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Havet A, Bouvard C, Moskal A, Chanelière M, Massardier J, Lebrun-Vignes B, Jonville-Bera AP, Payet C, Viprey M. Compliance with the pregnancy prevention program among women initiating isotretinoin treatment between 2014 and 2021: A nationwide cohort study on the French Health Data System (SNDS). J Eur Acad Dermatol Venereol 2024. [PMID: 38764351 DOI: 10.1111/jdv.20073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/15/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Despite the French pregnancy prevention program (PPP), a considerable number of pregnancies are potentially exposed to oral isotretinoin. New measures were taken by the French Medicines Agency, including the restriction of initial isotretinoin prescriptions to dermatology specialists in May 2015 and a new information campaign on teratogenicity in January 2019. OBJECTIVES The aims were to: describe, between 2014 and 2021, compliance with PPP recommendations: isotretinoin use as a second-line treatment, first prescription by a dermatology specialist, monthly prescription renewal and pregnancy testing (PT); assess the effect of the 2015 and 2019 measures on PT compliance; and identify the determinants of PT noncompliance. METHODS A retrospective cohort study was conducted among women aged 11-50 years initiating isotretinoin between 2014 and 2021 using the French Health Data System. PT compliance corresponded to pregnancy test completion and specific delays between prescription and dispensation. Time series analyses were performed to evaluate the effect of the 2015 and 2019 measures on PT compliance, and log-binomial and Poisson multivariate regression models were used to identify the determinants of PT noncompliance. RESULTS Isotretinoin was prescribed as a second-line treatment in 64% of initiations, mainly by dermatology specialists (92%). A new monthly prescription was observed in 98% of dispensations. PT compliance reached 61%, 72% and 25% at initiation, renewals and end of treatment, respectively. The 2015 measure was associated with better PT compliance at initiation and renewals. The 2019 measure had no significant effect on PT compliance at the initiation or end of treatment but was associated with a decrease in PT compliance at renewals. Age, low socioeconomic level, initiation by a nondermatology specialist and during summer were associated with PT noncompliance. CONCLUSIONS Understanding factors associated with PT noncompliance could help to target specific subpopulations of women treated with isotretinoin.
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Affiliation(s)
- A Havet
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Service Des Données de Santé, Lyon, France
| | - C Bouvard
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - A Moskal
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - M Chanelière
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Collège Universitaire de Médecine Générale, Université Lyon 1, Villeurbanne, France
| | - J Massardier
- Service de Gynécologie-Obstétrique, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Lyon, France
| | - B Lebrun-Vignes
- Service de Pharmacologie, Centre Régional de Pharmacovigilance, Hôpital Pitié-Salpêtrière, AP-HP, GH Sorbonne Université, Paris, France
| | - A-P Jonville-Bera
- Centre Régional de Pharmacovigilance, CHRU de Tours, Hôpital Bretonneau, Tours, France
| | - C Payet
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Service Des Données de Santé, Lyon, France
| | - M Viprey
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Service Des Données de Santé, Lyon, France
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Gerhardy L, Nassar N, Litchfield M, Kennedy D, Smith A, Gillies MB, Pearson SA, Zoega H, Shand A. Prescription retinoid and contraception use in women in Australia: A population-based study. Australas J Dermatol 2024. [PMID: 38693687 DOI: 10.1111/ajd.14294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND/OBECTIVES Oral retinoids are teratogenic, and pregnancy avoidance is an important part of retinoid prescribing. Australia does not have a standardised pregnancy prevention programme for women using oral retinoids, and the contraception strategies for women who use oral retinoids are not well understood. The objectives were to determine trends in the use of prescription retinoids among Australian reproductive-aged women and whether women dispensed oral retinoids used contraception concomitantly. METHODS This was a population-based study using Australian Pharmaceutical Benefits (PBS) dispensing claims for a random 10% sample of 15-44-year-old Australian women, 2013 - 2021. We described rates and annual trends in dispensing claims for PBS-listed retinoids and contraceptives. We also estimated concomitant oral retinoid and contraceptive use on the day of each retinoid dispensing and determined if there was a period of contraceptive treatment that overlapped. Estimates were then extrapolated to the national level. RESULTS There were 1,545,800 retinoid dispensings to reproductive-aged women; 57.1% were oral retinoids. The rate of retinoid dispensing to reproductive-aged women increased annually, from 28 dispensings per 1000 population in 2013 to 41 per 1000 in 2021. The rate of oral retinoid dispensing doubled over the study period, from 14 dispensings per 1000 population in 2013 to 28 per 1000 in 2021, while topical retinoid dispensing did not change. Only 25% of oral retinoid dispensings had evidence of concomitant contraceptive use in 2021. CONCLUSIONS Rates of oral retinoid dispensing have doubled among reproductive-aged women over the past decade. A large percentage of oral retinoid use does not appear to have concomitant contraception use, posing a risk of teratogenic effects in pregnancies.
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Affiliation(s)
- Laura Gerhardy
- Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School and Menzies Centre for Health Policy and Economics, University of Sydney, Camperdown, New South Wales, Australia
| | - Melisa Litchfield
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Debra Kennedy
- Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Annika Smith
- University of New South Wales, Darlinghurst, New South Wales, Australia
- Australia and St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Malcolm B Gillies
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Sallie-Anne Pearson
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Helga Zoega
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Antonia Shand
- Royal Hospital for Women, Randwick, New South Wales, Australia
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School and Menzies Centre for Health Policy and Economics, University of Sydney, Camperdown, New South Wales, Australia
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3
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Ivask M, Kurvits K, Uusküla M, Juppo A, Laius O, Siven M. Compliance with Pregnancy Prevention Recommendations for Isotretinoin Following the Amendment of the European Union Pregnancy Prevention Program: A Repeat Study in Estonia. Drugs Real World Outcomes 2024; 11:91-98. [PMID: 37462893 DOI: 10.1007/s40801-023-00381-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Isotretinoin, indicated for severe acne, is a potent teratogen and therefore contraindicated in pregnancy. Thus, the pregnancy prevention program (PPP) for isotretinoin has been introduced. OBJECTIVES The aim of this study was to assess the concomitant use of isotretinoin and effective contraception and the rate of potential isotretinoin-exposed pregnancies in females of childbearing age in 2017-2020 in Estonia. In addition, we aimed to evaluate whether compliance with the PPP has improved compared with the previous study conducted in Estonia covering the period of 2012-2016. METHODS This retrospective, nationwide study using prescription and healthcare claims data included 2575 females aged 15-45 years who started using isotretinoin between 2017 and 2020. RESULTS For 64.7% of females of childbearing age, no concurrent use of an effective contraceptive was detected while using isotretinoin. A moderately higher contraceptive coverage (35.3%) was observed compared with the previous study (29.7%) (p < 0.001). Complete contraception coverage was highest in females aged 30-39 years with an adjusted OR of 12.8 (p < 0.001) compared with the age group 15-19 years and 2.47 (p < 0.001) compared with the age group 20-29 years. 17 pregnancies coincided with the isotretinoin treatment-related period. The risk for potential isotretinoin-exposed pregnancy was 6.6 (95% CI 3.9-10.5) per 1000 treated females of childbearing age over the 4-year observation period. The risk for potential isotretinoin-exposed pregnancies per 1000 treated females was 1.0 in females aged 15-19 years, 11.6 in females aged 20-29 years, 8.8 in females aged 30-39 years, and 7.4 in females aged 40-45 years (p = 0.009). CONCLUSION A slight improvement in complete contraceptive coverage during isotretinoin use has not resulted in a decrease in the risk of isotretinoin-exposed pregnancies. The contraceptive usage and risk for pregnancy vary greatly across age groups, suggesting the need for a more targeted approach to improve the effectiveness of the PPP.
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Affiliation(s)
- Maaja Ivask
- Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.
- Roche International Pharmacovigilance, Roche Eesti OÜ, Tallinn, Estonia.
| | | | | | - Anne Juppo
- Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Ott Laius
- State Agency of Medicines, Tartu, Estonia
| | - Mia Siven
- Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- Helsinki Institute of Sustainability Science, HELSUS, Helsinki, Finland
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Durán CE, Riera-Arnau J, Abtahi S, Pajouheshnia R, Hoxhaj V, Gamba M, Alsina E, Martin-Perez M, Garcia-Poza P, Llorente-Garcia A, Gonzalez-Bermejo D, Ibánez L, Sabaté M, Vidal X, Ballarín E, Sanfélix-Gimeno G, Rodríguez-Bernal C, Peiró S, García-Sempere A, Sanchez-Saez F, Ientile V, Ingrasciotta Y, Guarneri C, Tanaglia M, Tari M, Herings R, Houben E, Swart-Polinder K, Holthuis E, Huerta C, Gini R, Roberto G, Bartolini C, Paoletti O, Limoncella G, Girardi A, Hyeraci G, Andersen M, Kristiansen SB, Hallgreen CE, Klungel O, Sturkenboom M. Impact of the 2018 revised Pregnancy Prevention Programme by the European Medicines Agency on the use of oral retinoids in females of childbearing age in Denmark, Italy, Netherlands, and Spain: an interrupted time series analysis. Front Pharmacol 2023; 14:1207976. [PMID: 37663263 PMCID: PMC10469888 DOI: 10.3389/fphar.2023.1207976] [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: 04/18/2023] [Accepted: 07/24/2023] [Indexed: 09/05/2023] Open
Abstract
Background: In March 2018, the European pregnancy prevention programme for oral retinoids was updated as part of risk minimisation measures (RMM), emphasising their contraindication in pregnant women. Objective: To measure the impact of the 2018 revision of the RMMs in Europe by assessing the utilisation patterns of isotretinoin, alitretinoin and acitretin, contraceptive measures, pregnancy testing, discontinuation, and pregnancy occurrence concomitantly with a retinoid prescription. Methods: An interrupted time series (ITS) analysis to compare level and trend changes after the risk minimisation measures implementation was conducted on a cohort of females of childbearing age (12-55 years of age) from January 2010 to December 2020, derived from six electronic health data sources in four countries: Denmark, Netherlands, Spain, and Italy. Monthly utilisation figures (incidence rates [IR], prevalence rates [PR] and proportions) of oral retinoids were calculated, as well as discontinuation rates, contraception coverage, pregnancy testing, and rates of exposed pregnancies to oral retinoids, before and after the 2018 RMMs. Results: From 10,714,182 females of child-bearing age, 88,992 used an oral retinoid at any point during the study period (mean age 18.9-22.2 years old). We found non-significant level and trend changes in incidence or prevalence of retinoid use in females of child-bearing age after the 2018 RMMs. The reason of discontinuation was unknown in >95% of cases. Contraception use showed a significant increase trend in Spain; for other databases this information was limited. Pregnancy testing was hardly recorded thus was not possible to model ITS analyses. After the 2018 RMM, rates of pregnancy occurrence during retinoid use, and start of a retinoid during a pregnancy varied from 0.0 to 0.4, and from 0.2 to 0.8, respectively. Conclusion: This study shows a limited impact of the 2018 RMMs on oral retinoids utilisation patterns among females of child-bearing age in four European countries. Pregnancies still occur during retinoid use, and oral retinoids are still prescribed to pregnant women. Contraception and pregnancy testing information was limited in most databases. Regulators, policymakers, prescribers, and researchers must rethink implementation strategies to avoid any pregnancy becoming temporarily related to retinoid use.
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Affiliation(s)
- Carlos E. Durán
- Julius Center for Health Sciences and Primary Care, Department of Data Science and Biostatistics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Judit Riera-Arnau
- Julius Center for Health Sciences and Primary Care, Department of Data Science and Biostatistics, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Clinical Pharmacology, Vall Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Shahab Abtahi
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Utrecht, Netherlands
| | - Romin Pajouheshnia
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Utrecht, Netherlands
| | - Vjola Hoxhaj
- Julius Center for Health Sciences and Primary Care, Department of Data Science and Biostatistics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Magdalena Gamba
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Utrecht, Netherlands
| | - Ema Alsina
- Julius Center for Health Sciences and Primary Care, Department of Data Science and Biostatistics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mar Martin-Perez
- Agencia Española de Medicamentos y Productos Sanitarios, Madrid, Spain
| | | | | | | | - Luisa Ibánez
- Department of Clinical Pharmacology, Vall Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Mònica Sabaté
- Department of Clinical Pharmacology, Vall Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Xavier Vidal
- Department of Clinical Pharmacology, Vall Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Elena Ballarín
- Department of Clinical Pharmacology, Vall Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Gabriel Sanfélix-Gimeno
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Health Services Research Unit (FISABIO - HSRU), Valencia, Spain
| | - Clara Rodríguez-Bernal
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Health Services Research Unit (FISABIO - HSRU), Valencia, Spain
| | - Salvador Peiró
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Health Services Research Unit (FISABIO - HSRU), Valencia, Spain
| | - Aníbal García-Sempere
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Health Services Research Unit (FISABIO - HSRU), Valencia, Spain
| | - Francisco Sanchez-Saez
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Health Services Research Unit (FISABIO - HSRU), Valencia, Spain
| | - Valentina Ientile
- Department of Biomedical and Dental Sciences and Morpho-functional Imaging, University of Messina, Messina, Italy
| | - Ylenia Ingrasciotta
- Section of Pharmacology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morpho-functional Imaging, University of Messina, Messina, Italy
| | - Matilde Tanaglia
- Section of Pharmacology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | | | | | | | | | - Consuelo Huerta
- Department of Public Health and Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Rosa Gini
- Agenzia Regionale di Sanità Della Toscana (ARS), Florence, Italy
| | - Giuseppe Roberto
- Agenzia Regionale di Sanità Della Toscana (ARS), Florence, Italy
| | | | - Olga Paoletti
- Agenzia Regionale di Sanità Della Toscana (ARS), Florence, Italy
| | | | - Anna Girardi
- Agenzia Regionale di Sanità Della Toscana (ARS), Florence, Italy
| | - Giulia Hyeraci
- Agenzia Regionale di Sanità Della Toscana (ARS), Florence, Italy
| | - Morten Andersen
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sarah Brøgger Kristiansen
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christine Erikstrup Hallgreen
- Copenhagen Centre for Regulatory Science, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Olaf Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Utrecht, Netherlands
| | - Miriam Sturkenboom
- Julius Center for Health Sciences and Primary Care, Department of Data Science and Biostatistics, University Medical Center Utrecht, Utrecht, Netherlands
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Hughes JE, Buckley N, Looney Y, Kirwan G, Mullooly M, Bennett KE. Evaluating awareness, knowledge and practice of healthcare professionals following implementation of a revised pregnancy prevention programme for isotretinoin in Ireland: A multi-stakeholder cross-sectional study. Pharmacoepidemiol Drug Saf 2023; 32:137-147. [PMID: 36073295 PMCID: PMC10092126 DOI: 10.1002/pds.5538] [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] [Received: 03/01/2022] [Revised: 08/10/2022] [Accepted: 09/05/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE In 2018, following an EU-wide safety review, a revised pregnancy prevention programme (PPP) was introduced for isotretinoin (Roaccutane®). This study aimed to examine awareness, knowledge, and experience implementing the revised isotretinoin PPP in clinical practice across three healthcare professional (HCP) groups in Ireland. METHODS A cross-sectional study using anonymous online surveys among general practitioners (GPs), community pharmacists, and specialist consultants was undertaken. Descriptive analyses are presented. RESULTS Across all HCP groups there was high (≥87%) awareness that oral isotretinoin is contraindicated in women of childbearing potential (WCBP) unless the conditions of the PPP are fulfilled, but varying awareness among GPs (54.9%) and community pharmacists (45.9%) that exposure during pregnancy can cause both severe fetal malformations and spontaneous abortions. Implementation of the PPP in clinical practice varied across HCP groups. When initiating isotretinoin in WCBP, 66.7% of specialists and 40.8% of GPs indicated they had considered alternative treatment options, and 71.4% of specialists and 31.6% of GPs reported they first requested a pregnancy test. There was limited provision of the patient reminder card to WCBP, where 26.1% of community pharmacists provide this at each dispensing, while 47.6% of specialists and 11.8% of GPs ensured WCBP had a copy of the card when initiating treatment. Across all HCP groups, there was high (≥81.6%) awareness of the need for urgent consultation and immediate cessation of isotretinoin in the event of an unplanned or suspected pregnancy. CONCLUSIONS Reinforcement of the provision and utilisation of the isotretinoin patient reminder card may be required, and further targeted education on specific elements of the PPP should be considered for GPs and community pharmacists.
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Affiliation(s)
- John E Hughes
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Niamh Buckley
- Health Products Regulatory Authority, Kevin O'Malley House, Earlsfort Terrace, Dublin 2, Ireland
| | - Yvonne Looney
- Health Products Regulatory Authority, Kevin O'Malley House, Earlsfort Terrace, Dublin 2, Ireland
| | - Gráinne Kirwan
- Health Products Regulatory Authority, Kevin O'Malley House, Earlsfort Terrace, Dublin 2, Ireland
| | - Maeve Mullooly
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Kathleen E Bennett
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland.,Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
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6
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Vona-Giralt G, Vilaplana-Carnerero C, Ouchi D, Gomez-Lumbreras A, Morros R, Giner-Soriano M. Risk of psychiatric events in women treated with isotretinoin: a self-controlled study with SIDIAP database. Expert Opin Drug Saf 2022; 22:213-219. [PMID: 36045482 DOI: 10.1080/14740338.2022.2120608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Since isotretinoin marketing, reports of psychiatric events have been noted. Howeverto date, a relation between these events and acne or isotretinoin treatment has not been clearly established. Our objective was to analyze the incidence of psychiatric events in women receiving isotretinoin. METHODS Self-controlled study including women treated with isotretinoin from July 2014 to December 2018. Data source was SIDIAP, a primary health care-based database from Catalonia, Spain. Risk of psychiatric events was analyzed during the isotretinoin exposure and during the previous and posterior periods of non-exposure. RESULTS We included 4,738 women in the study, 25.3% of them had history psychiatric disorders prior to receiving isotretinoin. During the follow-up, 782 (16.5%) patients were diagnosed with new mental disorders and 925 (19.5%) received new psychotropic drug prescriptions. We found a trend to an increase of new events when the previous non-exposure and the isotretinoin exposure periods were compared, with no significant differences. Incident psychiatric events during isotretinoin exposure was significantly higher in those patients with previous psychiatric history. CONCLUSIONS We cannot conclude any causality between acne and isotretinoin and the appearance of new psychiatric events. However, we contribute to the evidence with a more robust methodological approach, which minimizes the effect of confounding variables.
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Affiliation(s)
- Gemma Vona-Giralt
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Carles Vilaplana-Carnerero
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Dan Ouchi
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Ainhoa Gomez-Lumbreras
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Rosa Morros
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Institut Català de la Salut, Barcelona, Spain.,Plataforma SCReN, UICEC IDIAP Jordi Gol, Barcelona, Spain
| | - Maria Giner-Soriano
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
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7
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Sarayani A, Albogami Y, Thai TN, Smolinski NE, Patel P, Wang Y, Nduaguba S, Rasmussen SA, Winterstein AG. Prenatal exposure to teratogenic medications in the era of Risk Evaluation and Mitigation Strategies. Am J Obstet Gynecol 2022; 227:263.e1-263.e38. [PMID: 35032444 DOI: 10.1016/j.ajog.2022.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Prevention of prenatal exposures to teratogenic drugs is a significant clinical and public health concern. With the enactment of the US Food and Drug Administration Amendments Act in 2007, the US Food and Drug Administration has begun to require manufacturers to implement Risk Evaluation and Mitigation Strategies to prevent prenatal exposures. Among 12 risk evaluation and mitigation strategy drugs, several had predecessor risk mitigation plans (eg, isotretinoin) and some were newly required (eg, mycophenolate). Only a small proportion of teratogenic drugs are currently subject to Risk Evaluation and Mitigation Strategies, and the extent of prenatal exposure to the universe of teratogenic drugs compared with drugs subject to Risk Evaluation and Mitigation Strategies is unknown. Moreover, the effectiveness of such advanced risk mitigation programs in preventing prenatal exposure is not clear. OBJECTIVE This study aimed to characterize the epidemiology of prenatal exposures to definite and potential teratogens during the risk evaluation and mitigation strategy era. STUDY DESIGN We constructed a time-series of pregnancies identified from a national private insurance claims database (IBM MarketScan) to estimate prenatal exposures to teratogenic drugs (2006-2017). Pregnancy outcomes, gestational age, and the onset of pregnancy were determined with previously validated algorithms. The Teratology Information Service and Clinical Pharmacology databases were used to identify drugs with definite (n=141) or potential (n=65) teratogenic effects, and drugs with debatable risks such as benzodiazepines, statins, tetracyclines, sex hormones, infertility treatments, and gonadotropin-releasing hormone analogs were excluded. We defined prenatal exposure as ≥1 prescription fill or medical encounter involving administration of drugs with a definite teratogenic risk (including 12 for which there is a "current or discontinued" risk evaluation and mitigation strategy) or a potential teratogenic risk. We evaluated secular trends and modeled the effects of age, preconception exposure, and state healthcare quality rankings on prenatal exposure, adjusting for demographic factors and clinical conditions. RESULTS The cohort included 3,445,612 pregnancies (2,532,444 live deliveries). Prenatal exposures to definite teratogens decreased slightly during the study years from 1.86 to 1.24 per 100 pregnancies between 2006 and 2017, whereas exposure increased for potential teratogens from 3.40% to 5.33%. Prenatal exposure prevalences were higher during the first trimester and for pregnancies that ended in nonlive outcomes. Drugs subject to Risk Evaluation and Mitigation Strategies had low background utilization and contributed to a small proportion of prenatal exposures (15.1 per 100,000 pregnancies). We also observed fewer prenatal exposures to risk evaluation and mitigation strategy drugs among women of childbearing age who used these treatments (0.14% vs 0.36% for any definite teratogen). Age extremes and low state-level healthcare quality rankings were independent predictors of prenatal exposure. CONCLUSION Fetuses in more than 1 in 16 pregnancies continued to be exposed to teratogenic drugs during the past decade. Drugs with Risk Evaluation and Mitigation Strategies imposed a small burden of prenatal exposure because of the low background utilization rates and lower pregnancy prevalence among women of childbearing age who used these drugs. Although the declining exposure rates to teratogenic drugs with definite risk are encouraging, the rising prenatal exposure to drugs with potential risk calls for more assessments. Future research is needed to elucidate the health outcomes of fetuses exposed to potential risk drugs, understand the effectiveness of risk evaluation and mitigation strategy programs, and prioritize teratogenic drugs for advanced risk mitigation.
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Hughes JE, Buckley N, Looney Y, Kirwan G, Curran S, Doherty CP, Mullooly M, Bennett KE. Awareness, knowledge and practice of healthcare professionals following implementation of a Pregnancy Prevention Program for sodium valproate in Ireland: a multi-stakeholder cross-sectional study. Expert Opin Drug Saf 2021; 20:965-977. [PMID: 34080507 DOI: 10.1080/14740338.2021.1933429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To establish awareness, knowledge, use and experience in practice of a sodium valproate pregnancy prevention program (PPP) in Ireland ("prevent") among three healthcare professional (HCP) groups. METHODS A cross-sectional study using anonymous online surveys was conducted among general practitioners (GPs), pharmacists, and specialist consultants. Descriptive analyses are presented. RESULTS HCP response rates were 5.8% for GPs (90/1544), 10.7% for pharmacists (219/2052), and 7.6% for specialists (17/224). Across HCP groups, there was high awareness (>90%) for specialist referral when female valproate patients are planning pregnancy, or become pregnant, but less awareness to refer annually for specialist review. While awareness of a possible teratogenic effect at any stage of pregnancy was high (>80%), most GPs (62.2%, 95% CI: 51.3, 71.9%) and community pharmacists (53.1%, 95% CI: 43.2, 62.8%) were unsure of the magnitude of risk for developmental disorders, while most specialists under-estimated this risk (46.7%, 95% CI: 24.8, 69.9%). Although >70% of the respondents identified valproate to be contraindicated in any woman of childbearing potential unless the conditions of the PPP are fulfilled, experience implementing key elements in practice varied. CONCLUSIONS Our findings suggest continued effort is needed to ensure optimal implementation of "prevent" into clinical practice in Ireland.
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Affiliation(s)
- John E Hughes
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh Buckley
- Health Products Regulatory Authority, Dublin 2, Ireland
| | - Yvonne Looney
- Health Products Regulatory Authority, Dublin 2, Ireland
| | | | - Sinead Curran
- Health Products Regulatory Authority, Dublin 2, Ireland
| | - Colin P Doherty
- Trinity College Dublin School of Medicine.,FutureNeuro, the Science Foundation Ireland (SFI) Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland
| | - Maeve Mullooly
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kathleen E Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.,RCSI Data Science Centre, Dublin 2, Ireland
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9
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Gundogan B, Dowlut N, Rajmohan S, Borrelli MR, Millip M, Iosifidis C, Udeaja YZ, Mathew G, Fowler A, Agha R. Assessing the compliance of systematic review articles published in leading dermatology journals with the PRISMA statement guidelines: A systematic review. JAAD Int 2021; 1:157-174. [PMID: 34409336 PMCID: PMC8361930 DOI: 10.1016/j.jdin.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2020] [Indexed: 11/24/2022] Open
Abstract
Background Reporting quality of systematic reviews and meta-analyses is of critical importance in dermatology because of their key role in informing health care decisions. Objective To assess the compliance of systematic reviews and meta-analyses in leading dermatology journals with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines. Methods This review was carried out in accordance with PRISMA guidelines. Included studies were reviews published across 6 years in the top 4 highest-impact-factor dermatology journals of 2017. Records and full texts were screened independently. Data analysis was conducted with univariate multivariable linear regression. The primary outcome was to assess the compliance of systematic reviews and meta-analyses in leading dermatology journals with the PRISMA statement. Results A total of 166 studies were included and mean PRISMA compliance across all articles was 73%. Compliance significantly improved over time (β = .016; P = <.001). The worst reported checklist item was item 5 (reporting on protocol existence), with a compliance of 15% of articles. Conclusion PRISMA compliance within leading dermatology journals could be improved; however, it is steadily improving.
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Affiliation(s)
- Buket Gundogan
- University College London Hospital, London, United Kingdom
| | - Naeem Dowlut
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Mimi R Borrelli
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Mirabel Millip
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Christos Iosifidis
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Yagazie Z Udeaja
- Luton and Dunstable University Hospital NHS Foundation Trust, Luton, United Kingdom
| | - Ginimol Mathew
- University College London Medical School, Gower Street, London, United Kingdom
| | | | - Riaz Agha
- Bart's Health NHS Foundation Trust, London, United Kingdom
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10
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Non-compliance with pregnancy prevention recommendations for isotretinoin in Korea between 2019-2020. Obstet Gynecol Sci 2021; 64:201-208. [PMID: 33752279 PMCID: PMC7990996 DOI: 10.5468/ogs.20247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/08/2020] [Indexed: 11/29/2022] Open
Abstract
Objective Isotretinoin is commonly prescribed worldwide despite its notorious teratogenicity. A risk management program (RMP) was introduced in Korea to prevent isotretinoin use during pregnancy. Here, we evaluate the compliance of Korean women with the recommendations of the RMP. Methods This prospective cohort study was conducted between April 2019 and June 2020. Thirty-six and 82 patients received the prescription before and after the introduction of RMP, respectively. Results There was a significant difference in the total number of days for which isotretinoin was prescribed before and after the RMP was introduced (68.8±100.9 and 28.0±26.1 days, respectively). However, 1.43% (120/8,394) of the total patients contacted by the teratology information services were exposed to isotretinoin on an average. Conclusion The proportion of patients exposed to isotretinoin did not change, and there was no significant change in compliance, with the implementation of the RMP during the study period. Further studies are needed to evaluate the effectiveness of the RMP in the long term.
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11
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Shroukh WA, Steinke DT, Willis SC. Risk management of teratogenic medicines: A systematic review. Birth Defects Res 2020; 112:1755-1786. [DOI: 10.1002/bdr2.1799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Wejdan A. Shroukh
- Division of Pharmacy and Optometry, School of Health Sciences The University of Manchester Manchester UK
| | - Douglas T. Steinke
- Division of Pharmacy and Optometry, School of Health Sciences The University of Manchester Manchester UK
| | - Sarah C. Willis
- Division of Pharmacy and Optometry, School of Health Sciences The University of Manchester Manchester UK
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12
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Rashid ZA, Al-Tabakha MM, Alomar MJ. Proper Counseling and Dispensing of Isotretinoin Capsule Products by Community Pharmacists in UAE: A Simulated Patient Study. Clin Cosmet Investig Dermatol 2020; 13:405-414. [PMID: 32606878 PMCID: PMC7305830 DOI: 10.2147/ccid.s256302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/30/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate the pharmacist's assessment of patient eligibility for safe use of isotretinoin and the quality of pharmacist's counseling. PATIENTS AND METHODS A covert simulated patient (SP) methodology was used in which a trained female researcher, who was 25 years old, played the patient's role through this cross-sectional study by visiting community pharmacies and requesting isotretinoin capsules through a controlled prescription. A data form was used to collect the information following each pharmacy visit by asking about medical/family history and providing comprehensive counseling about the most common adverse effects, proper use instructions, and the importance of adherence to medication. The pharmacists, who did not initiate counseling, were prompted by the SP. RESULTS The pharmacists in 400 pharmacies who agreed to participate were visited by the SP. Only 7 (2%) pharmacists provided a complete assessment of patient eligibility for using isotretinoin with comprehensive counseling. Most of the pharmacists (84%) provided incomplete assessment as indicated by the overall score. Only 11 (3%) pharmacists asked the six crucial questions for the assessment of patient eligibility. On prompting, only 6 (2%) pharmacists provided complete counseling about the expected adverse effects. The most frequently provided adverse effect was dry skin, specifically dry lips (71.8%). A minority of 108 (27%) pharmacists provided education about the importance of using contraception during isotretinoin therapy. A complete level of counseling was provided by 125 (31.3%) pharmacists regarding the lab tests that the SP needs to undergo during therapy. Female pharmacists were more likely to provide counseling about the pregnancy test (mean=134, p=0.001). CONCLUSION Suboptimal level of the patient's assessment was revealed with poor educational counseling by the community pharmacists. New strategies are needed to improve pharmaceutical care services in the UAE.
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Affiliation(s)
- Zainab A Rashid
- Department of Clinical Sciences, College of Pharmacy & Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Moawia M Al-Tabakha
- Department of Pharmaceutical Sciences, College of Pharmacy & Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Muaed Jamal Alomar
- Department of Clinical Sciences, College of Pharmacy & Health Sciences, Ajman University, Ajman, United Arab Emirates
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13
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Mohammadhassanzadeh H, Sketris I, Traynor R, Alexander S, Winquist B, Stewart SA. Using Natural Language Processing to Examine the Uptake, Content, and Readability of Media Coverage of a Pan-Canadian Drug Safety Research Project: Cross-Sectional Observational Study. JMIR Form Res 2020; 4:e13296. [PMID: 31934872 PMCID: PMC6996767 DOI: 10.2196/13296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 07/11/2019] [Accepted: 09/26/2019] [Indexed: 11/18/2022] Open
Abstract
Background Isotretinoin, for treating cystic acne, increases the risk of miscarriage and fetal abnormalities when taken during pregnancy. The Health Canada–approved product monograph for isotretinoin includes pregnancy prevention guidelines. A recent study by the Canadian Network for Observational Drug Effect Studies (CNODES) on the occurrence of pregnancy and pregnancy outcomes during isotretinoin therapy estimated poor adherence to these guidelines. Media uptake of this study was unknown; awareness of this uptake could help improve drug safety communication. Objective The aim of this study was to understand how the media present pharmacoepidemiological research using the CNODES isotretinoin study as a case study. Methods Google News was searched (April 25-May 6, 2016), using a predefined set of terms, for mention of the CNODES study. In total, 26 articles and 3 CNODES publications (original article, press release, and podcast) were identified. The article texts were cleaned (eg, advertisements and links removed), and the podcast was transcribed. A dictionary of 1295 unique words was created using natural language processing (NLP) techniques (term frequency-inverse document frequency, Porter stemming, and stop-word filtering) to identify common words and phrases. Similarity between the articles and reference publications was calculated using Euclidian distance; articles were grouped using hierarchical agglomerative clustering. Nine readability scales were applied to measure text readability based on factors such as number of words, difficult words, syllables, sentence counts, and other textual metrics. Results The top 5 dictionary words were pregnancy (250 appearances), isotretinoin (220), study (209), drug (201), and women (185). Three distinct clusters were identified: Clusters 2 (5 articles) and 3 (4 articles) were from health-related websites and media, respectively; Cluster 1 (18 articles) contained largely media sources; 2 articles fell outside these clusters. Use of the term isotretinoin versus Accutane (a brand name of isotretinoin), discussion of pregnancy complications, and assignment of responsibility for guideline adherence varied between clusters. For example, the term pregnanc appeared most often in Clusters 1 (14.6 average times per article) and 2 (11.4) and relatively infrequently in Cluster 3 (1.8). Average readability for all articles was high (eg, Flesch-Kincaid, 13; Gunning Fog, 15; SMOG Index, 10; Coleman Liau Index, 15; Linsear Write Index, 13; and Text Standard, 13). Readability increased from Cluster 2 (Gunning Fog of 16.9) to 3 (12.2). It varied between clusters (average 13th-15th grade) but exceeded the recommended health information reading level (grade 6th to 8th), overall. Conclusions Media interpretation of the CNODES study varied, with differences in synonym usage and areas of focus. All articles were written above the recommended health information reading level. Analyzing media using NLP techniques can help determine drug safety communication effectiveness. This project is important for understanding how drug safety studies are taken up and redistributed in the media.
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Khiali S, Gharekhani A, Entezari-Maleki T. Isotretinoin; A review on the Utilization Pattern in Pregnancy. Adv Pharm Bull 2018; 8:377-382. [PMID: 30276133 PMCID: PMC6156490 DOI: 10.15171/apb.2018.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 07/22/2018] [Accepted: 08/09/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose: Isotretinoin is the most effective anti-acne drug with a long-term remission. However; it contains severe teratogenic effects with serious adverse drug reactions, which limits the use of medication. Methods: To review the use of isotretinoin during pregnancy, we carried out a comprehensive search of literature in Google Scholar, Scopus and PubMed/Medline from their inception until April 2015. Results: Database searching identified 277 records, of which, 38 articles were retrieved according to abstract and title assessment. After full-text review, 17 articles were excluded and finally, a total of 21 studies met the inclusion criteria. Data showed an increased pattern in the use of isotretinoin. In some studies, health care providers were not fully adhered to the risk reduction programs in pregnancy. Exposing to isotretinoin among pregnant women has still occurred due to detrimental adherence to risk reduction programs which resulted in live-born infants with different kinds of abnormalities. Conclusion: Despite the known serious adverse effect of isotretinoin, the use of drug was not based on the guidelines in some cases, which needs more attentions to prevent the severe drug related problems.
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Affiliation(s)
- Sajad Khiali
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Afshin Gharekhani
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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15
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Uusküla A, Pisarev H, Kurvits K, Laius O, Laanpere M, Uusküla M. Compliance with Pregnancy Prevention Recommendations for Isotretinoin in Estonia in 2012-2016. Drugs Real World Outcomes 2018; 5:129-136. [PMID: 29790022 PMCID: PMC5984611 DOI: 10.1007/s40801-018-0135-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Isotretinoin is an effective treatment for severe acne; no alternative treatment has an equal therapeutic effect. The teratogenic effects of isotretinoin can be avoided, and numerous recommendations and regulations are in force to minimize the risk of pregnancy during treatment. Objectives To describe isotretinoin prescription patterns for women aged 15–45 years, assess the concomitancy of isotretinoin and contraceptive use, and determine the rate of potential isotretinoin-exposed pregnancies in Estonia. Methods This retrospective, nationwide, population-based, cohort study derived data from national health insurance databases and included female patients aged 15–45 years in Estonia for whom one or more prescriptions for isotretinoin were dispensed between 2012 and 2016. The main outcome was the proportion of women who used systemic isotretinoin and had a concomitant record of (hormonal or intrauterine) contraception use covering the isotretinoin treatment period when pregnancy is contraindicated. Results Of the 2792 women aged 15–45 years filling an isotretinoin prescription, 15.7% (95% CI 14.4–17.1) had full and 13.9% (95% CI 12.7–15.3) partial (not covering the whole period during which pregnancy is contraindicated) contraceptive coverage. The risk for potential isotretinoin-exposed pregnancy was 3.6 (95% CI 2.0–7.0) per 1000 treated women over the 5-year observation period. The odds for full coverage with effective contraception increased with the age of the patient, with the duration of isotretinoin treatment and over the period of observation. Conclusion Our study adds to the existing literature documenting limited compliance with pregnancy prevention programs for isotretinoin-containing products, and calls for program assessment to identify whether new measures should be taken or whether weaknesses in policy or implementation can be corrected.
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Affiliation(s)
- Anneli Uusküla
- Department of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia.
| | - Heti Pisarev
- Department of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | | | - Ott Laius
- Agency of Medicines, 50411, Tartu, Estonia
| | - Made Laanpere
- Department of Obstetrics and Gynaecology, University of Tartu, Tartu, Estonia
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16
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Lelubre M, Hamdani J, Senterre C, Amighi K, Peres M, Schneider MP, Bugnon O, De Vriese C. Evaluation of compliance with isotretinoin PPP recommendations and exploration of reasons for non-compliance: Survey among French-speaking health care professionals and patients in Belgium. Pharmacoepidemiol Drug Saf 2018; 27:668-673. [PMID: 29726056 DOI: 10.1002/pds.4441] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 02/12/2018] [Accepted: 03/19/2018] [Indexed: 11/09/2022]
Abstract
PURPOSE To evaluate awareness of and compliance in Belgium by French-speaking health care professionals and patients with the isotretinoin safety recommendations regarding its teratogenic risk. METHOD Survey using online questionnaires, delivered from December 2014 to March 2015 for patients, pharmacists, dermatologists, and GPs and delivered again from September 2015 to October 2015 for GPs. RESULTS Questionnaires were completed by 24 dermatologists, 24 GPs, 58 pharmacists, and 33 female patients. The pregnancy prevention programme was poorly known by health care professionals (23.6%) and patients (15.2%). Health care professionals informed women of childbearing age in depth about the teratogenic risk (98.3% of pharmacists and 100.0% of GPs and dermatologists) and the importance of an effective contraceptive method (87.9% and 100.0%, respectively). Patients were less informed about the pregnancy test (25.9% and 14.6%) and the need to use a second contraceptive method (29.3% and 27.1%). The low compliance with the last 2 recommendations was due to a lack of adoption by health care professionals regarding the need for these recommendations if female patients have an effective contraceptive method and the pregnancy risk is discussed in detail with them. CONCLUSION The effectiveness of the pregnancy prevention programme recommendations should be reconsidered by an expert committee. Justifications should be added to effective recommendations to increase their adoption by health care professionals and patients.
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Affiliation(s)
- Mélanie Lelubre
- Université libre de Bruxelles (ULB), Faculté de Pharmacie, Brussels, Belgium.,School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.,Community Pharmacy, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Jamila Hamdani
- Pharmacovigilance Department, Federal Agency for Medicines and Health Products, Belgium
| | - Christelle Senterre
- Université libre de Bruxelles (ULB), School of Public Health, Research Center of Epidemiology, Biostatistics, and Clinical Research, Brussels, Belgium
| | - Karim Amighi
- Université libre de Bruxelles (ULB), Faculté de Pharmacie, Brussels, Belgium
| | - Marion Peres
- Université libre de Bruxelles (ULB), Faculté de Pharmacie, Brussels, Belgium
| | - Marie-Paule Schneider
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.,Community Pharmacy, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Olivier Bugnon
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.,Community Pharmacy, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Carine De Vriese
- Université libre de Bruxelles (ULB), Faculté de Pharmacie, Brussels, Belgium
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Kovitwanichkanont T, Driscoll T. A comparative review of the isotretinoin pregnancy risk management programs across four continents. Int J Dermatol 2018; 57:1035-1046. [DOI: 10.1111/ijd.13950] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 01/06/2018] [Accepted: 01/28/2018] [Indexed: 12/30/2022]
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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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The limitations of some European healthcare databases for monitoring the effectiveness of pregnancy prevention programmes as risk minimisation measures. Eur J Clin Pharmacol 2017; 74:513-520. [PMID: 29230493 DOI: 10.1007/s00228-017-2398-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Pregnancy prevention programmes (PPPs) exist for some medicines known to be highly teratogenic. It is increasingly recognised that the impact of these risk minimisation measures requires periodic evaluation. This study aimed to assess the extent to which some of the data needed to monitor the effectiveness of PPPs may be present in European healthcare databases. METHODS An inventory was completed for databases contributing to EUROmediCAT capturing pregnancy and prescription data in Denmark, Norway, the Netherlands, Italy (Tuscany/Emilia Romagna), Wales and the rest of the UK, to determine the extent of data collected that could be used to evaluate the impact of PPPs. RESULTS Data availability varied between databases. All databases could be used to identify the frequency and duration of prescriptions to women of childbearing age from primary care, but there were specific issues with availability of data from secondary care and private care. To estimate the frequency of exposed pregnancies, all databases could be linked to pregnancy data, but the accuracy of timing of the start of pregnancy was variable, and data on pregnancies ending in induced abortions were often not available. Data availability on contraception to estimate compliance with contraception requirements was variable and no data were available on pregnancy tests. CONCLUSION Current electronic healthcare databases do not contain all the data necessary to fully monitor the effectiveness of PPP implementation, and thus, special data collection measures need to be instituted.
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20
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Opel D, Kramer ON, Chevalier M, Bigby M, Albrecht J. Not every patient needs a triglyceride check, but all can get pancreatitis: a systematic review and clinical characterization of isotretinoin-associated pancreatitis. Br J Dermatol 2017; 177:960-966. [PMID: 27893168 DOI: 10.1111/bjd.15207] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2016] [Indexed: 12/30/2022]
Abstract
Monitoring of triglycerides for patients on isotretinoin is practised primarily to avoid hypertriglyceridaemia-associated pancreatitis. The aim of this study was to describe clinically the published cases of hypertriglyceride-associated pancreatitis. A comprehensive search strategy using MEDLINE, Embase and grey literature was conducted (1960 to January 2016) to identify all case reports of isotretinoin-associated pancreatitis and all relevant studies of isotretinoin and triglycerides for any indication (≥ 20 patients). Terms related to isotretinoin, triglycerides and pancreatitis were searched with all available synonyms. Any studies that used isotretinoin and mentioned triglycerides or pancreatitis were searched in full text, where available, for cases of pancreatitis. Studies from all countries and published in any language were included, but Korean and Turkish studies could not be analysed. Two authors independently reviewed the publications to determine eligibility, and for data extraction. In total, 125 papers fulfilled the inclusion criteria and were searched for cases of pancreatitis. Eleven papers with 25 cases of pancreatitis associated with isotretinoin were identified; four of these cases were likely due to hypertriglyceridaemia. Three patients had elevated baseline triglycerides, but no monitoring. Pancreatitis occurred 6 and 7 weeks, and 6 months after initiation of therapy. For the fourth patient who was treated for glioblastoma and died, no detailed clinical information was available. Idiosyncratic pancreatitis associated with isotretinoin is the most frequent pancreatitis on isotretinoin, and patients should be warned about it. Hypertriglyceride-associated pancreatitis is an exceedingly rare adverse event of isotretinoin therapy. Our data cannot give a frequency or risk for either adverse event. Based on the clinical information of the patients available, we conclude that for patients without elevated baseline triglycerides, or risk thereof, monitoring of triglycerides during therapy is of little value.
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Affiliation(s)
- D Opel
- Division of Dermatology, Department of Medicine, Loyola University Medical Center, Maywood, IL, U.S.A
| | - O N Kramer
- Medical School, University of Illinois, Chicago, IL, U.S.A
| | | | - M Bigby
- Department of Dermatology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, U.S.A
| | - J Albrecht
- Division of Dermatology, Department of Medicine, J.H. Stroger Hospital of Cook County, Chicago, IL, U.S.A.,Department of Dermatology, Rush Medical College, Chicago, IL, U.S.A
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Henry D, Dormuth C, Winquist B, Carney G, Bugden S, Teare G, Lévesque LE, Bérard A, Paterson JM, Platt RW. Occurrence of pregnancy and pregnancy outcomes during isotretinoin therapy. CMAJ 2016; 188:723-730. [PMID: 27114489 PMCID: PMC4938682 DOI: 10.1503/cmaj.151243] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2016] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Isotretinoin, a teratogen, is widely used to treat cystic acne. Although the risks of pregnancy during isotretinoin therapy are well recognized, there are doubts about the level of adherence with the pregnancy prevention program in Canada. Our objective was to evaluate the effectiveness of the Canadian pregnancy prevention program in 4 provinces: British Columbia, Saskatchewan, Manitoba and Ontario. METHODS Using administrative data, we identified 4 historical cohorts of female users of isotretinoin (aged 12-48 yr) for the period 1996 to 2011. We defined pregnancy using International Statistical Classification of Diseases and billing codes. One definition included only cases with documented pregnancy outcomes (high-specificity definition); the other definition also included individuals recorded as receiving prenatal care (high-sensitivity definition). We studied new courses of isotretinoin and detected pregnancies in 2 time windows: during isotretinoin treatment only and up to 42 weeks after treatment. Live births were followed for 1 year to identify congenital malformations. RESULTS A total of 59 271 female patients received 102 308 courses of isotretinoin. Between 24.3% and 32.9% of participants received prescriptions for oral contraceptives while they were taking isotretinoin, compared with 28.3% to 35.9% in the 12 months before isotretinoin was started. According to the high-specificity definition of pregnancy, there were 186 pregnancies during isotretinoin treatment (3.1/1000 isotretinoin users), compared with 367 (6.2/1000 users) according to the high-sensitivity definition. By 42 weeks after treatment, there were 1473 pregnancies (24.9/1000 users), according to the high-specificity definition. Of these, 1331 (90.4%) terminated spontaneously or were terminated by medical intervention. Among the 118 live births were 11 (9.3%) cases of congenital malformation. Pregnancy rates during isotretinoin treatment remained constant between 1996 and 2011. INTERPRETATION Adherence to the isotretinoin pregnancy prevention program in Canada was poor during the 15-year period of this study.
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Affiliation(s)
- David Henry
- Institute for Clinical Evaluative Sciences (Henry, Lévesque, Paterson), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Henry), University of Toronto, Toronto, Ont.; Faculty of Medicine (Dormuth, Carney), University of British Columbia, Vancouver, BC; Saskatchewan Health Quality Council (Winquist, Teare), Saskatoon, Sask.; College of Pharmacy (Bugden), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre for Health Services and Policy Research (Lévesque), Queen's University, Kingston, Ont.; Faculté de pharmacie (Bérard), Université de Montréal, Montréal, Qué.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Departments of Epidemiology and Biostatistics and of Pediatrics (Platt), McGill University, Montréal, Que.
| | - Colin Dormuth
- Institute for Clinical Evaluative Sciences (Henry, Lévesque, Paterson), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Henry), University of Toronto, Toronto, Ont.; Faculty of Medicine (Dormuth, Carney), University of British Columbia, Vancouver, BC; Saskatchewan Health Quality Council (Winquist, Teare), Saskatoon, Sask.; College of Pharmacy (Bugden), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre for Health Services and Policy Research (Lévesque), Queen's University, Kingston, Ont.; Faculté de pharmacie (Bérard), Université de Montréal, Montréal, Qué.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Departments of Epidemiology and Biostatistics and of Pediatrics (Platt), McGill University, Montréal, Que
| | - Brandace Winquist
- Institute for Clinical Evaluative Sciences (Henry, Lévesque, Paterson), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Henry), University of Toronto, Toronto, Ont.; Faculty of Medicine (Dormuth, Carney), University of British Columbia, Vancouver, BC; Saskatchewan Health Quality Council (Winquist, Teare), Saskatoon, Sask.; College of Pharmacy (Bugden), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre for Health Services and Policy Research (Lévesque), Queen's University, Kingston, Ont.; Faculté de pharmacie (Bérard), Université de Montréal, Montréal, Qué.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Departments of Epidemiology and Biostatistics and of Pediatrics (Platt), McGill University, Montréal, Que
| | - Greg Carney
- Institute for Clinical Evaluative Sciences (Henry, Lévesque, Paterson), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Henry), University of Toronto, Toronto, Ont.; Faculty of Medicine (Dormuth, Carney), University of British Columbia, Vancouver, BC; Saskatchewan Health Quality Council (Winquist, Teare), Saskatoon, Sask.; College of Pharmacy (Bugden), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre for Health Services and Policy Research (Lévesque), Queen's University, Kingston, Ont.; Faculté de pharmacie (Bérard), Université de Montréal, Montréal, Qué.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Departments of Epidemiology and Biostatistics and of Pediatrics (Platt), McGill University, Montréal, Que
| | - Shawn Bugden
- Institute for Clinical Evaluative Sciences (Henry, Lévesque, Paterson), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Henry), University of Toronto, Toronto, Ont.; Faculty of Medicine (Dormuth, Carney), University of British Columbia, Vancouver, BC; Saskatchewan Health Quality Council (Winquist, Teare), Saskatoon, Sask.; College of Pharmacy (Bugden), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre for Health Services and Policy Research (Lévesque), Queen's University, Kingston, Ont.; Faculté de pharmacie (Bérard), Université de Montréal, Montréal, Qué.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Departments of Epidemiology and Biostatistics and of Pediatrics (Platt), McGill University, Montréal, Que
| | - Gary Teare
- Institute for Clinical Evaluative Sciences (Henry, Lévesque, Paterson), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Henry), University of Toronto, Toronto, Ont.; Faculty of Medicine (Dormuth, Carney), University of British Columbia, Vancouver, BC; Saskatchewan Health Quality Council (Winquist, Teare), Saskatoon, Sask.; College of Pharmacy (Bugden), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre for Health Services and Policy Research (Lévesque), Queen's University, Kingston, Ont.; Faculté de pharmacie (Bérard), Université de Montréal, Montréal, Qué.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Departments of Epidemiology and Biostatistics and of Pediatrics (Platt), McGill University, Montréal, Que
| | - Linda E Lévesque
- Institute for Clinical Evaluative Sciences (Henry, Lévesque, Paterson), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Henry), University of Toronto, Toronto, Ont.; Faculty of Medicine (Dormuth, Carney), University of British Columbia, Vancouver, BC; Saskatchewan Health Quality Council (Winquist, Teare), Saskatoon, Sask.; College of Pharmacy (Bugden), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre for Health Services and Policy Research (Lévesque), Queen's University, Kingston, Ont.; Faculté de pharmacie (Bérard), Université de Montréal, Montréal, Qué.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Departments of Epidemiology and Biostatistics and of Pediatrics (Platt), McGill University, Montréal, Que
| | - Anick Bérard
- Institute for Clinical Evaluative Sciences (Henry, Lévesque, Paterson), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Henry), University of Toronto, Toronto, Ont.; Faculty of Medicine (Dormuth, Carney), University of British Columbia, Vancouver, BC; Saskatchewan Health Quality Council (Winquist, Teare), Saskatoon, Sask.; College of Pharmacy (Bugden), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre for Health Services and Policy Research (Lévesque), Queen's University, Kingston, Ont.; Faculté de pharmacie (Bérard), Université de Montréal, Montréal, Qué.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Departments of Epidemiology and Biostatistics and of Pediatrics (Platt), McGill University, Montréal, Que
| | - J Michael Paterson
- Institute for Clinical Evaluative Sciences (Henry, Lévesque, Paterson), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Henry), University of Toronto, Toronto, Ont.; Faculty of Medicine (Dormuth, Carney), University of British Columbia, Vancouver, BC; Saskatchewan Health Quality Council (Winquist, Teare), Saskatoon, Sask.; College of Pharmacy (Bugden), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre for Health Services and Policy Research (Lévesque), Queen's University, Kingston, Ont.; Faculté de pharmacie (Bérard), Université de Montréal, Montréal, Qué.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Departments of Epidemiology and Biostatistics and of Pediatrics (Platt), McGill University, Montréal, Que
| | - Robert W Platt
- Institute for Clinical Evaluative Sciences (Henry, Lévesque, Paterson), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Henry), University of Toronto, Toronto, Ont.; Faculty of Medicine (Dormuth, Carney), University of British Columbia, Vancouver, BC; Saskatchewan Health Quality Council (Winquist, Teare), Saskatoon, Sask.; College of Pharmacy (Bugden), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre for Health Services and Policy Research (Lévesque), Queen's University, Kingston, Ont.; Faculté de pharmacie (Bérard), Université de Montréal, Montréal, Qué.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Departments of Epidemiology and Biostatistics and of Pediatrics (Platt), McGill University, Montréal, Que
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Bhate K, Williams HC. What's new in acne? An analysis of systematic reviews published in 2011-2012. Clin Exp Dermatol 2015; 39:273-7; quiz 277-8. [PMID: 24635060 DOI: 10.1111/ced.12270] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2013] [Indexed: 11/26/2022]
Abstract
This review summarizes important clinical developments in acne vulgaris identified from 17 systematic reviews published between February 2011 and August 2012. Regarding causes, Demodex mites have been shown to be associated with both acne vulgaris and rosacea, although it is unclear if their eradication improves either disease. Some weak evidence has emerged that suggests a possible link between dairy produce and acne, which warrants further research. With reference to the effects of acne, there is good evidence that acne negatively affects quality of life, self-esteem and mood in adolescents. Acne is also associated with an increased risk of anxiety, depression and suicidal ideation, highlighting the importance of asking patients with acne directly about psychological issues in order to identify those who might benefit from early psychiatric support. Regarding treatment, there seems to be no additional benefit to using higher strengths of benzoyl peroxide, and lower strengths such as 2.5% have fewer side effects. Despite earlier concerns of increased mortality in those using topical tretinoin for skin cancer prevention, a systematic review on this topic has not found any convincing evidence of a link between such non-cutaneous events and once-daily application of 0.02-0.05% tretinoin. Combined oral contraceptives are of benefit in both inflammatory and non-inflammatory acne. Current surveys suggest that implementation of the pregnancy prevention programme for isotretinoin may not be stringent, and a high level of monitoring and audit is recommended. Ablative and non-ablative laser resurfacing for the treatment of acne scars may be beneficial, but further studies with a longer follow-up period are required.
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Affiliation(s)
- K Bhate
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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Zomerdijk IM, Ruiter R, Houweling LMA, Herings RMC, Sturkenboom MCJM, Straus SMJM, Stricker BH. Isotretinoin exposure during pregnancy: a population-based study in The Netherlands. BMJ Open 2014; 4:e005602. [PMID: 25392022 PMCID: PMC4244495 DOI: 10.1136/bmjopen-2014-005602] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To estimate isotretinoin exposure in Dutch pregnant women despite the implemented pregnancy prevention programme (PPP) and second, to analyse the occurrence of adverse fetal or neonatal outcomes in these isotretinoin exposed pregnancies. DESIGN Population-based study. SETTING The Netherlands. PARTICIPANTS A cohort of 203,962 pregnancies with onset between 1 January 1999 and 1 September 2007 consisting of 208,161 fetuses or neonates. MAIN OUTCOME MEASURES Isotretinoin exposure in the 30 days before or during pregnancy. Proportions of adverse fetal or neonatal outcomes, defined as intrauterine deaths ≥16 week of gestation and neonates with major congenital anomalies. ORs with 95% CIs adjusted for maternal age were calculated to estimate the risk of adverse fetal or neonatal outcome after maternal isotretinoin exposure. RESULTS 51 pregnancies, 2.5 (95% CI 1.9 to 3.3) per 10,000 pregnancies, were exposed to isotretinoin despite the pregnancy prevention programme. Forty-five of these pregnancies, 2.2 (95% CI 1.6 to 2.9) per 10,000 pregnancies, were exposed to isotretinoin during pregnancy and six additional women became pregnant within 30 days after isotretinoin discontinuation. In 60% of isotretinoin exposed pregnancies, women started isotretinoin while already pregnant. In five out of the 51 isotretinoin exposed pregnancies (53 fetuses), 9.4% (95% CI 1.3% to 17.6%), had an adverse fetal or neonatal outcome. The OR for adverse fetal or neonatal outcomes after isotretinoin exposure in 30 days before or during pregnancy was 2.3 (95% CI 0.9 to 5.7) after adjustment for maternal age. CONCLUSIONS Although a PPP was already implemented in 1988, we showed that isotretinoin exposed pregnancies and adverse fetal and neonatal events potentially related to the exposure still occur. These findings from the Netherlands add to the evidence that there is no full compliance to the isotretinoin PPP in many Western countries. Given the limited success of iPLEDGE, the question is which further measures are able to improve compliance.
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Affiliation(s)
- Ingeborg M Zomerdijk
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of pharmacovigilance, Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | - Rikje Ruiter
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Groene Hart Hospital, Gouda, The Netherlands
| | | | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Miriam C J M Sturkenboom
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sabine M J M Straus
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of pharmacovigilance, Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Drug Safety Unit, Inspectorate of Health Care, The Hague, The Netherlands
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Zomerdijk IM, Ruiter R, Houweling LMA, Herings RMC, Straus SMJM, Stricker BH. Dispensing of potentially teratogenic drugs before conception and during pregnancy: a population-based study. BJOG 2014; 122:1119-29. [DOI: 10.1111/1471-0528.13128] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2014] [Indexed: 12/16/2022]
Affiliation(s)
- IM Zomerdijk
- Department of Medical Informatics; Erasmus Medical Centre; Rotterdam the Netherlands
- Department of Epidemiology; Erasmus Medical Centre; Rotterdam the Netherlands
- Dutch Medicines Evaluation Board; Utrecht the Netherlands
| | - R Ruiter
- Department of Epidemiology; Erasmus Medical Centre; Rotterdam the Netherlands
| | - LMA Houweling
- PHARMO Institute for Drug Outcomes Research; Utrecht the Netherlands
| | - RMC Herings
- PHARMO Institute for Drug Outcomes Research; Utrecht the Netherlands
| | - SMJM Straus
- Department of Medical Informatics; Erasmus Medical Centre; Rotterdam the Netherlands
| | - BH Stricker
- Department of Epidemiology; Erasmus Medical Centre; Rotterdam the Netherlands
- Drug Safety Unit; Inspectorate of Health Care; The Hague the Netherlands
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Banerjee AK, Zomerdijk IM, Wooder S, Ingate S, Mayall SJ. Post-approval evaluation of effectiveness of risk minimisation: methods, challenges and interpretation. Drug Saf 2014; 37:33-42. [PMID: 24357107 DOI: 10.1007/s40264-013-0126-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Evaluation of the effectiveness of drug risk-minimisation measures is mandatory for both risk evaluation and mitigation strategies (REMS) in the United States and risk management plans in the European Union (EU-RMPs). Such evaluations aim to assess the impact of risk-minimisation measures on the knowledge, attitudes or behaviours of healthcare professionals or patients, the incidence of safety concerns, and their impact on the overall benefit-risk balance. Although many effectiveness evaluation models and methods are available, regulatory guidance and policy are still evolving. This paper considers evaluation strategies, challenges in evaluating risk minimisation post-authorisation, possible outcome measures and their interpretation, and potential emerging regulatory policy issues. Particular challenges include appropriate data collection, perceived and real burdens of performing evaluation on clinical practice, lack of comparators and benchmarking, and uncertainty about the best outcome measures.
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Affiliation(s)
- Anjan Kumar Banerjee
- Pope Woodhead & Associates, The Old Grammar School, 1 Ramsay Road, St Ives, Cambs, PE27 5BZ, UK,
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Lagan BM, Dolk H, White B, Uges DRA, Sinclair M. Assessing the availability of the teratogenic drug isotretinoin outside the pregnancy prevention programme: a survey of e-pharmacies. Pharmacoepidemiol Drug Saf 2014; 23:411-8. [PMID: 24493556 PMCID: PMC4265198 DOI: 10.1002/pds.3565] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 12/03/2013] [Accepted: 12/09/2013] [Indexed: 11/09/2022]
Abstract
Purpose The increase in online purchasing of medications raises safety concerns regarding teratogenic drugs. The use of the teratogenic drug ‘isotretinoin’ for women of childbearing age requires strict adherence to the Pregnancy Prevention Programme (PPP), a risk minimisation measure imposed on prescribers and users. We sought to determine how readily consumers can purchase isotretinoin online and the associated safety procedures and information. Methods A descriptive cross-sectional survey was conducted of 50 e-pharmacies identified from commonly used search engines. E-pharmacy characteristics and isotretinoin PPP specific criteria were evaluated. Purchases of isotretinoin from seven e-pharmacies not bearing authentication logos and not requiring a prescription were assessed for PPP policy adherence, purchasing procedures and compound quality. Results Forty-three (86%) of the e-pharmacies did not have an authentication seal/logo. Isotretinoin could be purchased from 42 sites without a valid prescription. Information on isotretinoin causing birth defects was lacking in 25 of the 50 sites, on not taking isotretinoin in pregnancy in 24 sites and not taking isotretinoin if planning or at risk of a pregnancy in 33 sites. Of the eight attempted purchases, seven arrived, all without any patient information leaflet. All were verified as isotretinoin. Conclusion The Internet provides a loophole for purchasing of medications known to cause congenital abnormalities, which needs to be addressed by medicines regulatory agencies worldwide. The current PPP for isotretinoin may be failing to protect mothers and babies from preventable harm—clinicians need to be aware of this, and the public needs to be educated about the potential risks.
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Affiliation(s)
- Hannah Browne
- Leeds General Infirmary; Great George Street Leeds LS1 3EX UK
| | - Gerald Mason
- Leeds General Infirmary; Great George Street Leeds LS1 3EX UK
| | - Thomas Tang
- Regional Fertility Centre; Belfast Teaching Hospitals NHS Trust; Belfast UK
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Rouzès A, Jonville-Béra AP. Isotrétinoïne et grossesse : bilan français de 25 années de suivi. Therapie 2014; 69:53-63. [DOI: 10.2515/therapie/2014008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 11/18/2013] [Indexed: 11/20/2022]
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Kmieć ML, Pajor A, Broniarczyk-Dyła G. Evaluation of biophysical skin parameters and assessment of hair growth in patients with acne treated with isotretinoin. Postepy Dermatol Alergol 2013; 30:343-9. [PMID: 24493996 PMCID: PMC3907898 DOI: 10.5114/pdia.2013.39432] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 06/18/2013] [Accepted: 08/20/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Treatment of the severe forms of acne vulgaris remains a challenge. Isotretinoin is a drug often used in these cases. Retinoids affect the mechanisms that play a role in the pathogenesis of acne, reduce the production of sebum and sizes of the sebaceous glands. However, isotretinoin appears to have undesirable side effects in the skin, mucous membranes and hair. AIM THE AIM OF THIS STUDY WAS TO ASSESS THE EFFECT OF ACNE VULGARIS TREATMENT WITH ISOTRETINOIN ON BIOPHYSICAL SKIN PARAMETERS: skin sebum and stratum corneum hydration levels, transepidermal water loss values, pH, erythema and hair growth parameters: total number, density and proportion of anagen hair. MATERIAL AND METHODS THE STUDY INCLUDED THIRTY PATIENTS WITH ACNE TYPES: papulopustular, conglobata and phlegmonosa. Patients were treated with isotretinoin at a dose of 0.5-1.0 mg/kg/day for a period of 4-7 months. The measurements of skin biophysical parameters were performed before and after the treatment using Sebumeter SM815, Corneometer CM825, Tewameter TM300, MX Mexameter MX18 and Skin-pH-Meter PH908. Hair growth parameters were evaluated with FotoFinder Dermoscope using the TrichoScan Professional V3.0.8.76 software. RESULTS The results of biophysical skin parameter measurements after the treatment showed a reduction in the severity of seborrhea. However, the skin was dry, which confirmed a lowered degree of stratum corneum hydration and an increase in transepidermal water loss values. Moreover, severity of erythema, an increase in pH value, and variations in selected hair growth parameters: decrease in total count, density and proportion of anagen hair were demonstrated. CONCLUSIONS The reduction in the skin sebum levels was observed after the treatment. There was dryness of the skin, which was confirmed by biophysical skin parameter measurements. Changes in the hair growth parameters showed telogen effluvium hair loss.
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Affiliation(s)
- Małgorzata L Kmieć
- Department of General, Esthetic Dermatology and Dermatosurgery, Medical University of Lodz, Poland. Head: Prof. Grażyna Broniarczyk-Dyła MD, PhD
| | - Anna Pajor
- Department of General, Esthetic Dermatology and Dermatosurgery, Medical University of Lodz, Poland. Head: Prof. Grażyna Broniarczyk-Dyła MD, PhD
| | - Grażyna Broniarczyk-Dyła
- Department of General, Esthetic Dermatology and Dermatosurgery, Medical University of Lodz, Poland. Head: Prof. Grażyna Broniarczyk-Dyła MD, PhD
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Gispen-de Wied CC, Leufkens HG. From molecule to market access: Drug regulatory science as an upcoming discipline. Eur J Pharmacol 2013; 719:9-15. [DOI: 10.1016/j.ejphar.2013.07.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 07/11/2013] [Indexed: 10/26/2022]
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Crijns I, Mantel-Teeuwisse A, Bloemberg R, Pinas E, Straus S, de Jong-van den Berg L. Healthcare professional surveys to investigate the implementation of the isotretinoin Pregnancy Prevention Programme: a descriptive study. Expert Opin Drug Saf 2012; 12:29-38. [DOI: 10.1517/14740338.2013.745850] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Current world literature. Curr Opin Pediatr 2012; 24:547-53. [PMID: 22790103 DOI: 10.1097/mop.0b013e3283566807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zomerdijk IM, Sayed-Tabatabaei FA, Trifirò G, Blackburn SC, Sturkenboom MC, Straus SM. Risk Minimization Activities of Centrally Authorized Products in the EU. Drug Saf 2012; 35:299-314. [DOI: 10.2165/11594560-000000000-00000] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Crijns H, Straus S, De Jong-van denBerg L. Oral isotretinoin and pregnancy prevention programmes: reply from authors. Br J Dermatol 2012. [DOI: 10.1111/j.1365-2133.2011.10687.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thiboutot D, Gollnick H, Bettoli V, Dréno B, Kang S, Leyden JJ, Shalita A, Torres V. Oral isotretinoin and pregnancy prevention programmes. Br J Dermatol 2012; 166:466-7; author reply 467-8. [PMID: 21985025 DOI: 10.1111/j.1365-2133.2011.10686.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Spezielle Arzneimitteltherapie in der Schwangerschaft. ARZNEIMITTEL IN SCHWANGERSCHAFT UND STILLZEIT 2012. [PMCID: PMC7271212 DOI: 10.1016/b978-3-437-21203-1.10002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dupuy A. Quoi de neuf en thérapeutique dermatologique ? Ann Dermatol Venereol 2011; 138 Suppl 4:S263-72. [DOI: 10.1016/s0151-9638(11)70100-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Artama M, Gissler M, Malm H, Ritvanen A. Nationwide register-based surveillance system on drugs and pregnancy in Finland 1996-2006. Pharmacoepidemiol Drug Saf 2011; 20:729-38. [PMID: 21626607 DOI: 10.1002/pds.2159] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 02/28/2011] [Accepted: 04/06/2011] [Indexed: 11/06/2022]
Abstract
PURPOSE The aim of this population-based nationwide drugs and pregnancy surveillance system was to get basic information on the use of prescribed drugs during pregnancy and to achieve more detailed information on drug exposure-outcome associations with data obtained from the Finnish national health registers. METHODS The data are based on information on all pregnancies ending in births (n = 632,629) or termination of pregnancy (TOP) (n = 117,255) in Finland between 1996 and 2006. The data containing information on maternal background factors, chronic diseases and drug purchases during pregnancy, born children, induced abortions, perinatal health and major congenital malformations were obtained from the Finnish national health registers. Information from the different registers was merged through record linkages based on unique personal identification numbers. Statistical analyses were conducted between the exposed and unexposed for individual drugs or Anatomical Therapeutic Chemical (ATC) classification drug groups in multivariate logistic regression including potential confounding factors. RESULTS Nearly half of parturients and almost every third woman with TOP purchased drugs at least once 1 month prior to pregnancy and/or during pregnancy. The most frequent chronic diseases during pregnancy were asthma, hypothyroidism, epilepsy, rheumatoid arthritis and diabetes. Previously known causal connections between maternal chronic diseases and/or medication and perinatal health risks were already seen in the ATC-group-level analysis. CONCLUSIONS Comprehensive and detailed information for pharmacoepidemiological research on the effects of drug use during pregnancy in a cohort setting is possible with long-term and cumulative data collection.
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Affiliation(s)
- Miia Artama
- National Institute for Health and Welfare, THL, Helsinki, Finland.
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