination of β3-ARAs with anticholinergic compounds allows for increased efficacy.
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Affiliation(s)
- Jan Krhut
- Department of Urology, University Hospital, Ostrava, Czech Republic
- Department of Surgical Studies, Medical Faculty, Ostrava University, Ostrava, Czech Republic
- Correspondence: Jan Krhut, Department of Urology, University Hospital, Tř 17 Listopadu 1790, Ostrava70852, Czech Republic, Tel +420 59-737-5307, Fax +420 59-737-5301, Email
| | - Barbora Skugarevská
- Department of Urology, University Hospital, Ostrava, Czech Republic
- Department of Surgical Studies, Medical Faculty, Ostrava University, Ostrava, Czech Republic
| | - David Míka
- Department of Urology, University Hospital, Ostrava, Czech Republic
- Department of Surgical Studies, Medical Faculty, Ostrava University, Ostrava, Czech Republic
| | - Lars Lund
- Research Unit of Urology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Urology, Odense University Hospital, Odense, Denmark
| | - Peter Zvara
- Research Unit of Urology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Urology, Odense University Hospital, Odense, Denmark
- Biomedical Laboratory, University of Southern Denmark, Odense, Denmark
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