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Ogilvie RP, Layton JB, Lloyd PC, Jiao Y, Djibo DA, Wong HL, Gruber JF, Parambi R, Deng J, Miller M, Song J, Weatherby LB, Peetluk L, Lo AC, Matuska K, Wernecke M, Bui CL, Clarke TC, Cho S, Bell EJ, Yang G, Amend KL, Forshee RA, Anderson SA, McMahill-Walraven CN, Chillarige Y, Anthony MS, Seeger JD, Shoaibi A. Effectiveness of BNT162b2 COVID-19 primary series vaccination in children aged 5-17 years in the United States: a cohort study. BMC Pediatr 2024; 24:276. [PMID: 38671379 PMCID: PMC11047006 DOI: 10.1186/s12887-024-04756-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND COVID-19 vaccines are authorized for use in children in the United States; real-world assessment of vaccine effectiveness in children is needed. This study's objective was to estimate the effectiveness of receiving a complete primary series of monovalent BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine in US children. METHODS This cohort study identified children aged 5-17 years vaccinated with BNT162b2 matched with unvaccinated children. Participants and BNT162b2 vaccinations were identified in Optum and CVS Health insurance administrative claims databases linked with Immunization Information System (IIS) COVID-19 vaccination records from 16 US jurisdictions between December 11, 2020, and May 31, 2022 (end date varied by database and IIS). Vaccinated children were followed from their first BNT162b2 dose and matched to unvaccinated children on calendar date, US county of residence, and demographic and clinical factors. Censoring occurred if vaccinated children failed to receive a timely dose 2 or if unvaccinated children received any dose. Two COVID-19 outcome definitions were evaluated: COVID-19 diagnosis in any medical setting and COVID-19 diagnosis in hospitals/emergency departments (EDs). Propensity score-weighted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated with Cox proportional hazards models, and vaccine effectiveness (VE) was estimated as 1 minus HR. VE was estimated overall, within age subgroups, and within variant-specific eras. Sensitivity, negative control, and quantitative bias analyses evaluated various potential biases. RESULTS There were 453,655 eligible vaccinated children one-to-one matched to unvaccinated comparators (mean age 12 years; 50% female). COVID-19 hospitalizations/ED visits were rare in children, regardless of vaccination status (Optum, 41.2 per 10,000 person-years; CVS Health, 44.1 per 10,000 person-years). Overall, vaccination was associated with reduced incidence of any medically diagnosed COVID-19 (meta-analyzed VE = 38% [95% CI, 36-40%]) and hospital/ED-diagnosed COVID-19 (meta-analyzed VE = 61% [95% CI, 56-65%]). VE estimates were lowest among children 5-11 years and during the Omicron-variant era. CONCLUSIONS Receipt of a complete BNT162b2 vaccine primary series was associated with overall reduced medically diagnosed COVID-19 and hospital/ED-diagnosed COVID-19 in children; observed VE estimates differed by age group and variant era. REGISTRATION The study protocol was publicly posted on the BEST Initiative website ( https://bestinitiative.org/wp-content/uploads/2022/03/C19-VX-Effectiveness-Protocol_2022_508.pdf ).
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Affiliation(s)
| | - J Bradley Layton
- RTI Health Solutions, 3040 East Cornwallis Rd, PO Box 12194, Research Triangle Park, NC, 27709, USA.
| | | | | | | | - Hui Lee Wong
- US Food and Drug Administration, Silver Spring, MD, USA
| | | | | | - Jie Deng
- Optum Epidemiology, Boston, MA, USA
| | | | | | | | | | | | | | | | - Christine L Bui
- RTI Health Solutions, 3040 East Cornwallis Rd, PO Box 12194, Research Triangle Park, NC, 27709, USA
| | | | - Sylvia Cho
- US Food and Drug Administration, Silver Spring, MD, USA
| | | | | | | | | | | | | | | | - Mary S Anthony
- RTI Health Solutions, 3040 East Cornwallis Rd, PO Box 12194, Research Triangle Park, NC, 27709, USA
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Hu M, Shoaibi A, Feng Y, Lloyd PC, Wong HL, Smith ER, Amend KL, Kline A, Beachler DC, Gruber JF, Mitra M, Seeger JD, Harris C, Secora A, Obidi J, Wang J, Song J, McMahill-Walraven CN, Reich C, McEvoy R, Do R, Chillarige Y, Clifford R, Cooper DD, Forshee RA, Anderson SA. Safety of Ancestral Monovalent BNT162b2, mRNA-1273, and NVX-CoV2373 COVID-19 Vaccines in US Children Aged 6 Months to 17 Years. JAMA Netw Open 2024; 7:e248192. [PMID: 38656578 PMCID: PMC11043896 DOI: 10.1001/jamanetworkopen.2024.8192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/12/2024] [Indexed: 04/26/2024] Open
Abstract
Importance Active monitoring of health outcomes after COVID-19 vaccination provides early detection of rare outcomes that may not be identified in prelicensure trials. Objective To conduct near-real-time monitoring of health outcomes after COVID-19 vaccination in the US pediatric population. Design, Setting, and Participants This cohort study evaluated 21 prespecified health outcomes after exposure before early 2023 to BNT162b2, mRNA-1273, or NVX-CoV2373 ancestral monovalent COVID-19 vaccines in children aged 6 months to 17 years by applying a near-real-time monitoring framework using health care data from 3 commercial claims databases in the US (Optum [through April 2023], Carelon Research [through March 2023], and CVS Health [through February 2023]). Increased rates of each outcome after vaccination were compared with annual historical rates from January 1 to December 31, 2019, and January 1 to December 31, 2020, as well as between April 1 and December 31, 2020. Exposure Receipt of an ancestral monovalent BNT162b2, mRNA-1273, or NVX-CoV2373 COVID-19 vaccine dose identified through administrative claims data linked with Immunization Information Systems data. Main Outcomes and Measures Twenty-one prespecified health outcomes, of which 15 underwent sequential testing and 6 were only monitored descriptively due to lack of historical rates. Results Among 4 102 016 vaccinated enrollees aged 6 months to 17 years, 2 058 142 (50.2%) were male and 3 901 370 (95.1%) lived in an urban area. Thirteen of 15 sequentially tested outcomes did not meet the threshold for a statistical signal. Statistical signals were detected for myocarditis or pericarditis after BNT162b2 vaccination in children aged 12 to 17 years and seizure after vaccination with BNT162b2 and mRNA-1273 in children aged 2 to 4 or 5 years. However, in post hoc sensitivity analyses, a statistical signal for seizure was observed only after mRNA-1273 when 2019 background rates were selected; no statistical signal was observed when 2022 rates were selected. Conclusions and Relevance In this cohort study of pediatric enrollees across 3 commercial health insurance databases, statistical signals detected for myocarditis or pericarditis after BNT162b2 (ages 12-17 years) were consistent with previous reports, and seizures after BNT162b2 (ages 2-4 years) and mRNA-1273 vaccinations (ages 2-5 years) should be further investigated in a robust epidemiologic study with confounding adjustment. The US Food and Drug Administration concludes that the known and potential benefits of COVID-19 vaccination outweigh the known and potential risks of COVID-19 infection.
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Affiliation(s)
- Mao Hu
- Acumen LLC, Burlingame, California
| | - Azadeh Shoaibi
- US Food and Drug Administration, Silver Spring, Maryland
| | | | | | - Hui Lee Wong
- US Food and Drug Administration, Silver Spring, Maryland
| | | | | | | | | | | | | | | | | | | | - Joyce Obidi
- US Food and Drug Administration, Silver Spring, Maryland
| | | | | | | | | | | | - Rose Do
- Acumen LLC, Burlingame, California
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Lloyd PC, Lufkin B, Moll K, Ogilvie RP, McMahill-Walraven CN, Beachler DC, Kelman JA, Shi X, Hobbi S, Amend KL, Djibo DA, Shangguan S, Shoaibi A, Sheng M, Secora A, Zhou CK, Kowarski L, Chillarige Y, Forshee RA, Anderson SA, Muthuri S, Seeger JD, Kline A, Reich C, MaCurdy T, Wong HL. Incidence rates of thrombosis with thrombocytopenia syndrome (TTS) among adults in United States commercial and Medicare claims databases, 2017-2020. Vaccine 2024; 42:2004-2010. [PMID: 38388240 DOI: 10.1016/j.vaccine.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 01/25/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Increased risk of thrombosis with thrombocytopenia syndrome (TTS) following adenovirus vector-based COVID-19 vaccinations has been identified in passive surveillance systems. TTS incidence rates (IRs) in the United States (U.S.) are needed to contextualize reports following COVID-19 vaccination. METHODS We estimated annual and monthly IRs of overall TTS, common site TTS, and unusual site TTS for adults aged 18-64 years in Carelon Research and MarketScan commercial claims (2017-Oct 2020), CVS Health and Optum commercial claims (2019-Oct 2020), and adults aged ≥ 65 years using CMS Medicare claims (2019-Oct 2020); IRs were stratified by age, sex, and race/ethnicity (CMS Medicare). RESULTS Across data sources, annual IRs for overall TTS were similar between Jan-Dec 2019 and Jan-Oct 2020. Rates were higher in Medicare (IRs: 370.72 and 365.63 per 100,000 person-years for 2019 and 2020, respectively) than commercial data sources (MarketScan IRs: 24.21 and 24.06 per 100,000 person-years; Optum IRs: 32.60 and 31.29 per 100,000 person-years; Carelon Research IRs: 24.46 and 26.16 per 100,000 person-years; CVS Health IRs: 30.31 and 30.25 per 100,000 person-years). Across years and databases, common site TTS IRs increased with age and were higher among males. Among adults aged ≥ 65 years, the common site TTS IR was highest among non-Hispanic black adults. Annual unusual site TTS IRs ranged between 2.02 and 3.04 (commercial) and 12.49 (Medicare) per 100,000 person-years for Jan-Dec 2019; IRs ranged between 1.53 and 2.67 (commercial) and 11.57 (Medicare) per 100,000 person-years for Jan-Oct 2020. Unusual site TTS IRs were higher in males and increased with age in commercial data sources; among adults aged ≥ 65 years, IRs decreased with age and were highest among non-Hispanic American Indian/Alaska native adults. CONCLUSION TTS IRs were generally similar across years, higher for males, and increased with age. These rates may contribute to surveillance of post-vaccination TTS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Cindy Ke Zhou
- US Food and Drug Administration, Silver Spring, MD, USA
| | | | | | | | | | | | | | | | | | - Thomas MaCurdy
- Acumen LLC, Burlingame, CA, USA; Department of Economics, Stanford University, Stanford, CA, USA
| | - Hui Lee Wong
- US Food and Drug Administration, Silver Spring, MD, USA
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Lu Y, Matuska K, Nadimpalli G, Ma Y, Duma N, Zhang HT, Chiang Y, Lyu H, Chillarige Y, Kelman JA, Forshee RA, Anderson SA. Stroke Risk After COVID-19 Bivalent Vaccination Among US Older Adults. JAMA 2024; 331:938-950. [PMID: 38502075 PMCID: PMC10951737 DOI: 10.1001/jama.2024.1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/24/2024] [Indexed: 03/20/2024]
Abstract
Importance In January 2023, the US Centers for Disease Control and Prevention and the US Food and Drug Administration noted a safety concern for ischemic stroke among adults aged 65 years or older who received the Pfizer-BioNTech BNT162b2; WT/OMI BA.4/BA.5 COVID-19 bivalent vaccine. Objective To evaluate stroke risk after administration of (1) either brand of the COVID-19 bivalent vaccine, (2) either brand of the COVID-19 bivalent plus a high-dose or adjuvanted influenza vaccine on the same day (concomitant administration), and (3) a high-dose or adjuvanted influenza vaccine. Design, Setting, and Participants Self-controlled case series including 11 001 Medicare beneficiaries aged 65 years or older who experienced stroke after receiving either brand of the COVID-19 bivalent vaccine (among 5 397 278 vaccinated individuals). The study period was August 31, 2022, through February 4, 2023. Exposures Receipt of (1) either brand of the COVID-19 bivalent vaccine (primary) or (2) a high-dose or adjuvanted influenza vaccine (secondary). Main Outcomes and Measures Stroke risk (nonhemorrhagic stroke, transient ischemic attack, combined outcome of nonhemorrhagic stroke or transient ischemic attack, or hemorrhagic stroke) during the 1- to 21-day or 22- to 42-day risk window after vaccination vs the 43- to 90-day control window. Results There were 5 397 278 Medicare beneficiaries who received either brand of the COVID-19 bivalent vaccine (median age, 74 years [IQR, 70-80 years]; 56% were women). Among the 11 001 beneficiaries who experienced stroke after receiving either brand of the COVID-19 bivalent vaccine, there were no statistically significant associations between either brand of the COVID-19 bivalent vaccine and the outcomes of nonhemorrhagic stroke, transient ischemic attack, nonhemorrhagic stroke or transient ischemic attack, or hemorrhagic stroke during the 1- to 21-day or 22- to 42-day risk window vs the 43- to 90-day control window (incidence rate ratio [IRR] range, 0.72-1.12). Among the 4596 beneficiaries who experienced stroke after concomitant administration of either brand of the COVID-19 bivalent vaccine plus a high-dose or adjuvanted influenza vaccine, there was a statistically significant association between vaccination and nonhemorrhagic stroke during the 22- to 42-day risk window for the Pfizer-BioNTech BNT162b2; WT/OMI BA.4/BA.5 COVID-19 bivalent vaccine (IRR, 1.20 [95% CI, 1.01-1.42]; risk difference/100 000 doses, 3.13 [95% CI, 0.05-6.22]) and a statistically significant association between vaccination and transient ischemic attack during the 1- to 21-day risk window for the Moderna mRNA-1273.222 COVID-19 bivalent vaccine (IRR, 1.35 [95% CI, 1.06-1.74]; risk difference/100 000 doses, 3.33 [95% CI, 0.46-6.20]). Among the 21 345 beneficiaries who experienced stroke after administration of a high-dose or adjuvanted influenza vaccine, there was a statistically significant association between vaccination and nonhemorrhagic stroke during the 22- to 42-day risk window (IRR, 1.09 [95% CI, 1.02-1.17]; risk difference/100 000 doses, 1.65 [95% CI, 0.43-2.87]). Conclusions and Relevance Among Medicare beneficiaries aged 65 years or older who experienced stroke after receiving either brand of the COVID-19 bivalent vaccine, there was no evidence of a significantly elevated risk for stroke during the days immediately after vaccination.
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MESH Headings
- Aged
- Female
- Humans
- Male
- 2019-nCoV Vaccine mRNA-1273/adverse effects
- 2019-nCoV Vaccine mRNA-1273/therapeutic use
- Adjuvants, Immunologic/adverse effects
- Adjuvants, Immunologic/therapeutic use
- BNT162 Vaccine/adverse effects
- BNT162 Vaccine/therapeutic use
- COVID-19/prevention & control
- COVID-19 Vaccines/adverse effects
- COVID-19 Vaccines/therapeutic use
- Hemorrhagic Stroke/chemically induced
- Hemorrhagic Stroke/epidemiology
- Hemorrhagic Stroke/etiology
- Influenza Vaccines/adverse effects
- Influenza Vaccines/therapeutic use
- Ischemic Attack, Transient/chemically induced
- Ischemic Attack, Transient/epidemiology
- Ischemic Attack, Transient/etiology
- Medicare
- Stroke/epidemiology
- Stroke/etiology
- Stroke/prevention & control
- United States/epidemiology
- Vaccination/adverse effects
- Vaccination/methods
- Vaccines, Combined/adverse effects
- Vaccines, Combined/therapeutic use
- Centers for Disease Control and Prevention, U.S./statistics & numerical data
- United States Food and Drug Administration/statistics & numerical data
- Ischemic Stroke/chemically induced
- Ischemic Stroke/epidemiology
- Ischemic Stroke/etiology
- Influenza, Human/prevention & control
- Aged, 80 and over
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Affiliation(s)
- Yun Lu
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | | | | | - Yuxin Ma
- Acumen LLC, Burlingame, California
| | | | - Henry T Zhang
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | | | - Hai Lyu
- Acumen LLC, Burlingame, California
| | | | | | - Richard A Forshee
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Steven A Anderson
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
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Lu Y, Lindaas A, Matuska K, Izurieta HS, McEvoy R, Menis M, Shi X, Steele WR, Wernecke M, Chillarige Y, Wong HL, Kelman JA, Forshee RA. Real-world Effectiveness of mRNA COVID-19 Vaccines Among US Nursing Home Residents Aged ≥65 Years in the Pre-Delta and High Delta Periods. Open Forum Infect Dis 2024; 11:ofae051. [PMID: 38505296 PMCID: PMC10950043 DOI: 10.1093/ofid/ofae051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/25/2024] [Indexed: 03/21/2024] Open
Abstract
Background Long-term care residents were among the most vulnerable during the COVID-19 pandemic. We estimated vaccine effectiveness of mRNA COVID-19 vaccines in Medicare nursing home residents aged ≥65 years during pre-Delta and high Delta periods. Methods We conducted a retrospective cohort study from 13 December 2020 to 20 November 2021 using Medicare claims data. Exposures included 2 and 3 doses of Pfizer-BioNTech and Moderna COVID-19 vaccines. We used inverse probability weighting and Cox proportional hazards models to estimate absolute and relative vaccine effectiveness. Results Two-dose vaccine effectiveness against COVID-19-related death was 69.8% (95% CI, 65.9%‒73.3%) during the pre-Delta period and 55.7% (49.5%‒61.1%) during the high Delta period, without adjusting for time since vaccination. We observed substantial waning of effectiveness from 65.1% (54.2%‒73.5%) within 6 months from second-dose vaccination to 45.2% (30.6%‒56.7%) ≥6 months after second-dose vaccination in the high Delta period. Three doses provided 88.7% (73.5%‒95.2%) vaccine effectiveness against death, and the incremental benefit of 3 vs 2 doses was 74.6% (40.4%‒89.2%) during high Delta. Among beneficiaries with a prior COVID-19 infection, 3-dose vaccine effectiveness for preventing death was 78.6% (50.0%‒90.8%), and the additional protection of 3 vs 2 doses was 70.0% (30.1%‒87.1%) during high Delta. Vaccine effectiveness estimates against less severe outcomes (eg, infection) were lower. Conclusions This nationwide real-world study demonstrated that mRNA COVID-19 vaccines provided substantial protection against COVID-19-related death. Two-dose protection waned after 6 months. Third doses during the high Delta period provided significant additional protection for individuals with or without a prior COVID-19 infection.
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Affiliation(s)
- Yun Lu
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | | | | | - Hector S Izurieta
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Mikhail Menis
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Whitney R Steele
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | | | | | - Hui Lee Wong
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jeffrey A Kelman
- Center for Medicare, Centers for Medicare and Medicaid Services, Washington, DC, USA
| | - Richard A Forshee
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
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6
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Layton JB, Peetluk L, Wong HL, Jiao Y, Djibo DA, Bui C, Lloyd PC, Gruber JF, Miller M, Ogilvie RP, Deng J, Parambi R, Song J, Weatherby LB, Lo AC, Matuska K, Wernecke M, Clarke TC, Cho S, Bell EJ, Seeger JD, Yang GW, Illei D, Forshee RA, Anderson SA, McMahill-Walraven CN, Chillarige Y, Amend KL, Anthony MS, Shoaibi A. Effectiveness of monovalent COVID-19 booster/additional vaccine doses in the United States. Vaccine X 2024; 16:100447. [PMID: 38318230 PMCID: PMC10840109 DOI: 10.1016/j.jvacx.2024.100447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/07/2024] Open
Abstract
Background Monovalent booster/additional doses of COVID-19 vaccines were first authorized in August 2021 in the United States. We evaluated the real-world effectiveness of receipt of a monovalent booster/additional dose of COVID-19 vaccine compared with receiving a primary vaccine series without a booster/additional dose. Methods Cohorts of individuals receiving a COVID-19 booster/additional dose after receipt of a complete primary vaccine series were identified in 2 administrative insurance claims databases (Optum, CVS Health) supplemented with state immunization information system data between August 2021 and March 2022. Individuals with a complete primary series but without a booster/additional dose were one-to-one matched to boosted individuals on calendar date, geography, and clinical factors. COVID-19 diagnoses were identified in any medical setting, or specifically in hospitals/emergency departments (EDs). Propensity score-weighted hazards ratios (HRs) and 95% confidence intervals (CI) were estimated with Cox proportional hazards models; vaccine effectiveness (VE) was estimated as 1 minus the HR by vaccine brand overall and within subgroups of variant-specific eras, immunocompromised status, and homologous/heterologous booster status. Results Across both data sources, we identified 752,165 matched pairs for BNT162b2, 410,501 for mRNA-1273, and 11,398 for JNJ-7836735. For any medically diagnosed COVID-19, meta-analyzed VE estimates for BNT162b2, mRNA-1273, and JNJ-7836735, respectively, were: BNT162b2, 54% (95% CI, 53%-56%); mRNA-1273, 58% (95% CI, 56%-59%); JNJ-7836735, 34% (95% CI, 23%-44%). For hospital/ED-diagnosed COVID-19, VE estimates ranged from 70% to 76%. VE was generally lower during the Omicron era than the Delta era and for immunocompromised individuals. There was little difference observed by homologous or heterologous booster status. Conclusion The original, monovalent booster/additional doses were reasonably effective in real-world use among the populations for which they were indicated during the study period. Additional studies may be informative in the future as new variants emerge and new vaccines become available.Registration: The study protocol was publicly posted on the BEST Initiative website (https://bestinitiative.org/wp-content/uploads/2022/03/C19-VX-Effectiveness-Protocol_2022_508.pdf).
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Affiliation(s)
| | | | - Hui Lee Wong
- US Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | | | | | - Christine Bui
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - Patricia C. Lloyd
- US Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | - Joann F. Gruber
- US Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | | | | | - Jie Deng
- Optum Epidemiology, Boston, MA, USA
| | | | | | | | | | | | | | - Tainya C. Clarke
- US Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | - Sylvia Cho
- US Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | | | | | | | | | - Richard A. Forshee
- US Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | - Steven A. Anderson
- US Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | | | | | | | | | - Azadeh Shoaibi
- US Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD, USA
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Lerro CC, Bradley MC, Forshee RA, Rivera DR. The Bar Is High: Evaluating Fit-for-Use Oncology Real-World Data for Regulatory Decision Making. JCO Clin Cancer Inform 2024; 8:e2300261. [PMID: 38241598 PMCID: PMC10807892 DOI: 10.1200/cci.23.00261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 01/21/2024] Open
Affiliation(s)
- Catherine C. Lerro
- Oncology Center of Excellence, Office of the Commissioner, US Food and Drug Administration, Silver Spring, MD
| | - Marie C. Bradley
- Office of Medical Policy, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD
| | - Richard A. Forshee
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD
| | - Donna R. Rivera
- Oncology Center of Excellence, Office of the Commissioner, US Food and Drug Administration, Silver Spring, MD
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Graham DJ, Izurieta HS, Zhang D, Avagyan A, Lyu H, Wiederhorn R, Lu Y, Mosholder AD, Smith ER, Zhao Y, Shangguan S, Tsai HT, Pennap D, Sandhu AT, Wernecke M, MaCurdy TE, Kelman JA, Forshee RA. Risk of Severe COVID-19 in Prevalent Users of Alpha-1 Adrenergic Receptor Antagonists: A National Case-Control Study of Medicare Beneficiaries. Am J Med 2023; 136:1018-1025.e3. [PMID: 37454868 DOI: 10.1016/j.amjmed.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/03/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Alpha-1 adrenergic receptor antagonists prevent cytokine storm in mouse sepsis models. This led to the hypothesis that alpha-1 blockers may prevent severe coronavirus disease 2019 (COVID-19), which is characterized by hypercytokinemia and progressive respiratory failure. METHODS We performed an observational case-control study in male Medicare beneficiaries aged 65 years or older, with or without benign prostatic hyperplasia (BPH), and treated with alpha-1 receptor blockers or 5-alpha reductase inhibitors. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated for outcomes of uncomplicated and severe COVID-19 hospitalization (intensive care unit admission, invasive mechanical ventilation, or death). RESULTS There were 20,963 cases of hospitalized COVID-19 matched to 101,161 controls on calendar date and neighborhood of residence. In the primary analysis (males with BPH), there was no difference in risk of uncomplicated COVID-19 hospitalization (aOR 1.08, 95% CI 0.996-1.17) or hospitalization with severe complications (aOR 0.97, 95% CI 0.88-1.08). In the secondary analysis (males with or without BPH), the corresponding aORs were 1.02 (95% CI, 0.96-1.09) (uncomplicated) and 0.99 (95% CI, 0.91-1.07) (complicated), respectively. Subgroup and sensitivity analyses yielded similar results. Of note, there was no difference in risk of severe COVID-19 hospitalization when comparing non-selective vs selective alpha-1 blocker use (aOR 0.98, 95% CI 0.86-1.10), higher- vs lower-dose alpha-1 blocker use (aOR 0.96, 95% CI 0.86-1.08), or current vs remote alpha-1 blocker use (aOR 1.04, 95% CI 0.91-1.18). CONCLUSIONS Prevalent use of alpha-1 receptor blockers was not associated with a protective or harmful effect on risk of uncomplicated or severe hospitalized COVID-19.
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Affiliation(s)
- David J Graham
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md.
| | - Hector S Izurieta
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Md
| | - Di Zhang
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md
| | | | | | - Roger Wiederhorn
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md
| | - Yun Lu
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Md
| | - Andrew D Mosholder
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md
| | | | - Yueqin Zhao
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md
| | | | - Huei-Ting Tsai
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md
| | - Dinci Pennap
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md
| | - Alexander T Sandhu
- Acumen, LLC; Division of Cardiology, Department of Medicine, Stanford University, Calif
| | | | - Thomas E MaCurdy
- Acumen, LLC; Department of Economics, Stanford University, Calif
| | | | - Richard A Forshee
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Md
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9
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Custer B, Whitaker BI, Pollack LM, Buccheri R, Bruhn RL, Crowder LA, Stramer SL, Reik RA, Pandey S, Stone M, Di Germanio C, Buchacz K, Eder AF, Lu Y, Forshee RA, Anderson SA, Marks PW. HIV risk behavior profiles among men who have sex with men interested in donating blood: Findings from the Assessing Donor Variability and New Concepts in Eligibility study. Transfusion 2023; 63:1872-1884. [PMID: 37642154 DOI: 10.1111/trf.17515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Individual risk assessment allows donors to be evaluated based on their own behaviors. Study objectives were to assess human immunodeficiency virus (HIV) risk behaviors in men who have sex with men (MSM) and estimate the proportion of the study population who would not be deferred for higher risk HIV sexual behaviors. STUDY DESIGN AND METHODS Cross-sectional survey and biomarker assessment were conducted in eight U.S. cities. Participants were sexually active MSM interested in blood donation aged 18-39 years, assigned male sex at birth. Participants completed surveys during two study visits to define eligibility, and self-reported sexual and HIV prevention behaviors. Blood was drawn at study visit 1 and tested for HIV and the presence of tenofovir, one of the drugs in oral HIV pre-exposure prophylaxis (PrEP). Associations were assessed between HIV infection status or HIV PrEP use and behaviors, including sex partners, new partners, and anal sex. RESULTS A total of 1566 MSM completed the visit 1 questionnaire and blood draw and 1197 completed the visit 2 questionnaire. Among 1562 persons without HIV, 789 (50.4%) were not taking PrEP. Of those not taking PrEP, 66.2% reported one sexual partner or no anal sex and 69% reported no new sexual partners or no anal sex with a new partner in the past 3 months. CONCLUSION The study found that questions were able to identify sexually active, HIV-negative MSM who report lower risk sexual behaviors. About a quarter of enrolled study participants would be potentially eligible blood donors using individual risk assessment questions.
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Affiliation(s)
- Brian Custer
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Barbee I Whitaker
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
| | - Lance M Pollack
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Renata Buccheri
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Roberta L Bruhn
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Lauren A Crowder
- American Red Cross, Scientific Affairs, Rockville, Maryland, USA
| | - Susan L Stramer
- American Red Cross, Scientific Affairs, Gaithersburg, Maryland, USA
| | | | - Suchitra Pandey
- Stanford Blood Center & Stanford University, Palo Alto, California, USA
| | - Mars Stone
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Clara Di Germanio
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Kate Buchacz
- U.S. Centers for Disease Control and Prevention, HIV Research Branch, Division of HIV Prevention, Atlanta, Georgia, USA
| | - Anne F Eder
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
| | - Yun Lu
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
| | - Richard A Forshee
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
| | - Steven A Anderson
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
| | - Peter W Marks
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
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10
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Yogurtcu ON, Funk PR, Forshee RA, Anderson SA, Marks PW, Yang H. Benefit-risk assessment of Covid-19 vaccine, MRNA (MRNA-1273) for males age 18-64 years. Vaccine X 2023; 14:100325. [PMID: 37324525 PMCID: PMC10234830 DOI: 10.1016/j.jvacx.2023.100325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/13/2022] [Accepted: 05/30/2023] [Indexed: 06/17/2023] Open
Abstract
Since the authorization of the Moderna mRNA COVID-19 vaccine, real-world evidence has indicated its effectiveness in preventing COVID-19 cases. However, increased cases of mRNA vaccine-associated myocarditis/pericarditis have been reported, predominantly in young adults and adolescents. The Food and Drug Administration conducted a benefit-risk assessment to inform the review of the Biologics License Application for use of the Moderna vaccine among individuals ages 18 and older. We modeled the benefit-risk per million individuals who receive two complete doses of the vaccine. Benefit endpoints were vaccine-preventable COVID-19 cases, hospitalizations, intensive care unit (ICU) admissions, and deaths. The risk endpoints were vaccine-related myocarditis/pericarditis cases, hospitalizations, ICU admissions, and deaths. The analysis was conducted on the age-stratified male population due to data signals and previous work showing males to be the main risk group. We constructed six scenarios to evaluate the impact of uncertainty associated with pandemic dynamics, vaccine effectiveness (VE) against novel variants, and rates of vaccine-associated myocarditis/pericarditis cases on the model results. For our most likely scenario, we assumed the US COVID-19 incidence was for the week of December 25, 2021, with a VE of 30% against cases and 72% against hospitalization with the Omicron-dominant strain. Our source for estimating vaccine-attributable myocarditis/pericarditis rates was FDA's CBER Biologics Effectiveness and Safety (BEST) System databases. Overall, our results supported the conclusion that the benefits of the vaccine outweigh its risks. Remarkably, we predicted vaccinating one million 18-25 year-old males would prevent 82,484 cases, 4,766 hospitalizations, 1,144 ICU admissions, and 51 deaths due to COVID-19, comparing to 128 vaccine-attributable myocarditis/pericarditis cases, 110 hospitalizations, zero ICU admissions, and zero deaths. Uncertainties in the pandemic trajectory, effectiveness of vaccine against novel variants, and vaccine-attributable myocarditis/pericarditis rate are important limitations of our analysis. Also, the model does not evaluate potential long-term adverse effects due to either COVID-19 or vaccine-attributable myocarditis/pericarditis.
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Affiliation(s)
- Osman N Yogurtcu
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US FDA, Silver Spring, MD, USA
| | - Patrick R Funk
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US FDA, Silver Spring, MD, USA
| | - Richard A Forshee
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US FDA, Silver Spring, MD, USA
| | - Steven A Anderson
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US FDA, Silver Spring, MD, USA
| | - Peter W Marks
- Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, US FDA, Silver Spring, MD, USA
- Office of the Center Director, Center for Biologics Evaluation and Research, US FDA, Silver Spring, MD, USA
| | - Hong Yang
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US FDA, Silver Spring, MD, USA
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11
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Shoaibi A, Lloyd PC, Wong HL, Clarke TC, Chillarige Y, Do R, Hu M, Jiao Y, Kwist A, Lindaas A, Matuska K, McEvoy R, Ondari M, Parulekar S, Shi X, Wang J, Lu Y, Obidi J, Zhou CK, Kelman JA, Forshee RA, Anderson SA. Evaluation of potential adverse events following COVID-19 mRNA vaccination among adults aged 65 years and older: Two self-controlled studies in the U.S. Vaccine 2023:S0264-410X(23)00682-5. [PMID: 37344261 DOI: 10.1016/j.vaccine.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/09/2023] [Accepted: 06/02/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Our near-real-time safety monitoring of 16 adverse events (AEs) following COVID-19 mRNA vaccination identified potential elevation in risk for six AEs following primary series and monovalent booster dose administration. The crude association with AEs does not imply causality. Accordingly, we conducted robust evaluation of potential associations. METHODS We conducted two self-controlled case series studies of COVID-19 mRNA vaccines (BNT162b2 and mRNA-1273) in U.S. Medicare beneficiaries aged ≥ 65 years. Adjusted incidence rate ratio (IRRs) and 95 % confidence intervals (CIs) were estimated following primary series doses for acute myocardial infarction (AMI), pulmonary embolism (PE), immune thrombocytopenia (ITP), disseminated intravascular coagulation (DIC); and following monovalent booster doses for AMI, PE, ITP, Bell's Palsy (BP) and Myocarditis/Pericarditis (Myo/Peri). RESULTS The primary series study included 3,360,981 individuals who received 6,388,542 primary series doses; the booster study included 6,156,100 individuals with one monovalent booster dose. The AMI IRR following BNT162b2 primary series and booster was 1.04 (95 % CI: 0.91 to 1.18) and 1.06 (95 % CI: 1.003 to 1.12), respectively; for mRNA-1273 primary series and booster, 1.01 (95 % CI: 0.82 to 1.26) and 1.05 (95 % CI: 0.998 to 1.11), respectively. The hospital inpatient PE IRR following BNT162b2 primary series and booster was 1.19 (95 % CI: 1.03 to 1.38) and 0.86 (95 % CI: 0.78 to 0.95), respectively; for mRNA-1273 primary series and booster, 1.15 (95 % CI: 0.94 to 1.41) and 0.87 (95 % CI: 0.79 to 0.96), respectively. The studies' results do not support that exposure to COVID-19 mRNA vaccines elevate the risk of ITP, DIC, Myo/Peri, and BP. CONCLUSION We did not find an increased risk for AMI, ITP, DIC, BP, and Myo/Peri and there was not consistent evidence for PE after exposure to COVID-19 mRNA primary series or monovalent booster vaccines. These results support the favorable safety profile of COVID-19 mRNA vaccines administered in the U.S. elderly population.
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Affiliation(s)
- Azadeh Shoaibi
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, U. S. Food & Drug Administration, 10903 New Hampshire Ave., Building 71, Silver Spring, MD 20993, United States.
| | - Patricia C Lloyd
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, U. S. Food & Drug Administration, 10903 New Hampshire Ave., Building 71, Silver Spring, MD 20993, United States.
| | - Hui-Lee Wong
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, U. S. Food & Drug Administration, 10903 New Hampshire Ave., Building 71, Silver Spring, MD 20993, United States.
| | - Tainya C Clarke
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, U. S. Food & Drug Administration, 10903 New Hampshire Ave., Building 71, Silver Spring, MD 20993, United States.
| | - Yoganand Chillarige
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Rose Do
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Mao Hu
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Yixin Jiao
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Andrew Kwist
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Arnstein Lindaas
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Kathryn Matuska
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Rowan McEvoy
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Michelle Ondari
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Shruti Parulekar
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Xiangyu Shi
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Jing Wang
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Yun Lu
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, U. S. Food & Drug Administration, 10903 New Hampshire Ave., Building 71, Silver Spring, MD 20993, United States.
| | - Joyce Obidi
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, U. S. Food & Drug Administration, 10903 New Hampshire Ave., Building 71, Silver Spring, MD 20993, United States.
| | - Cindy K Zhou
- Formerly Affiliated with US Food and Drug Administration, Silver Spring, MD, United States
| | - Jeffrey A Kelman
- Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Mail Stop B3-30-03, Baltimore, MD 21244-1850, United States
| | - Richard A Forshee
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, U. S. Food & Drug Administration, 10903 New Hampshire Ave., Building 71, Silver Spring, MD 20993, United States.
| | - Steven A Anderson
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, U. S. Food & Drug Administration, 10903 New Hampshire Ave., Building 71, Silver Spring, MD 20993, United States.
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12
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Schneider KL, Bell EJ, Zhou CK, Yang G, Lloyd P, Clarke TC, Wilkinson M, Myers EE, Amend KL, Seeger JD, Chillarige Y, Forshee RA, Shoaibi A, Anderson SA, Wong HL. Use of Immunization Information Systems in Ascertainment of COVID-19 Vaccinations for Claims-Based Vaccine Safety and Effectiveness Studies. JAMA Netw Open 2023; 6:e2313512. [PMID: 37191962 DOI: 10.1001/jamanetworkopen.2023.13512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
Importance Safety and effectiveness studies of COVID-19 vaccines are being conducted using clinical data, including administrative claims. However, claims data only partially capture administered COVID-19 vaccine doses for numerous reasons, such as vaccination at sites that do not generate claims for reimbursement. Objective To evaluate the extent to which Immunization Information Systems (IIS) data linked to claims data enhances claims-based COVID-19 vaccine capture for a commercially insured population and to estimate the magnitude of misclassification of vaccinated individuals as having unvaccinated status in the linked IIS and claims data. Design, Setting, and Participants This cohort study used claims data from a commercial health insurance database and obtained vaccination data from IIS repositories in 11 US states. Participants were individuals younger than 65 years who resided in 1 of 11 states of interest and who were insured in health plans from December 1, 2020, through December 31, 2021. Main Outcomes and Measures Estimated proportion of individuals with at least 1 dose of any COVID-19 vaccine and proportion of individuals with a completed vaccine series based on general population guidelines. Vaccination status estimates were calculated and compared using claims data alone and linked IIS and claims data. Remaining misclassification of vaccination status was assessed by comparing linked IIS and claims data estimates with estimates from external surveillance data sources (Centers for Disease Control and Prevention [CDC] and state Department of Health [DOH]) and capture-recapture analysis. Results This cohort study included 5 112 722 individuals (mean [SD] age, 33.5 [17.6] years; 2 618 098 females [51.2%]) from 11 states. Characteristics of those who received at least 1 vaccine dose and those who completed a vaccine series were similar to the overall study population. The proportion with at least 1 vaccine dose increased from 32.8% using claims data alone to 48.1% when the data were supplemented with IIS vaccination records. Vaccination estimates using linked IIS and claims data varied widely by state. The percentage of individuals who completed a vaccine series increased from 24.4% to 41.9% after the addition of IIS vaccine records and varied across states. The percentages of underrecording using linked IIS and claims data were 12.1% to 47.1% lower than those using CDC data, 9.1% to 46.9% lower than the state DOH, and 9.2% to 50.9% lower than capture-recapture analysis. Conclusion and Relevance Results of this study suggested that supplementing COVID-19 claims records with IIS vaccination records substantially increased the number of individuals who were identified as vaccinated, yet potential underrecording remained. Improvements in reporting vaccination data to IIS infrastructures could allow frequent updates of vaccination status for all individuals and all vaccines.
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Affiliation(s)
| | | | - C K Zhou
- Clinical Safety and Risk Management, Moderna, Cambridge, Massachusetts
| | - Grace Yang
- OptumServe Consulting, Falls Church, Virginia
| | - Patricia Lloyd
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Tainya C Clarke
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | | | | | | | | | | | - Richard A Forshee
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Azadeh Shoaibi
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Steven A Anderson
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Hui-Lee Wong
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
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13
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Mutanga JN, Nukala U, Rodriguez Messan M, Yogurtcu ON, McCormick Q, Sauna ZE, Whitaker BI, Forshee RA, Yang H. A Retrospective Review of Center for Biologics Evaluation and Research Advisory Committee Meetings in the Context of the FDA's Benefit-Risk Framework. AAPS J 2023; 25:24. [PMID: 36759415 PMCID: PMC9911185 DOI: 10.1208/s12248-023-00789-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/22/2023] [Indexed: 02/11/2023] Open
Abstract
The US FDA Center for Biologics Evaluation and Research (CBER) is responsible for the regulation of biologically derived products. FDA has established Advisory Committees (AC) as vehicles to seek external expert advice on scientific and technical matters related to the development and evaluation of products regulated by the agency. We aimed to identify and evaluate common topics discussed in CBER AC meetings during the regulatory decision-making process for biological products and medical devices. We analyzed the content of 119 CBER-led AC meetings between 2009 and 2021 listed on the FDA AC webpage. We reviewed publicly available meeting materials such as briefing documents, summaries, and transcripts. Using a structured review codebook based on FDA benefit-risk guidance, we identified important considerations within the benefit-risk dimensions discussed at the AC meetings: therapeutic context, benefit, risk and risk management, and benefit-risk trade-off, where evidence and uncertainty are critical parts of the FDA benefit-risk framework. Based on a detailed review of 24 topics discussed in 23 selected AC meetings conducted between 2016 and 2021, the two most frequently discussed considerations were "Uncertainty about assessment of the safety profile" and "Uncertainty about assessment of the benefit based on clinical trial data" (16/24 times each) as defined in our codebook. Most of the reviewed meetings discussed Investigational New Drug or Biologics License Applications of products. This review could help sponsors better plan and design studies by contextualizing how the benefit-risk dimensions were embedded in the AC discussions and the considerations that went into the final AC recommendations.
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Affiliation(s)
- Jane Namangolwa Mutanga
- grid.417587.80000 0001 2243 3366Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US FDA, Silver Spring, Maryland USA
| | - Ujwani Nukala
- grid.417587.80000 0001 2243 3366Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US FDA, Silver Spring, Maryland USA
| | - Marisabel Rodriguez Messan
- grid.417587.80000 0001 2243 3366Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US FDA, Silver Spring, Maryland USA
| | - Osman N. Yogurtcu
- grid.417587.80000 0001 2243 3366Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US FDA, Silver Spring, Maryland USA
| | - Quinn McCormick
- grid.417587.80000 0001 2243 3366Office of Therapeutic Products, Center for Biologics Evaluation and Research, US FDA, Silver Spring, Maryland USA
| | - Zuben E. Sauna
- grid.417587.80000 0001 2243 3366Office of Therapeutic Products, Center for Biologics Evaluation and Research, US FDA, Silver Spring, Maryland USA
| | - Barbee I. Whitaker
- grid.417587.80000 0001 2243 3366Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US FDA, Silver Spring, Maryland USA
| | - Richard A. Forshee
- grid.417587.80000 0001 2243 3366Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US FDA, Silver Spring, Maryland USA
| | - Hong Yang
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US FDA, Silver Spring, Maryland, USA.
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14
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Belov AA, Rodriguez Messan M, Yogurtcu ON, Schultz K, Maxfield K, Thompson L, Revell S, Warren-Henderson Y, Tegenge MA, Sauna ZE, Forshee RA. Summary of a Public FDA Workshop: Model Informed Drug Development Approaches for Immunogenicity Assessments. Clin Pharmacol Ther 2023; 113:221-225. [PMID: 35253213 DOI: 10.1002/cpt.2572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/08/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Artur A Belov
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US FDA, Silver Spring, Maryland, USA
| | - Marisabel Rodriguez Messan
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US FDA, Silver Spring, Maryland, USA
| | - Osman N Yogurtcu
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US FDA, Silver Spring, Maryland, USA
| | - Kimberly Schultz
- Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, US FDA, Silver Spring, Maryland, USA
| | - Kimberly Maxfield
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US FDA, Silver Spring, Maryland, USA
| | - Laura Thompson
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US FDA, Silver Spring, Maryland, USA
| | - Sherri Revell
- Office of Communication, Outreach and Development, Center for Biologics Evaluation and Research, US FDA, Silver Spring, Maryland, USA
| | - Yolonda Warren-Henderson
- Office of Communication, Outreach and Development, Center for Biologics Evaluation and Research, US FDA, Silver Spring, Maryland, USA
| | - Million A Tegenge
- Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, US FDA, Silver Spring, Maryland, USA
| | - Zuben E Sauna
- Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, US FDA, Silver Spring, Maryland, USA
| | - Richard A Forshee
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US FDA, Silver Spring, Maryland, USA
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15
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Wong HL, Tworkoski E, Ke Zhou C, Hu M, Thompson D, Lufkin B, Do R, Feinberg L, Chillarige Y, Dimova R, Lloyd PC, MaCurdy T, Forshee RA, Kelman JA, Shoaibi A, Anderson SA. Surveillance of COVID-19 vaccine safety among elderly persons aged 65 years and older. Vaccine 2023; 41:532-539. [PMID: 36496287 PMCID: PMC9712075 DOI: 10.1016/j.vaccine.2022.11.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Monitoring safety outcomes following COVID-19 vaccination is critical for understanding vaccine safety especially when used in key populations such as elderly persons age 65 years and older who can benefit greatly from vaccination. We present new findings from a nationally representative early warning system that may expand the safety knowledge base to further public trust and inform decision making on vaccine safety by government agencies, healthcare providers, interested stakeholders, and the public. METHODS We evaluated 14 outcomes of interest following COVID-19 vaccination using the US Centers for Medicare & Medicaid Services (CMS) data covering 30,712,101 elderly persons. The CMS data from December 11, 2020 through Jan 15, 2022 included 17,411,342 COVID-19 vaccinees who received a total of 34,639,937 doses. We conducted weekly sequential testing and generated rate ratios (RR) of observed outcome rates compared to historical (or expected) rates prior to COVID-19 vaccination. FINDINGS Four outcomes met the threshold for a statistical signal following BNT162b2 vaccination including pulmonary embolism (PE; RR = 1.54), acute myocardial infarction (AMI; RR = 1.42), disseminated intravascular coagulation (DIC; RR = 1.91), and immune thrombocytopenia (ITP; RR = 1.44). After further evaluation, only the RR for PE still met the statistical threshold for a signal; however, the RRs for AMI, DIC, and ITP no longer did. No statistical signals were identified following vaccination with either the mRNA-1273 or Ad26 COV2.S vaccines. INTERPRETATION This early warning system is the first to identify temporal associations for PE, AMI, DIC, and ITP following BNT162b2 vaccination in the elderly. Because an early warning system does not prove that the vaccines cause these outcomes, more robust epidemiologic studies with adjustment for confounding, including age and nursing home residency, are underway to further evaluate these signals. FDA strongly believes the potential benefits of COVID-19 vaccination outweigh the potential risks of COVID-19 infection.
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Affiliation(s)
- Hui-Lee Wong
- US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Cindy Ke Zhou
- US Food and Drug Administration, Silver Spring, MD, USA
| | - Mao Hu
- Acumen LLC, Burlingame, CA, USA
| | | | | | - Rose Do
- US Food and Drug Administration, Silver Spring, MD, USA
| | | | | | | | | | - Thomas MaCurdy
- Acumen LLC, Burlingame, CA, USA,Department of Economics, Stanford University, Stanford, CA, USA
| | | | | | | | - Steven A. Anderson
- US Food and Drug Administration, Silver Spring, MD, USA,Corresponding author
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16
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Huang Y, Forshee RA, Fares-Gusmao R, Chancey C, Rios M, Anderson SA, Yang H. A Risk Assessment Model for Transfusion Transmission of Dengue. Lett Appl Microbiol 2022; 75:1330-1335. [PMID: 35947088 DOI: 10.1111/lam.13802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 11/27/2022]
Abstract
Dengue virus (DENV) is a disease-causing agent normally transmitted from person to person through the bite of an infected mosquito. In addition to mosquito-borne cases of dengue, there are instances of transmission of dengue after receipt of blood products or donor organs or tissue. To improve blood safety, we developed a quantitative risk assessment model to estimate the dengue risk of transmission to blood transfusion recipients from preclinical and subclinical blood donors. We derived predictive coefficients from model simulations for predicting the risk outcomes such as monthly infectious blood units and transfusion-transmitted DENV cases based on the rate of reported clinical cases. The model was validated with a previous study where donor blood samples from the 2012 dengue transmission season in Rio de Janeiro, Brazil were tested for DENV RNA by a transcription-mediated amplification (TMA) assay. In that study about 69.4% donations were tested by the TMA assay and 78 samples were found positive, indicating that 112 DENV RNA-positive donations would have been detected if testing screening had been performed on all donations. Our model estimated a mean of 93 (2.5th%ile -97.5th%ile : 47 - 186) infected units among the donations, which was consistent with the reported numbers.
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Affiliation(s)
- Yin Huang
- FDA Center for Biologics Evaluation and Research, Office of Biostatistics and Pharmacovigilance
| | - Richard A Forshee
- FDA Center for Biologics Evaluation and Research, Office of Biostatistics and Pharmacovigilance
| | - Rafaelle Fares-Gusmao
- FDA Center for Biologics Evaluation and Research, Office of Blood Research and Review
| | - Caren Chancey
- FDA Center for Biologics Evaluation and Research, Office of Blood Research and Review
| | - Maria Rios
- FDA Center for Biologics Evaluation and Research, Office of Blood Research and Review
| | - Steven A Anderson
- FDA Center for Biologics Evaluation and Research, Office of Biostatistics and Pharmacovigilance
| | - Hong Yang
- FDA Center for Biologics Evaluation and Research, Office of Biostatistics and Pharmacovigilance
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17
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Mutanga JN, Whitaker BI, Forshee RA. Regulatory considerations for study of infant protection through maternal immunization. Vaccine 2022; 40:3556-3565. [PMID: 35570075 DOI: 10.1016/j.vaccine.2022.04.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 03/29/2022] [Accepted: 04/27/2022] [Indexed: 11/17/2022]
Abstract
Childhood Immunization is one of the critical strategies to decrease infant morbidity and mortality due to infectious diseases, but primary immunization schedules for infants in most countries start at 2 months of age. Childhood vaccines therefore begin providing adequate protection later in life, leaving infants vulnerable to infectious diseases and creating an immunity gap that results in higher morbidity and mortality among younger infants. Maternal immunization, the practice of vaccinating individuals during pregnancy, reduces the risk of infant infection primarily through the transfer of protective maternal antibodies to the fetus during late pregnancy. Although much progress has been made in public health policies to support maternal immunization research, inclusion of pregnant individuals and children in clinical trials remains challenging. This has resulted in paucity of evidence regarding safety and effectiveness of vaccines to support licensure of products intended for use during pregnancy and lactation to prevent disease in the infant. In addition, although safeguards for clinical research in pregnancy are supportive, experimental vaccines, e.g., Respiratory Syncytial Virus, are more complicated to study because data on safety, efficacy, and dosing are limited. This requires randomized controlled trials with safety monitoring for the mother, the fetus, and the infant with follow-up for at least 1 year or longer to assess long-term health outcomes that may be associated with peripartum vaccine exposure. The goal of this paper is to discuss the general regulatory considerations for clinical research to evaluate safety and effectiveness of vaccines administered during pregnancy to protect infants from disease. This could be useful to inform future vaccine trials. This discussion is not intended to provide agency guidance nor to articulate agency policy.
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Affiliation(s)
- Jane Namangolwa Mutanga
- US Food and Drug Administration, Center for Biologics Evaluation and Research, 10903 New Hampshire Ave, Silver Spring, MD 20993, USA.
| | - Barbee I Whitaker
- US Food and Drug Administration, Center for Biologics Evaluation and Research, 10903 New Hampshire Ave, Silver Spring, MD 20993, USA
| | - Richard A Forshee
- US Food and Drug Administration, Center for Biologics Evaluation and Research, 10903 New Hampshire Ave, Silver Spring, MD 20993, USA
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18
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Funk PR, Yogurtcu ON, Forshee RA, Anderson SA, Marks PW, Yang H. Benefit-risk assessment of COVID-19 vaccine, mRNA (Comirnaty) for age 16-29 years. Vaccine 2022; 40:2781-2789. [PMID: 35370016 PMCID: PMC8958165 DOI: 10.1016/j.vaccine.2022.03.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/10/2022] [Accepted: 03/12/2022] [Indexed: 12/31/2022]
Abstract
Since authorization of the Pfizer-BioNTech COVID-19 Vaccine, mRNA (Comirnaty), real-world evidence has indicated the vaccines are effective in preventing COVID-19 cases and related hospitalizations and deaths. However, increased cases of myocarditis/pericarditis have been reported in the United States associated with vaccination, particularly in adolescents and young adults. FDA conducted a benefit-risk assessment to determine whether the benefits of vaccination outweigh the risks among various age (16–17, 18–24, 25–29) and sex (M/F) subgroups being considered for approved use of the vaccine. We conducted a simulation study with sensitivity analysis of the benefits and risks of the vaccine across possible pandemic scenarios. The model results show benefits outweigh the risks for all scenarios including the high-risk subgroup, males 16–17 years old. Our worst-case scenario used sex and age subgroup-specific incidences for COVID-19 cases (47–98 per million per day) and hospitalizations (1–4 per million per day) which are the US COVID-19 incidences as of July 10, 2021, vaccine efficacy of 70% against COVID-19 cases and 80% against hospitalization, and unlikely, pessimistic, non-zero vaccine-attributable myocarditis death rate. For males 16–17 years old, the model predicts prevented COVID cases, hospitalizations, ICUs, and deaths of 13577, 127, 41, and 1, respectively; while the predicted ranges for excess myocarditis/pericarditis cases, hospitalizations, and deaths attributable to the vaccine are [98–196], [98–196], and 0, respectively, for the worst-case scenario. Considering the different clinical implications of hospitalization due to COVID-19 infection versus vaccine-attributable myocarditis/pericarditis cases, we determine the benefits still outweigh the risks even for this high-risk subgroup. Our results demonstrate that the benefits of the vaccine outweigh its risks for all age and sex subgroups we analyze in this study. Uncertainties exist in this assessment as both benefits and risks of vaccination may change with the continuing evolution of the pandemic.
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Affiliation(s)
- Patrick R Funk
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US FDA, Silver Spring, MD, USA
| | - Osman N Yogurtcu
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US FDA, Silver Spring, MD, USA
| | - Richard A Forshee
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US FDA, Silver Spring, MD, USA
| | - Steve A Anderson
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US FDA, Silver Spring, MD, USA
| | - Peter W Marks
- Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, US FDA, Silver Spring, MD, USA; Office of the Center Director, Center for Biologics Evaluation and Research, US FDA, Silver Spring, MD, USA
| | - Hong Yang
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US FDA, Silver Spring, MD, USA.
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19
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Goud R, Lufkin B, Duffy J, Whitaker B, Wong HL, Liao J, Lo AC, Parulekar S, Agger P, Anderson SA, Wernecke M, MaCurdy TE, Weintraub E, Kelman JA, Forshee RA. Risk of Guillain-Barré Syndrome Following Recombinant Zoster Vaccine in Medicare Beneficiaries. JAMA Intern Med 2021; 181:1623-1630. [PMID: 34724025 PMCID: PMC8561433 DOI: 10.1001/jamainternmed.2021.6227] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Guillain-Barré syndrome can be reported after vaccination. This study assesses the risk of Guillain-Barré syndrome after administration of recombinant zoster vaccine (RZV or Shingrix), which is administered in 2 doses 2 to 6 months apart. OBJECTIVE Use Medicare claims data to evaluate risk of developing Guillain-Barré syndrome following vaccination with zoster vaccine. DESIGN, SETTING, AND PARTICIPANTS This case series cohort study included 849 397 RZV-vaccinated and 1 817 099 zoster vaccine live (ZVL or Zostavax)-vaccinated beneficiaries aged 65 years or older. Self-controlled analyses included events identified from 2 113 758 eligible RZV-vaccinated beneficiaries 65 years or older. We compared the relative risk of Guillain-Barré syndrome after RZV vs ZVL, followed by claims-based and medical record-based self-controlled case series analyses to assess risk of Guillain-Barré syndrome during a postvaccination risk window (days 1-42) compared with a control window (days 43-183). In self-controlled analyses, RZV vaccinees were observed from October 1, 2017, to February 29, 2020. Patients were identified in the inpatient, outpatient procedural (including emergency department), and office settings using Medicare administrative data. EXPOSURES Vaccination with RZV or ZVL vaccines. MAIN OUTCOMES AND MEASURES Guillain-Barré syndrome was identified in Medicare administrative claims data, and cases were assessed through medical record review using the Brighton Collaboration case definition. RESULTS Amongst those who received RZV vaccinees, the mean age was 74.8 years at first dose, and 58% were women, whereas among those who received the ZVL vaccine, the mean age was 74.3 years, and 60% were women. In the cohort analysis we detected an increase in risk of Guillain-Barré syndrome among RZV vaccinees compared with ZVL vaccinees (rate ratio [RR], 2.34; 95% CI, 1.01-5.41; P = .047). In the self-controlled analyses, we observed 24 and 20 cases during the risk and control period, respectively. Our claims-based analysis identified an increased risk in the risk window compared with the control window (RR, 2.84; 95% CI, 1.53-5.27; P = .001), with an attributable risk of 3 per million RZV doses (95% CI, 0.62-5.64). Our medical record-based analysis confirmed this increased risk (RR, 4.96; 95% CI, 1.43-17.27; P = .01). CONCLUSIONS AND RELEVANCE Findings of this case series cohort study indicate a slightly increased risk of Guillain-Barré syndrome during the 42 days following RZV vaccination in the Medicare population, with approximately 3 excess Guillain-Barré syndrome cases per million vaccinations. Clinicians and patients should be aware of this risk, while considering the benefit of decreasing the risk of herpes zoster and its complications through an efficacious vaccine, as risk-benefit balance remains in favor of vaccination.
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Affiliation(s)
- Ravi Goud
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | | | - Jonathan Duffy
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Barbee Whitaker
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Hui-Lee Wong
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | | | | | | | - Paula Agger
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Steven A Anderson
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | | | - Thomas E MaCurdy
- Acumen, LLC.,Department of Economics, Stanford University, Stanford, California
| | - Eric Weintraub
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Richard A Forshee
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
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20
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Graham DJ, Izurieta HS, Muthuri SG, Zhang D, Sandhu AT, Lu Y, Zhao Y, Feng Y, Eworuke E, Lyu H, Gandotra C, Smith ER, Avagyan A, Wernecke M, Kelman JA, Forshee RA, MaCurdy TE. Risk of Covid-19-Related Hospitalization and More Severe Outcomes in Medicare Beneficiaries Treated with Renin-Angiotensin-Aldosterone System Inhibitors for Hypertension. J Gen Intern Med 2021; 36:3802-3809. [PMID: 34599472 PMCID: PMC8486159 DOI: 10.1007/s11606-021-07155-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND There are theoretical concerns that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) could increase the risk of severe Covid-19. OBJECTIVE To determine if ACEIs and ARBs are associated with an increased risk of Covid-19 hospitalization overall, or hospitalization involving intensive care unit (ICU) admission, invasive mechanical ventilation, or death. DESIGN Observational case-control study. PARTICIPANTS Medicare beneficiaries aged ≥ 66 years with hypertension, treated with ACEIs, ARBs, calcium channel blockers (CCBs), or thiazide diuretics. MAIN MEASURES Adjusted odds ratios (OR) and 95% confidence intervals (CI) for the outcomes of Covid-19 hospitalization, or hospitalization involving ICU admission, invasive mechanical ventilation, or death. RESULTS A total of 35,300 cases of hospitalized Covid-19 were matched to 228,228 controls on calendar date and neighborhood of residence. The median age of cases was 79 years, 57.4% were female, and the median duration of hospitalization was 8 days (interquartile range 5-12). ACEIs and ARBs were associated with a slight reduction in Covid-19 hospitalization risk compared with treatment with other first-line antihypertensives (OR for ACEIs 0.95, 95% CI 0.92-0.98; OR for ARBs 0.94, 95% CI 0.90-0.97). Similar results were obtained for hospitalizations involving ICU admission, invasive mechanical ventilation, or death. There were no meaningful differences in risk for ACEIs compared with ARBs. In an analysis restricted to monotherapy with a first-line agent, CCBs were associated with a small increased risk of Covid-19 hospitalization compared with ACEIs (OR 1.09, 95% CI 1.04-1.14), ARBs (OR 1.10, 95% CI 1.05-1.15), or thiazide diuretics (OR 1.11, 95% CI 1.03-1.19). CONCLUSIONS ACEIs and ARBs were not associated with an increased risk of Covid-19 hospitalization or with hospitalization involving ICU admission, invasive mechanical ventilation, or death. The finding of a small increased risk of Covid-19 hospitalization with CCBs was unexpected and could be due to residual confounding.
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Affiliation(s)
- David J Graham
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Ave, Building 22, Room 4314, Silver Spring, MD, 20993, USA.
| | - Hector S Izurieta
- Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Di Zhang
- Office of Biostatistics, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Alexander T Sandhu
- Acumen LLC, Burlingame, CA, USA
- Division of Cardiology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Yun Lu
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Yueqin Zhao
- Office of Biostatistics, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Efe Eworuke
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Ave, Building 22, Room 4314, Silver Spring, MD, 20993, USA
| | - Hai Lyu
- Acumen LLC, Burlingame, CA, USA
| | - Charu Gandotra
- Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | | | | | | | | | - Richard A Forshee
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Thomas E MaCurdy
- Acumen LLC, Burlingame, CA, USA
- Department of Economics, Stanford University, Stanford, CA, USA
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21
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Lu Y, Jiao Y, Graham DJ, Wu Y, Wang J, Menis M, Chillarige Y, Wernecke M, Kelman J, Forshee RA, Izurieta HS. Risk factors for COVID-19 deaths among elderly nursing home Medicare beneficiaries in the pre-vaccine period. J Infect Dis 2021; 225:567-577. [PMID: 34618896 DOI: 10.1093/infdis/jiab515] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/02/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Evaluate pre-vaccine pandemic period COVID-19 death risk factors among nursing home (NH) residents. METHODS Retrospective cohort study covering Medicare fee-for-service beneficiaries ages ≥65 residing in U.S. NHs. We estimated adjusted hazard ratios (HRs) using multivariate Cox proportional hazards regressions. RESULTS Among 608,251 elderly NH residents, 57,398 (9.4%) died of COVID-related illness April 1 to December 22, 2020. About 46.9% (26,893) of these COVID-19 deaths occurred without prior COVID-19 hospitalizations. We observed a consistently increasing age trend for COVID-19 deaths. Racial/ethnic minorities generally shared a similarly high risk of NH COVID-19 deaths with Whites. NH facility characteristics including for-profit ownership and low health inspection ratings were associated with higher death risk. Resident characteristics, including male (HR 1.69), end-stage renal disease (HR 1.42), cognitive impairment (HR 1.34), and immunocompromised status (HR 1.20) were important death risk factors. Other individual-level characteristics were less predictive of death than they were in community-dwelling population. CONCLUSIONS Low NH health inspection ratings and private ownership contributed to COVID-19 death risks. Nearly half of NH COVID-19 deaths occurred without prior COVID-19 hospitalization and older residents were less likely to get hospitalized with COVID-19. No substantial differences were observed by race/ethnicity and socioeconomic status for NH COVID-19 deaths.
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Affiliation(s)
- Yun Lu
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | | | - David J Graham
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Yue Wu
- Acumen LLC, Burlingame, CA, USA
| | | | - Mikhail Menis
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | | | | | - Jeffrey Kelman
- Centers for Medicare and Medicaid Services, Washington DC, USA
| | - Richard A Forshee
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Hector S Izurieta
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
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22
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Huang Y, Lin Z, Wang W, Weiss C, Xie H, Forshee RA. Comparison of hemagglutination inhibition and hemagglutinin pseudovirus neutralization titres in relation to protection against influenza in a mouse model. Lett Appl Microbiol 2021; 73:294-299. [PMID: 34028058 DOI: 10.1111/lam.13513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/28/2021] [Accepted: 05/13/2021] [Indexed: 11/29/2022]
Abstract
The hemagglutination inhibition (HI) test has long been used as a standard measure of antibody response for inactivated influenza vaccines. However, the HI test has limitations, such as insensitivity when using some H3N2 virus strains and failure to detect neutralizing antibodies that target regions distant from the receptor binding site. We therefore examined a hemagglutinin pseudovirus neutralization (PVN) test as a possible supplement or alternative to the HI test. We evaluated the association of HI or PVN titres with protection against influenza infection in mice based on morbidity (where the illness was defined as 25% body weight loss). We assessed this relationship using dose-response models incorporating HI or PVN titres as a variable. The morbidity was correlated with the pre-exposure titres, and such a correlation was well described by a modified dose-response model. The mathematical modelling suggests that PVN titres consistently show a stronger association with in vivo protection as compared to HI titres in mice. Given our findings, the PVN test warrants further investigation as a tool for evaluating antibody responses to influenza vaccines containing hemagglutinin. The resulting models may also be useful for analyzing human clinical data to identify potentially protective antibody titres against influenza illness.
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Affiliation(s)
- Y Huang
- Office of Biostatistics and Epidemiology, FDA Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | - Z Lin
- Office of Vaccines Research and Review, FDA Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | - W Wang
- Office of Vaccines Research and Review, FDA Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | - C Weiss
- Office of Vaccines Research and Review, FDA Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | - H Xie
- Office of Vaccines Research and Review, FDA Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | - R A Forshee
- Office of Biostatistics and Epidemiology, FDA Center for Biologics Evaluation and Research, Silver Spring, MD, USA
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23
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Abstract
Quantifying how accurate epidemiological models of COVID-19 forecast the number of future cases and deaths can help frame how to incorporate mathematical models to inform public health decisions. Here we analyze and score the predictive ability of publicly available COVID-19 epidemiological models on the COVID-19 Forecast Hub. Our score uses the posted forecast cumulative distributions to compute the log-likelihood for held-out COVID-19 positive cases and deaths. Scores are updated continuously as new data become available, and model performance is tracked over time. We use model scores to construct ensemble models based on past performance. Our publicly available quantitative framework may aid in improving modeling frameworks, and assist policy makers in selecting modeling paradigms to balance the delicate trade-offs between the economy and public health.
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Affiliation(s)
- Osman N Yogurtcu
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US FDA, 10903 New Hampshire Ave, Silver Spring, 20993, Maryland, USA
| | - Marisabel Rodriguez Messan
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US FDA, 10903 New Hampshire Ave, Silver Spring, 20993, Maryland, USA
| | - Richard C Gerkin
- School of Life Sciences, Arizona State University, Tempe, 85287, Arizona, USA
| | - Artur A Belov
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US FDA, 10903 New Hampshire Ave, Silver Spring, 20993, Maryland, USA
| | - Hong Yang
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US FDA, 10903 New Hampshire Ave, Silver Spring, 20993, Maryland, USA
| | - Richard A Forshee
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US FDA, 10903 New Hampshire Ave, Silver Spring, 20993, Maryland, USA
| | - Carson C Chow
- Mathematical Biology Section, NIDDK/LBM, NIH, Bethesda, 20892, Maryland, USA
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24
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Menis M, Whitaker BI, Wernecke M, Jiao Y, Eder A, Kumar S, Xu W, Liao J, Wei Y, MaCurdy TE, Kelman JA, Anderson SA, Forshee RA. Babesiosis Occurrence Among United States Medicare Beneficiaries, Ages 65 and Older, During 2006-2017: Overall and by State and County of Residence. Open Forum Infect Dis 2020; 8:ofaa608. [PMID: 33598501 DOI: 10.1093/ofid/ofaa608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/09/2020] [Indexed: 12/29/2022] Open
Abstract
Background Human babesiosis is a mild-to-severe parasitic infection that poses health concerns especially in older and other at-risk populations. The study objective was to assess babesiosis occurrence among US Medicare beneficiaries, ages 65 and older, during 2006-2017. Methods Our retrospective claims-based study used Medicare databases. Babesiosis cases were identified using recorded diagnosis codes. The study estimated rates (per 100 000 beneficiary-years) overall, by year, diagnosis month, demographics, and state and county of residence. Results Nationwide, 19 469 beneficiaries had babesiosis recorded, at a rate of 6 per 100 000 person-years, ranging from 4 in 2006 to 9 in 2017 (P < .05). The highest babesiosis rates by state were in the following: Massachusetts (62), Rhode Island (61), Connecticut (51), New York (30), and New Jersey (19). The highest rates by county were in the following: Nantucket, Massachusetts (1089); Dukes, Massachusetts (236); Barnstable, Massachusetts (213); and Dutchess, New York (205). Increasing rates, from 2006 through 2017 (P < .05), were identified in multiple states, including states previously considered nonendemic. New Hampshire, Maine, Vermont, Pennsylvania, and Delaware saw rates increase by several times. Conclusions Our 12-year study shows substantially increasing babesiosis diagnosis trends, with highest rates in well established endemic states. It also suggests expansion of babesiosis infections in other states and highlights the utility of real-world evidence.
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Affiliation(s)
- Mikhail Menis
- Food and Drug Administration, Silver Spring, Maryland, USA
| | | | | | | | - Anne Eder
- Food and Drug Administration, Silver Spring, Maryland, USA
| | - Sanjai Kumar
- Food and Drug Administration, Silver Spring, Maryland, USA
| | - Wenjie Xu
- Acumen LLC, Burlingame, California, USA
| | | | - Yuqin Wei
- Acumen LLC, Burlingame, California, USA
| | - Thomas E MaCurdy
- Acumen LLC, Burlingame, California, USA.,Stanford University, Stanford, California, USA
| | - Jeffrey A Kelman
- Centers for Medicare & Medicaid Services, Baltimore, Maryland, USA
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25
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Perez-Vilar S, Hu M, Weintraub E, Arya D, Lufkin B, Myers T, Woo EJ, Lo AC, Chu S, Swarr M, Liao J, Wernecke M, MaCurdy T, Kelman J, Anderson S, Duffy J, Forshee RA. Guillain-Barré Syndrome After High-Dose Influenza Vaccine Administration in the United States, 2018-2019 Season. J Infect Dis 2020; 223:416-425. [PMID: 33137184 DOI: 10.1093/infdis/jiaa543] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/09/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The Vaccine Safety Datalink (VSD) identified a statistical signal for an increased risk of Guillain-Barré syndrome (GBS) in days 1-42 after 2018-2019 high-dose influenza vaccine (IIV3-HD) administration. We evaluated the signal using Medicare. METHODS We conducted early- and end-of-season claims-based self-controlled risk interval analyses among Medicare beneficiaries ages ≥65 years, using days 8-21 and 1-42 postvaccination as risk windows and days 43-84 as control window. The VSD conducted chart-confirmed analyses. RESULTS Among 7 453 690 IIV3-HD vaccinations, we did not detect a statistically significant increased GBS risk for either the 8- to 21-day (odds ratio [OR], 1.85; 95% confidence interval [CI], 0.99-3.44) or 1- to 42-day (OR, 1.31; 95% CI, 0.78-2.18) risk windows. The findings from the end-of-season analyses were fully consistent with the early-season analyses for both the 8- to 21-day (OR, 1.64; 95% CI, 0.92-2.91) and 1- to 42-day (OR, 1.12; 95% CI, 0.70-1.79) risk windows. The VSD's chart-confirmed analysis, involving 646 996 IIV3-HD vaccinations, with 1 case each in the risk and control windows, yielded a relative risk of 1.00 (95% CI, 0.06-15.99). CONCLUSIONS The Medicare analyses did not exclude an association between IIV3-HD and GBS, but it determined that, if such a risk existed, it was similar in magnitude to prior seasons. Chart-confirmed VSD results did not confirm an increased risk of GBS.
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Affiliation(s)
- Silvia Perez-Vilar
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Mao Hu
- Acumen LLC, Burlingame, California, USA
| | - Eric Weintraub
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Deepa Arya
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Tanya Myers
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily Jane Woo
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - An-Chi Lo
- Acumen LLC, Burlingame, California, USA
| | - Steve Chu
- Centers for Medicare & Medicaid Services, Washington, DC, USA
| | | | | | | | - Tom MaCurdy
- Acumen LLC, Burlingame, California, USA.,Department of Economics, Stanford University, Stanford, California, USA
| | - Jeffrey Kelman
- Centers for Medicare & Medicaid Services, Washington, DC, USA
| | - Steven Anderson
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jonathan Duffy
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard A Forshee
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
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Lu Y, Chillarige Y, Izurieta HS, Wei Y, Xu W, Lu M, Sung HM, Lindaas A, Wernecke M, Macurdy T, Kelman J, Forshee RA. Effect of Age on Relative Effectiveness of High-Dose Versus Standard-Dose Influenza Vaccines Among US Medicare Beneficiaries Aged ≥65 Years. J Infect Dis 2020; 220:1511-1520. [PMID: 31290553 DOI: 10.1093/infdis/jiz360] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/08/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Studies have found that the high-dose influenza vaccine has a higher relative vaccine effectiveness (RVE) versus standard-dose vaccines in some seasons. We evaluated the effect of age on the RVE of high-dose versus standard-dose influenza vaccines among Medicare beneficiaries. METHODS A 6-season retrospective cohort study from 2012 to 2018 among Medicare beneficiaries aged ≥65 years was performed. Poisson regression was used to evaluate the effect of age on the RVE of high-dose versus standard-dose influenza vaccines in preventing influenza-related hospitalizations. RESULTS The study included >19 million vaccinated beneficiaries in a community pharmacy setting. The Poisson models indicated a slightly increasing trend in RVE with age in all seasons. The high-dose vaccine was more effective than standard-dose vaccines in preventing influenza-related hospital encounters (ie, influenza-related inpatient stays and emergency department visits) in the 2012-2013 (RVE, 23.1%; 95% confidence interval [CI], 17.6%-28.3%), 2013-2014 (RVE, 15.3%; 95% CI, 7.8%-22.3%), 2014-2015 (RVE, 8.9%; 95% CI, 5.6%-12.1%), and 2016-2017 (RVE, 12.6%; 95% CI, 6.3%-18.4%) seasons and was at least as effective in all other seasons. We also found that the high-dose vaccine was consistently more effective than standard-dose vaccines across all seasons for people aged ≥85 years. Similar trends were observed for influenza-related inpatient stays. CONCLUSIONS The RVE of high-dose versus standard-dose influenza vaccines increases with age.
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Affiliation(s)
- Yun Lu
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | | | - Hector S Izurieta
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland.,Universidad Rey Juan Carlos, Madrid, Spain
| | - Yuqin Wei
- Acumen, Burlingame, Stanford University, Stanford, California
| | - Wenjie Xu
- Acumen, Burlingame, Stanford University, Stanford, California
| | - Michael Lu
- Acumen, Burlingame, Stanford University, Stanford, California
| | - Heng-Ming Sung
- Acumen, Burlingame, Stanford University, Stanford, California
| | | | | | - Thomas Macurdy
- Acumen, Burlingame, Stanford University, Stanford, California.,Department of Economics, Stanford University, Stanford, California
| | - Jeffrey Kelman
- Centers for Medicare and Medicaid Services, Washington, D. C
| | - Richard A Forshee
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
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27
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Huang Y, Forshee RA, Keire D, Lee S, Gregori L, Asher DM, Bett C, Niland B, Brubaker SA, Anderson SA, Yang H. Assessment of risk of variant creutzfeldt-Jakob disease (vCJD) from use of bovine heparin. Pharmacoepidemiol Drug Saf 2020; 29:575-581. [PMID: 32134162 DOI: 10.1002/pds.4982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE In the late1990s, reacting to the outbreak of bovine spongiform encephalopathy (BSE) in the United Kingdom that caused a new variant of Creutzfeldt-Jakob disease (vCJD) in humans, manufacturers withdrew bovine heparin from the market in the United States. There have been growing concerns about the adequate supply and safety of porcine heparin. Since the BSE epidemic has been declining markedly, the US Food and Drug Administration reevaluates the vCJD risk via use of bovine heparin. METHODS We developed a computational model to estimate the vCJD risk to patients receiving bovine heparin injections. The model incorporated information including BSE prevalence, infectivity levels in the intestines, manufacturing batch size, yield of heparin, reduction in infectivity by manufacturing process, and the dose-response relationship. RESULTS The model estimates a median risk of vCJD infection from a single intravenous dose (10 000 USP units) of heparin made from US-sourced bovine intestines to be 6.9 × 10-9 (2.5-97.fifth percentile: 1.5 × 10-9 -4.3 × 10-8 ), a risk of 1 in 145 million, and 4.6 × 10-8 (2.5-97.fifth percentile: 1.1 × 10-8 -2.6 × 10-7 ), a risk of 1 in 22 million for Canada-sourced products. The model estimates a median risk of 1.4 × 10-7 (2.5-97.fifth percentile: 2.9 × 10-8 -9.3 × 10-7 ) and 9.6 × 10-7 (2.5-97.fifth percentile: 2.1 × 10-7 -5.6 × 10-6 ) for a typical treatment for venous thromboembolism (infusion of 2-4 doses daily per week) using US-sourced and Canada-sourced bovine heparin, respectively. CONCLUSIONS The model estimates the vCJD risk from use of heparin when appropriately manufactured from US or Canadian cattle is likely small. The model and conclusions should not be applied to other medicinal products manufactured using bovine-derived materials.
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Affiliation(s)
- Yin Huang
- FDA Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, Silver Spring, Maryland
| | - Richard A Forshee
- FDA Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, Silver Spring, Maryland
| | - David Keire
- FDA Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Silver Spring, Maryland
| | - Sau Lee
- FDA Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Silver Spring, Maryland
| | - Luisa Gregori
- FDA Center for Biologics Evaluation and Research, Office of Blood Research and Review, Silver Spring, Maryland
| | - David M Asher
- FDA Center for Biologics Evaluation and Research, Office of Blood Research and Review, Silver Spring, Maryland
| | - Cyrus Bett
- FDA Center for Biologics Evaluation and Research, Office of Blood Research and Review, Silver Spring, Maryland
| | - Brian Niland
- FDA Center for Biologics Evaluation and Research, Office of Tissues and Advanced Therapies, Silver Spring, Maryland
| | - Scott A Brubaker
- FDA Center for Biologics Evaluation and Research, Office of Tissues and Advanced Therapies, Silver Spring, Maryland
| | - Steven A Anderson
- FDA Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, Silver Spring, Maryland
| | - Hong Yang
- FDA Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, Silver Spring, Maryland
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28
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Lu Y, Chillarige Y, Izurieta HS, Wei Y, Xu W, Lu M, Sung HM, Lindaas A, Wernecke M, Macurdy T, Kelman J, Forshee RA. Erratum to: Effect of Age on Relative Effectiveness of High-Dose Versus Standard-Dose Influenza Vaccines Among US Medicare Beneficiaries Aged ≥65 Years. J Infect Dis 2020; 221:168. [PMID: 31621860 DOI: 10.1093/infdis/jiz463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Yun Lu
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | | | - Hector S Izurieta
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland.,Universidad Rey Juan Carlos, Madrid, Spain
| | | | | | | | | | | | | | - Thomas Macurdy
- Acumen, Burlingame.,Department of Economics, Stanford University, Stanford, California
| | - Jeffrey Kelman
- Centers for Medicare and Medicaid Services, Washington, D. C
| | - Richard A Forshee
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
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29
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Tegenge MA, Von Tungeln LS, Anderson SA, Mitkus RJ, Vanlandingham MM, Forshee RA, Beland FA. Comparative pharmacokinetic and biodistribution study of two distinct squalene-containing oil-in-water emulsion adjuvants in H5N1 influenza vaccines. Regul Toxicol Pharmacol 2019; 108:104436. [PMID: 31381939 DOI: 10.1016/j.yrtph.2019.104436] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/15/2019] [Accepted: 08/01/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND In recent years, there has been great interest from academia, industry and government scientists for an increased understanding of the mode of action of vaccine adjuvants to characterize the safety and efficacy of vaccines. In this context, pharmacokinetic (PK) and biodistribution studies are useful for quantifying the concentration of vaccine adjuvants in mechanistically or toxicologically relevant target tissues. METHODS In this study, we conducted a comparative analysis of the PK and biodistribution profile of radiolabeled squalene for up to 336 h (14 days) after intramuscular injection of mice with adjuvanted H5N1 influenza vaccines. The evaluated adjuvants included an experimental-grade squalene-in-water (SQ/W) emulsion (AddaVax®) and an adjuvant system (AS03®) that contained squalene and α-tocopherol in the oil phase of the emulsion. RESULTS The half-life of the initial exponential decay from quadriceps muscle was 1.5 h for AS03 versus 12.9 h for AddaVax. At early time points (1-6 h), there was about a 10-fold higher concentration of labeled squalene in draining lymph nodes following AS03 injection compared to AddaVax. The area-under-concentration curve up to 336 h (AUC0-336hr) and peak concentration of squalene in spleen (immune organ) was about 1.7-fold higher following injection of AS03 than AddaVax. The peak systemic tissue concentration of squalene from the two adjuvants, with or without antigen, remained below 1% of injected dose for toxicologically relevant target tissues, such as spinal cord, brain, and kidney. The pharmacokinetics of AS03 was unaffected by the presence of H5N1 antigen. CONCLUSIONS This study demonstrates a rapid decline of AS03 from the quadriceps muscles of mice as compared to conventional SQ/W emulsion adjuvant, with an increased transfer to mechanistically relevant tissues such as local lymph nodes. Systemic tissue exposure to potential toxicological target tissues was very low.
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Affiliation(s)
- Million A Tegenge
- Office of Biostatistics & Epidemiology, Center for Biologics Evaluation and Research, FDA, Silver Spring, MD, 20993, USA.
| | - Linda S Von Tungeln
- Division of Biochemical Toxicology, National Center for Toxicological Research, FDA, Jefferson, AR, 72079, USA
| | - Steven A Anderson
- Office of Biostatistics & Epidemiology, Center for Biologics Evaluation and Research, FDA, Silver Spring, MD, 20993, USA
| | - Robert J Mitkus
- Office of Biostatistics & Epidemiology, Center for Biologics Evaluation and Research, FDA, Silver Spring, MD, 20993, USA; Current Address: BASF Corporation, 26 Davis Drive, Durham, NC, 27709, USA
| | - Michelle M Vanlandingham
- Division of Biochemical Toxicology, National Center for Toxicological Research, FDA, Jefferson, AR, 72079, USA
| | - Richard A Forshee
- Office of Biostatistics & Epidemiology, Center for Biologics Evaluation and Research, FDA, Silver Spring, MD, 20993, USA
| | - Frederick A Beland
- Division of Biochemical Toxicology, National Center for Toxicological Research, FDA, Jefferson, AR, 72079, USA
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Forshee RA, Hu M, Arya D, Perez-Vilar S, Anderson SA, Lo AC, Swarr M, Wernecke M, MaCurdy T, Chu S, Kelman J. A simulation study of the statistical power and signaling characteristics of an early season sequential test for influenza vaccine safety. Pharmacoepidemiol Drug Saf 2019; 28:1077-1085. [PMID: 31222967 DOI: 10.1002/pds.4807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/19/2019] [Accepted: 04/24/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE The US Food and Drug Administration monitors the risk of Guillain-Barré syndrome (GBS) following influenza vaccination using several data sources including Medicare. In the 2017 to 2018 season, we transitioned our near real-time surveillance in Medicare to more effectively detect large GBS risk increases early in the season while avoiding false positives. METHODS We conducted a simulation study examining the ability of the updating sequential probability ratio test (USPRT) to detect substantially elevated GBS risk in the 8- to 21-day postvaccination versus 5× to 30× the historical rate. We varied the first testing week (weeks 5-8) and the null rate (1×-3×) and evaluated power. We estimated signal probability and the risk ratio (RR) after signaling when high-risk seasons were rare. RESULTS Applying fixed alternatives, we found >80% power to detect a risk 30× the historical rate in week 5 for the 1× null and in week 6 for the 1.5× to 3× nulls. Nearly all testing schedules had >80% power for a 5× risk by week 11. To test the robustness of USPRT, we further simulated seasons where 1% were true high-risk seasons. Using a 1× null led to 10% of seasons signaling by week 11 (median RR approximately 1.4), which decreased to approximately 1% with the ≥2.5× null (median RR approximately 16.0). CONCLUSIONS On the basis of the results from this simulation and subsequent consultations with experts and stakeholders, we specified USPRT to test continuously from weeks 7 to 11 using the null hypothesis that the observed GBS rate was 2.5× the historical rate. This helped improve the ability of USPRT to provide early detection of GBS risk following influenza vaccination as part of a multilayered system of surveillance.
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Affiliation(s)
- Richard A Forshee
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Mao Hu
- Acumen LLC, Burlingame, California, USA
| | - Deepa Arya
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Silvia Perez-Vilar
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Steven A Anderson
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - An-Chi Lo
- Acumen LLC, Burlingame, California, USA
| | | | | | - Tom MaCurdy
- Acumen LLC, Burlingame, California, USA.,Department of Economics, Stanford University, Stanford, California, USA
| | - Steve Chu
- Center for Medicare, Centers for Medicare and Medicaid Services, Baltimore, Maryland, USA
| | - Jeffrey Kelman
- Center for Medicare, Centers for Medicare and Medicaid Services, Baltimore, Maryland, USA
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31
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Perez-Vilar S, Wernecke M, Arya D, Lo AC, Lufkin B, Hu M, Chu S, MaCurdy TE, Kelman J, Forshee RA. Surveillance for Guillain-Barré syndrome after influenza vaccination among U.S. Medicare beneficiaries during the 2017-2018 season. Vaccine 2019; 37:3856-3865. [PMID: 31122853 DOI: 10.1016/j.vaccine.2019.05.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The U.S. Food and Drug Administration and the Centers for Medicare & Medicaid Services have been actively monitoring the risk of Guillain-Barré syndrome (GBS) following influenza vaccination among Fee-for-Service (FFS) Medicare beneficiaries every season since 2008. We present our evaluation of the GBS risk following influenza vaccinations during the 2017-2018 season. METHODS We implemented a multilayered approach to active safety surveillance that included near real-time surveillance early in the season, comparing GBS rates post-vaccination during the 2017-2018 season with rates from five prior seasons using the Updating Sequential Probability Ratio Test (USPRT), and end-of-season self-controlled risk interval (SCRI) analyses. RESULTS We identified approximately 16 million influenza vaccinations. The near real-time surveillance did not signal for a potential 2.5-fold increased GBS risk either in days 8-21 or 1-42 post-influenza vaccination. In the SCRI analyses, we did not detect statistically significant increased GBS risks among influenza-vaccinated Medicare beneficiaries ≥65 years for either the 8-21 or 1-42-day risk windows for all seasonal vaccines combined, high-dose vaccine, or standard-dose vaccines; we did detect an increased GBS risk in days 8-21 post-vaccination for individuals vaccinated with the adjuvanted vaccine (OR: 3.75; 95% CI: 1.01, 13.96), although this finding was not statistically significant after multiplicity adjustment (p = 0.146). CONCLUSIONS Our multilayered surveillance approach-which allows for early detection of elevated GBS risk and provides reliable end-of-season SCRI estimates of effect size-did not identify an increased GBS risk following 2017-2018 influenza vaccinations. The slightly increased GBS risk with the adjuvanted vaccine, which was not statistically significant following multiplicity adjustment, is consistent with the package inserts of all U.S.-licensed influenza vaccines, which warn of a potential low increased GBS risk. The benefits of influenza vaccines in preventing morbidity and mortality heavily outweigh this potential risk.
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Affiliation(s)
- Silvia Perez-Vilar
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, United States.
| | | | - Deepa Arya
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, United States.
| | | | | | - Mao Hu
- Acumen LLC, United States.
| | - Steve Chu
- Centers for Medicare and Medicaid Services, United States.
| | - Thomas E MaCurdy
- Stanford University, Department of Economics and Hoover Institution, United States; Acumen LLC, United States.
| | - Jeffrey Kelman
- Centers for Medicare and Medicaid Services, United States.
| | - Richard A Forshee
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, United States.
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32
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Yogurtcu ON, Yang H, Chancey C, Forshee RA, Eder AF. Predictive model for Zika virus RNA minipool nucleic acid testing in outbreak scenarios. Transfusion 2019; 59:2211-2217. [PMID: 30938839 DOI: 10.1111/trf.15296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 02/25/2019] [Accepted: 03/14/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Zika virus (ZIKV), a mosquito-borne flavivirus, causes asymptomatic infections in blood donors and can be transmitted by transfusion. During the 2016 US outbreak, universal individual-donation nucleic acid testing (ID-NAT) was used to screen the blood supply for ZIKV. Testing pooled samples from multiple donations with minipool (MP)-NAT is less sensitive than ID-NAT, which raised questions about its utility in ZIKV outbreaks. STUDY DESIGN AND METHODS A mathematical model and computer simulation determined the risk of missing ID-NAT-reactive and immunoglobulin (Ig) M-negative donations in a ZIKV outbreak if MP-NAT is used initially instead of ID-NAT. The model calculated the time required for ZIKV RNA to replicate to a concentration detectable by testing donations individually or in pools of 6 (MP6) or 16 (MP16). A computer simulation then randomly selected infection times to determine the probability of detection by the candidate tests. RESULTS The probability of detecting the first ID-NAT-reactive unit in an outbreak is 92% (2.5th-97.5th percentile, 79%-99%) by MP6 and 85% (2.5th-97.5th percentile, 67%-99%) by MP16. When one donation is detected by MP-NAT, the model predicts that the chance of having missed one or more ID-NAT-reactive donations is 8% to 15%. The probability of missing a unit by MP-NAT is constant over the course of the outbreak (8% by MP6, 15% by MP16). CONCLUSION The model predicts that the probability that a candidate MP-NAT will detect the first ID-NAT-reactive unit in a ZIKV outbreak is 85% to 92% and remains constant over time.
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Affiliation(s)
- Osman N Yogurtcu
- Office of Blood Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Hong Yang
- Office of Blood Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Caren Chancey
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Richard A Forshee
- Office of Blood Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Anne F Eder
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
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33
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Dahlgren FS, Shay DK, Izurieta HS, Forshee RA, Wernecke M, Chillarige Y, Lu Y, Kelman JA, Reed C. Patterns of seasonal influenza activity in U.S. core-based statistical areas, described using prescriptions of oseltamivir in Medicare claims data. Epidemics 2018; 26:23-31. [PMID: 30249390 PMCID: PMC6519085 DOI: 10.1016/j.epidem.2018.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/11/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022] Open
Abstract
Using Medicare claims data on prescriptions of oseltamivir dispensed to people 65 years old and older, we present a descriptive analysis of patterns of influenza activity in the United States for 579 core-based statistical areas (CBSAs) from the 2010–2011 through the 2015–2016 influenza seasons. During this time, 1,010,819 beneficiaries received a prescription of oseltamivir, ranging from 45,888 in 2011–2012 to 380,745 in 2014–2015. For each season, the peak weekly number of prescriptions correlated with the total number of prescriptions (Pearson’s r ≥ 0.88). The variance in peak timing decreased with increasing severity (p < 0.0001). Among these 579 CBSAs, neither peak timing, nor relative timing, nor severity of influenza seasons showed evidence of spatial autocorrelation (0.02 ≤ Moran’s I ≤ 0.23). After aggregating data to the state level, agreement between the seasonal severity at the CBSA level and the state level was fair (median Cohen’s weighted κ = 0.32, interquartile range = 0.26–0.39). Based on seasonal severity, relative timing, and geographic place, we used hierarchical agglomerative clustering to join CBSAs into influenza zones for each season. Seasonal maps of influenza zones showed no obvious patterns that might assist in predicting influenza zones for future seasons. Because of the large number of prescriptions, these data may be especially useful for characterizing influenza activity and geographic distribution during low severity seasons, when other data sources measuring influenza activity are likely to be sparse.
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Affiliation(s)
- F Scott Dahlgren
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Influenza Division, Atlanta, GA, USA.
| | - David K Shay
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Influenza Division, Atlanta, GA, USA
| | - Hector S Izurieta
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Richard A Forshee
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | | | | | - Yun Lu
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | | | - Carrie Reed
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Influenza Division, Atlanta, GA, USA
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34
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Dahlgren FS, Shay DK, Izurieta HS, Forshee RA, Wernecke M, Chillarige Y, Lu Y, Kelman JA, Reed C. Evaluating oseltamivir prescriptions in Centers for Medicare and Medicaid Services medical claims records as an indicator of seasonal influenza in the United States. Influenza Other Respir Viruses 2018; 12:465-474. [PMID: 29505168 PMCID: PMC6005588 DOI: 10.1111/irv.12552] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2018] [Indexed: 12/04/2022] Open
Abstract
Background Over 34 million residents of the United States aged 65 years and older are also Medicare prescription drug beneficiaries. Medical claims records for this age group potentially provide a wealth of data for better understanding influenza epidemiology. Objective The purpose of this study was to evaluate data on oseltamivir dispensing extracted from medical claims records as an indicator of influenza activity in the United States for the 2010‐11 through 2014‐15 influenza seasons. Methods We used Centers for Medicare and Medicaid Services (CMS) medical claims data to evaluate the weekly number of therapeutic oseltamivir prescriptions dispensed following a rapid influenza diagnostic test among beneficiaries 65 years old and older as an indicator of influenza timing and intensity. We compared the temporal changes in this indicator to changes in the proportion of influenza‐like illnesses among outpatient visits in the US Outpatient Influenza‐like Illness Surveillance Network (ILINet) by administrative regions defined by the US Department of Health and Human Services. Using the moving epidemic method, we determined intensity thresholds and categorized the severity of seasons for both CMS and ILINet data. Results Centers for Medicare and Medicaid Services oseltamivir data and ILINet data were strongly correlated by administrative region (median Spearman's ρ = 0.78; interquartile range = 0.73‐0.80). CMS oseltamivir data and ILINet data substantially agreed (Cohen's weighted κ = 0.62) as to the seasonal severity across administrative regions. Conclusions Our results support the use of oseltamivir dispensing in medical claims data as an indicator of US influenza activity.
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Affiliation(s)
- F Scott Dahlgren
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Influenza Division, Atlanta, GA, USA
| | - David K Shay
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Influenza Division, Atlanta, GA, USA
| | - Hector S Izurieta
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Richard A Forshee
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | | | | | - Yun Lu
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | | | - Carrie Reed
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Influenza Division, Atlanta, GA, USA
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35
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Greenwald MA, Kerby S, Francis K, Noller AC, Gormley WT, Biswas R, Forshee RA. Detection of human immunodeficiency virus, hepatitis C virus, and hepatitis B virus in postmortem blood specimens using infectious disease assays licensed for cadaveric donor screening. Transpl Infect Dis 2018; 20. [PMID: 29178465 DOI: 10.1111/tid.12825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 08/02/2017] [Accepted: 08/30/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Evaluation of assay performance on postmortem blood specimens (obtained after cessation of the heartbeat) presents unique scientific and regulatory challenges. In the United States, assay performance is evaluated in part by spiking postmortem specimens. METHODS Fifty-four specimens obtained from decedents known to be infected with human immunodeficiency virus (HIV), hepatitis C virus (HCV), or hepatitis B virus (HBV), including some coinfections, were tested for each virus using Food and Drug Administration (FDA)-licensed donor screening tests for nucleic acid, antibody, and antigen. RESULTS For each disease, >95% of subjects who were reported to have an infection at the time of death had a positive test result on at least one of the donor screening assays for that infection. CONCLUSION Licensed donor screening tests were positive on postmortem specimens obtained within 24 hours of death from individuals dying with HIV, HCV, and/or HBV, and were able to detect presence of the virus. The use of multiple tests (including antibody and direct viral detection methods) is necessary to adequately evaluate donors.
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Affiliation(s)
- Melissa A Greenwald
- Division of Transplantation, Health Resources and Services Administration, Rockville, MD, USA
| | - Stephen Kerby
- US Food and Drug Administration, Silver Spring, MD, USA
| | - Kori Francis
- US Food and Drug Administration, Silver Spring, MD, USA
| | - Anna C Noller
- Virginia Office of the Chief Medical Examiner, Richmond, VA, USA
| | | | - Robin Biswas
- US Food and Drug Administration, Silver Spring, MD, USA
| | - Richard A Forshee
- Office of Biostatistics and Epidemiology, US Food and Drug Administration, Silver Spring, MD, USA
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Sridhar G, Ekezue BF, Izurieta HS, Forshee RA, Selvam N, Mintz PD, Anderson SA, Menis MD. Occurrence of hemolytic reactions on the same day as immune globulin product administrations during 2008 to 2014. Transfusion 2017; 58:70-80. [DOI: 10.1111/trf.14384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/24/2017] [Accepted: 08/24/2017] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Hector S. Izurieta
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration; Silver Spring Maryland
| | - Richard A. Forshee
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration; Silver Spring Maryland
| | | | - Paul D. Mintz
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration; Silver Spring Maryland
| | - Steven A. Anderson
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration; Silver Spring Maryland
| | - Mikhail D. Menis
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration; Silver Spring Maryland
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Ekezue BF, Sridhar G, Forshee RA, Izurieta HS, Selvam N, Mintz PD, Anderson SA, Menis MD. Occurrence of acute renal failure on the same day as immune globulin product administrations during 2008 to 2014. Transfusion 2017; 57:2977-2986. [PMID: 29027208 DOI: 10.1111/trf.14330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 07/21/2017] [Accepted: 07/26/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Acute renal failure (ARF) is a rare serious adverse event after immune globulin (IG) use. Our large claims-based study evaluated occurrence of same-day ARF after administration of different IGs and ascertained potential risk factors, during the 2008 to 2014 study period. STUDY DESIGN AND METHODS A retrospective cohort study was conducted using a large commercial administrative database. The cohort included individuals exposed to IG products as identified by procedure codes. ARF was ascertained using ICD-9-CM diagnoses. Unadjusted same-day ARF rates (per 1000 persons exposed) were estimated overall and by age, sex, and IG products. Regression analyses were conducted to control for confounding and assess potential risk factors. RESULTS Of 20,440 persons exposed, 163 (7.97 per 1000) had a recorded same-day ARF. The unadjusted nonzero same-day ARF rates (per 1000) ranged from 1.92 (95% confidence interval [CI], 0.05-10.69) for Hizentra to 16.97 (95% CI, 11.36-24.37) for Privigen and differed by sex. In multivariate analyses, compared to Gammagard Liquid, no significantly elevated ARF risks were identified with any IGs. A significantly lower odds ratio was identified with Gamunex, 0.53 (95% CI, 0.30-0.93). Age 45 and over, prior renal impairment, hypertension, and other factors were associated with increased risk of same-day ARF. CONCLUSION The study showed variation in the risk of IG-related ARF by age, sex, and IG products. The study results suggest the importance of recipient factors, such as older age and underlying health conditions. Variations in ARF occurrence may also be explained by product dosage, administration route and rate, and manufacturing processes, which warrant further evaluation.
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Affiliation(s)
| | | | - Richard A Forshee
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Hector S Izurieta
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | | | - Paul D Mintz
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Steven A Anderson
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Mikhail D Menis
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
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Tegenge MA, Moncur MM, Sokolic R, Forshee RA, Irony T. Advancing the science of patient input throughout the regulatory decision-making process. Learn Health Syst 2017; 1:e10032. [PMID: 31245564 PMCID: PMC6508573 DOI: 10.1002/lrh2.10032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/20/2017] [Accepted: 05/13/2017] [Indexed: 11/12/2022] Open
Abstract
The US Food and Drug Administration (FDA) understands the value of patient input in the regulatory decision-making process and has worked to enhance meaningful engagement. In recent years, there has been an increased scientific demand for more systematic and quantitative approaches to incorporate patient input throughout the medical product lifecycle, including to inform regulatory benefit-risk assessments. The use of patient preference information (PPI), elicited using established scientific methods, is a promising strategy for accomplishing this. Although much of the science behind PPI is not new, its application in a regulatory setting will require adapting and advancing the science of identifying, collecting, and evaluating patient input for informing regulatory decision making. Patient input and empowerment are foundational to a learning healthcare system. A learning healthcare system paradigm can also help us better understand and continuously improve the incorporation of the patient perspective in regulatory decision making. In this article, we highlight the Food and Drug Administration's Center for Biologics Evaluation and Research experience and current initiatives on advancing the science of patient input in a regulatory setting, in particular, PPI. We provide a use case that explores how the principles and benefits of PPI applied in shared clinical decision making can be realized and leveraged to enhance regulatory evaluation of innovative therapies. To further advance the application of the science of patient input in our regulatory framework, we compiled a list of example resources that support stakeholders in designing and conducting PPI studies. More collaborative research among stakeholders is needed to establish best practice approaches, ensure scientific validity, and continuously learn and improve the systematic incorporation of scientific patient input throughout the regulatory decision-making process.
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Affiliation(s)
- Million A. Tegenge
- Office of Biostatistics and EpidemiologyCenter for Biologics Evaluation and Research (CBER)US Food and Drug AdministrationSilver SpringMaryland
| | - Megan M. Moncur
- Office of Biostatistics and EpidemiologyCenter for Biologics Evaluation and Research (CBER)US Food and Drug AdministrationSilver SpringMaryland
| | - Robert Sokolic
- Office of Tissues and Advanced TherapiesCBER, US Food and Drug AdministrationSilver SpringMaryland
| | - Richard A. Forshee
- Office of Biostatistics and EpidemiologyCenter for Biologics Evaluation and Research (CBER)US Food and Drug AdministrationSilver SpringMaryland
| | - Telba Irony
- Office of Biostatistics and EpidemiologyCenter for Biologics Evaluation and Research (CBER)US Food and Drug AdministrationSilver SpringMaryland
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Tegenge MA, Yang H, Forshee RA. Predicting dose sparing benefit and bleeding risk of pharmacokinetic-based personalized prophylactic dosing of factor VIII products. Haemophilia 2017; 23:705-711. [PMID: 28543946 DOI: 10.1111/hae.13270] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Previously published factor VIII (FVIII) pharmacokinetic (PK)-based dosing approaches employ fixed infusion interval with a wide dose range that may lead to increased risk of bleeding, excessive doses or decreased health-related quality of life. AIM The objectives of the study includes (i) personalizing infusion interval in lieu of fixed infusion, (ii) constraining dose within the range of 10-50 IU/kg and (iii) characterizing bleeding risk of PK-based dosing in comparison with empiric standard doses. METHODS Patient demographics and PK parameters for conventional FVIII products were obtained from published literatures. Subject-specific PK parameters were derived from FVIII activities vs time data generated through simulation. RESULTS Our data indicated approximately 4%, 38%, 37% and 20% of the subjects can be dosed with infusion interval of every 24, 48, 72 and 96 hours, respectively, for maintaining a target 1 IU/dL FVIII level within the dose range of 10-50 IU/kg. Maintaining an alternative trough value of 3 or 5 IU/dL requires more frequent infusion. The predicted median probability of bleeding risk per year was 35.7% (range, 11%-49%) for PK-based dosing maintaining 1 IU/dL. Predicted median bleeding risk was 37.9% (0%-74%), 32.8% (0%-72%) and 26.7% (0%-70%) for standard dosing of 20, 30 and 50 IU/kg, respectively. PK-based dosing resulted in a dose sparing benefit compared to standard dose of 30 or 50 IU/kg three times per week. CONCLUSION The results of the study demonstrate the feasibility of individualizing infusion interval, restricting FVIII dose, trough and peak concentration within an acceptable range.
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Affiliation(s)
- M A Tegenge
- Office of Biostatistics & Epidemiology, Center for Biologics Evaluation and Research, US FDA, Silver Spring, USA
| | - H Yang
- Office of Biostatistics & Epidemiology, Center for Biologics Evaluation and Research, US FDA, Silver Spring, USA
| | - R A Forshee
- Office of Biostatistics & Epidemiology, Center for Biologics Evaluation and Research, US FDA, Silver Spring, USA
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Shay DK, Chillarige Y, Kelman J, Forshee RA, Foppa IM, Wernecke M, Lu Y, Ferdinands JM, Iyengar A, Fry AM, Worrall C, Izurieta HS. Comparative Effectiveness of High-Dose Versus Standard-Dose Influenza Vaccines Among US Medicare Beneficiaries in Preventing Postinfluenza Deaths During 2012-2013 and 2013-2014. J Infect Dis 2017; 215:510-517. [PMID: 28329311 DOI: 10.1093/infdis/jiw641] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/06/2017] [Indexed: 12/31/2022] Open
Abstract
Background Recipients of high-dose vs standard-dose influenza vaccines have fewer influenza illnesses. We evaluated the comparative effectiveness of high-dose vaccine in preventing postinfluenza deaths during 2012-2013 and 2013-2014, when influenza viruses and vaccines were similar. Methods We identified Medicare beneficiaries aged ≥65 years who received high-dose or standard-dose vaccines in community-located pharmacies offering both vaccines. The primary outcome was death in the 30 days following an inpatient or emergency department encounter listing an influenza International of Classification of Diseases, Ninth Revision, Clinical Modification code. Effectiveness was estimated by using multivariate Poisson regression models; effectiveness was allowed to vary by season. Results We studied 1039645 recipients of high-dose and 1683264 recipients of standard-dose vaccines during 2012-2013, and 1508176 high-dose and 1877327 standard-dose recipients during 2013-2014. Vaccinees were well-balanced for medical conditions and indicators of frail health. Rates of postinfluenza death were 0.028 and 0.038/10000 person-weeks in high-dose and standard-dose recipients, respectively. Comparative effectiveness was 24.0% (95% confidence interval [CI], .6%-42%); there was evidence of variation by season (P = .12). In 2012-2013, high-dose was 36.4% (95% CI, 9.0%-56%) more effective in reducing mortality; in 2013-2014, it was 2.5% (95% CI, -47% to 35%). Conclusions High-dose vaccine was significantly more effective in preventing postinfluenza deaths in 2012-2013, when A(H3N2) circulation was common, but not in 2013-2014.
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Affiliation(s)
- David K Shay
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Jeffrey Kelman
- Centers for Medicare and Medicaid Services, Washington, District of Columbia, USA
| | - Richard A Forshee
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Ivo M Foppa
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Battelle Memorial Institute, Atlanta, Georgia, USA
| | | | - Yun Lu
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jill M Ferdinands
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Chris Worrall
- Centers for Medicare and Medicaid Services, Washington, District of Columbia, USA
| | - Hector S Izurieta
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA.,Department of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain
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Simonetti A, Ezzeldin H, Menis M, McKean S, Izurieta H, Anderson SA, Forshee RA. Modeling the potential impact on the US blood supply of transfusing critically ill patients with fresher stored red blood cells. PLoS One 2017; 12:e0174033. [PMID: 28319164 PMCID: PMC5358863 DOI: 10.1371/journal.pone.0174033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 03/02/2017] [Indexed: 01/09/2023] Open
Abstract
Background Although some studies have suggested that transfusion recipients may have better medical outcomes if transfused with red blood cell units stored for a short time, the overall body of evidence shows mixed results. It is important to understand how using fresher stored red blood cell units for certain patient groups may affect blood availability. Methods Based on the Stock-and-Flow simulation model of the US blood supply developed by Simonetti et al. 2014, we evaluated a newly implemented allocation method of preferentially transfusing fresher stored red blood cell units to a subset of high-risk group of critically ill patients and its potential impact on supply. Results Simulation results showed that, depending on the scenario, the US blood total supply might be reduced between 2-42%, when compared to the standard of care in transfusion medicine practice. Among our simulated scenarios, we observed that the number of expired red blood cell units modulated the supply levels. The age threshold of the required red blood cell units was inversely correlated with both the supply levels and the number of transfused units that failed to meet that age threshold. Conclusion To our knowledge, this study represents the first attempt to develop a comprehensive framework to evaluate the impact of preferentially transfusing fresher stored red blood cells to the higher-risk critically ill patients on supply. Model results show the difficulties to identify an optimal scenario.
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Affiliation(s)
- Arianna Simonetti
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America
- * E-mail:
| | - Hussein Ezzeldin
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America
| | - Mikhail Menis
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America
| | | | - Hector Izurieta
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America
| | - Steven A. Anderson
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America
| | - Richard A. Forshee
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America
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Yang H, Huang Y, Gregori L, Asher DM, Bui T, Forshee RA, Anderson SA. Geographic exposure risk of variant Creutzfeldt-Jakob disease in US blood donors: a risk-ranking model to evaluate alternative donor-deferral policies. Transfusion 2017; 57:924-932. [DOI: 10.1111/trf.13971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/18/2016] [Accepted: 11/20/2016] [Indexed: 01/05/2023]
Affiliation(s)
- Hong Yang
- US Food and Drug Administration; Silver Spring Maryland
| | - Yin Huang
- US Food and Drug Administration; Silver Spring Maryland
| | - Luisa Gregori
- US Food and Drug Administration; Silver Spring Maryland
| | | | - Travis Bui
- US Food and Drug Administration; Silver Spring Maryland
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Tegenge MA, Von Tungeln LS, Mitkus RJ, Anderson SA, Vanlandingham MM, Forshee RA, Beland FA. Pharmacokinetics and biodistribution of squalene-containing emulsion adjuvant following intramuscular injection of H5N1 influenza vaccine in mice. Regul Toxicol Pharmacol 2016; 81:113-119. [PMID: 27498239 DOI: 10.1016/j.yrtph.2016.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 11/15/2022]
Abstract
Squalene is a component of oil-in-water emulsion adjuvants developed for potential use in some influenza vaccines. The biodistribution of the squalene-containing emulsion adjuvant (AddaVax™) alone and as part of complete H5N1 vaccine was quantified in mechanistically and toxicologically relevant target tissues up to 336 h (14 days) following injection into quadriceps muscle. At 1 h, about 55% of the intramuscularly injected dose of squalene was detected in the local quadriceps muscles and this decreased to 26% at 48 h. Twenty-four hours after the injection, approximately 5%, 1%, and 0.6% of the injected dose was detected in inguinal fat, draining lymph nodes, and sciatic nerve, respectively. The peak concentration for kidney, brain, spinal cord, bone marrow, and spleen was each less than 1% of the injected dose, and H5N1 antigen did not significantly alter the biodistribution of squalene to these tissues. The area-under-blood-concentration curve (AUC) and peak blood concentration (Cmax) of squalene were slightly higher (20-25%) in the presence of H5N1 antigen. A population pharmacokinetic model-based statistical analysis identified body weight and H5N1 antigen as covariates influencing the clearance of squalene. The results contribute to the body of knowledge informing benefit-risk analyses of squalene-containing emulsion vaccine adjuvants.
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Affiliation(s)
- Million A Tegenge
- Office of Biostatistics & Epidemiology, Center for Biologics Evaluation and Research, FDA, USA.
| | - Linda S Von Tungeln
- Division of Biochemical Toxicology, National Center for Toxicological Research, FDA, USA
| | - Robert J Mitkus
- Office of Biostatistics & Epidemiology, Center for Biologics Evaluation and Research, FDA, USA
| | - Steven A Anderson
- Office of Biostatistics & Epidemiology, Center for Biologics Evaluation and Research, FDA, USA
| | | | - Richard A Forshee
- Office of Biostatistics & Epidemiology, Center for Biologics Evaluation and Research, FDA, USA
| | - Frederick A Beland
- Division of Biochemical Toxicology, National Center for Toxicological Research, FDA, USA
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Abstract
Nonrandomized studies are essential in the postmarket activities of the US Food and Drug Administration, which, however, must often act on the basis of imperfect data. Systematic errors can lead to inaccurate inferences, so it is critical to develop analytic methods that quantify uncertainty and bias and ensure that these methods are implemented when needed. "Quantitative bias analysis" is an overarching term for methods that estimate quantitatively the direction, magnitude, and uncertainty associated with systematic errors influencing measures of associations. The Food and Drug Administration sponsored a collaborative project to develop tools to better quantify the uncertainties associated with postmarket surveillance studies used in regulatory decision making. We have described the rationale, progress, and future directions of this project.
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Affiliation(s)
- Timothy L Lash
- Timothy L. Lash is with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA. Matthew P. Fox is with the Department of Epidemiology, Boston University School of Public Health, Boston, MA. At the time of the study, Darryl Cooney was with SciMetrika LLC, Durham, NC. Yun Lu and Richard A. Forshee are with the Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | - Matthew P Fox
- Timothy L. Lash is with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA. Matthew P. Fox is with the Department of Epidemiology, Boston University School of Public Health, Boston, MA. At the time of the study, Darryl Cooney was with SciMetrika LLC, Durham, NC. Yun Lu and Richard A. Forshee are with the Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | - Darryl Cooney
- Timothy L. Lash is with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA. Matthew P. Fox is with the Department of Epidemiology, Boston University School of Public Health, Boston, MA. At the time of the study, Darryl Cooney was with SciMetrika LLC, Durham, NC. Yun Lu and Richard A. Forshee are with the Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | - Yun Lu
- Timothy L. Lash is with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA. Matthew P. Fox is with the Department of Epidemiology, Boston University School of Public Health, Boston, MA. At the time of the study, Darryl Cooney was with SciMetrika LLC, Durham, NC. Yun Lu and Richard A. Forshee are with the Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | - Richard A Forshee
- Timothy L. Lash is with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA. Matthew P. Fox is with the Department of Epidemiology, Boston University School of Public Health, Boston, MA. At the time of the study, Darryl Cooney was with SciMetrika LLC, Durham, NC. Yun Lu and Richard A. Forshee are with the Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD
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Ekezue BF, Sridhar G, Ovanesov MV, Forshee RA, Izurieta HS, Selvam N, Parunov LA, Jain N, Mintz PD, Epstein JS, Anderson SA, Menis MD. Clotting factor product administration and same-day occurrence of thrombotic events, as recorded in a large healthcare database during 2008-2013. J Thromb Haemost 2015; 13:2168-79. [PMID: 26414338 DOI: 10.1111/jth.13155] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 09/12/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Thrombotic events (TEs) are serious adverse events that can occur following administration of clotting factors (CFs). OBJECTIVES To evaluate occurrence of same-day TEs for different CF products and potential risk factors. METHODS A retrospective cohort study of individuals exposed to CF products during 2008-2013 was conducted using a large commercial insurance database. CF products were identified by procedure codes, and TEs were ascertained via diagnosis codes. Crude same-day TE rates (per 1000 persons exposed) were estimated overall and by congenital factor deficiency (CFD) status, CF products, age and gender. Multivariable logistic regression analyses were used to control for confounding. Laboratory analysis was used to compare the procoagulant activities of FIX products. RESULTS Of 3801 individuals exposed to CFs, 117 (30.8 per 1000) had same-day TEs recorded. The crude same-day TE rate was higher for CF users without CFD, 70.2 (102 of 1452), as compared with those with CFD, 6.4 (15 of 2349) (RR, 11.0; 95% CI, 6.4-18.9). For individuals without CFD, a significantly increased same-day TE risk was identified for factor IX complex (OR, 6.92; 95% CI, 3.11-15.40), factor VIIa (OR, 9.42; 95% CI, 4.99-17.78) and other products when compared with fibrin sealant. An increased risk of a TE was found with older age (≥ 45 years), history of TEs and underlying health conditions. The laboratory identified elevated procoagulant activity in Profilnine(®) and Benefix(®) . CONCLUSIONS The study shows an increased same-day TE risk for CF users without CFD and suggests substantial off-label CF use. The study findings also show elevated same-day TE rates for different CF products and suggest the importance of product properties and patient factors.
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Affiliation(s)
| | - G Sridhar
- HealthCore Inc, Silver Spring, MD, USA
| | - M V Ovanesov
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - R A Forshee
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - H S Izurieta
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - N Selvam
- HealthCore Inc, Silver Spring, MD, USA
| | - L A Parunov
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - N Jain
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - P D Mintz
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - J S Epstein
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - S A Anderson
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - M D Menis
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
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Lababidi S, Sutherland A, Krasnicka B, Forshee RA, Anderson SA. Overall conceptual framework for studying the genetics of autoimmune diseases following vaccination: a regulatory perspective. Biomark Med 2015; 9:1107-20. [DOI: 10.2217/bmm.15.67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The US Vaccine Adverse Event Reporting System contains case reports of autoimmune diseases (ADs) occurring following vaccinations. ADs are rare and occur in unvaccinated people, making the potential association between vaccines and ADs challenging to evaluate. Developing mechanistic pathways that link genes, immune mediators, vaccine components and ADs would be helpful for hypothesis generation, enhancing theories of biologic plausibility and grouping rare autoimmune adverse events to increase the ability to detect and evaluate safety signals. Here, we propose a conceptual framework for investigating the genetics of ADs as safety signals following vaccination, potentially contributing to the identification of relevant biomarkers. We also discuss a study design that incorporates genetic information into postmarket clinical evaluation of autoimmune adverse events following vaccination.
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Affiliation(s)
- Samir Lababidi
- Office of Biostatistics & Epidemiology, Center for Biologics Evaluation & Research, US Food & Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993-0002, USA
| | - Andrea Sutherland
- Johns Hopkins University, School of Public Health, Baltimore MD, USA
| | - Barbara Krasnicka
- Division of Biostatistics, Office of Biostatistics & Epidemiology, Center for Biologics Evaluation & Research, US Food & Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993-0002, USA
| | - Richard A Forshee
- Office of Biostatistics & Epidemiology, Center for Biologics Evaluation & Research, US Food & Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993-0002, USA
| | - Steven A Anderson
- Office of Biostatistics & Epidemiology, Center for Biologics Evaluation & Research, US Food & Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993-0002, USA
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47
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Ekezue BF, Sridhar G, Izurieta HS, Forshee RA, Selvam N, Ovanesov MV, Jain N, Mintz PD, Anderson SA, Menis M. Clotting Factor (Cf) Product Use And Same-Day Risk For Thrombotic Adverse Events (Tes), As Recorded In Large Health Care Database During 2008-2013 Study Period. Value Health 2014; 17:A473. [PMID: 27201359 DOI: 10.1016/j.jval.2014.08.1348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - G Sridhar
- HealthCore Inc., Alexandria, VA, USA
| | - H S Izurieta
- U. S. Federal Drug Administration, Silver Spring, MD, USA
| | - R A Forshee
- U. S. Federal Drug Administration, Silver Spring, MD, USA
| | - N Selvam
- HealthCore Inc., Alexandria, VA, USA
| | - M V Ovanesov
- U. S. Federal Drug Administration, Silver Spring, MD, USA
| | - N Jain
- U. S. Federal Drug Administration, Silver Spring, MD, USA
| | - P D Mintz
- U. S. Federal Drug Administration, Silver Spring, MD, USA
| | - S A Anderson
- U. S. Federal Drug Administration, Silver Spring, MD, USA
| | - M Menis
- U. S. Federal Drug Administration, Silver Spring, MD, USA
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48
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Menis M, Forshee RA, Anderson SA, McKean S, Gondalia R, Warnock R, Johnson C, Mintz PD, Worrall CM, Kelman JA, Izurieta HS. Posttransfusion purpura occurrence and potential risk factors among the inpatient US elderly, as recorded in large Medicare databases during 2011 through 2012. Transfusion 2014; 55:284-95. [DOI: 10.1111/trf.12782] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 05/28/2014] [Accepted: 06/01/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Mikhail Menis
- Food and Drug Administration; Silver Spring Maryland
| | | | | | | | | | | | | | - Paul D. Mintz
- Food and Drug Administration; Silver Spring Maryland
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49
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Sridhar G, Ekezue BF, Izurieta HS, Selvam N, Ovanesov MV, Divan HA, Liang Y, Golding B, Forshee RA, Anderson SA, Menis M. Immune globulins and same-day thrombotic events as recorded in a large health care database during 2008 to 2012. Transfusion 2014; 54:2553-65. [DOI: 10.1111/trf.12663] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/03/2014] [Accepted: 02/25/2014] [Indexed: 01/01/2023]
Affiliation(s)
| | | | - Hector S. Izurieta
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | | | - Mikhail V. Ovanesov
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | | | - Yideng Liang
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | - Basil Golding
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | - Richard A. Forshee
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | - Steven A. Anderson
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | - Mikhail Menis
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
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50
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Mitkus RJ, King DB, Walderhaug MO, Forshee RA. A comparative pharmacokinetic estimate of mercury in U.S. Infants following yearly exposures to inactivated influenza vaccines containing thimerosal. Risk Anal 2014; 34:735-750. [PMID: 24117921 DOI: 10.1111/risa.12124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The use of thimerosal preservative in childhood vaccines has been largely eliminated over the past decade in the United States because vaccines have been reformulated in single-dose vials that do not require preservative. An exception is the inactivated influenza vaccines, which are formulated in both multidose vials requiring preservative and preservative-free single-dose vials. As part of an ongoing evaluation by USFDA of the safety of biologics throughout their lifecycle, the infant body burden of mercury following scheduled exposures to thimerosal preservative in inactivated influenza vaccines in the United States was estimated and compared to the infant body burden of mercury following daily exposures to dietary methylmercury at the reference dose established by the USEPA. Body burdens were estimated using kinetic parameters derived from experiments conducted in infant monkeys that were exposed episodically to thimerosal or MeHg at identical doses. We found that the body burden of mercury (AUC) in infants (including low birth weight) over the first 4.5 years of life following yearly exposures to thimerosal was two orders of magnitude lower than that estimated for exposures to the lowest regulatory threshold for MeHg over the same time period. In addition, peak body burdens of mercury following episodic exposures to thimerosal in this worst-case analysis did not exceed the corresponding safe body burden of mercury from methylmercury at any time, even for low-birth-weight infants. Our pharmacokinetic analysis supports the acknowledged safety of thimerosal when used as a preservative at current levels in certain multidose infant vaccines in the United States.
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Affiliation(s)
- Robert J Mitkus
- Office of Biostatistics and Epidemiology, USFDA Center for Biologics Evaluation and Research, Rockville, MD, USA
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