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Fukuda K, Narukawa M. Decision and timing of safety-related labeling changes for new drugs in Japan: Comparison with the United States and the European Union. Pharmacoepidemiol Drug Saf 2023; 32:1331-1340. [PMID: 37395168 DOI: 10.1002/pds.5664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/07/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE The aim of this study was to compare safety-related labeling changes for newly approved drugs in Japan with those in the United States (US) and the European Union (EU), where guidance on the details of pharmacovigilance (PV) process has been published, to examine the extent to which the Japanese PV process is working. METHODS Safety-related labeling changes for new drugs approved within 1 year in Japan, the US, and the EU were reviewed for the number, timing, and concordance of contents of the labeling change between countries/region. RESULTS The number of labeling changes and median time from approval to the change (min, max) were 57 cases and 814 (90, 2454) days in Japan, 63 cases and 852 (161, 3051) days in the US, and 50 cases and 851 (157, 2699) days in the EU. Distribution of the revision date of the concordant labeling change in the three countries/region and distribution of differences in revision date between the two countries/region showed no trend of delayed labeling change in a specific country/region. Concordance rate of the labeling change was 36.1% (30/83) in US-EU, 21.2% (21/99) in Japan-US, and 23.0% (20/87) in Japan-EU (Fisher's exact test, p = 0.0313 [Japan-US vs. US-EU], p = 0.066 [Japan-EU vs. US-EU]). CONCLUSIONS There was no trend of fewer or later labeling changes in Japan compared to those in the US/EU. While the concordance rate in US-EU was low, that in Japan-US and Japan-EU were even lower. Further investigation is needed to understand the reasons for these differences.
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Affiliation(s)
- Koichi Fukuda
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, Minato-ku, Japan
| | - Mamoru Narukawa
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, Minato-ku, Japan
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2
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Zara J, Nordin SM, Isha ASN. Influence of communication determinants on safety commitment in a high-risk workplace: a systematic literature review of four communication dimensions. Front Public Health 2023; 11:1225995. [PMID: 37614453 PMCID: PMC10442955 DOI: 10.3389/fpubh.2023.1225995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/18/2023] [Indexed: 08/25/2023] Open
Abstract
Health, safety, and environment (HSE) are critical aspects of any industry, particularly in high-risk environments, such as the oil and gas industry. Continuous accident reports indicate the requirement for the effective implementation of safety rules, regulations, and practices. This systematic literature review examines the relationship between safety communication and safety commitment in high-risk workplaces, specifically focusing on the oil and gas industry. The review comprises 1,439 articles from 2004 to 2023, retrieved from the Scopus and Web of Science databases following the PRISMA comprehensive guidelines. This study considers safety communication, communication climate, and communication satisfaction to evaluate their influence on safety commitment under occupational health and safety. This study identifies safety commitment issues and their underlying factors, discussing measures for preventing and reducing accidents and incidents and highlighting preventive measures for future research. It also signifies the variables influencing accident and incident rates. The research underscores the importance of communication dimensions and the need for workers to possess adequate skills, knowledge, and attitudes regarding occupational safety and health procedures. Moreover, the study contributes to the industrial and academic domains by improving organizational safety commitment, promoting a safety culture, and developing effective communication strategies. Furthermore, practitioners may benefit from this comprehensive overview in developing, evaluating, and enhancing occupational safety.
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Affiliation(s)
- Jamil Zara
- Center of Social Innovation, Department of Management and Humanities, Universiti Teknologi PETRONAS, Seri Iskandar, Malaysia
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3
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Roldan Munoz S, Postmus D, de Vries ST, Gross-Martirosyan L, Bahri P, Hillege H, Mol PGM. What Factors Make EU Regulators Want to Communicate Drug Safety Issues Related to SGLT2 Inhibitors? An Online Survey Study. Drug Saf 2023; 46:243-255. [PMID: 36790560 PMCID: PMC9988744 DOI: 10.1007/s40264-022-01270-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Previous studies have found differences in the communication of safety issues among medicines regulatory agencies. OBJECTIVES To explore (1) to what extent regulators' opinions regarding the need to communicate safety issues related to sodium-glucose cotransporter-2 (SGLT2) inhibitors might be influenced by their concern about the safety issue, and (2) whether regulators' concerns might be influenced by certain characteristics of the safety issue or by the demographic and professional characteristics and attitudes of the regulators. METHODS An online cross-sectional survey study with a rating-based conjoint analysis among clinical and pharmacovigilance assessors from the EU regulatory network was performed between April and June 2021. Regulators were invited by email, and participants were asked about their level of concern and their opinion regarding the need to communicate about 12 scenarios defined by four characteristics: adverse drug reaction, source of information, causality, and frequency. The outcomes for the first objective were to update the summary of product characteristics (SmPC; yes/no) and to send direct healthcare professional communications (DHPC; yes/no). The determinant was regulators' level of concern (range 0-100%). The outcome of the second objective was regulators' level of concern, and the determinants were the characteristics of the safety issue, demographic and professional characteristics, and attitudes of the regulators (beliefs about medicines and risk perception). RESULTS A total of 222 regulators completed the survey (64% women; mean age 46 ± 10 years). Depending on the scenario, 54-94% and 25-74% of the participants would update the SmPC or send a DHPC, respectively. The participants' level of concern influenced their opinions regarding the need to update the SmPC and send a DHPC (odds ratio (OR) 13.0; 95% confidence interval (CI) 7.8-21.7 and OR 13.6; 95% CI 9.5-19.2, respectively, for every 10% increase in the level of concern). All characteristics of the safety issue influenced the level of concern. Younger participants, women, and those working for Eastern European agencies had a higher level of concern than older participants, men, and those working in other regions. Beliefs about medicines and general risk perception also influenced their concern. CONCLUSIONS The opinion regarding the need to communicate safety issues was influenced by the concern of regulators. Regulators' concern was influenced by the characteristics of the safety issue, demographic characteristics, and attitudes. Diverse groups of experts regarding such factors would ensure that various views are incorporated in risk communication decisions.
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Affiliation(s)
- Sonia Roldan Munoz
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Douwe Postmus
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sieta T de Vries
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | | | - Priya Bahri
- European Medicines Agency, Amsterdam, The Netherlands
| | - Hans Hillege
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | - Peter G M Mol
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands.
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Mintzes B, Reynolds E, Bahri P, Perry LT, Bhasale AL, Morrow RL, Dormuth CR. How do safety warnings on medicines affect prescribing? Expert Opin Drug Saf 2022; 21:1269-1273. [PMID: 36208037 DOI: 10.1080/14740338.2022.2134342] [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
INTRODUCTION Many adverse effects of medicines only become known after approval, prompting regulatory agencies to issue post-market safety advisories to inform clinicians and support safer care. Our team evaluated advisories issued by national regulators in Australia, Canada, Denmark, the United Kingdom, and the United States from 2007 to 2016 inclusive, comparing regulators' decisions to warn, effects on prescribing, doctors' awareness and responses to warnings, relevant regulatory policies, and specific case studies. AREAS COVERED Based mainly on our research program and a narrative review, this commentary describes how often regulators issue safety advisories and effects on clinical practice. We found extensive differences in decisions to warn, timing and content of warnings. Monitoring advice is often inadequate. The most systematic estimate suggests an average reduction in prescribing of around 6% compared with settings with no advisory. Interviews with doctors suggest limited awareness, uptake, and at times belief in these warnings. EXPERT OPINION Post-market safety advisories are an important intervention aiming to improve prescribing and use of medicines. However, differing warnings mean that some patients may be exposed to riskier prescribing than others. Better integration of new safety information into clinical practice is needed, as well as improved transparency, independence, and public engagement in regulatory decision-making.
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Affiliation(s)
- Barbara Mintzes
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ellen Reynolds
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Priya Bahri
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands; Pharmacovigilance Office, European Medicines Agency, Amsterdam, the Netherlands
| | - Lucy T Perry
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Alice L Bhasale
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Richard L Morrow
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Colin R Dormuth
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
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Dhodapkar MM, Shi X, Ramachandran R, Chen EM, Wallach JD, Ross JS. Characterization and corroboration of safety signals identified from the US Food and Drug Administration Adverse Event Reporting System, 2008-19: cross sectional study. BMJ 2022; 379:e071752. [PMID: 36198428 PMCID: PMC9533298 DOI: 10.1136/bmj-2022-071752] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To characterize potential drug safety signals identified from the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS), from 2008 to 2019, to determine how often these signals resulted in regulatory action by the FDA and whether these actions were corroborated by published research findings or public assessments by the Sentinel Initiative. DESIGN Cross sectional study. SETTING USA. POPULATION Safety signals identified from the FAERS and publicly reported by the FDA between 2008 and 2019; and review of the relevant literature published before and after safety signals were reported in 2014-15. Literature searches were performed in November 2019, Sentinel Initiative assessments were searched in December 2021, and data analysis was finalized in December 2021. MAIN OUTCOME MEASURES Safety signals and resulting regulatory actions; number and characteristics of published studies, including corroboration of regulatory action as evidenced by significant associations (or no associations) between the drug related to the signal and the adverse event. RESULTS From 2008 to 2019, 603 potential safety signals identified from the FAERS were reported by the FDA (median 48 annually, interquartile range 41-61), of which 413 (68.5%) were resolved as of December 2021 (372 of 399 (93.2%) signals ≥3 years old were resolved). Among the resolved safety signals, 91 (22.0%) led to no regulatory action and 322 (78.0%) resulted in regulatory action, including 319 (77.2%) changes to drug labeling and 59 (14.3%) drug safety communications or other public communications from the FDA. For a subset of 82 potential safety signals reported in 2014-15, a literature search identified 1712 relevant publications; 1201 (70.2%) were case reports or case series. Among these 82 safety signals, 76 (92.7%) were resolved, of which relevant published research was identified for 57 (75.0%) signals and relevant Sentinel Initiative assessments for four (5.3%) signals. Regulatory actions by the FDA were corroborated by at least one relevant published research study for 17 of the 57 (29.8%) resolved safety signals; none of the relevant Sentinel Initiative assessments corroborated FDA regulatory action. CONCLUSIONS Most potential safety signals identified from the FAERS led to regulatory action by the FDA. Only a third of regulatory actions were corroborated by published research, however, and none by public assessments from the Sentinel Initiative. These findings suggest that either the FDA is taking regulatory actions based on evidence not made publicly available or more comprehensive safety evaluations might be needed when potential safety signals are identified.
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Affiliation(s)
| | - Xiaoting Shi
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Reshma Ramachandran
- National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Collaboration for Research Integrity and Transparency, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Section of General Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Evan M Chen
- Department of Ophthalmology, UCSF Medical Center, San Francisco, CA, USA
| | - Joshua D Wallach
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Joseph S Ross
- National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Collaboration for Research Integrity and Transparency, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Section of General Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Health System, New Haven, CT, USA
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6
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Hooimeyer A, Bhasale A, Perry L, Fabbri A, Mohammad A, McEwin E, Mintzes B. Regulatory post-market drug safety advisories on cardiac harm: A comparison of four national regulatory agencies. Pharmacol Res Perspect 2020; 8:e00680. [PMID: 33169534 PMCID: PMC7652786 DOI: 10.1002/prp2.680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/17/2020] [Accepted: 09/19/2020] [Indexed: 11/26/2022] Open
Abstract
Information on rare adverse effects is often limited when a medication is initially approved for marketing. Medicines regulators use safety advisories to warn health professionals and consumers about emerging harms. This study aimed to identify characteristics and advice provided in cardiac safety advisories released by regulators in Australia, Canada, the United Kingdom, and the United States. This was a retrospective study of safety advisories about cardiac-related adverse events issued by these four international medicines regulators between 2010 and 2016. A descriptive overview was followed by a more detailed content analysis, focusing on recommended actions for health professionals, including monitoring advice. For the latter, we applied the systematic information for monitoring (SIM) scale to assess adequacy. Over this period, 164 safety advisories about cardiac harms were issued by the four regulators. There were 61 drugs with advisories of cardiac risk, only 9 (14.7%) of which had advisories from all regulators in countries where the drug was approved. The most common adverse events were cardiac arrhythmias (n = 97, 59.1%) and coronary artery disorders (n = 39, 23.8%). The most frequent advice to prescribers was to monitor patients (n = 74, 45.1%), although only 41.2% of these advisories provided detailed advice on how monitoring should occur. We found many differences in the decision to warn and the advice provided. Patient monitoring was most often recommended, but key information such as frequency or thresholds for action was often lacking. Healthcare professionals and consumers need consistent information about rare serious harms so that they can make informed decisions.
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Affiliation(s)
- Ashleigh Hooimeyer
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Alice Bhasale
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Lucy Perry
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Alice Fabbri
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
- Centre for Evidence‐Based Medicine Odense (CEBMO)Odense University Hospital and University of Southern DenmarkOdenseDenmark
| | - Annim Mohammad
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Eliza McEwin
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Barbara Mintzes
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
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7
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Bhasale AL, Sarpatwari A, De Bruin ML, Lexchin J, Lopert R, Bahri P, Mintzes BJ. Postmarket Safety Communication for Protection of Public Health: A Comparison of Regulatory Policy in Australia, Canada, the European Union, and the United States. Clin Pharmacol Ther 2020; 109:1424-1442. [PMID: 32767557 DOI: 10.1002/cpt.2010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/25/2020] [Indexed: 12/29/2022]
Abstract
In the wake of the withdrawal of the nonsteroidal anti-inflammatory drug rofecoxib, regulators worldwide reconsidered their approach to postmarket safety. Many have since adopted a "life cycle" approach to regulation of medicines, facilitating faster approval of new medicines while planning for potential postmarket safety issues. A crucial aspect of postmarket safety is the effective and timely communication of emerging risk information using postmarket safety advisories, commonly issued as letters to healthcare professionals, drug safety bulletins, media alerts, and website announcements. Yet regulators differ in their use of postmarket safety advisories. We examined the capacity of regulators in the United States, Europe, Canada, and Australia to warn about postmarket safety issues through safety advisories by assessing their governance, legislative authority, risk communication capabilities, and transparency.
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Affiliation(s)
- Alice L Bhasale
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Ameet Sarpatwari
- Program on Regulation, Therapeutics, and Law (PORTAL) Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marie L De Bruin
- Copenhagen Center for Regulatory Science, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Ruth Lopert
- George Washington University, Washington, DC, USA
| | - Priya Bahri
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,European Medicines Agency, Amsterdam
| | - Barbara J Mintzes
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
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8
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Francisca RDC, Baba E, Hoeve CE, Zomerdijk IM, Sturkenboom MCJM, Straus SMJM. Introduction or Discontinuation of Additional Risk Minimisation Measures During the Life Cycle of Medicines in Europe. Drug Saf 2020; 44:63-72. [PMID: 33000427 PMCID: PMC7813721 DOI: 10.1007/s40264-020-00993-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction Additional risk minimisation measures (aRMMs) may be required to minimise important risks of medicines. aRMMs may be required at the time of authorisation, but may also be introduced or discontinued during the product life cycle as new safety information arises. The aim of this study is to describe post-authorisation introductions of new aRMMs and discontinuations of existing aRMMs for medicines authorised in the European Union (EU). Methods We performed a retrospective cohort study that included all new active substances authorised through the EU centralised procedure between January 1st 2006 and December 31st 2017. Data was extracted from European Public Assessment Reports available on the website of the European Medicines Agency (ema.europa.eu). Medicines were followed up from the date of marketing authorisation (MA) until first introduction or discontinuation of aRMMs, excluding Direct Healthcare Professional Communications (DHPCs), withdrawal/suspension/revocation of the MA, or July 1st 2018, when data extraction took place. Descriptive statistics were used to analyse frequency data, and survival analysis was used to calculate 5- and 10-year probability of introduction or discontinuation of aRMMs. Results A total of 476 medicines were authorised during the study period. The probability of getting aRMMs after authorisation for products authorised without aRMMs was 3.5% [95% confidence interval (CI) 1.2–5.7] within 5 years after authorisation and 6.9% (95% CI 2.6–11) within 10 years after authorisation. For products authorised with aRMMs, the probability of discontinuation of aRMMs was 0.9% (95% CI 0–2.6) within 5 years and 8.3% (95% CI 0–16.1) within 10 years after authorisation. Conclusions We found low probabilities of introduction and discontinuation of aRMMs (excluding DHPCs) during the product life cycle for medicines authorised between 2006 and 2017. The low rate of discontinuation may potentially be due to a lack of robust data on effectiveness of aRMMs. Further research is needed to get more insight into the dynamics of aRMMs during the medicine life cycle.
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Affiliation(s)
- Reynold D C Francisca
- Erasmus Medical Centre, Department of Medical Informatics, Rotterdam, The Netherlands.
- Medicines Evaluation Board, Department of Pharmacovigilance, Utrecht, The Netherlands.
| | - Emna Baba
- Medicines Evaluation Board, Department of Pharmacovigilance, Utrecht, The Netherlands
| | - Christina E Hoeve
- Erasmus Medical Centre, Department of Medical Informatics, Rotterdam, The Netherlands
- Medicines Evaluation Board, Department of Pharmacovigilance, Utrecht, The Netherlands
| | - Inge M Zomerdijk
- Erasmus Medical Centre, Department of Medical Informatics, Rotterdam, The Netherlands
- Medicines Evaluation Board, Department of Pharmacovigilance, Utrecht, The Netherlands
| | | | - Sabine M J M Straus
- Erasmus Medical Centre, Department of Medical Informatics, Rotterdam, The Netherlands
- Medicines Evaluation Board, Department of Pharmacovigilance, Utrecht, The Netherlands
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9
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Sartori D, Aronson JK, Onakpoya IJ. Signals of adverse drug reactions communicated by pharmacovigilance stakeholders: protocol for a scoping review of the global literature. Syst Rev 2020; 9:180. [PMID: 32791982 PMCID: PMC7425142 DOI: 10.1186/s13643-020-01429-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/23/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Signals of adverse drug reactions (ADRs) form the basis of some regulatory risk-minimization actions in pharmacovigilance. Reviews of limited scope have highlighted that such signals are mostly supported by reports of ADRs or multiple types of evidence. The time that elapses between a report of a suspected ADR and the communication of a signal has not been systematically characterized. Neither has the features of reports of suspected ADRs that authors used to support putative causal relationships, although difficulties with establishing causal relationships between medicinal products and adverse events have been highlighted. The objectives of this study will be to describe the evidence underpinning signals in pharmacovigilance, the features of reports of ADRs supporting signals, and the time that it takes to communicate a signal. METHODS We shall retrieve records from PubMed, EMBASE, Web of Science, and PsycINFO (from inception onwards), without language/design restrictions, and apply backward citation screening. We shall hand-search the websites of 35 regulatory agencies/authorities, restricted publications from the Uppsala Monitoring Centre, and drug bulletins. Signals will be requested from the competent stakeholder, if absent from websites. We shall use VigiBase, the World Health Organization's Global Individual Case Safety Report database, to determine the dates on which ADRs were reported. We shall manage records using EndNote (v. 8.2); one reviewer will screen titles/abstracts and full texts, a second will cross-validate the findings, and a third will arbitrate disagreements. Data will be charted via the Systematic Reviews Data Repository, following the same procedures as for data retrieval. Evidence will be categorized according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Features of reports of ADRs will be coded. Tables will display frequencies of types of evidence and features of reports of ADRs. We shall use plots or pictograms (if appropriate) to represent the time from the first report of a suspected ADR to a signal. DISCUSSION We expect the findings from this review will allow a better understanding of global patterns of similarities or differences in terms of supporting evidence and timing of communications and identify relevant research questions for future systematic reviews. SYSTEMATIC REVIEW REGISTRATION: osf.io/a4xns.
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Affiliation(s)
- Daniele Sartori
- Uppsala Monitoring Centre, Bredgränd 7B, 753 20, Uppsala, Sweden.
| | - Jeffrey K Aronson
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, OX2 6GG, United Kingdom
| | - Igho J Onakpoya
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, OX2 6GG, United Kingdom
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10
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Perry LT, Bhasale A, Fabbri A, Lexchin J, Puil L, Joarder M, Mintzes B. A descriptive analysis of medicines safety advisories issued by national medicines regulators in Australia, Canada, the United Kingdom and the United States ‐ 2007 to 2016. Pharmacoepidemiol Drug Saf 2020; 29:1054-1063. [DOI: 10.1002/pds.5072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/19/2020] [Accepted: 06/05/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Lucy T. Perry
- School of Pharmacy, Faculty of Medicine and Health, and Charles Perkins Centre University of Sydney Sydney New South Wales Australia
| | - Alice Bhasale
- School of Pharmacy, Faculty of Medicine and Health, and Charles Perkins Centre University of Sydney Sydney New South Wales Australia
| | - Alice Fabbri
- School of Pharmacy, Faculty of Medicine and Health, and Charles Perkins Centre University of Sydney Sydney New South Wales Australia
- Centre for Evidence Based Medicine Odense Odense University Hospital and University of Southern Denmark Odense Denmark
| | - Joel Lexchin
- School of Health Policy & Management, Faculty of Health York University Toronto Ontario Canada
| | - Lorri Puil
- Department of Anaesthesiology, Pharmacology & Therapeutics, Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Maisah Joarder
- School of Pharmacy, Faculty of Medicine and Health, and Charles Perkins Centre University of Sydney Sydney New South Wales Australia
| | - Barbara Mintzes
- School of Pharmacy, Faculty of Medicine and Health, and Charles Perkins Centre University of Sydney Sydney New South Wales Australia
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11
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Bhasale A, Mintzes B, Sarpatwari A. Communicating emerging risks of SGLT2 inhibitors-timeliness and transparency of medicine regulators. BMJ 2020; 369:m1107. [PMID: 32349976 DOI: 10.1136/bmj.m1107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Alice Bhasale
- University of Sydney Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, 6W75, The Hub, Charles Perkins Centre D17, University of Sydney, NSW 2006, Australia
| | - Barbara Mintzes
- University of Sydney Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, 6W75, The Hub, Charles Perkins Centre D17, University of Sydney, NSW 2006, Australia
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Ameet Sarpatwari
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
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12
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Puil L, Lexchin J, Bero L, Mangin D, Hallgreen CE, Wong GWK, Mintzes B. The impact of post-market regulatory safety advisories on patients, prescribers, and the healthcare system. Hippokratia 2019. [DOI: 10.1002/14651858.cd013510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Lorri Puil
- University of British Columbia; Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine; 2176 Health Sciences Mall Vancouver BC Canada V6T 1Z3
| | - Joel Lexchin
- York University; School of Health Policy and Management; 121 Walmer Rd Toronto ON Canada M5R 2X8
| | - Lisa Bero
- The University of Sydney; Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health; D17, 6th floor, Charles Perkins Centre, , The University of Sydney
- NSW
- 2006 Camperdown, Sydney NSW Australia 2006
| | - Dee Mangin
- McMaster University; Family Medicine; Hamilton Canada
| | - Christine E Hallgreen
- University of Copenhagen; Copenhagen Centre for Regulatory Science (CORS), Department of Pharmacy, Faculty of Health and Medical Sciences; Universitetsparken 2 Copenhagen Denmark 2100
| | - Gavin WK Wong
- University of British Columbia; Centre for Clinical Epidemiology and Evaluation; 828 West 10th Avenue Vancouver British Columbia Canada V5Z 1M9
| | - Barbara Mintzes
- The University of Sydney; Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health; D17, 6th floor, Charles Perkins Centre, , The University of Sydney
- NSW
- 2006 Camperdown, Sydney NSW Australia 2006
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13
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Perry LT, Bhasale A, Fabbri A, Lexchin J, Puil L, Joarder M, Mintzes B. Comparative Analysis of Medicines Safety Advisories Released by Australia, Canada, the United States, and the United Kingdom. JAMA Intern Med 2019; 179:982-984. [PMID: 31033999 PMCID: PMC6583834 DOI: 10.1001/jamainternmed.2019.0294] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study examines how often medicines regulators in Australia, Canada, the United Kingdom, and the United States were concordant in their decisions to issue safety advisories on approved prescription medicines.
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Affiliation(s)
- Lucy T Perry
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alice Bhasale
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alice Fabbri
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Joel Lexchin
- School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Lorri Puil
- Department of Anaesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maisah Joarder
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Barbara Mintzes
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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14
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Bjerre LM, Parlow S, de Launay D, Hogel M, Black CD, Mattison DR, Grimshaw JM, Watson MC. Comparative, cross-sectional study of the format, content and timing of medication safety letters issued in Canada, the USA and the UK. BMJ Open 2018; 8:e020150. [PMID: 30297342 PMCID: PMC6194396 DOI: 10.1136/bmjopen-2017-020150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 06/19/2018] [Accepted: 08/22/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess consistency in the format and content, and overlap of subject and timing, of medication safety letters issued by regulatory health authorities to healthcare providers in Canada, the USA and the UK. DESIGN A cross-sectional study comparing medication safety letters issued for the purpose of alerting healthcare providers to newly identified medication problems associated with medications already on the market. SETTING Online databases operated by Health Canada, the US Food and Drug Administration and the UK Medicines and Healthcare products Regulatory Agency were searched to select medication safety letters issued between 1 January 2010 and 31 December 2014. Format, content and timing of each medication safety letter were assessed using an abstraction tool comprising 21 characteristics deemed relevant by consensus of the research team. MAIN OUTCOME MEASURES Main outcome measures included, first, characteristics (format and content) of medication safety letters and second, overlap of subject and release date across countries. RESULTS Of 330 medication safety letters identified, 227 dealt with unique issues relating to medications available in all three countries. Of these 227 letters, 21 (9%) medication problems were the subject of letters released in all three countries; 40 (18%) in two countries and 166 (73%) in only one country. Only 13 (62%) of the 21 letters issued in all three countries were released within 6 months of each other. CONCLUSIONS Significant discrepancies in both the subject and timing of medication safety letters issued by health authorities in three countries (Canada, the USA and the UK) where medical practice is otherwise comparable, raising questions about why, how and when medication problems are identified and communicated to healthcare providers by the authorities. More rapid communication of medication problems and better alignment between authorities could enhance patient safety.
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Affiliation(s)
- Lise M Bjerre
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- CT Lamont Primary Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Simon Parlow
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David de Launay
- CT Lamont Primary Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Matthew Hogel
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- CT Lamont Primary Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Cody D Black
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- CT Lamont Primary Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Donald R Mattison
- Risk Sciences International, (RSI), Ottawa, Ontario, Canada
- McLaughlin Center for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeremy M Grimshaw
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Margaret C Watson
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
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15
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Kruik-Kollöffel WJ, van der Palen J, Kruik HJ, van Herk-Sukel MPP, Movig KLL. Prescription behavior for gastroprotective drugs in new users as a result of communications regarding clopidogrel - proton pump inhibitor interaction. Pharmacol Res Perspect 2016; 4:e00242. [PMID: 28116095 PMCID: PMC5242171 DOI: 10.1002/prp2.242] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/24/2016] [Indexed: 12/30/2022] Open
Abstract
Safety concerns of the concomitant use of clopidogrel and proton pump inhibitors (PPIs) were published in 2009 and 2010 by the medicines regulatory agencies, including a direct healthcare professional communication. We examined the association between various safety statements and prescription behavior for gastroprotective drugs in naïve patients in the Netherlands during the years 2008–2011. Data from the PHARMO Database Network were analyzed with interrupted time series analyses to estimate the impact of each communication on drug prescriptions. Dispensings were used as a proxy variable for prescription behavior. After the early communication in January 2009, 15.5% (95% CI 7.8, 23.4) more patients started concomitantly with (es)omeprazole and 13.8% (95% CI 6.5, 21.2) less with other PPIs. Directly after the first statement in June 2009, we found a steep increase in histamine 2‐receptor antagonists (H2RA) peaking at 25%, placing those patients at risk for gastrointestinal events. This effect for H2RA faded away after a few months. In February 2010, when the official advice via an adjusted statement was to avoid (es)omeprazole, we found a decrease of 11.9% (95% CI 5.7, 18.2) for (es)omeprazole and an increase of +16.0% (95% CI 10.3, 21.7) for other PPIs. Still 22.6% (95% CI 19.5, 25.7) of patients started on (es)omeprazole in February 2010, placing them at risk for cardiovascular events. Advices of regulatory authorities were followed, however, reluctantly and not fully, probably partly because of the existing scientific doubt about the interaction.
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Affiliation(s)
- Willemien J Kruik-Kollöffel
- Department of Clinical Pharmacy Medisch Spectrum Twente Enschede The Netherlands; Present address: Department of Clinical Pharmacy Saxenburgh Group Hardenberg The Netherlands
| | - Job van der Palen
- Medical School Twente Medisch Spectrum Twente Enschede The Netherlands; Department of Research Methodology, Measurement and Data Analysis University of Twente Enschede The Netherlands
| | - H Joost Kruik
- Department of Cardiology Hospital Group Twente Almelo and Hengelo The Netherlands
| | | | - Kris L L Movig
- Department of Clinical Pharmacy Medisch Spectrum Twente Enschede The Netherlands
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16
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Zeitoun JD, Lefèvre JH, Downing NS, Bergeron H, Ross JS. Regulatory anticipation of postmarket safety problems for novel medicines approved by the EMA between 2001 and 2010: a cross-sectional study. Pharmacoepidemiol Drug Saf 2015; 25:687-94. [PMID: 26554874 DOI: 10.1002/pds.3910] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/28/2015] [Accepted: 10/12/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE The aim of the study is to describe preapproval safety concerns expressed by the European Medicines Agency (EMA) following regulatory review and to compare those concerns with subsequent issuance of postmarket safety communications. METHODS All novel medicines approved by the EMA through the centralized authorization procedure from 2001 to 2010 were included. Preapproval safety concerns were identified through examination of information related to regulatory review publicly available on the EMA's website. Relevant postmarket safety events were identified through Dear Healthcare Professional Communications (DHPCs), including those resulting in a withdrawal, issued by at least one of four leading national regulators of the European Union. RESULTS Among the 184 novel medicines included, the EMA had expressed at least one preapproval safety concern for 110 (59.8%) of them. Then, at least one safety communication was issued for 53 (28.8%) medicines within the postmarket period of study, totaling 90 DHPCs and 5 withdrawals. Overall, these 95 DHPCs and withdrawals were pertaining to 66 different clinical safety events. The EMA had expressed a preapproval concern consistent with the postmarket safety event for 22.7% (15 of 66). The rate of issuance of a postmarket safety communication was not statistically different between medicines with or without any preapproval safety concern (31.8% vs. 24%, p = 0.25). CONCLUSIONS Preapproval safety concerns are frequently expressed by the EMA following regulatory review. However, when comparing postmarket safety communications with prior concerns, anticipation was low. Our findings emphasize the need to systematically conduct postmarket studies dedicated to safety evaluation. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jean-David Zeitoun
- Sciences Po, Paris, France.,Department of Gastroenterology and Nutrition, Saint-Antoine Hospital, APHP, Paris, France.,Department of Proctology, Croix Saint-Simon Hospital, Paris, France
| | - Jérémie H Lefèvre
- Department of General and Digestive Surgery, Saint-Antoine Hospital, APHP, Paris, France.,University Paris VI, Paris, France
| | - Nicholas S Downing
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Henri Bergeron
- Sciences Po, Paris, France.,National Centre for Scientific Research (CNRS), Paris, France
| | - Joseph S Ross
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA.,Section of General Internal Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Department of Health Policy and Management, Yale University School of Public Health, New Haven, CT, USA
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17
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Zeitoun JD, Lefèvre JH, Downing NS, Bergeron H, Ross JS. Regulatory review time and post-market safety events for novel medicines approved by the EMA between 2001 and 2010: a cross-sectional study. Br J Clin Pharmacol 2015; 80:716-26. [PMID: 25808713 DOI: 10.1111/bcp.12643] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/25/2015] [Accepted: 03/20/2015] [Indexed: 02/01/2023] Open
Abstract
AIMS Regulatory review time has been associated with post-market medication safety issues in the United States. Our objective was to evaluate whether regulatory review time and near deadline approval are associated with post-market safety events (PMSEs) for novel medicines approved by the European Medicines Agency (EMA). METHODS We performed a cross-sectional analysis of all novel medicines approved by the EMA through the centralized authorization procedure between 2001 and 2010. PMSEs were defined as withdrawals and communications identified through Dear Healthcare Professional Communications (DHPCs). Regulatory review time was defined as the time that elapsed between the start of the assessment procedure and approval. Near regulatory deadline approval was defined as approval within the 30 days before the EMA's 210 day regulatory deadline. RESULTS Among 161 eligible medicines, PMSEs were identified for 49 (30.4%), 44 of which were DHPCs, five of which were withdrawals. Median regulatory review time was 337 days (IQR 276-406) and was not associated with PMSEs (P = 0.57). However, when categorized by regulatory review speed tertile, there were differences in risk of PMSEs, with higher rates among medicines in the middle tertile (25 of 55, 45.4%; P = 0.01). Finally, 26 medicines were approved near the 210 day regulatory deadline, but were not more likely to have PMSEs (38.5% vs. 28.7%; P = 0.32). CONCLUSIONS Neither faster EMA regulatory review speed nor approval near regulatory deadlines was associated with greater likelihood of PMSEs among recently approved novel medicines.
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Affiliation(s)
- Jean-David Zeitoun
- Sciences Po, Paris, France.,Department of Gastroenterology and Nutrition, Saint-Antoine Hospital, APHP, Paris.,Department of Proctology, Croix Saint-Simon Hospital, Paris, France
| | - Jérémie H Lefèvre
- Department of General and Digestive Surgery, Saint-Antoine Hospital, APHP, Paris, France.,University Paris VI, Paris, France
| | - Nicholas S Downing
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Henri Bergeron
- Sciences Po, Paris, France.,Senior Research Fellow at the National Centre for Scientific Research (CNRS), France
| | - Joseph S Ross
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA.,Section of General Internal Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine.,Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut, USA
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