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Xie J, Li J, Liu Y, Wang H, Wang Y, Yang Y, Chen Y, Jiang R, Shao R. Comparison of novel oncology drugs that received dual approval from the US accelerated approval and EU conditional marketing authorisation pathways, 2006-2021: a cross-sectional study. BMJ Open 2023; 13:e069132. [PMID: 37286329 DOI: 10.1136/bmjopen-2022-069132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVE We aimed to provide insight into differences in drug review decisions made by the US Food and Drug Administration's (FDA) accelerated approval (AA) pathway and the European Medicines Agency's (EMA) conditional marketing authorisation (CMA) pathway, and to add to the current knowledge base of drug approval processes. DESIGN, SETTING, PARTICIPANTS This cross-sectional study thoroughly examines novel oncology drugs with dual approval through FDA AA and EMA CMA between 2006 and 2021. Statistical analysis was performed from June to July 2022. PRIMARY AND SECONDARY OUTCOME MEASURES The study examined the regulatory differences between regions for dually approved novel oncology drugs, including approval decisions, pivotal efficacy clinical trials, speed of review and postmarketing obligations. RESULTS During this time period, there was a difference in the use of the FDA AA and the EMA CMA (FDA: EMA: 41.2%: 70.0%, p<0.05). Of the 25 drugs approved by both the FDA AA and the EMA CMA, 22 (88.0%) of the regulatory decisions were based on the same pivotal clinical trials. But there were more differences in the requirements for postmarketing obligations, with the EMA's postmarketing obligations focusing on the efficacy and safety of the drug (EMA: FDA: 63.0%: 27.0%, p<0.05) and the FDA's postmarketing obligations focusing more on the efficacy (FDA: EMA: 73.0%: 23.9%, p<0.05). In addition, both the USA and EU had some postmarketing obligations completed beyond the schedule (30.4% and 19.2% in the USA and EU, respectively), with the longest delays lasting 3.7 years (0.2-3.7 years) and 3.3 years (0.04-3.3 years) in the USA and EU, respectively. CONCLUSIONS The FDA and EMA have different orientations and benefit-risk balance considerations in the use of AA or CMA. It is also the case that the shortcomings in the design and implementation of postmarketing studies have made it a challenge to obtain the evidence needed to confirm a drug's benefits.
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Affiliation(s)
- Jinping Xie
- Institute of Regulatory Science for Medical Products, China Pharmaceutical University, Nanjing, Jiangsu, China
- NMPA Key Laboratory for Drug Regulatory Innovation and Evaluation, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Jinlian Li
- Institute of Regulatory Science for Medical Products, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Yue Liu
- Institute of Regulatory Science for Medical Products, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Haoyang Wang
- Institute of Regulatory Science for Medical Products, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Yifei Wang
- Institute of Regulatory Science for Medical Products, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Yifan Yang
- Institute of Regulatory Science for Medical Products, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Yi Chen
- Institute of Regulatory Science for Medical Products, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Rong Jiang
- Institute of Regulatory Science for Medical Products, China Pharmaceutical University, Nanjing, Jiangsu, China
- NMPA Key Laboratory for Drug Regulatory Innovation and Evaluation, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Rong Shao
- Institute of Regulatory Science for Medical Products, China Pharmaceutical University, Nanjing, Jiangsu, China
- NMPA Key Laboratory for Drug Regulatory Innovation and Evaluation, China Pharmaceutical University, Nanjing, Jiangsu, China
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Comment on: "Proposals for Engaging Patients and Healthcare Professionals in Risk Minimisation from an Analysis of Stakeholder Input to the EU Valproate Assessment Using the Novel Analysing Stakeholder Safety Engagement Tool (ASSET)". Drug Saf 2021; 44:1007-1009. [PMID: 34324173 DOI: 10.1007/s40264-021-01101-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
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Barraco F, Greil R, Herbrecht R, Schmidt B, Reiter A, Willenbacher W, Raymakers R, Liersch R, Wroclawska M, Pack R, Burock K, Karumanchi D, Gisslinger H. Real‐world non‐interventional long‐term post‐authorisation safety study of ruxolitinib in myelofibrosis. Br J Haematol 2020; 191:764-774. [DOI: 10.1111/bjh.16729] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/16/2020] [Indexed: 12/16/2022]
Affiliation(s)
| | - Richard Greil
- Salzburg Cancer Research InstituteParacelsus Medical University SalzburgCancer Cluster Salzburg Salzburg Austria
| | - Raoul Herbrecht
- Inserm Hôpitaux Universitaires de Strasbourg and Université de Strasbourg Strasbourg France
| | | | | | - Wolfgang Willenbacher
- Universitaetsklinik Innsbruck Innsbruck Austria
- Oncotyrol Center for Personalized Cancer Medicine Innsbruck Austria
| | | | - Rüdiger Liersch
- Internal Medicine Hematology and Oncology Studienzentrale GEHO Muenster Germany
| | | | | | | | | | - Heinz Gisslinger
- Department of Hematology and Blood Coagulation Medical University of Vienna Vienna Austria
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Safety of Biologics Approved for the Treatment of Rheumatoid Arthritis and Other Autoimmune Diseases: A Disproportionality Analysis from the FDA Adverse Event Reporting System (FAERS). BioDrugs 2019; 32:377-390. [PMID: 29873000 DOI: 10.1007/s40259-018-0285-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The molecular and pharmacological complexity of biologic disease-modifying antirheumatic drugs used for the management of rheumatoid arthritis (RA) favors the occurrence of adverse drug reactions (ADRs), which should be constantly monitored in post-marketing safety studies. OBJECTIVE The aim of this study was to identify signals of disproportionate reporting (SDR) of clinical relevance related to the use of biologic drugs approved for RA and other autoimmune diseases. METHODS All suspected ADRs registered in the FDA Adverse Event Reporting System between January 2003 and June 2016 were collected. The reporting odds ratio was used as a measure of disproportionality to identify possible SDRs related to biologics. Those involving important medical events and designated medical events (DME) were prioritized. RESULTS In total, 2602 SDRs were prioritized. The most commonly reported were 'Infections and infestations' (32.2%) and 'Neoplasms benign, malignant, and unspecified' (20.4%), and were mainly related to use of infliximab (25.3%, p < 0.001, and 28.8%, p = 0.002, respectively). Sixty-three signals involving DMEs were identified, most of which were related to rituximab (n = 27), and were mainly due to 'blood disorders'. Amongst the DMEs detected for more than one biologic, 'intestinal perforation' and 'pulmonary fibrosis' were related to most of them. CONCLUSIONS The results of this study highlight possible safety issues associated with biologics, whose relationship should be more thoroughly investigated. Our results contribute to future research on the identification of clinically relevant risks associated with these drugs, and may help contribute to their rational and safe use.
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Wiktorowicz M, Moscou K, Lexchin J. Transnational pharmacogovernance: emergent patterns in the jazz of pharmaceutical policy convergence. Global Health 2018; 14:86. [PMID: 30134929 PMCID: PMC6106922 DOI: 10.1186/s12992-018-0402-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/30/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND As a transnational policy network, the International Council for Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) aligns international regulatory standards to address the pressures of globalization on the pharmaceutical industry and increase access to new medicines. Founding ICH members include regulators and pharmaceutical industry trade associations in the European Union, the United States and Japan. In this paper we explore the manner in which state interdependence fosters the conditions for regulatory harmonization by tracing the underlying parallels between ICH and member state pharmacogovernance to clarify emergent patterns in regulatory policy convergence. RESULTS A shift to the life cycle approach to pharmaceutical regulation corresponded with international convergence in pre-market standards as emphasis shifted to post-market standards where convergence remains unresolved. Transnational pharmacogovernance was found to concentrate regulatory authority within a co-regulatory model of bilateral negotiation with pharmaceutical trade associations in defining safety and efficacy standards. Given a context of state interdependence, parallels were found between transnational and ICH member pharmacogovernance modes that guide policy development. Divergent modes of state regulatory governance that re-calibrate perceptions of risk and risk mitigation were found to coincide with post-market policy dissonance. CONCLUSION Although interdependence fostered harmonization in pre-market standards and aligned with increased focus on post-market approaches, the confluence of divergent state governance modes and perceptions of risk may inspire improvisation in post-market standards. As the ICH expands to an ensemble with a greater global reach, further research is needed to clarify the manner in which interdependence shapes transnational pharmacogovernance and the conditions that foster policy convergence in the public interest.
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Affiliation(s)
- Mary Wiktorowicz
- School of Health Policy and Management, York University, Toronto, Canada
| | - Kathy Moscou
- School of Health Policy and Management, York University, Toronto, Canada
- WHO Collaborating Centre for Governance, Accountability and Transparency in the Pharmaceutical Sector, University of Toronto, Toronto, Canada
- Faculty of Education, Brandon University, Brandon, Canada
| | - Joel Lexchin
- School of Health Policy and Management, York University, Toronto, Canada
- WHO Collaborating Centre for Governance, Accountability and Transparency in the Pharmaceutical Sector, University of Toronto, Toronto, Canada
- University Health Network, Faculty of Medicine, University of Toronto, Toronto, Canada
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Ikeda J, Kaneko M, Narukawa M. Analysis of factors related to the occurrence of important drug-specific postmarketing safety-related regulatory actions: A cohort study focused on first-in-class drugs. Pharmacoepidemiol Drug Saf 2018; 27:1393-1401. [DOI: 10.1002/pds.4634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Junji Ikeda
- Department of Clinical Medicine (Pharmaceutical Medicine); Kitasato University Graduate School of Pharmaceutical Sciences; Tokyo Japan
- Department of Clinical Development, Department of Biometrics; Otsuka Pharmaceutical Co., Ltd.; Osaka Japan
| | - Masayuki Kaneko
- Department of Clinical Medicine (Pharmaceutical Medicine); Kitasato University Graduate School of Pharmaceutical Sciences; Tokyo Japan
| | - Mamoru Narukawa
- Department of Clinical Medicine (Pharmaceutical Medicine); Kitasato University Graduate School of Pharmaceutical Sciences; Tokyo Japan
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Randomized clinical trials and observational studies in the assessment of drug safety. Rev Epidemiol Sante Publique 2018; 66:217-225. [PMID: 29685700 DOI: 10.1016/j.respe.2018.03.133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 03/15/2017] [Accepted: 03/13/2018] [Indexed: 01/17/2023] Open
Abstract
Randomized clinical trials are considered as the preferred design to assess the potential causal relationships between drugs or other medical interventions and intended effects. For this reason, randomized clinical trials are generally the basis of development programs in the life cycle of drugs and the cornerstone of evidence-based medicine. Instead, randomized clinical trials are not the design of choice for the detection and assessment of rare, delayed and/or unexpected effects related to drug safety. Moreover, the highly homogeneous populations resulting from restrictive eligibility criteria make randomized clinical trials inappropriate to describe comprehensively the safety profile of drugs. In that context, observational studies have a key added value when evaluating the benefit-risk balance of the drugs. However, observational studies are more prone to bias than randomized clinical trials and they have to be designed, conducted and reported judiciously. In this article, we discuss the strengths and limitations of randomized clinical trials and of observational studies, more particularly regarding their contribution to the knowledge of medicines' safety profile. In addition, we present general recommendations for the sensible use of observational data.
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Iwasaki M, Kaneko M, Narukawa M. Characterization of the Recent Postmarketing Safety Measures in Europe Focusing on Additional Pharmacovigilance Activities. Pharmaceut Med 2017. [DOI: 10.1007/s40290-016-0177-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Engel P, Almas MF, De Bruin ML, Starzyk K, Blackburn S, Dreyer NA. Lessons learned on the design and the conduct of Post-Authorization Safety Studies: review of 3 years of PRAC oversight. Br J Clin Pharmacol 2016; 83:884-893. [PMID: 27780289 DOI: 10.1111/bcp.13165] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/18/2016] [Accepted: 10/23/2016] [Indexed: 01/03/2023] Open
Abstract
AIMS To describe and characterize the first cohort of Post-Authorization Safety Study (PASS) protocols reviewed under the recent European pharmacovigilance legislation. METHODS A systematic approach was used to compile all publicly available information on PASS protocols and assessments submitted from July 2012 to July 2015 from Pharmacovigilance Risk Assessment Committee (PRAC) minutes, European Medicines Agency (EMA) and European Network of Pharmacovigilance and Pharmacoepidemiology (ENCePP) webpages. RESULTS During the study period, 189 different PASS protocols were submitted to the PRAC, half of which were entered in the ENCePP electronic register of post-authorization studies (EU-PAS) by July 2015. Those protocols were assessed during 353 PRAC reviews. The EMA published only 31% of the PRAC feedback, of which the main concerns were study design (37%) and feasibility (30%). Among the 189 PASS, slightly more involved primary data capture (58%). PASS assessing drug utilization mainly leveraged secondary data sources (58%). The majority of the PASS did not include a comparator (65%) and 35% of PASS also evaluated clinical effectiveness endpoints. CONCLUSIONS To the best of our knowledge this is the first comprehensive review of three years of PASS protocols submitted under the new pharmacovigilance legislation. Our results show that both EMA and PASS sponsors could respectively increase the availability of protocol assessments and documents in the EU-PAS. Protocol content review and the high number of PRAC comments related to methodological issues and feasibility concerns should raise awareness among PASS stakeholders to design more thoughtful studies according to pharmacoepidemiological principles and existing guidelines.
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Affiliation(s)
- Pierre Engel
- Real-World Insights, QuintilesIMS, Saint Ouen, France
| | | | - Marieke Louise De Bruin
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands.,Copenhagen Centre for Regulatory Science (CORS), University of Copenhagen, Denmark
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Bourke A, Bate A, Sauer BC, Brown JS, Hall GC. Evidence generation from healthcare databases: recommendations for managing change. Pharmacoepidemiol Drug Saf 2016; 25:749-54. [DOI: 10.1002/pds.4004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/28/2016] [Accepted: 03/06/2016] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Brian C. Sauer
- University of Utah School of Medicine; Salt Lake City UT USA
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Hoekman J, Klamer TT, Mantel-Teeuwisse AK, Leufkens HGM, De Bruin ML. Characteristics and follow-up of postmarketing studies of conditionally authorized medicines in the EU. Br J Clin Pharmacol 2016; 82:213-26. [PMID: 26992001 DOI: 10.1111/bcp.12940] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 02/12/2016] [Accepted: 03/13/2016] [Indexed: 12/26/2022] Open
Abstract
AIM The aim of the present study was to provide an insight into the characteristics and follow-up of postmarketing studies of medicines that were conditionally authorized in the European Union (EU). METHODS We compiled a list of all postmarketing studies attached as specific obligations to the licence of medicines that were granted conditional marketing authorization from January 2006 to April 2014. Studies were characterized based on their objective, design, status upon marketing authorization (MA) and due data set by authorities. They were linked to online study registrations (Clinicaltrials.gov, ENCePP) to determine completion date. We described and associated characteristics of studies and medicines, and determined whether studies were completed on time. RESULTS A total of 59 postmarketing studies were requested for 21 conditionally authorized medicines. Most studies had an interventional study design (73%), were ongoing upon MA (61%) and aimed to provide additional data on efficacy (45%). Interventional studies were more often ongoing and providing efficacy data, while observational and other studies were more often new and providing safety data. Frequent grounds for requesting postmarketing studies were 'long-term follow-up' and 'increase data on subpopulations'. Of the 34 studies eligible for follow-up analysis, 26 (76%) were completed and 17 (50%) completed on time. Actual completion time took a median (interquartile range) of 274 (-121 to 556) days longer than expected. CONCLUSIONS Our results indicated that most postmarketing studies attached to a conditional marketing authorization were eventually completed but that half were completed with a substantial delay. The observations suggest caution when broadening the use of postmarketing studies for resolving uncertainties about benefits and risks after MA.
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Affiliation(s)
- Jarno Hoekman
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Innovation Studies Group, Copernicus Institute for Sustainable Development, Utrecht University, Utrecht, The Netherlands
| | - Thea T Klamer
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hubert G M Leufkens
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | - Marie L De Bruin
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Dutch Medicines Evaluation Board, Utrecht, The Netherlands
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Renwick MJ, Smolina K, Gladstone EJ, Weymann D, Morgan SG. Postmarket policy considerations for biosimilar oncology drugs. Lancet Oncol 2016; 17:e31-8. [DOI: 10.1016/s1470-2045(15)00381-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 09/27/2015] [Accepted: 09/28/2015] [Indexed: 11/26/2022]
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Botelho SF, Reis AMM. Pharmacovigilance risk mitigation plans: action in public health to promote the safe use of medication. CIENCIA & SAUDE COLETIVA 2015; 20:3897-905. [PMID: 26691813 DOI: 10.1590/1413-812320152012.16442014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 01/28/2015] [Indexed: 11/22/2022] Open
Abstract
Risk mitigation plans (RMP) are an innovative and important strategy for monitoring the sanitary risks of medication. The scope of the study was to identify RMPs for drugs registered with the Food and Drug Administration (FDA) and the actions to minimize risks established by the Brazilian Health Surveillance Agency (Anvisa) and the manufacturers of these drugs. This is a quantitative and descriptive study including a survey together with the pharmaceutical industries and research on sites and databases of Anvisa, the FDA and pharmaceutical industries. Forty drugs with RMPs filed with the FDA were also registered with Anvisa. Only 4 laboratories (10f%) reported RMPs developed in Brazil. Safety information for 15 drugs (37.5%) were located on the Anvisa site. In 91.4% of Brazilian user package leaflets there is safety information equivalent to actions to promote safe use described in RMPs available on the FDA website. The actions of communication on drug safety and sanitary risk of drugs needs to be expanded by Anvisa. The RMP is an important strategy in public health for managing new risks, monitoring known risks and, especially, for promoting the safe use of medication.
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Abstract
Pharmacovigilance (PV) plays a key role in the healthcare system through
assessment, monitoring and discovery of interactions amongst drugs and their
effects in human. Pharmaceutical and biotechnological medicines are designed to
cure, prevent or treat diseases; however, there are also risks particularly
adverse drug reactions (ADRs) can cause serious harm to patients. Thus, for
safety medication ADRs monitoring required for each medicine throughout its life
cycle, during development of drug such as pre-marketing including early stages
of drug design, clinical trials, and post-marketing surveillance. PV is concerns
with the detection, assessment, understanding and prevention of ADRs.
Pharmacogenetics and pharmacogenomics are an indispensable part of the clinical
research. Variation in the human genome is a cause of variable response to drugs
and susceptibility to diseases are determined, which is important for early drug
discovery to PV. Moreover, PV has traditionally involved in mining spontaneous
reports submitted to national surveillance systems. The research focus is
shifting toward the use of data generated from platforms outside the
conventional framework such as electronic medical records, biomedical
literature, and patient-reported data in health forums. The emerging trend in PV
is to link premarketing data with human safety information observed in the
post-marketing phase. The PV system team obtains valuable additional
information, building up the scientific data contained in the original report
and making it more informative. This necessitates an utmost requirement for
effective regulations of the drug approval process and conscious pre and post
approval vigilance of the undesired effects, especially in India. Adverse events
reported by PV system potentially benefit to the community due to their
proximity to both population and public health practitioners, in terms of
language and knowledge, enables easy contact with reporters by electronically.
Hence, PV helps to the patients get well and to manage optimally or ideally,
avoid illness is a collective responsibility of industry, drug regulators,
clinicians and other healthcare professionals to enhance their contribution to
public health. This review summarized objectives and methodologies used in PV
with critical overview of existing PV in India, challenges to overcome and
future prospects with respect to Indian context.
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Blažek B, Misbah SA, Soler-Palacin P, McCoy B, Leibl H, Engl W, Empson V, Gelmont D, Nikolov N. Human immunoglobulin (KIOVIG®/GAMMAGARD LIQUID®) for immunodeficiency and autoimmune diseases: an observational cohort study. Immunotherapy 2015; 7:753-63. [PMID: 25865232 DOI: 10.2217/imt.15.30] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
AIM To document the therapeutic efficacy and safety of Human Normal Immunoglobulin 10% Liquid (KIOVIG(®)/GAMMAGARD LIQUID(®) [IVIG 10%]) under clinical routine conditions. PATIENTS & METHODS Subjects received IVIG 10% according to the prescribing information and were followed for 6 ± 1 weeks to 12 ± 2 months depending on indication. Efficacy, adverse events, infusion rates and duration and dose were recorded. RESULTS Overall efficacy of IVIG 10% was rated as good or very good by the investigator in 81.8% of subjects; overall tolerability was good or very good in 87.5%. One serious adverse drug reaction (ADR) occurred (urticaria); no severe ADRs occurred. CONCLUSION In this observational study, the efficacy and safety of IVIG 10% in routine clinical practice was similar to that previously reported in clinical studies.
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Affiliation(s)
- Bohumír Blažek
- Faculty Hospital Ostrava, 17 Listopadu 1790, 708 52 Ostava-Poruba, Czech Republic
| | - Siraj A Misbah
- John Radcliffe 2 Hospital Academic Centre L4, Oxford, OX3 9DU, UK
| | - Pere Soler-Palacin
- Hospital Universitari Vall D'Hebron, Passeig Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Barbara McCoy
- Baxter BioScience, Donau-City Strasse 7, 1220 Vienna, Austria
| | - Heinz Leibl
- Baxter BioScience, Donau-City Strasse 7, 1220 Vienna, Austria
| | - Werner Engl
- Baxter BioScience, Donau-City Strasse 7, 1220 Vienna, Austria
| | - Victoria Empson
- Baxter BioScience, Donau-City Strasse 7, 1220 Vienna, Austria
| | - David Gelmont
- Baxter Healthcare Corporation, 1 Baxter Way, Westlake Village, CA 3811, USA
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Risk Management Plans as a Tool for Proactive Pharmacovigilance: A Cohort Study of Newly Approved Drugs in Europe. Clin Pharmacol Ther 2014; 96:723-31. [DOI: 10.1038/clpt.2014.184] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/12/2014] [Indexed: 12/28/2022]
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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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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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Hartmann M, Schaffner P. Legal Requirements, Definitions, and Standards for Non-interventional Drug Studies: A Global Picture of Variability-Results and Conclusions From a Single-Institution Survey. Ther Innov Regul Sci 2013; 47:684-691. [PMID: 30235553 DOI: 10.1177/2168479013497033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Non-interventional studies (NIS) have become increasingly important in the continuous benefit-risk assessment of medicines. However, the diversity in study designs and in requirements necessitates a careful planning of NIS. In view of a changing regulatory environment, a company-internal online survey was initiated to gather information on existing standards, definitions, and requirements for NIS and to draw advice for the future conduct of multinational NIS. Answers from 45 countries worldwide depicted a global picture of variability in terms of legal and regulatory requirements for NIS. Definitions and terminology are lacking harmonization, and different good practice standards are concurrently in use. Variations in terms of applicable standards and requirements were observed within most geographic regions. The methodological variety in terms of study designs and the divergent perspectives on NIS constitute communicative barriers. Because of the absence of one worldwide applicable good practice standard, differences in semantics and regulatory systems contribute to system disparities.
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Affiliation(s)
- Markus Hartmann
- Supplementary material for this article is available on the journal's website at http://tirs.sagepub.com/supplemental. 1 European Consulting & Contracting in Oncology, Trier, Germany
| | - Patricia Schaffner
- 2 Center of Excellence Collaborative Science, Merck KGaA, Global Medical, Safety and CMO, Darmstadt, Germany
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Arlett PR, Kurz X. New approaches to strengthen pharmacovigilance. DRUG DISCOVERY TODAY. TECHNOLOGIES 2013; 8:e1-e42. [PMID: 24103839 DOI: 10.1016/j.ddtec.2011.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Aydinkarahaliloglu ND, Aykac E, Kasap Y, Durmus N, Babacanoglu C, Basgut CE, Artiran G, Kerman S. Pharmaceutical risk management in Turkey: the first national overview. Regul Toxicol Pharmacol 2013; 67:344-50. [PMID: 23994623 DOI: 10.1016/j.yrtph.2013.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 08/17/2013] [Indexed: 11/26/2022]
Abstract
Risk management plans and actions aim to limit the known risks of drugs and provide valuable data to evaluate actual risks and pre-disposing factors for adverse drug reactions. In this study, it is aimed to evaluate and summarize the risk management actions in Turkey between 2005 and 2013 for the first time. The drugs monitored with a risk management plan and actions taken are evaluated by examining the records of the Turkish Pharmaceuticals and Medical Devices Agency retrospectively. Various risk management actions such as provision of information, summary of product characteristics and patient information leaflets, direct communication with healthcare professionals, patient and physician brochures, change of the legal status of the drug, education of doctors and pharmacists, control of number and validity of prescriptions, using informed consent forms, using "drug safety surveillance form" for the TNF blockers (firstly on the world), using web-based monitoring system, web-based prescription and web-based adverse reaction monitoring system were used for safe use of drugs during and after authorization in Turkey. Although, most of the actions are similar to those of international health authorities, the remaining are specific to the conditions of Turkey such as "drug safety surveillance form" for the TNF blockers.
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Affiliation(s)
- N D Aydinkarahaliloglu
- Department of Risk Management, Turkish Medicines and Medical Devices Agency, Ankara 06520, Turkey
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Ebbers HC, Mantel-Teeuwisse AK, Sayed-Tabatabaei FA, Moors EHM, Schellekens H, Leufkens HGM. The role of Periodic Safety Update Reports in the safety management of biopharmaceuticals. Eur J Clin Pharmacol 2013; 69:217-26. [PMID: 22706615 PMCID: PMC3548093 DOI: 10.1007/s00228-012-1317-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 05/14/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To describe and assess the outcomes of Periodic Safety Update Report (PSUR) evaluations of biopharmaceuticals. METHODS A cross-sectional analysis was performed of follow-up requirements of PSURs submitted for centrally approved biopharmaceuticals in the European Union between 1 July 2008 and 30 June 2010. A follow-up analysis on a subset of products that submitted multiple PSURs within the study period was also performed. RESULTS The cross-sectional analysis included 70 PSURs. Potential safety concerns occurred in 57 (83 %) of all PSURs, and 26 (37 %) concluded a need to change the Summary of Product Characteristics (SPC). In comparison to newer products, products authorized for more than 10 years contained significantly fewer potential safety concerns (60 vs. 92 %; p < 0.01) and required fewer SPC changes (15 vs. 46 %; p = 0.03). For 45 products, multiple PSURs were submitted that could be included in a follow-up analysis. For this subset of products, of the 106 newly identified safety potential safety issues, 7 (7%) resulted in requirements for label changes in the following PSUR. CONCLUSIONS PSURs facilitate communication between regulators and marketing authorization holders. Potential safety concerns occur for the majority of biopharmaceuticals and throughout their lifecycle, but for established products PSUR evaluations rarely lead to regulatory actions.
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Affiliation(s)
- Hans C. Ebbers
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, P.O. Box 80 082, 3508 TB Utrecht, The Netherlands
| | - Aukje K. Mantel-Teeuwisse
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, P.O. Box 80 082, 3508 TB Utrecht, The Netherlands
| | | | - Ellen H. M. Moors
- Innovation Studies, Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands
| | - Huub Schellekens
- Innovation Studies, Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht, The Netherlands
| | - Hubert G. M. Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, P.O. Box 80 082, 3508 TB Utrecht, The Netherlands
- Medicines Evaluation Board, Utrecht, The Netherlands
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A Descriptive Study of Additional Risk Minimization Measures Included in Risk Management Plans Reviewed by the United Kingdom Regulatory Authority. Pharmaceut Med 2013. [DOI: 10.1007/s40290-013-0006-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kiri VA. A pathway to improved prospective observational post-authorization safety studies. Drug Saf 2012; 35:711-24. [PMID: 22861669 DOI: 10.1007/bf03261968] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Randomized controlled trials (RCTs) are the gold standard for assessing the efficacy of drugs but not necessarily so for drug safety where inadequate power to detect either multiple or rare adverse events is a major handicap. Furthermore, the conditions under which drugs are approved for market use are often different from the settings in actual use. Indeed, with their control mechanisms, trials are by design largely inadequate for the identification of potential safety signals, especially of the rare type, hence the value of postmarketing surveillance and risk management plan-based activities. Today, clinical trials constitute only a part of the research that goes into assessing the safety of drugs. Observational studies, where the investigators merely collect data on treatments received by patients and their health status in routine clinical practice are increasing in uptake because they reflect the real-life utility of drugs, despite the absence of random treatment assignment. Although such studies generally provide less compelling evidence than RCTs, they can be far more useful to drug safety assessment activities than generally acknowledged. An increasing number of post-authorization safety studies (PASS) within the European Medicines Agency's jurisdiction are of the observational type - considered perhaps as more appropriate vehicles for exploring and documenting how products perform in the real world. A similar trend is emerging in the US following the FDA Amendments Act of 2007; since early 2010, an increasing number of post-approval commitments mandated by the FDA include observational studies. However, despite this pattern, not much is known about ongoing efforts to address many of the recognized inadequacies associated with existing methodologies and practices currently adopted in observational PASS. This current opinion presents an overview of some of the main challenges we face in prospective observational PASS, mainly from practical experience, and proposes certain steps for improvement.
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Affiliation(s)
- Victor A Kiri
- Centre of Biostatistics, University of Limerick, Limerick, Ireland.
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Ebbers HC, Mantel-Teeuwisse AK, Moors EH, Sayed Tabatabaei FA, Schellekens H, Leufkens HG. A Cohort Study Exploring Determinants of Safety-Related Regulatory Actions for Biopharmaceuticals. Drug Saf 2012; 35:417-27. [DOI: 10.2165/11597850-000000000-00000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Pharmacovigilance in Europe and North America: divergent approaches. Soc Sci Med 2012; 75:165-70. [PMID: 22521677 DOI: 10.1016/j.socscimed.2011.11.046] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 10/13/2011] [Accepted: 11/29/2011] [Indexed: 11/24/2022]
Abstract
Although international medicines regulators adopt a common system to assess the safety and efficacy of new drugs, pre-market evaluation is recognized as incomplete given the much larger post-market experience to follow. Adverse drug reactions contribute to more than 100,000 deaths in the United States annually and are among the top 10 leading causes of death. Regulators are developing active surveillance approaches to assess the risks of medicines in the post-market phase to enhance passive adverse drug reaction reporting systems that capture only one to ten percent of ADRs. The objective of this study is to compare international approaches to active surveillance and the manner in which regulatory agencies access and use post-market evidence in their decisions. A conceptual framework is used to guide the comparative analysis of pharmacovigilance governance and policy in the United Kingdom, France, the European Union, the United States and Canada using data gathered from key informant interviews and document review. While research networks are emerging internationally, we found a greater reliance on industry funding and oversight of post-market research in Europe compared to an emphasis on publicly funded programs in North America.
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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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Risk management of biosimilars in oncology: each medicine is a work in progress. Target Oncol 2012; 7 Suppl 1:S43-9. [PMID: 22274817 PMCID: PMC3291842 DOI: 10.1007/s11523-011-0188-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 08/01/2011] [Indexed: 12/12/2022]
Abstract
Drug licensing and drug safety monitoring for standard chemical entities have been established and are routinely used. These have resulted in a solid foundation of knowledge from which confident therapeutic decisions can be made. For many chemical entities, this advanced level of experience is also present for the generic products. The expertise surrounding the development of biosimilar competitor versions is increasing and progress is encouraging. To address the re-engineering and comparability complexities of biosimilars, the European Union imposed a requirement that risk management plans be included in the medications’ marketing applications. This paper summarizes and discusses the circumstances complicating the public’s view of drug safety, historical incidents during the transition from innovative to competitor products, as well as retrospective assessments of the development and post-marketing experiences thus far with two biosimilars. Through assessing the market entries and post-marketing experiences of biosimilars used in oncology, the healthcare field can better prepare for the next wave of comparator-products: biosimilar monoclonal antibodies.
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Curtin F, Schulz P. Assessing the benefit: risk ratio of a drug--randomized and naturalistic evidence. DIALOGUES IN CLINICAL NEUROSCIENCE 2011. [PMID: 21842615 PMCID: PMC3181998 DOI: 10.31887/dcns.2011.13.2/fcurtin] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Randomized evidence from clinical trials and naturalistic evidence collected from pharmacoepidemiology and pharmacovigilance activities both contribute to the initial and continuous assessment of the benefits and risks of a drug, ie, the balance between therapeutic efficacy and safety risks. Benefit-risk assessment (BRA) mainly relies on a qualitative assessment of quantitative data. Current attempts to quantify BRA are reviewed and discussed, along with the expectations of regulatory authorities such as the Food and Drug Administration and the European Medicines Agency. No method provides a fully satisfactory solution regarding BRA, because it is difficult to reduce its multidimensional aspect to simple metrics, in a context where other therapeutic alternatives play a role. Consistency and transparency are key in this assessment, which is performed throughout the whole drug life cycle. BRA is mainly based on randomized clinical studies during clinical development, and it is continued and consolidated by naturalistic data once the drug is on the market.
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Tubach F, Lamarque-Garnier V, Castot A. Role of the post-marketing authorisation studies in drug risk surveillance: specifications and methodologies. Therapie 2011; 66:355-62, 347-54. [PMID: 21851800 DOI: 10.2515/therapie/2011048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 05/30/2011] [Indexed: 11/20/2022]
Abstract
Studies conducted after the marketing authorisation with the objective of identification, characterization or quantification of one or more risks (called PASS "Post-Authorisation Safety Studies"), have been strengthened in the past years with the implementation of the concept of risk management plans (RMPs), established in 2005 in the European regulatory framework and recently amended as part of the community revision. These safety studies, interventional or not, are related to a marketed drug, whether or not the drug is used within the market authorisation conditions. Apart from these safety studies, other studies whose primary objective is not risk assessment, including assessment of efficacy, description of prescription data and use in real life, pharmacokinetics, public health impact ... can complete available safety data.The Giens Round Table examined PASS from the risk management plans of a sample of marketing authorisation holders (participants to the Round Table) and identified the main characteristics of proposed actions. Concerning the specifications and the choice of methodology, only a general outline has been sketched in view of the complexity and diversity of drug risks situations.
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Tubach F, Lamarque-Garnier V, Castot A, Auclert L, Bonnin M, Daudin M, Dubois C, Francillon A, Frauger E, Girault D, Gourlay ML, Jolliet P, Jaïs CK, Grimaldi L, Lièvre M, Maillère P, Maugendre P, Micallef J, Miranda S, Pariente A, Bigot SP, Pentel J, Prestat L, Pruvot F, Ferrer VQ, Rocher F, Saussier C, Zanetti L. Place des études post-AMM dans le suivi des risques du médicament : cahier des charges et méthodologies. Therapie 2011; 66:347-54. [DOI: 10.2515/therapie/2011041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 05/30/2011] [Indexed: 11/20/2022]
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Risk management of biosimilars in oncology. ONCOLOGIE 2011. [DOI: 10.1007/s10269-011-2016-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Leufkens H(BG, Schellekens H, Aronsson B. Post-innovation innovation of medicinal products. DRUG DISCOVERY TODAY. TECHNOLOGIES 2011; 8:e1-e42. [PMID: 24103842 DOI: 10.1016/j.ddtec.2011.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Giezen TJ, Mantel-Teeuwisse AK, Meyboom RHB, Straus SMJM, Leufkens HGM, Egberts TCG. Mapping the safety profile of biologicals: a disproportionality analysis using the WHO adverse drug reaction database, VigiBase. Drug Saf 2010; 33:865-78. [PMID: 20812771 DOI: 10.2165/11538330-000000000-00000] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Biologicals have specific characteristics, as compared with the small molecule drugs, and carry specific risks. Safety problems, for example infliximab and the risk for tuberculosis, have been identified via spontaneous reports of suspected adverse drug reactions (ADRs). However, in general there is limited data on the nature of spontaneously reported suspected ADRs for biologicals. OBJECTIVE To map the safety profile of biologicals as compared with all other drugs. In addition, mechanistic classes of biologicals will be compared. METHODS Data was obtained from the ADR database (VigiBase) maintained by the WHO Collaborating Centre for International Drug Monitoring. A disproportionality analysis was performed in which case reports for biologicals and all other drugs (the reference group), reported between January 1995 and December 2008, were selected. Vaccines were not included in the analysis. Suspected ADRs were classified according to Medical Dictionary for Regulatory Activities (MedDRA) version 12.0 at the System Organ Class (SOC) level. Biologicals were classified into mechanistic classes: antibodies, cytokines, enzymes, growth factors, hormones (reference group), interferons, receptors and others/various. The safety profile of the biologicals versus all other drugs in the database and of the various mechanistic classes of biologicals was compared using the proportional reporting ratio (PRR). RESULTS 191,004 case reports containing 546,474 suspected ADRs were reported for 62 different biologicals, and 2,556,209 case reports containing 8,761,522 suspected ADRs were reported for all other drugs (the reference group). It was found that two-thirds of all suspected ADRs reported for biologicals were reported for five active substances: etanercept (20.3%), interferon-beta-1a (15.6%), infliximab (11.6%), teriparatide (10.7%) and adalimumab (9.0%). Comparison of the safety profile of biologicals and the reference group showed that suspected ADRs for biologicals were more frequently reported in the SOCs 'Infections and infestations' (PRR 4.5), 'Surgical and medical procedures' (PRR 2.4) and 'Neoplasms benign, malignant and unspecified' (PRR 2.1), and less frequently reported in the SOCs 'Psychiatric disorders' (PRR 0.4), 'Vascular disorders' (PRR 0.4) and 'Pregnancy, puerperium and perinatal conditions' (PRR 0.4). Regarding the differences in safety profile between various mechanistic classes of biologicals, compared with hormones (reference group), 'Infections and infestations' were more frequently reported for receptors and antibodies. 'Neoplasms benign, malignant and unspecified' were more frequently reported for antibodies, cytokines, interferons and receptors, and less frequently for enzymes as compared with the reference group. CONCLUSIONS In VigiBase, five biologicals comprise two-thirds of the suspected ADRs reported for biologicals, which might distort the relation found between a specific biological and a specific adverse event in case of quantitative signal detection. Therefore the choice of reference group to be used in case of quantitative signal detection should be considered very carefully. This study confirmed that biologicals have a different safety profile compared with all other drugs in the database and, within the group of biologicals, differences exist between mechanistic classes. Infections are, for example, frequently reported for receptors and antibodies, which often have an immune compromising effect. Such predictable safety issues should be specifically studied by preregistration clinical trials and/or targeted pharmacovigilance. In addition, since not all adverse reactions can be predicted or detected during development, spontaneous reporting remains an important tool for the early detection of signals.
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Affiliation(s)
- Thijs J Giezen
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2010. [DOI: 10.1002/pds.1852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Frau S, Font Pous M, Luppino MR, Conforti A. Risk Management Plans: are they a tool for improving drug safety? Eur J Clin Pharmacol 2010; 66:785-90. [DOI: 10.1007/s00228-010-0848-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Accepted: 05/20/2010] [Indexed: 10/19/2022]
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Heemstra HE, Giezen TJ, Mantel-Teeuwisse AK, de Vrueh RLA, Leufkens HGM. Safety-related regulatory actions for orphan drugs in the US and EU: a cohort study. Drug Saf 2010; 33:127-37. [PMID: 20082539 DOI: 10.2165/11319870-000000000-00000] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Drugs for rare diseases, so-called orphan drugs, are often intended for serious or chronically debilitating diseases. Safety information is more limited at the time of approval for orphan drugs as a result of various factors, such as the limited number of patients in clinical trials, quality of the clinical trials and special approval procedures. Several studies have been conducted on safety-related regulatory actions for drugs, but none of these have specifically focused on orphan drugs. OBJECTIVE To determine the frequency and nature of safety-related regulatory actions for orphan drugs in the US and EU. METHODS This cohort study examined publicly available data from the websites of US and EU regulatory authorities on orphan drugs approved in the US and/or the EU between January 2000 and December 2007. The main outcome measures were the nature, frequency and timing of safety-related regulatory actions, defined as (i) safety withdrawals; (ii) 'black-box' warnings; and (iii) written communications to healthcare professionals issued by the US FDA or the European Medicines Agency between January 2000 and June 2008. RESULTS Ninety-five orphan drugs were approved during the study period (75 in the US, 44 in the EU, and 24 in both regions). Ten products (10.5%) received a safety-related regulatory action. No safety withdrawals, four black-box warnings and 12 written communications were identified. The probability of a first safety-related regulatory action for orphan drugs was 20.3% after 8 years of follow-up. Orphan drugs approved by accelerated approval (relative risk [RR] 3.32; 95% CI 1.06, 10.42), oncological products (RR 7.83; 95% CI 0.96, 63.82) and products for gastrointestinal and metabolism indications (RR 10.44; 95% CI 1.25, 87.27) may have a higher risk for a safety-related regulatory action. CONCLUSIONS The probability of a first safety-related regulatory action for an orphan drug was slightly lower than that reported in the literature for biologicals in one study and new molecular entities in another study. However, detection of safety issues may be complicated by the limited experience with orphan drugs in practical use due to the low prevalences of the diseases they are used for. Doctors and pharmacists should therefore be vigilant with regard to the occurrence of a safety-related issue for orphan drugs.
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Affiliation(s)
- Harald E Heemstra
- Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3508 TB Utrecht, the Netherlands
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Journal Watch. Pharmaceut Med 2010. [DOI: 10.1007/bf03256798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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