1
|
Zuo W, Sun Y, Liu R, Du L, Yang N, Sun W, Wang P, Tang X, Liu Y, Ma Y, Meng M, Lei R, Yan X, Peng H, Chang Q, Pan H, Zhang B, Chen Y, Zhang S. Management guideline for the off-label use of medicine in China (2021). Expert Rev Clin Pharmacol 2022; 15:1253-1268. [PMID: 36047057 DOI: 10.1080/17512433.2022.2120468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Off-label drug use embodies a thorough clinical diagnosis and evaluation of treatment needs and should not be confused with unreasonable drug use, but it also faces potential risks with drug safety and legal issues. RESEARCH DESIGN AND METHODS We first established a guideline working group. Following the guideline development process recommended by the World Health Organization Handbook and the Chinese Medical Association, the key questions were determined through literature searches of PubMed, CNKI (Chinese National Knowledge Infrastructure) and other databases. Both the evidence and the clinicians' diagnosis and treatment workload were considered to formulate the initial recommendations. Finally, two rounds of Delphi surveys and one expert seminar were organized to determine the final recommendations of this guideline. Meanwhile, we graded the recommendations based on the body of evidence. RESULTS We determined nine questions and proposed a total of 23 recommendations regarding the definition of off-label use of drugs, applicable circumstances, classification of evidence, informed consent, legal basis, adverse drug reaction monitoring and evaluation, management procedure, responsibilities and obligations of different stakeholders, medical insurance reimbursement, and the national approval system. CONCLUSIONS This guideline standardized clinical off-label drug use and provided suggestions and references for the management of off-label drug use.
Collapse
Affiliation(s)
- Wei Zuo
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, 100730 China.,These authors are the first authors and contributed equally
| | - Yajia Sun
- School of Public Health, Lanzhou University, Lanzhou 730000, China.,Institute of Health Data Science, Lanzhou University, Lanzhou 730000, China.,These authors are the first authors and contributed equally
| | - Rongji Liu
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, 100730 China.,These authors are the first authors and contributed equally
| | - Liping Du
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, 100730 China
| | - Nan Yang
- Institute of Health Data Science, Lanzhou University, Lanzhou 730000, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Wenjuan Sun
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, 100730 China
| | - Ping Wang
- Institute of Health Data Science, Lanzhou University, Lanzhou 730000, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Xiaowan Tang
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, 100730 China
| | - Yunlan Liu
- School of Public Health, Lanzhou University, Lanzhou 730000, China.,Institute of Health Data Science, Lanzhou University, Lanzhou 730000, China
| | - Yuanyuan Ma
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, 100730 China
| | - Min Meng
- Department of Chevidence Lab Child & Adolescent Health, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.,Gansu Provincial Hospital, Lanzhou 730000, China
| | - Ruobing Lei
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.,Chevidence Lab Child & Adolescent Health, Department of Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Xuelian Yan
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, 100730 China
| | - Hua Peng
- Department of Medical Administration, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, 100730, China
| | - Qing Chang
- Department of Medical Administration, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, 100730, China
| | - Hui Pan
- Department of Medical Administration, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, 100730, China
| | - Bo Zhang
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, 100730 China
| | - Yaolong Chen
- School of Public Health, Lanzhou University, Lanzhou 730000, China.,Institute of Health Data Science, Lanzhou University, Lanzhou 730000, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China.,Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Shuyang Zhang
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | | |
Collapse
|
2
|
Analyse des prescriptions hospitalières hors AMM des médicaments chez l’adulte et étude de la faisabilité de leur détection par le codage CIM-10 du PMSI. Therapie 2022; 77:329-338. [DOI: 10.1016/j.therap.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/02/2021] [Accepted: 10/15/2021] [Indexed: 11/18/2022]
|
3
|
Schäfer W, Reinders T, Riedel O, Haug U. How often are antidepressants prescribed off-label among older adults in Germany? A claims data analysis. Br J Clin Pharmacol 2020; 87:1778-1789. [PMID: 32986874 DOI: 10.1111/bcp.14564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 09/01/2020] [Accepted: 09/13/2020] [Indexed: 11/29/2022] Open
Abstract
AIM To estimate the extent of off-label prescribing of antidepressants in older adults and to characterize patients with off-label vs on-label prescriptions of antidepressants using a large German health claims database. METHODS Using data from the German Pharmacoepidemiological Research Database (GePaRD), we conducted a cross-sectional study in adults aged 65 years or older with a dispensation of an antidepressant between 1 January 2009 and 31 December 2015 after a period of 365 days without such a dispensation. We assessed the overall and annual proportion of off-label prescriptions of antidepressants by class and individual substance. RESULTS Among 263 276 incident users of antidepressants, the proportion of off-label prescribing was 43.6% (95% CI 43.4-43.8%) with little variation between 2009 and 2015 (42.2-44.4%). The proportion of off-label use was higher in men (49%) than women (41%). While the proportion of off-label prescriptions was highest for tri- and tetracyclic antidepressants with 56.2% (amitriptyline 54.6%, maximum 65.9% for trimipramine), it amounted to 41.8% for selective serotonin reuptake inhibitors (citalopram 41.6%, maximum 46.0% for escitalopram) and was 51.2% for mirtazapine. Indicators of overall morbidity were similar in both groups, eg, pain was coded in 72% of off-label users vs 77% of on-label users (insomnia 20% vs 24%). CONCLUSION Our study suggests a high prevalence of off-label antidepressant use among older adults in Germany, which was not restricted to certain classes of antidepressants or individual antidepressants. Given the unclear risk-benefit ratio, studies investigating the safety of off-label use among older adults for individual antidepressants are urgently needed.
Collapse
Affiliation(s)
- Wiebke Schäfer
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, Bremen, 28359, Germany
| | - Tammo Reinders
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, Bremen, 28359, Germany
| | - Oliver Riedel
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, Bremen, 28359, Germany
| | - Ulrike Haug
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, Bremen, 28359, Germany.,Faculty of Human and Health Sciences, University of Bremen, Bremen, 28359, Germany
| |
Collapse
|
4
|
Mahé E, Corgibet F, Maccari F, Hadj-Rabia S, Phan C, Ruer-Mulard M, Boralévi F, Barbarot S, Bursztejn AC, Lahfa M, Severino-Freire M, Aubin F, Barthélémy H, Amy de la Bretêque M, Beauchet A. Prescriptions hors AMM (autorisation de mise sur le marché) dans le psoriasis de l’enfant. Ann Dermatol Venereol 2020; 147:429-438. [DOI: 10.1016/j.annder.2020.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 01/03/2020] [Accepted: 01/27/2020] [Indexed: 01/13/2023]
|
5
|
Bénard-Laribière A, Noize P, Girodet PO, Lassalle R, Dureau-Pournin C, Droz-Perroteau C, Fourrier-Réglat A, Salvo F, Bezin J, Pariente A. Monitoring of drug misuse or potential misuse in a nationwide healthcare insurance database: A cross-sectional study in France. Therapie 2018; 74:469-476. [PMID: 30857740 DOI: 10.1016/j.therap.2018.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/15/2018] [Accepted: 12/24/2018] [Indexed: 12/29/2022]
Abstract
AIM OF THE STUDY To provide a tool for drug misuse or potential misuse monitoring by using a healthcare insurance database. METHODS A cross-sectional study repeated quarterly from 2007 to 2014 was conducted using data from a 1/97th random sample of the French national healthcare reimbursement system. For each drug studied, ad hoc indicators were designed to assess drug misuse, defined as prescriptions that did not comply with the label stipulated in the summary of product characteristics, in terms of the drug (e.g., interactions) or the patient (age, medical history). We focused on specifically identified situations of drug misuse involving non-steroidal anti-inflammatory drugs (NSAIDs), antiemetics in patients with Parkinson's disease and antipsychotics in pediatrics; we also focused on direct anticoagulants, asthma and oral antidiabetic drugs but results for these latter are only shown in supplementary materials. RESULTS At-risk prescribing of NSAIDs in patients treated by diuretics or renin-angiotensin system inhibitors always remained higher than 14% over the study (maximum: 19%; 2014 quarter 4: 15.4%). Off-label prescribing of contraindicated anti-dopaminergic antiemetics with dopaminergic antiparkinson drugs was marginal (maximum: 2.2%; 2014 quarter 4: 0.5%) but represented at least 5.5% of antiemetic prescriptions. Despite the rise in antipsychotic prescriptions in pediatrics, no dramatic increase in misuse related to age was observed during the study period (2007 quarter 1: 16.1%; 2014 quarter 4: 11.1%). The highest degree of misuse was observed for aripiprazole and for second-generation antipsychotics other than risperidone and aripiprazole. CONCLUSION This study provides a simple tool to monitor drug misuse or potential misuse using information from a health insurance database. The results highlight the need for the Regulator to rethink risk management information campaigns and to modify the official information on products.
Collapse
Affiliation(s)
- Anne Bénard-Laribière
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, 33000 Bordeaux, France.
| | - Pernelle Noize
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, 33000 Bordeaux, France; Clinical Pharmacology, University Hospital of Bordeaux, 33000 Bordeaux, France
| | - Pierre-Oliver Girodet
- Clinical Pharmacology, University Hospital of Bordeaux, 33000 Bordeaux, France; Bordeaux PharmacoEpi, University of Bordeaux, Inserm, CIC Bordeaux CIC1401, 33000 Bordeaux, France
| | - Régis Lassalle
- Bordeaux PharmacoEpi, University of Bordeaux, Inserm, CIC Bordeaux CIC1401, 33000 Bordeaux, France
| | - Caroline Dureau-Pournin
- Bordeaux PharmacoEpi, University of Bordeaux, Inserm, CIC Bordeaux CIC1401, 33000 Bordeaux, France
| | - Cécile Droz-Perroteau
- Bordeaux PharmacoEpi, University of Bordeaux, Inserm, CIC Bordeaux CIC1401, 33000 Bordeaux, France
| | - Annie Fourrier-Réglat
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, 33000 Bordeaux, France; Clinical Pharmacology, University Hospital of Bordeaux, 33000 Bordeaux, France
| | - Francesco Salvo
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, 33000 Bordeaux, France; Clinical Pharmacology, University Hospital of Bordeaux, 33000 Bordeaux, France
| | - Julien Bezin
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, 33000 Bordeaux, France; Clinical Pharmacology, University Hospital of Bordeaux, 33000 Bordeaux, France
| | - Antoine Pariente
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, 33000 Bordeaux, France; Clinical Pharmacology, University Hospital of Bordeaux, 33000 Bordeaux, France
| | | |
Collapse
|
6
|
Blin A, Laroche ML, Coubret A. Distinction AMM et hors AMM, de la prescription à la dispensation. ACTUALITES PHARMACEUTIQUES 2018. [DOI: 10.1016/j.actpha.2018.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
7
|
Falabregues A, Daul M, Pourroy B, Gauthier-Villano L, Pisano P, Rathelot P, Vialettes B. Pertinence des prescriptions « hors AMM/RTU » des molécules onéreuses dans un hôpital universitaire. Therapie 2015; 70:385-402. [DOI: 10.2515/therapie/2015008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 11/28/2014] [Indexed: 11/20/2022]
|
8
|
Courrier V, Fournier JP, Sommet A, Montastruc JL, Poutrain JC. Parenteral Anticoagulants Use in General Practice. Clin Appl Thromb Hemost 2015; 21:319-24. [DOI: 10.1177/1076029614548057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Using parenteral anticoagulants in compliance with their summaries of product characteristics (SPCs) and consensus guidelines is associated with decreased rates of adverse drug reactions. The objectives were to assess compliance of parenteral anticoagulants use with SPCs and 4 consensus guidelines in outpatients of general practice. A descriptive cross-sectional study was conducted among 112 teaching general practitioners’ offices, from May to October 2011. Among the 332 adult outpatients consecutively included, 108 (32.5%) had a parenteral anticoagulant therapy complying with SPCs for both indication and regimen. The rate of compliance increased when considering consensus guidelines (159 patients, 47.9%). Rate of adverse events was 5.4%, including 0.6% of serious adverse events. This study showed that the use of parenteral anticoagulants complies with indications and regimens of SPCs in only 1 of the 3 outpatients. Further studies should be conducted in primary care to explore reasons for such low compliance rates.
Collapse
Affiliation(s)
- Vincent Courrier
- Département Universitaire de Médecine Générale, Faculté de Médecine, Université de Toulouse, Toulouse, France
| | - Jean-Pascal Fournier
- Département Universitaire de Médecine Générale, Faculté de Médecine, Université de Toulouse, Toulouse, France
- Laboratoire de Pharmacologie Médicale et Clinique, Équipe de Pharmacoépidémiologie INSERM UMR 1027, Faculté de Médecine, Université de Toulouse, Toulouse, France
| | - Agnès Sommet
- Laboratoire de Pharmacologie Médicale et Clinique, Équipe de Pharmacoépidémiologie INSERM UMR 1027, Faculté de Médecine, Université de Toulouse, Toulouse, France
- Service de Pharmacologie Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d’Information sur le Médicament, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jean-Louis Montastruc
- Laboratoire de Pharmacologie Médicale et Clinique, Équipe de Pharmacoépidémiologie INSERM UMR 1027, Faculté de Médecine, Université de Toulouse, Toulouse, France
- Service de Pharmacologie Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d’Information sur le Médicament, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jean-Christophe Poutrain
- Département Universitaire de Médecine Générale, Faculté de Médecine, Université de Toulouse, Toulouse, France
| |
Collapse
|
9
|
Rolland B, Deheul S, Danel T, Bence C, Blanquart MC, Bonord A, Semal R, Briand T, Sochala M, Dubocage C, Dupriez F, Duquesne D, Gibour B, Loosfeld X, Henebelle D, Henon M, Vernalde E, Matton C, Bacquet JE, Molmy L, Sarasy F, Simioni N, Richez C, Gentil-Spinosi L, Vosgien V, Yguel J, Ledent T, Auffret M, Wilquin M, Ziolkowski D, Sochala M, Gautier S, Bordet R, Cottencin O. La « recommandation temporaire d’utilisation » sur le baclofène : point de vue des prescripteurs du dispositif CAMTEA. Therapie 2015; 70:235-8. [DOI: 10.2515/therapie/2014210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 10/03/2014] [Indexed: 11/20/2022]
|
10
|
Danés I, Agustí A, Vallano A, Alerany C, Martínez J, Bosch JA, Ferrer A, Gratacós L, Pérez A, Olmo M, Marron SMC, Valderrama A, Bonafont X. Outcomes of off-label drug uses in hospitals: a multicentric prospective study. Eur J Clin Pharmacol 2014; 70:1385-93. [PMID: 25196202 PMCID: PMC4198805 DOI: 10.1007/s00228-014-1746-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 08/26/2014] [Indexed: 01/05/2023]
Abstract
PURPOSE The study aims to assess the clinical evidence, outcome and cost of off-label use of medicines in the hospital setting. METHODS A multicentric prospective cohort study of patients treated with off-label medicines was carried out in five tertiary hospitals from May 2011 to May 2012. Information on clinical characteristics of patients, drugs, outcomes and costs was collected. Patients were followed up to 6 months, and information was assessed by reviewing clinical records and interviewing physicians. RESULTS A total of 226 patients were included. The median (interquartile range (IQR)) age of patients was 46 (33-62) years; 59 % were women. Patients had received a median of three previous treatments, and a lack of response (or suboptimal) was the main reason for off-label use (72.1 %). A total of 232 off-label medicines were administered for 102 different indications. The most frequent medicines were rituximab (49; 21.1 %), botulinum toxin (25; 10.7 %) and omalizumab (14; 6.0 %). In 117 (51.8 %) cases, the level of clinical evidence for their use was low. A partial clinical response was observed in 82 patients (36.3 %), complete response in 71 (31.4 %) and stabilization in 11 (4.9 %). A total of 58 (26.5 %) patients had adverse effects, which in 11 (4.9 %) were severe. The median (IQR) cost per patient was 2,943.07 (541.9-5,872.54). CONCLUSIONS There was a high variability of off-label medicines and indications. Although the clinical evidence of off-label medicines was often low, clinical response was observed in many patients with previous multiple treatment failure, but at the expense of some adverse effects and a high cost. Registers of patients would be helpful for clinical decisions, although clinical trials are needed.
Collapse
Affiliation(s)
- I Danés
- Clinical Pharmacology Service, Fundació Institut Català de Farmacologia. Hospital Universitari Vall d'Hebron, Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron, 119-129, Barcelona, Spain,
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|