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Khoo YK, Lim JCW, Tan-Koi WC, Kitikiti NS, Sim-Devadas AL. Promoting Collaboration of Regulators and Patients in Improving Drug Safety and Regulatory Decision Making. Drug Saf 2024; 47:217-225. [PMID: 38082120 DOI: 10.1007/s40264-023-01385-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 02/19/2024]
Abstract
Pharmacovigilance involves a continuous process of evaluating, monitoring and communicating the safety profile of a medicine throughout its life cycle. This process involves a range of stakeholders, including national regulatory authorities, industry, health organisations, healthcare providers and patients. Although patients are the end users of medicines and experts in their medical conditions, patient involvement is still nascent in the Asia-Pacific region. While there are positive examples and encouraging trends, several key challenges currently hinder systemic patient involvement in drug safety and regulatory decision making. Systemic issues such as a lack of formalised frameworks or platforms, underdeveloped communication and information exchange channels, and paternalistic health systems constrain greater patient involvement and collaborative regulator-patient activities. Addressing these challenges will greatly advance collaboration among regulators, patients, and patient advocates to enhance drug safety and regulatory decision making.
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Affiliation(s)
- Yoong Khean Khoo
- Centre of Regulatory Excellence, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
- SingHealth Duke-NUS Global Health Institute, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - John C W Lim
- Centre of Regulatory Excellence, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- SingHealth Duke-NUS Global Health Institute, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Consortium for Clinical Research and Innovation, 23 Rochester Park, Singapore, 139234, Singapore
| | - Wei Chuen Tan-Koi
- Centre of Regulatory Excellence, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Nokuthula Sikhethiwe Kitikiti
- Centre of Regulatory Excellence, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Takeda Pharmaceuticals International, 8 Marina Boulevard, Singapore, 018981, Singapore
| | - Ai Ling Sim-Devadas
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232, Singapore
- SingHealth Patient Advocacy Network, Singapore Health Services, 31 Third Hospital Avenue, Singapore, 168753, Singapore
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Worakunphanich W, Suwankesawong W, Youngkong S, Thavorncharoensap M, Anderson C, Toh LS. Thai stakeholders' awareness and perceptions of the patient adverse event reporting system for herbal medicines: a qualitative study. Int J Clin Pharm 2023; 45:491-501. [PMID: 36745312 PMCID: PMC9901401 DOI: 10.1007/s11096-022-01533-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/20/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND In Thailand, the consumption of herbal medicines has been increasing. Adverse events (AEs) of herbal medicines have been identified through the spontaneous reporting system. However, the number of patients reporting AEs of herbal medicines remains limited. AIM To explore the awareness and perceptions about the patient reporting system and to explore attitudes towards safety of herbal medicines, experiences, and intention to report AEs of herbal medicines. METHOD Semi-structured in-depth interviews were conducted with stakeholders (patients, community pharmacists, village health volunteers, and consumers who had experienced submitting a complaint about health products to the Consumers Foundation). Additionally, a focus group discussion was held with stakeholders (academics, herbal medicine manufacturers, healthcare professionals, policy maker who was responsible for promoting the use of herbal medicines, pharmacovigilance staff, patient, and representative from patient organisations). The data were audio recorded, transcribed verbatim and analysed using thematic analysis. RESULTS Fifty participants were interviewed and the focus group discussion included 12 participants. Patients had positive attitudes towards the safety of herbal medicines. Lack of awareness of the patient reporting system was identified. Nevertheless, all stakeholders acknowledged the importance of the safety monitoring of herbal medicines and indicated a willingness to report AEs via the patient reporting system in the future. A simple reporting system, a variety of reporting channels, the provision of feedback, and providing rewards would motivate patients to report AEs. CONCLUSION Although there is a lack of awareness, this provides a great opportunity to improve patient AE reporting system for herbal medicines in Thailand.
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Affiliation(s)
- Wiwan Worakunphanich
- Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
- Department of Thai Traditional and Alternative Medicine, Thai Traditional Medicine Research Institute, Ministry of Public Health, Nonthaburi, Thailand
| | - Wimon Suwankesawong
- The College of Pharmaceutical and Health Consumer Protection of Thailand, Bangkok, Thailand
| | - Sitaporn Youngkong
- Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Montarat Thavorncharoensap
- Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Claire Anderson
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Li Shean Toh
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK.
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Robinson F, Wilkes S, Schaefer N, Goldstein M, Rice M, Gray J, Meyers S, Valentino LA. Patient-centered pharmacovigilance: priority actions from the inherited bleeding disorders community. Ther Adv Drug Saf 2023; 14:20420986221146418. [PMID: 36861041 PMCID: PMC9969430 DOI: 10.1177/20420986221146418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 12/01/2022] [Indexed: 02/26/2023] Open
Abstract
Pharmacovigilance, the science and practice of monitoring the effects of medicinals and their safety, is the responsibility of all stakeholders involved in the development, manufacture, regulation, distribution, prescription, and use of drugs and devices. The patient is the stakeholder most impacted by and the greatest source of information on safety issues. It is rare, however, for the patient to take a central role and exert leadership in the design and execution of pharmacovigilance. Patient organizations in the inherited bleeding disorders community are among the most established and empowered, particularly in the rare disorders. In this review, two of the largest bleeding disorders patient organizations, Hemophilia Federation of America (HFA) and National Hemophilia Foundation (NHF), offer insights into the priority actions required of all stakeholders to improve pharmacovigilance. The recent and ongoing increase in incidents raising safety concerns and a therapeutic landscape on the cusp of unprecedented expansion heighten the urgency of a recommitment to the primacy of patient safety and well-being in drug development and distribution. Plain Language Summary Patients at the center of product safety Every medical device and therapeutic product has potential benefits and harms. The pharmaceutical and biomedical companies that develop them must demonstrate that they are effective, and the safety risks are limited or manageable, for regulators to approve them for use and sale. After the product has been approved and people are using it in their daily lives, it is important to continue to collect information about any negative side effects or adverse events; this is called pharmacovigilance. Regulators, like the United States (US) Food and Drug Administration, the companies that sell and distribute the products, and healthcare professionals who prescribe them are all required to participate in collecting, reporting, analyzing, and communicating this information. The people with the most firsthand knowledge of the benefits and harms of the drug or device are the patients who use them. They have an important responsibility to learn how to recognize adverse events, how to report them, and to stay informed of any news about the product from the other partners in the pharmacovigilance network. Those partners have a crucial responsibility to provide clear, easy-to-understand information to patients about any new safety concerns that come to light. The community of people with inherited bleeding disorders has recently encountered problems with poor communication of product safety issues, prompting two large US patient organizations, National Hemophilia Foundation and Hemophilia Federation of America, to hold a Safety Summit with all the pharmacovigilance network partners. Together they developed recommendations to improve the collection and communication of information about product safety so that patients can make well-informed, timely decisions about their use of drugs and devices. This article presents these recommendations in the context of how pharmacovigilance is supposed to work and some of the challenges encountered by the community.
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Affiliation(s)
| | - Sonji Wilkes
- Hemophilia Federation of America, Washington,
DC, USA
| | | | | | | | | | - Sharon Meyers
- Hemophilia Federation of America, Washington,
DC, USA
| | - Leonard A. Valentino
- National Hemophilia Foundation, 7 Penn Plaza,
Suite 102, New York, NY 1001, USA
- Internal Medicine and Pediatrics, Rush
University, Chicago, IL, USA
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Dirkson A, den Hollander D, Verberne S, Desar I, Husson O, van der Graaf WTA, Oosten A, Reyners AKL, Steeghs N, van Loon W, van Oortmerssen G, Gelderblom H, Kraaij W. Sample Bias in Web-Based Patient-Generated Health Data of Dutch Patients With Gastrointestinal Stromal Tumor: Survey Study. JMIR Form Res 2022; 6:e36755. [PMID: 36520526 PMCID: PMC9801270 DOI: 10.2196/36755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Increasingly, social media is being recognized as a potential resource for patient-generated health data, for example, for pharmacovigilance. Although the representativeness of the web-based patient population is often noted as a concern, studies in this field are limited. OBJECTIVE This study aimed to investigate the sample bias of patient-centered social media in Dutch patients with gastrointestinal stromal tumor (GIST). METHODS A population-based survey was conducted in the Netherlands among 328 patients with GIST diagnosed 2-13 years ago to investigate their digital communication use with fellow patients. A logistic regression analysis was used to analyze clinical and demographic differences between forum users and nonusers. RESULTS Overall, 17.9% (59/328) of survey respondents reported having contact with fellow patients via social media. Moreover, 78% (46/59) of forum users made use of GIST patient forums. We found no statistically significant differences for age, sex, socioeconomic status, and time since diagnosis between forum users (n=46) and nonusers (n=273). Patient forum users did differ significantly in (self-reported) treatment phase from nonusers (P=.001). Of the 46 forum users, only 2 (4%) were cured and not being monitored; 3 (7%) were on adjuvant, curative treatment; 19 (41%) were being monitored after adjuvant treatment; and 22 (48%) were on palliative treatment. In contrast, of the 273 patients who did not use disease-specific forums to communicate with fellow patients, 56 (20.5%) were cured and not being monitored, 31 (11.3%) were on curative treatment, 139 (50.9%) were being monitored after treatment, and 42 (15.3%) were on palliative treatment. The odds of being on a patient forum were 2.8 times as high for a patient who is being monitored compared with a patient that is considered cured. The odds of being on a patient forum were 1.9 times as high for patients who were on curative (adjuvant) treatment and 10 times as high for patients who were in the palliative phase compared with patients who were considered cured. Forum users also reported a lower level of social functioning (84.8 out of 100) than nonusers (93.8 out of 100; P=.008). CONCLUSIONS Forum users showed no particular bias on the most important demographic variables of age, sex, socioeconomic status, and time since diagnosis. This may reflect the narrowing digital divide. Overrepresentation and underrepresentation of patients with GIST in different treatment phases on social media should be taken into account when sourcing patient forums for patient-generated health data. A further investigation of the sample bias in other web-based patient populations is warranted.
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Affiliation(s)
- Anne Dirkson
- Leiden Institute of Advanced Computer Science, Leiden University, Leiden, Netherlands
| | - Dide den Hollander
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Suzan Verberne
- Leiden Institute of Advanced Computer Science, Leiden University, Leiden, Netherlands
| | - Ingrid Desar
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Olga Husson
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Surgical Oncology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Medical Oncology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Astrid Oosten
- Department of Medical Oncology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Anna K L Reyners
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Neeltje Steeghs
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Wouter van Loon
- Department of Methodology and Statistics, Leiden University, Leiden, Netherlands
| | - Gerard van Oortmerssen
- Leiden Institute of Advanced Computer Science, Leiden University, Leiden, Netherlands
- Sarcoma Patient Advocacy Global Network, Wölfersheim, Germany
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Wessel Kraaij
- Leiden Institute of Advanced Computer Science, Leiden University, Leiden, Netherlands
- The Netherlands Organisation for Applied Scientific Research, Den Haag, Netherlands
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Worakunphanich W, Youngkong S, Suwankesawong W, Anderson C, Thavorncharoensap M. Comparison of Patient Adverse Drug Reaction Reporting Systems in Nine Selected Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084447. [PMID: 35457318 PMCID: PMC9028008 DOI: 10.3390/ijerph19084447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/23/2022] [Accepted: 04/04/2022] [Indexed: 02/01/2023]
Abstract
Patients are recognized as important players in the pharmacovigilance system. This study aims to describe and compare the characteristics of patient reporting systems, reporting forms, awareness raising-activities, and the statistics related to patient reporting in the selected countries. Fifteen countries (eight Western countries and seven Asian countries) were purposively selected. A questionnaire survey was distributed to national pharmacovigilance authorities in those countries. Nine countries (five Western countries and four Asian countries) returned the questionnaire. A review of the websites of national pharmacovigilance centres was conducted. The proportion of patient reports in the selected Western countries ranged from 57.83% to 14.37%, while it was accounted for less than 1% in the selected Asian countries. Currently, patients in all nine countries can report adverse drug reactions online via a website. The number of clicks from the national pharmacovigilance website to reach the online reporting form range from one to five clicks. Countries with higher patient reporting rates seemed to share the following characteristics; provision of feedback, engagement with patient organizations, and implementation of several activities to raise the awareness of the general public on the importance of pharmacovigilance. To increase the number of patient reports, the strengths of each country's system should be adopted.
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Affiliation(s)
- Wiwan Worakunphanich
- Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand;
- Thai Traditional Medicine Research Institute, Department of Thai Traditional and Alternative Medicine, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - Sitaporn Youngkong
- Health Technology Assessment Graduate Program, Mahidol University, Bangkok 10400, Thailand;
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand
| | - Wimon Suwankesawong
- The College of Pharmaceutical and Health Consumer Protection of Thailand, Bangkok 10330, Thailand;
| | - Claire Anderson
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Montarat Thavorncharoensap
- Health Technology Assessment Graduate Program, Mahidol University, Bangkok 10400, Thailand;
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand
- Correspondence:
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Martin GL, Jouganous J, Savidan R, Bellec A, Goehrs C, Benkebil M, Miremont G, Micallef J, Salvo F, Pariente A, Létinier L. Validation of Artificial Intelligence to Support the Automatic Coding of Patient Adverse Drug Reaction Reports, Using Nationwide Pharmacovigilance Data. Drug Saf 2022; 45:535-548. [PMID: 35579816 PMCID: PMC9112264 DOI: 10.1007/s40264-022-01153-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Adverse drug reaction reports are usually manually assessed by pharmacovigilance experts to detect safety signals associated with drugs. With the recent extension of reporting to patients and the emergence of mass media-related sanitary crises, adverse drug reaction reports currently frequently overwhelm pharmacovigilance networks. Artificial intelligence could help support the work of pharmacovigilance experts during such crises, by automatically coding reports, allowing them to prioritise or accelerate their manual assessment. After a previous study showing first results, we developed and compared state-of-the-art machine learning models using a larger nationwide dataset, aiming to automatically pre-code patients' adverse drug reaction reports. OBJECTIVES We aimed to determine the best artificial intelligence model identifying adverse drug reactions and assessing seriousness in patients reports from the French national pharmacovigilance web portal. METHODS Reports coded by 27 Pharmacovigilance Centres between March 2017 and December 2020 were selected (n = 11,633). For each report, the Portable Document Format form containing free-text information filled by the patient, and the corresponding encodings of adverse event symptoms (in Medical Dictionary for Regulatory Activities Preferred Terms) and seriousness were obtained. This encoding by experts was used as the reference to train and evaluate models, which contained input data processing and machine-learning natural language processing to learn and predict encodings. We developed and compared different approaches for data processing and classifiers. Performance was evaluated using receiver operating characteristic area under the curve (AUC), F-measure, sensitivity, specificity and positive predictive value. We used data from 26 Pharmacovigilance Centres for training and internal validation. External validation was performed using data from the remaining Pharmacovigilance Centres during the same period. RESULTS Internal validation: for adverse drug reaction identification, Term Frequency-Inverse Document Frequency (TF-IDF) + Light Gradient Boosted Machine (LGBM) achieved an AUC of 0.97 and an F-measure of 0.80. The Cross-lingual Language Model (XLM) [transformer] obtained an AUC of 0.97 and an F-measure of 0.78. For seriousness assessment, FastText + LGBM achieved an AUC of 0.85 and an F-measure of 0.63. CamemBERT (transformer) + Light Gradient Boosted Machine obtained an AUC of 0.84 and an F-measure of 0.63. External validation for both adverse drug reaction identification and seriousness assessment tasks yielded consistent and robust results. CONCLUSIONS Our artificial intelligence models showed promising performance to automatically code patient adverse drug reaction reports, with very similar results across approaches. Our system has been deployed by national health authorities in France since January 2021 to facilitate pharmacovigilance of COVID-19 vaccines. Further studies will be needed to validate the performance of the tool in real-life settings.
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Affiliation(s)
- Guillaume L Martin
- Synapse Medicine, 3 rue Lafayette, 33000, Bordeaux, France
- Département de Santé Publique, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | | | - Romain Savidan
- Synapse Medicine, 3 rue Lafayette, 33000, Bordeaux, France
| | - Axel Bellec
- Synapse Medicine, 3 rue Lafayette, 33000, Bordeaux, France
| | - Clément Goehrs
- Synapse Medicine, 3 rue Lafayette, 33000, Bordeaux, France
| | - Mehdi Benkebil
- Surveillance Division, Agence Nationale de Sécurité du Médicament et des Produits de Santé (ANSM), Saint Denis, France
| | - Ghada Miremont
- University of Bordeaux, INSERM, BPH, U1219, Team Pharmacoepidemiology, Bordeaux, France
- CHU de Bordeaux, Pôle de Santé Publique, Service de Pharmacologie Médicale, Centre de Pharmacovigilance de Bordeaux, Bordeaux, France
| | - Joëlle Micallef
- CRPV Marseille Provence Corse, Service Hospitalo-Universitaire de Pharmacologie Clinique et Pharmacovigilance, Assistance Publique Hôpitaux de Marseille, Marseille, France
- Aix Marseille Université, Institut des Neurosciences des Systèmes, INSERM 1106, Marseille, France
| | - Francesco Salvo
- University of Bordeaux, INSERM, BPH, U1219, Team Pharmacoepidemiology, Bordeaux, France
- CHU de Bordeaux, Pôle de Santé Publique, Service de Pharmacologie Médicale, Centre de Pharmacovigilance de Bordeaux, Bordeaux, France
| | - Antoine Pariente
- University of Bordeaux, INSERM, BPH, U1219, Team Pharmacoepidemiology, Bordeaux, France
- CHU de Bordeaux, Pôle de Santé Publique, Service de Pharmacologie Médicale, Centre de Pharmacovigilance de Bordeaux, Bordeaux, France
| | - Louis Létinier
- Synapse Medicine, 3 rue Lafayette, 33000, Bordeaux, France.
- University of Bordeaux, INSERM, BPH, U1219, Team Pharmacoepidemiology, Bordeaux, France.
- CHU de Bordeaux, Pôle de Santé Publique, Service de Pharmacologie Médicale, Centre de Pharmacovigilance de Bordeaux, Bordeaux, France.
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A patient-centred web-based adverse drug reaction reporting system identifies not yet labelled potential safety issues. Eur J Clin Pharmacol 2021; 77:1697-1704. [PMID: 34143228 PMCID: PMC8212270 DOI: 10.1007/s00228-021-03134-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/03/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Reporting of adverse drug reactions (ADRs) by patients is essential for a comprehensive risk-benefit evaluation of drugs after marketing, but only few data are available regarding patient-centred web-based ADR reporting systems. Hence, we aimed to analyze ADRs reported by patients with a particular emphasis on novel drugs and serious ADRs not yet labelled in the respective summary of product characteristics (SPC). METHODS All ADR reports received by a web-based, patient-centred platform ( www.nebenwirkungen.de ) between April 1, 2019, and September 1, 2020, were descriptively analyzed. ADRs and drugs were coded automatically according to MedDRA and ATC classification system. SPC labelling of reported ADRs for novel drugs marketed since 2015 was checked manually. RESULTS In total, 13,515 patient reports including 29,529 ADRs were received during the study period (serious ADRs [SADRs] n = 1,318; 4.5%). Women were affected in more than two-thirds of ADR reports. The most common patient-reported ADRs were nausea, dizziness and headache, whereas arrhythmia, intestinal obstruction and erectile dysfunction were the most frequent SADRs. Ciprofloxacin, levothyroxine and venlafaxine were the compounds most frequently suspected for causing both ADRs and SADRs. Regarding novel compounds, 289 reports including 739 ADRs were received (mainly fatigue, headache and myalgia). Three hundred thirty-one (44.8%) out of those ADRs were not yet labelled in the respective SPC, whereof twelve were SADRs. CONCLUSION The majority of patient-reported ADRs were non-serious. However, a relevant number of non-labelled even serious ADRs was reported for novel compounds by patients. Despite well-known limitations of patient-reported ADRs, this web-based ADR reporting system contributes to the identification of new ADRs and thus can help to improve patients' safety complementing other pharmacovigilance instruments.
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Shrestha S, Palaian S. Respiratory concerns of gabapentin and pregabalin: What does it mean to the pharmacovigilance systems in developing countries? F1000Res 2020; 9:32. [PMID: 33728039 PMCID: PMC7919607 DOI: 10.12688/f1000research.21962.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 10/29/2023] Open
Abstract
Gabapentin and pregabalin, commonly known as gabapentinoids, have been widely used globally. This paper highlights the serious breathing problems due to using gabapentin and pregabalin which was warned by the United States Food and Drug Administration on December, 2019. In this article, we tried to recommend suggestions for controlling these adverse drug reactions (ADRs). Safety reports of gabapentin and pregabalin should be obtained from concerned manufacturers and reviewed for respiratory depression effects. There should be strict prescription monitoring and drug use evaluation studies. Concurrent use of gabapentin and pregabalin with other respiratory depressants such as opioids should be strictly monitored. Educating patients can help in the early detection of ADRs due to gabapentin and pregabalin. Anecdotal reports on these medications should be encouraged.
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Affiliation(s)
- Sunil Shrestha
- Department of Pharmacy, Nepal Cancer Hospital and Research Center, Lalitpur, Nepal
- Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Nepal
| | - Subish Palaian
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
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9
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Shrestha S, Palaian S. Respiratory concerns of gabapentin and pregabalin: What does it mean to the pharmacovigilance systems in developing countries? F1000Res 2020; 9:32. [PMID: 33728039 PMCID: PMC7919607 DOI: 10.12688/f1000research.21962.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 11/20/2022] Open
Abstract
Gabapentin and pregabalin, commonly known as gabapentinoids, have been widely used globally. This paper highlights the serious breathing problems due to using gabapentin and pregabalin which was warned by the United States Food and Drug Administration on December, 2019. In this article, we tried to recommend suggestions for controlling these adverse drug reactions (ADRs). Safety reports of gabapentin and pregabalin should be obtained from concerned manufacturers and reviewed for respiratory depression effects. There should be strict prescription monitoring and drug use evaluation studies. Concurrent use of gabapentin and pregabalin with other respiratory depressants such as opioids should be strictly monitored. Educating patients can help in the early detection of ADRs due to gabapentin and pregabalin. Anecdotal reports on these medications should be encouraged.
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Affiliation(s)
- Sunil Shrestha
- Department of Pharmacy, Nepal Cancer Hospital and Research Center, Lalitpur, Nepal.,Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Nepal
| | - Subish Palaian
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
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10
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Spanakis M, Sfakianakis S, Kallergis G, Spanakis EG, Sakkalis V. PharmActa: Personalized pharmaceutical care eHealth platform for patients and pharmacists. J Biomed Inform 2019; 100:103336. [PMID: 31689550 DOI: 10.1016/j.jbi.2019.103336] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 09/17/2019] [Accepted: 10/31/2019] [Indexed: 11/28/2022]
Abstract
Community pharmacists are critically placed in the patient care chain being an extended frontline within primary healthcare networks across Europe. They are trained to ensure safe and effective medication use, a crucial and responsible role, extending beyond the common misconception limited to just providing timely access to medicines for the population. Technology-wise, eHealth being committed to an effective, networked, patient-centered and accessible healthcare would prove a real asset in this direction by achieving improved therapy adherence with better outcomes and direct contribution to a cost-effective healthcare system. In this work, we present PharmActa, a personalized eHealth platform that addresses key features of pharmaceutical care and enhances communication of pharmacists with patients for optimizing pharmacotherapy. PharmActa empowers patients by providing pharmaceutical care services, such as drug interactions tools, reminders for assisting adhesion and compliance, information regarding adverse drug reactions, as well as pharmacovigilance along with related tools for healthcare management. In addition, it allows the pharmacists to review the medication history in order to provide personalized pharmaceutical care services; thus enhancing their role as healthcare providers. Finally, a mechanism allowing such a system to be interconnected with a developed medical repository following European and International interoperability standards, is also presented. Thus far, the evaluation results presented in this work indicate that PharmActa can be of great benefit to healthcare professionals, especially pharmacists and patients.
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Affiliation(s)
- Marios Spanakis
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece.
| | - Stelios Sfakianakis
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece
| | - George Kallergis
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece
| | - Emmanouil G Spanakis
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece
| | - Vangelis Sakkalis
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece
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Ramsey A, Sheikh A. Innovations in Health Care Delivery: Drug Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2143-2150. [DOI: 10.1016/j.jaip.2019.04.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 01/03/2023]
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Quamar AH, Schmeler MR, Collins DM, Schein RM. Information communication technology-enabled instrumental activities of daily living: a paradigm shift in functional assessment. Disabil Rehabil Assist Technol 2019; 15:746-753. [DOI: 10.1080/17483107.2019.1650298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Abbas H. Quamar
- Department of Counseling, Human Performance and Rehabilitation, University of Arkansas, Little Rock, AR, USA
| | - Mark R. Schmeler
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Diane M. Collins
- Department of Occupational Therapy, University of Texas Medical Branch, Galveston, TX, USA
| | - Richard M. Schein
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
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Nikfarjam A, Ransohoff JD, Callahan A, Jones E, Loew B, Kwong BY, Sarin KY, Shah NH. Early Detection of Adverse Drug Reactions in Social Health Networks: A Natural Language Processing Pipeline for Signal Detection. JMIR Public Health Surveill 2019; 5:e11264. [PMID: 31162134 PMCID: PMC6684218 DOI: 10.2196/11264] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 02/27/2019] [Accepted: 04/04/2019] [Indexed: 12/31/2022] Open
Abstract
Background Adverse drug reactions (ADRs) occur in nearly all patients on chemotherapy, causing morbidity and therapy disruptions. Detection of such ADRs is limited in clinical trials, which are underpowered to detect rare events. Early recognition of ADRs in the postmarketing phase could substantially reduce morbidity and decrease societal costs. Internet community health forums provide a mechanism for individuals to discuss real-time health concerns and can enable computational detection of ADRs. Objective The goal of this study is to identify cutaneous ADR signals in social health networks and compare the frequency and timing of these ADRs to clinical reports in the literature. Methods We present a natural language processing-based, ADR signal-generation pipeline based on patient posts on Internet social health networks. We identified user posts from the Inspire health forums related to two chemotherapy classes: erlotinib, an epidermal growth factor receptor inhibitor, and nivolumab and pembrolizumab, immune checkpoint inhibitors. We extracted mentions of ADRs from unstructured content of patient posts. We then performed population-level association analyses and time-to-detection analyses. Results Our system detected cutaneous ADRs from patient reports with high precision (0.90) and at frequencies comparable to those documented in the literature but an average of 7 months ahead of their literature reporting. Known ADRs were associated with higher proportional reporting ratios compared to negative controls, demonstrating the robustness of our analyses. Our named entity recognition system achieved a 0.738 microaveraged F-measure in detecting ADR entities, not limited to cutaneous ADRs, in health forum posts. Additionally, we discovered the novel ADR of hypohidrosis reported by 23 patients in erlotinib-related posts; this ADR was absent from 15 years of literature on this medication and we recently reported the finding in a clinical oncology journal. Conclusions Several hundred million patients report health concerns in social health networks, yet this information is markedly underutilized for pharmacosurveillance. We demonstrated the ability of a natural language processing-based signal-generation pipeline to accurately detect patient reports of ADRs months in advance of literature reporting and the robustness of statistical analyses to validate system detections. Our findings suggest the important contributions that social health network data can play in contributing to more comprehensive and timely pharmacovigilance.
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Affiliation(s)
- Azadeh Nikfarjam
- Stanford Center for Biomedical Informatics Research, Stanford Department of Medicine, Stanford, CA, United States
| | - Julia D Ransohoff
- Stanford Center for Biomedical Informatics Research, Stanford Department of Medicine, Stanford, CA, United States
| | - Alison Callahan
- Stanford Center for Biomedical Informatics Research, Stanford Department of Medicine, Stanford, CA, United States
| | | | | | - Bernice Y Kwong
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Kavita Y Sarin
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Nigam H Shah
- Stanford Center for Biomedical Informatics Research, Stanford Department of Medicine, Stanford, CA, United States
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Harnessing social media data for pharmacovigilance: a review of current state of the art, challenges and future directions. INTERNATIONAL JOURNAL OF DATA SCIENCE AND ANALYTICS 2019. [DOI: 10.1007/s41060-019-00175-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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15
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Wang J, Zhang M, Li S, He B. Adapting and applying common methods used in pharmacovigilance to the environment: A possible starting point for the implementation of eco-pharmacovigilance. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2018; 61:67-70. [PMID: 29852371 DOI: 10.1016/j.etap.2018.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/22/2018] [Accepted: 05/23/2018] [Indexed: 06/08/2023]
Abstract
Now, the occurrence of pharmaceuticals in natural environment has been frequently reported around the world. As a kind of biologically active compounds specially designed to be effective even at very low concentration levels, pharmaceuticals in the environment could have adverse impacts to the health of human beings or other non-targeted organisms due to long-term exposures. To minimize the pharmaceutical pollution from the perspective of drug administration, a new concept called as eco-pharmacovigilance (EPV) has been proposed as a kind of pharmacovigilance(PV) for the environment. However, as a new and comprehensive science, EPV has not sophisticated methods in practice and formalized implementation model up to now. Since EPV is a special kind of PV, it could be feasible to draw on the experience of PV as a possible and reasonable starting point for EPV. In this paper, we discussed the common methods and activities used in PV including spontaneous reporting, intensive monitoring, database studies, and their potential applicability to the environment. And we concluded that these common methods in PV could be adapted and applied to EPV. But there is still the need for organizational, technical and financial supports of the EPV system.
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Affiliation(s)
- Jun Wang
- Department of Pharmacology, College of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Mengya Zhang
- Department of Pharmacology, College of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Shulan Li
- Department of Pharmacology, College of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Bingshu He
- Hubei Woman and Child Hospital, Wuhan, 430070, China.
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Goetz M, Müller M, Matthies LM, Hansen J, Doster A, Szabo A, Pauluschke-Fröhlich J, Abele H, Sohn C, Wallwiener M, Wallwiener S. Perceptions of Patient Engagement Applications During Pregnancy: A Qualitative Assessment of the Patient's Perspective. JMIR Mhealth Uhealth 2017; 5:e73. [PMID: 28550005 PMCID: PMC5466700 DOI: 10.2196/mhealth.7040] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/29/2017] [Accepted: 04/11/2017] [Indexed: 01/17/2023] Open
Abstract
Background With growing demand for medical information and health applications in pregnancy, the potential of electronic health (eHealth) and mobile health (mHealth) solutions in clinical care is increasingly unfolding. However, we still do not know how pregnant women engage with mobile apps, how such apps impact routine medical care, and whether benefit expectations are met. Whereas recent research has raised the subject of user distribution and analyzed the content of pregnancy applications, there is still a significant knowledge gap regarding what pregnant women like and dislike about pregnancy tools, along with how such interventions could be improved. Objective The aim of the study was to examine the perceptions and expectations of mobile and Web-based patient-engagement pregnancy applications. We assessed usability requirements, general acceptance of eHealth, and the impact of eHealth and mHealth pregnancy applications on the doctor-patient interaction and daily clinical routine. Methods A qualitative study was conducted at the maternity department of a major German university hospital. The sample included 30 women with low- to medium-risk pregnancies. Half of the patients were seen during outpatient care and half were hospitalized for several days. The extent and frequency of Web- and mobile phone app usage were assessed. Semistructured interviews were conducted and analyzed using systematic thematic analysis. Results Patients had a high demand for Web-based pregnancy applications. Study findings suggested a strong request for personalization, monitoring, and accessibility for frequent use as main themes derived from the interviews. Fostering patient empowerment in the doctor-patient relationship was also highly valued for a pregnancy app. Participants favored further integration of medical apps in their daily routine and pregnancy care. However, concerns were raised about content quality, trustworthiness of Web sources, and individual data security. Conclusions eHealth and mHealth applications are a highly frequented source of information. Expectations and usability requirements for those applications are also high, thus posing a challenge to interdisciplinary service providers. Patients’ attitude toward integrating apps in routine care settings was positive with a favorable influence on patient empowerment. Health care professionals should guide pregnant women toward a successful integration of these educational tools in pregnancy care.
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Affiliation(s)
- Maren Goetz
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Mitho Müller
- Department of Psychology, Ludwig Maximilian University, Munich, Germany
| | - Lina Maria Matthies
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Jenny Hansen
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Anne Doster
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Akos Szabo
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | | | - Harald Abele
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Christof Sohn
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Stephanie Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
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