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Hurley E, Geisler BP, Lupattelli A, Poblador-Plou B, Lassalle R, Jové J, Bernard MA, Sakr D, Sanfélix-Gimeno G, Sánchez-Saez F, Rodríguez-Bernal CL, Sabaté M, Ballarín E, Aguilera C, Jordan S, Thayer D, Farr I, Ahmed S, Bartolini C, Limoncella G, Paoletti O, Gini R, Maglanoc LA, Dudukina E, Ehrenstein V, Alsina E, Vaz TA, Riera-Arnau J, Sturkenboom MCJM, Nordeng HME. COVID-19 and pregnancy: A European study on pre- and post-infection medication use. Eur J Clin Pharmacol 2024; 80:707-716. [PMID: 38347228 PMCID: PMC11001745 DOI: 10.1007/s00228-024-03639-z] [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] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/25/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE The COVID-19 pandemic has impacted medication needs and prescribing practices, including those affecting pregnant women. Our goal was to investigate patterns of medication use among pregnant women with COVID-19, focusing on variations by trimester of infection and location. METHODS We conducted an observational study using six electronic healthcare databases from six European regions (Aragon/Spain; France; Norway; Tuscany, Italy; Valencia/Spain; and Wales/UK). The prevalence of primary care prescribing or dispensing was compared in the 30-day periods before and after a positive COVID-19 test or diagnosis. RESULTS The study included 294,126 pregnant women, of whom 8943 (3.0%) tested positive for, or were diagnosed with, COVID-19 during their pregnancy. A significantly higher use of antithrombotic medications was observed particularly after COVID-19 infection in the second and third trimesters. The highest increase was observed in the Valencia region where use of antithrombotic medications in the third trimester increased from 3.8% before COVID-19 to 61.9% after the infection. Increases in other countries were lower; for example, in Norway, the prevalence of antithrombotic medication use changed from around 1-2% before to around 6% after COVID-19 in the third trimester. Smaller and less consistent increases were observed in the use of other drug classes, such as antimicrobials and systemic corticosteroids. CONCLUSION Our findings highlight the substantial impact of COVID-19 on primary care medication use among pregnant women, with a marked increase in the use of antithrombotic medications post-COVID-19. These results underscore the need for further research to understand the broader implications of these patterns on maternal and neonatal/fetal health outcomes.
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Affiliation(s)
- Eimir Hurley
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Benjamin P Geisler
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Beatriz Poblador-Plou
- EpiChron Research Group, Aragon Health Sciences Institute, Miguel Servet University Hospital, Saragossa, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion, Research Network on Health Services in Chronic Diseases, Institute of Health Carlos III, Madrid, Spain
| | - Régis Lassalle
- Bordeaux PharmacoEpi, Plateforme de recherche en Pharmaco-épidémiologie, Bordeaux, France
| | - Jérémy Jové
- Bordeaux PharmacoEpi, Plateforme de recherche en Pharmaco-épidémiologie, Bordeaux, France
| | - Marie-Agnes Bernard
- Bordeaux PharmacoEpi, Plateforme de recherche en Pharmaco-épidémiologie, Bordeaux, France
| | - Dunia Sakr
- Bordeaux PharmacoEpi, Plateforme de recherche en Pharmaco-épidémiologie, Bordeaux, France
| | - Gabriel Sanfélix-Gimeno
- Health Services Research and Pharmacoepidemiology Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Valencia, Spain
| | - Francisco Sánchez-Saez
- Health Services Research and Pharmacoepidemiology Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Valencia, Spain
| | - Clara L Rodríguez-Bernal
- Health Services Research and Pharmacoepidemiology Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Valencia, Spain
| | - Mònica Sabaté
- Department of Clinical Pharmacology, Vall d`Hebron Hospital Universitari, Vall Hebron Institut de Recerca, Barcelona, Spain
| | - Elena Ballarín
- Department of Clinical Pharmacology, Vall d`Hebron Hospital Universitari, Vall Hebron Institut de Recerca, Barcelona, Spain
| | - Cristina Aguilera
- Department of Clinical Pharmacology, Vall d`Hebron Hospital Universitari, Vall Hebron Institut de Recerca, Barcelona, Spain
| | - Sue Jordan
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, UK
| | - Daniel Thayer
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, UK
| | - Ian Farr
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, UK
| | - Saira Ahmed
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, UK
| | | | | | - Olga Paoletti
- Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Rosa Gini
- Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Luigi A Maglanoc
- IT Department, Data Management, University of Oslo, Oslo, Norway
| | - Elena Dudukina
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Ema Alsina
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tiago A Vaz
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Judit Riera-Arnau
- Department of Clinical Pharmacology, Vall d`Hebron Hospital Universitari, Vall Hebron Institut de Recerca, Barcelona, Spain
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Miriam C J M Sturkenboom
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hedvig M E Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway.
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Kiss PAJ, Uijl A, de Boer AR, Duk TCX, Grobbee DE, Hollander M, Smits E, Sturkenboom MCJM, Peters SAE. Sex differences in the intensity of statin prescriptions at initiation in a primary care setting. Heart 2024:heartjnl-2023-323722. [PMID: 38580433 DOI: 10.1136/heartjnl-2023-323722] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/21/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Current guidelines for the prevention and management of cardiovascular diseases (CVD) provide similar recommendations for the use of statins in both women and men. In this study, we assessed sex differences in the intensity of statin prescriptions at initiation and in the achievement of treatment targets, among individuals without and with CVD, in a primary care setting. METHODS Electronic health record data from statin users were extracted from the PHARMO Data Network. Poisson regressions were used to investigate sex differences in statin intensity and in the achievement of treatment targets. Analyses were stratified by age group, disease status and/or CVD risk category. RESULTS We included 82 714 individuals (46% women) aged 40-99 years old. In both sexes, the proportion of individuals with a dispensed prescription for high-intensity statin at initiation increased between 2011 and 2020. Women were less likely to be prescribed high-intensity statins as compared with men, both in the subgroups without a history of CVD (risk ratio (RR) 0.69 (95% CI: 0.63 to 0.75)) and with CVD (RR 0.77 (95% CI: 0.74 to 0.81)). Women were less likely than men to achieve target levels of low-density lipoprotein cholesterol following statin initiation in the subgroup without CVD (RR 0.98 (95% CI: 0.97 to 1.00)) and with a history of CVD (RR 0.94 (95% CI: 0.89 to 0.98)). CONCLUSION Compared with men, women were less likely to be prescribed high-intensity statins at initiation and to achieve treatment targets, both in people without and with a history of CVD, and independent of differences in other individual and clinical characteristics.
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Affiliation(s)
- Pauline A J Kiss
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alicia Uijl
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Annemarijn R de Boer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tessa C X Duk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Monika Hollander
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Miriam C J M Sturkenboom
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- The George Institute for Global Health UK, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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Hollestelle MJ, van der Graaf R, Sturkenboom MCJM, Cunnington M, van Delden JJM. Building a Sustainable Learning Health Care System for Pregnant and Lactating People: Interview Study Among Data Access Providers. JMIR Pediatr Parent 2024; 7:e47092. [PMID: 38329780 PMCID: PMC10884907 DOI: 10.2196/47092] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 11/16/2023] [Accepted: 11/29/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND In many areas of health care, learning health care systems (LHSs) are seen as promising ways to accelerate research and outcomes for patients by reusing health and research data. For example, considering pregnant and lactating people, for whom there is still a poor evidence base for medication safety and efficacy, an LHS presents an interesting way forward. Combining unique data sources across Europe in an LHS could help clarify how medications affect pregnancy outcomes and lactation exposures. In general, a remaining challenge of data-intensive health research, which is at the core of an LHS, has been obtaining meaningful access to data. These unique data sources, also called data access providers (DAPs), are both public and private organizations and are important stakeholders in the development of a sustainable and ethically responsible LHS. Sustainability is often discussed as a challenge in LHS development. Moreover, DAPs are increasingly expected to move beyond regulatory compliance and are seen as moral agents tasked with upholding ethical principles, such as transparency, trustworthiness, responsibility, and community engagement. OBJECTIVE This study aims to explore the views of people working for DAPs who participate in a public-private partnership to build a sustainable and ethically responsible LHS. METHODS Using a qualitative interview design, we interviewed 14 people involved in the Innovative Medicines Initiative (IMI) ConcePTION (Continuum of Evidence from Pregnancy Exposures, Reproductive Toxicology and Breastfeeding to Improve Outcomes Now) project, a public-private collaboration with the goal of building an LHS for pregnant and lactating people. The pseudonymized transcripts were analyzed thematically. RESULTS A total of 3 themes were identified: opportunities and responsibilities, conditions for participation and commitment, and challenges for a knowledge-generating ecosystem. The respondents generally regarded the collaboration as an opportunity for various reasons beyond the primary goal of generating knowledge about medication safety during pregnancy and lactation. Respondents had different interpretations of responsibility in the context of data-intensive research in a public-private network. Respondents explained that resources (financial and other), scientific output, motivation, agreements collaboration with the pharmaceutical industry, trust, and transparency are important conditions for participating in and committing to the ConcePTION LHS. Respondents also discussed the challenges of an LHS, including the limitations to (real-world) data analyses and governance procedures. CONCLUSIONS Our respondents were motivated by diverse opportunities to contribute to an LHS for pregnant and lactating people, primarily centered on advancing knowledge on medication safety. Although a shared responsibility for enabling real-world data analyses is acknowledged, their focus remains on their work and contribution to the project rather than on safeguarding ethical data handling. The results of our interviews underline the importance of a transparent governance structure, emphasizing the trust between DAPs and the public for the success and sustainability of an LHS.
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Affiliation(s)
- Marieke J Hollestelle
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Bioethics & Health Humanities, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rieke van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Bioethics & Health Humanities, University Medical Center Utrecht, Utrecht, Netherlands
| | - Miriam C J M Sturkenboom
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Data Science & Biostatistics, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Johannes J M van Delden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Bioethics & Health Humanities, University Medical Center Utrecht, Utrecht, Netherlands
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Kiss PAJ, Uijl A, Betancur E, de Boer AR, Grobbee DE, Hollander M, Onland-Moret CN, Sturkenboom MCJM, Peters SAE. Sex Differences in the Primary Prevention of Cardiovascular Diseases in a Dutch Primary Care Setting. Glob Heart 2024; 19:6. [PMID: 38250702 PMCID: PMC10798167 DOI: 10.5334/gh.1284] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 12/04/2023] [Indexed: 01/23/2024] Open
Abstract
Background Sex differences in the primary prevention of cardiovascular diseases (CVD) have been shown, but the evidence is mixed and fragmented. In this study, we assessed sex differences in cardiovascular risk factors assessment, risk factor levels, treatment, and meeting of treatment targets, within a Dutch primary care setting. Methods Data were obtained from individuals aged 40 to 70 years old, without prior CVD, registered during the entire year in 2018 at one of the 51 general practices participating in the Julius General Practitioner's Network (JGPN). History of CVD was defined based on the International Classification of Primary Care (ICPC). Linear and Poisson regressions were used to investigate sex differences in risk factor assessment, risk factor levels, treatment, and meeting of treatment targets. Results We included 83,903 individuals (50% women). With the exception of glycated hemoglobin (HbA1c), all risk factors for CVD were more often measured in women than in men. Lipid measurements and body mass index values were higher in women, while blood pressure (BP) and HbA1c levels were higher in men, along with estimated glomerular filtration rate (eGFR) levels. Among individuals with elevated BP or cholesterol levels, no sex difference was observed in the prescription of antihypertensive medications (RR 1.00, 95% CI: 0.94-1.06) but women were less likely than men to receive lipid-lowering medications (RR 0.87, 95% CI: 0.79-0.95). Among treated individuals, women were more likely than men to meet adequate levels of blood pressure (RR 1.17, 95% CI: 1.09-1.25) and less likely to meet target levels of cholesterol (RR 0.90, 95% CI: 0.83-0.98). Conclusion While women were more likely to have their CVD risk factors measured, they were less likely to be prescribed lipid-lowering medications and to meet target levels. When treated, men were less likely to achieve adequate blood pressure control.
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Affiliation(s)
- Pauline A. J. Kiss
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Alicia Uijl
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
| | - Estefania Betancur
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Annemarijn R. de Boer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Diederick E. Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Monika Hollander
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Charlotte N. Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Miriam C. J. M. Sturkenboom
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Sanne A. E. Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
- The George Institute for Global Health, School of Public Health, Imperial College London, London, United Kingdom
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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de Bruin O, Engjom H, Vousden N, Ramakrishnan R, Aabakke AJM, Äyräs O, Donati S, Jónasdóttir E, Knight M, Overtoom EM, Salvatore MA, Sturkenboom MCJM, Svanvik T, Varpula R, Vercoutere A, Bloemenkamp KWM. Variations across Europe in hospitalization and management of pregnant women with SARS-CoV-2 during the initial phase of the pandemic: Multi-national population-based cohort study using the International Network of Obstetric Survey Systems (INOSS). Acta Obstet Gynecol Scand 2023; 102:1521-1530. [PMID: 37594175 PMCID: PMC10577630 DOI: 10.1111/aogs.14643] [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] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION The majority of data on COVID-19 in pregnancy are not from sound population-based active surveillance systems. MATERIAL AND METHODS We conducted a multi-national study of population-based national or regional prospective cohorts using standardized definitions within the International Network of Obstetric Survey systems (INOSS). From a source population of women giving birth between March 1 and August 31, 2020, we included pregnant women admitted to hospital with a positive SARS-CoV-2 PCR test ≤7 days prior to or during admission and up to 2 days after birth. The admissions were further categorized as COVID-19-related or non-COVID-19-related. The primary outcome of interest was incidence of COVID-19-related hospital admission. Secondary outcomes included severe maternal disease (ICU admission and mechanical ventilation) and COVID-19-directed medical treatment. RESULTS In a source population of 816 628 maternities, a total of 2338 pregnant women were admitted with SARS-CoV-2; among them 940 (40%) were COVID-19-related admissions. The pooled incidence estimate for COVID-19-related admission was 0.59 (95% confidence interval 0.27-1.02) per 1000 maternities, with notable heterogeneity across countries (I2 = 97.3%, P = 0.00). In the COVID-19 admission group, between 8% and 17% of the women were admitted to intensive care, and 5%-13% needed mechanical ventilation. Thromboprophylaxis was the most frequent treatment given during COVID-19-related admission (range 14%-55%). Among 908 infants born to women in the COVID-19-related admission group, 5 (0.6%) stillbirths were reported. CONCLUSIONS During the initial months of the pandemic, we found substantial variations in incidence of COVID-19-related admissions in nine European countries. Few pregnant women received COVID-19-directed medical treatment. Several barriers to rapid surveillance were identified. Investment in robust surveillance should be prioritized to prepare for future pandemics.
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Affiliation(s)
- Odette de Bruin
- Department of Obstetrics, Birth Center Wilhelmina Children's Hospital, Division Woman and BabyUniversity Medical Center UtrechtUtrechtthe Netherlands
- Department of Biostatistics and Research Support, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Hilde Engjom
- Division of Mental and Physical HealthNorwegian Institute of Public HealthBergenNorway
- Department of Obstetrics and GynecologyHaukeland University HospitalBergenNorway
| | - Nicola Vousden
- National Perinatal Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Rema Ramakrishnan
- National Perinatal Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Anna J. M. Aabakke
- Department of Obstetrics and GynecologyCopenhagen University Hospital‐HolbækHolbækDenmark
- Department of Obstetrics and GynecologyCopenhagen University Hospital‐Nordsjælland‐HillerødHillerødDenmark
| | - Outi Äyräs
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Serena Donati
- National Center for Disease Prevention and Health PromotionIstituto Superiore di Sanità – Italian National Institute of HealthRomeItaly
| | - Eva Jónasdóttir
- Department of Obstetrics and GynecologyLandspitali University HospitalReykjavikIceland
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Evelien M. Overtoom
- Department of Obstetrics, Birth Center Wilhelmina Children's Hospital, Division Woman and BabyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Michele A. Salvatore
- National Center for Disease Prevention and Health PromotionIstituto Superiore di Sanità – Italian National Institute of HealthRomeItaly
| | - Miriam C. J. M. Sturkenboom
- Department of Biostatistics and Research Support, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Teresia Svanvik
- Region Västra Götaland, Sahlgrenska University HospitalDepartment of Obstetrics and GynecologyGothenburgSweden
| | - Reetta Varpula
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - An Vercoutere
- Department of Obstetrics and Gynecology, CUB Hôpital ErasmeHôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles (ULB)BrusselsBelgium
| | - Kitty W. M. Bloemenkamp
- Department of Obstetrics, Birth Center Wilhelmina Children's Hospital, Division Woman and BabyUniversity Medical Center UtrechtUtrechtthe Netherlands
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Willame C, Weibel D, Sturkenboom MCJM. Authors' Reply to Juergen O Kirchner's Comment on "Incidence Rates of Autoimmune Diseases in European Healthcare Databases: A Contribution of the ADVANCE Project". Drug Saf 2023; 46:813-815. [PMID: 37243964 PMCID: PMC10221730 DOI: 10.1007/s40264-023-01311-6] [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] [Accepted: 04/17/2023] [Indexed: 05/29/2023]
Affiliation(s)
- Corinne Willame
- Department Datascience and Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands.
| | - Daniel Weibel
- Department Datascience and Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
| | - Miriam C J M Sturkenboom
- Department Datascience and Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
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Sisay MM, Montesinos-Guevara C, Osman AK, Saraswati PW, Tilahun B, Ayele TA, Ahmadizar F, Durán CE, Sturkenboom MCJM, van de Ven P, Weibel D. COVID-19 Vaccine Safety Monitoring Studies in Low- and Middle-Income Countries (LMICs)-A Systematic Review of Study Designs and Methods. Vaccines (Basel) 2023; 11:1035. [PMID: 37376424 DOI: 10.3390/vaccines11061035] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Post-marketing vaccine safety surveillance aims to monitor and quantify adverse events following immunization in a population, but little is known about their implementation in low- and middle-income countries (LMICs). We aimed to synthesize methodological approaches used to assess adverse events following COVID-19 vaccination in LMICs. METHODS For this systematic review, we searched articles published from 1 December 2019 to 18 February 2022 in main databases, including MEDLINE and Embase. We included all peer-reviewed observational COVID-19 vaccine safety monitoring studies. We excluded randomized controlled trials and case reports. We extracted data using a standardized extraction form. Two authors assessed study quality using the modified Newcastle-Ottawa Quality Assessment Scale. All findings were summarized narratively using frequency tables and figures. RESULTS Our search found 4254 studies, of which 58 were eligible for analysis. Many of the studies included in this review were conducted in middle-income countries, with 26 studies (45%) in lower-middle-income and 28 (48%) in upper-middle-income countries. More specifically, 14 studies were conducted in the Middle East region, 16 in South Asia, 8 in Latin America, 8 in Europe and Central Asia, and 4 in Africa. Only 3% scored 7-8 points (good quality) on the Newcastle-Ottawa Scale methodological quality assessment, while 10% got 5-6 points (medium). About 15 studies (25.9%) used a cohort study design and the rest were cross-sectional. In half of them (50%), vaccination data were gathered from the participants' self-reporting methods. Seventeen studies (29.3%) used multivariable binary logistic regression and three (5.2%) used survival analyses. Only 12 studies (20.7%) performed model diagnostics and validity checks (e.g., the goodness of fit, identification of outliers, and co-linearity). CONCLUSIONS Published studies on COVID-19 vaccine safety surveillance in LMICs are limited in number and the methods used do not often address potential confounders. Active surveillance of vaccines in LMICs are needed to advocate vaccination programs. Implementing training programs in pharmacoepidemiology in LMICs is essential.
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Affiliation(s)
- Malede Mequanent Sisay
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Camila Montesinos-Guevara
- Centro de Investigación en Epidemiología Clínica y Salud Pública (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito 341113, Ecuador
| | - Alhadi Khogali Osman
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Putri Widi Saraswati
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Fariba Ahmadizar
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Carlos E Durán
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
- Centro de Pensamiento Medicamentos, Information y Poder, Universidad Nacional de Colombia, Bogotá 111321, Colombia
| | - Miriam C J M Sturkenboom
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Peter van de Ven
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Daniel Weibel
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
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8
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Black SB, Chandler RE, Edwards KM, Sturkenboom MCJM. Assessing vaccine safety during a pandemic: Recent experience and lessons learned for the future. Vaccine 2023:S0264-410X(23)00468-1. [PMID: 37198019 DOI: 10.1016/j.vaccine.2023.04.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/23/2023] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 05/19/2023]
Abstract
During the roll out of vaccines during a pandemic, questions regarding vaccine safety often arise. This was surely true during the SARS-CoV-2 pandemic. Different tools and capabilities exist during the pre-authorization phase and post introduction each with its strengths and limitations. Here we review the various tools and their strengths and limitations and discuss what functioned well in high income settings and the limitations that unequal vaccine safety pharmacovigilance capacity imposed upon middle and low income countries.
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Affiliation(s)
| | | | - Kathryn M Edwards
- Sarah H. Sell and Cornelius Vanderbilt Professor of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States.
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9
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Willame C, Dodd C, Durán CE, Elbers RJHJ, Gini R, Bartolini C, Paoletti O, Wang L, Ehrenstein V, Kahlert J, Haug U, Schink T, Diez-Domingo J, Mira-Iglesias A, Carreras JJ, Vergara-Hernández C, Giaquinto C, Barbieri E, Stona L, Huerta C, Martín-Pérez M, García-Poza P, de Burgos A, Martínez-González M, Bryant V, Villalobos F, Pallejà-Millán M, Aragón M, Carreras JJ, Souverein P, Thurin NH, Weibel D, Klungel OH, Sturkenboom MCJM. Background rates of 41 adverse events of special interest for COVID-19 vaccines in 10 European healthcare databases - an ACCESS cohort study. Vaccine 2023; 41:251-262. [PMID: 36446653 PMCID: PMC9678835 DOI: 10.1016/j.vaccine.2022.11.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [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: 02/23/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND In May 2020, the ACCESS (The vACCine covid-19 monitoring readinESS) project was launched to prepare real-world monitoring of COVID-19 vaccines. Within this project, this study aimed to generate background incidence rates of 41 adverse events of special interest (AESI) to contextualize potential safety signals detected following administration of COVID-19 vaccines. METHODS A dynamic cohort study was conducted using a distributed data network of 10 healthcare databases from 7 European countries (Italy, Spain, Denmark, The Netherlands, Germany, France and United Kingdom) over the period 2017 to 2020. A common protocol (EUPAS37273), common data model, and common analytics programs were applied for syntactic, semantic and analytical harmonization. Incidence rates (IR) for each AESI and each database were calculated by age and sex by dividing the number of incident cases by the total person-time at risk. Age-standardized rates were pooled using random effect models according to the provenance of the events. FINDINGS A total number of 63,456,074 individuals were included in the study, contributing to 211.7 million person-years. A clear age pattern was observed for most AESIs, rates also varied by provenance of disease diagnosis (primary care, specialist care). Thrombosis with thrombocytopenia rates were extremely low ranging from 0.06 to 4.53/100,000 person-years for cerebral venous sinus thrombosis (CVST) with thrombocytopenia (TP) and mixed venous and arterial thrombosis with TP, respectively. INTERPRETATION Given the nature of the AESIs and the setting (general practitioners or hospital-based databases or both), background rates from databases that show the highest level of completeness (primary care and specialist care) should be preferred, others can be used for sensitivity. The study was designed to ensure representativeness to the European population and generalizability of the background incidence rates. FUNDING The project has received support from the European Medicines Agency under the Framework service contract nr EMA/2018/28/PE.
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Affiliation(s)
- C Willame
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - C Dodd
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - CE Durán
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - RJHJ Elbers
- Department of Data science & Biostatistic, Data manegement, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - R Gini
- Agenzia regionale di sanità della Toscana, via Pietro Dazzi 1, 55100 Florence, Italy
| | - C Bartolini
- Agenzia regionale di sanità della Toscana, via Pietro Dazzi 1, 55100 Florence, Italy
| | - O Paoletti
- Agenzia regionale di sanità della Toscana, via Pietro Dazzi 1, 55100 Florence, Italy
| | - L Wang
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - V Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - J Kahlert
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - U Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Faculty of Human and Health Sciences, University of Bremen, Germany
| | - T Schink
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, 28359 Bremen, Germany
| | - J Diez-Domingo
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - A Mira-Iglesias
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - JJ Carreras
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - C Vergara-Hernández
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - C Giaquinto
- Division of Paediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, Padova, Italy
| | - E Barbieri
- Division of Paediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, Padova, Italy
| | - L Stona
- Fondazione Penta ONLUS, Corso Stati Uniti 4, 35127 Padova, Italy
| | - C Huerta
- Department of Public Health and Maternal and Child Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - M Martín-Pérez
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - P García-Poza
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - A de Burgos
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - M Martínez-González
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - V Bryant
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - F Villalobos
- Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43202 Reus, Spain
| | - M Pallejà-Millán
- Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43202 Reus, Spain
| | - M Aragón
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - JJ Carreras
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - P Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO BOX 80082, 3508 TB Utrecht, the Netherlands
| | - NH Thurin
- INSERM CIC-P1401, Bordeaux PharmacoEpi, Univ. Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux cedex, France
| | - D Weibel
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - OH Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO BOX 80082, 3508 TB Utrecht, the Netherlands
| | - MCJM Sturkenboom
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands,Corresponding author at: Department Datascience & Biostatistics Univerisity Medical Center Utrecht, Heidelberglaan 100, The Netherlands
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10
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Bots SH, Riera-Arnau J, Belitser SV, Messina D, Aragón M, Alsina E, Douglas IJ, Durán CE, García-Poza P, Gini R, Herings RMC, Huerta C, Sisay MM, Martín-Pérez M, Martin I, Overbeek JA, Paoletti O, Pallejà-Millán M, Schultze A, Souverein P, Swart KMA, Villalobos F, Klungel OH, Sturkenboom MCJM. Myocarditis and pericarditis associated with SARS-CoV-2 vaccines: A population-based descriptive cohort and a nested self-controlled risk interval study using electronic health care data from four European countries. Front Pharmacol 2022; 13:1038043. [PMID: 36506571 PMCID: PMC9730238 DOI: 10.3389/fphar.2022.1038043] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Estimates of the association between COVID-19 vaccines and myo-/pericarditis risk vary widely across studies due to scarcity of events, especially in age- and sex-stratified analyses. Methods: Population-based cohort study with nested self-controlled risk interval (SCRI) using healthcare data from five European databases. Individuals were followed from 01/01/2020 until end of data availability (31/12/2021 latest). Outcome was first myo-/pericarditis diagnosis. Exposures were first and second dose of Pfizer, AstraZeneca, Moderna, and Janssen COVID-19 vaccines. Baseline incidence rates (IRs), and vaccine- and dose-specific IRs and rate differences were calculated from the cohort The SCRI calculated calendar time-adjusted IR ratios (IRR), using a 60-day pre-vaccination control period and dose-specific 28-day risk windows. IRRs were pooled using random effects meta-analysis. Findings: Over 35 million individuals (49·2% women, median age 39-49 years) were included, of which 57·4% received at least one COVID-19 vaccine dose. Baseline incidence of myocarditis was low. Myocarditis IRRs were elevated after vaccination in those aged < 30 years, after both Pfizer vaccine doses (IRR = 3·3, 95%CI 1·2-9.4; 7·8, 95%CI 2·6-23·5, respectively) and Moderna vaccine dose 2 (IRR = 6·1, 95%CI 1·1-33·5). An effect of AstraZeneca vaccine dose 2 could not be excluded (IRR = 2·42, 95%CI 0·96-6·07). Pericarditis was not associated with vaccination. Interpretation: mRNA-based COVID-19 vaccines and potentially AstraZeneca are associated with increased myocarditis risk in younger individuals, although absolute incidence remains low. More data on children (≤ 11 years) are needed.
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Affiliation(s)
- Sophie H. Bots
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Judit Riera-Arnau
- Department of Datascience and Biostatistics, Julius Center for Health Sciences and Primary Health, University Medical Center Utrecht, Utrecht, Netherlands,Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Svetlana V. Belitser
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | | | - Maria Aragón
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Ema Alsina
- Department of Datascience and Biostatistics, Julius Center for Health Sciences and Primary Health, University Medical Center Utrecht, Utrecht, Netherlands,Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ian J. Douglas
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Carlos E. Durán
- Department of Datascience and Biostatistics, Julius Center for Health Sciences and Primary Health, University Medical Center Utrecht, Utrecht, Netherlands,Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Rosa Gini
- Agenzia Regionale di Sanitá, Florence, Toscana, Italy
| | | | - Consuelo Huerta
- Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Malede Mequanent Sisay
- Department of Datascience and Biostatistics, Julius Center for Health Sciences and Primary Health, University Medical Center Utrecht, Utrecht, Netherlands,Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Martín-Pérez
- Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Ivonne Martin
- Department of Datascience and Biostatistics, Julius Center for Health Sciences and Primary Health, University Medical Center Utrecht, Utrecht, Netherlands,Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Olga Paoletti
- Agenzia Regionale di Sanitá, Florence, Toscana, Italy
| | - Meritxell Pallejà-Millán
- Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Anna Schultze
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Patrick Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | | | - Felipe Villalobos
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Olaf H. Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Miriam C. J. M. Sturkenboom
- Department of Datascience and Biostatistics, Julius Center for Health Sciences and Primary Health, University Medical Center Utrecht, Utrecht, Netherlands,Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain,*Correspondence: Miriam C. J. M. Sturkenboom,
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11
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Favre G, Gerbier E, Maisonneuve E, Pomar L, Winterfeld U, Lepigeon K, Bloemenkamp KWM, de Bruin O, Eimir H, Nordeng H, Siiskonen SJ, Sturkenboom MCJM, Baud D, Panchaud A. COVID-19-related medicine utilization study in pregnancy: The COVI-PREG cohort. Br J Clin Pharmacol 2022; 89:1560-1574. [PMID: 36417423 DOI: 10.1111/bcp.15611] [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: 07/12/2022] [Revised: 09/23/2022] [Accepted: 11/06/2022] [Indexed: 11/27/2022] Open
Abstract
AIM The objective of this study was to describe the use of COVID-19-related medicines during pregnancy and their evolution between the early/late periods of the pandemic. METHODS Pregnant women who tested positive for SARS-CoV-2 from March 2020 to July 2021 were included using the COVI-PREG registry. Exposure to the following COVID-19-related medicines was recorded: antibiotics, antivirals, hydroxychloroquine, corticosteroids, anti-interleukin-6 and immunoglobulins. We described the prevalence of medicines used, by trimester of pregnancy, maternal COVID-19 severity level and early/late period of the pandemic (before and after 1 July 2020). FINDINGS We included 1964 pregnant patients who tested positive for SARS-CoV-2. Overall, 10.4% (205/1964) received at least one COVID-19-related medicine including antibiotics (8.6%; 169/1694), corticosteroids (3.2%; 62/1964), antivirals (2.0%; 39/1964), hydroxychloroquine (1.4%; 27/1964) and anti-interleukin-6 (0.3%; 5/1964). The use of at least one COVID-19-related medicine was 3.1% (12/381) in asymptomatic individuals, 4.2% (52/1233) in outpatients, 19.7% (46/233) in inpatients without oxygen, 72.1% (44/61) in those requiring standard oxygen, 95.7% (22/23) in those requiring high flow oxygen, 96.2% (25/26) in patients who required intubation and 57.1% (4/7) among patients who died. The proportion who received medicines to treat COVID-19 was higher before than after July 2020 (16.7% vs. 7.7%). Antibiotics, antivirals and hydroxychloroquine had lower rates of use during the late period. CONCLUSION Medicine use in pregnancy increased with disease severity. The trend towards increased use of corticosteroids seems to be aligned with changing guidelines. Evidence is still needed regarding the effectiveness and safety of COVID-19-related medicines in pregnancy.
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Affiliation(s)
- Guillaume Favre
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland
| | - Eva Gerbier
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Emeline Maisonneuve
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Léo Pomar
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland.,School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Ursula Winterfeld
- Swiss Teratogen Information Service, Clinical pharmacology service, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Karine Lepigeon
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, WKZ Birth Centre, Division Woman and Baby, UMC Utrecht, Utrecht, the Netherlands
| | - Odette de Bruin
- Department of Obstetrics, WKZ Birth Centre, Division Woman and Baby, UMC Utrecht, Utrecht, the Netherlands.,Julius Global Health, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hurley Eimir
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Satu J Siiskonen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | | | - David Baud
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland
| | - Alice Panchaud
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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12
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Pane J, Verhamme KMC, Villegas D, Gamez L, Rebollo I, Sturkenboom MCJM. Challenges Associated with the Safety Signal Detection Process for Medical Devices. Med Devices (Auckl) 2021; 14:43-57. [PMID: 33658868 PMCID: PMC7917351 DOI: 10.2147/mder.s278868] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background Previous safety issues involving medical devices have stressed the need for better safety signal detection. Various European Union (EU) national competent authorities have started to focus on strengthening the analysis of vigilance data. Consequently, article 90 of the new EU regulation states that the European Commission shall put in place systems and processes to actively monitor medical device safety signals. Methods A systematic literature review was conducted to synthesize the current state of knowledge and investigate the present tools used for medical device safety signal detection. An electronic literature search was performed in Embase, Medline, Cochrane, Web of science, and Google scholar from inception until January 2017. Articles that included terms related to medical devices and terms associated with safety were selected. A further selection was based on the abstract review. A full review of the remaining articles was conducted to decide on which articles finally to consider relevant for this review. Completeness was assessed based on the content of the articles. Results Our search resulted in a total of 20,819 articles, of which 24 met the inclusion criteria and were subject to data extraction and completeness scoring. A wide range of data sources, especially spontaneous reporting systems and registries, used for the detection and assessment of product problems and patient harms associated with the use of medical devices, were studied. Coding is remarkably heterogeneous, no agreement on the preferred methods for signal detection exists, and no gold standard for signal detection has been established thus far. Conclusion Data source harmonization, the development of gold standard signal detection methodologies and the standardization of coding dictionaries are amongst the recommendations to support the implementation of a new proactive approach to signal detection. The new safety surveillance system will be able to use real-world evidence to support regulatory decision-making across all jurisdictions.
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Affiliation(s)
- Josep Pane
- Department of Medical Informatics, Erasmus Medical Center, University of Rotterdam, Rotterdam, Netherlands.,Alcon, Fort Worth, USA
| | - Katia M C Verhamme
- Department of Medical Informatics, Erasmus Medical Center, University of Rotterdam, Rotterdam, Netherlands
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13
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Willame C, Dodd C, van der Aa L, Picelli G, Emborg HD, Kahlert J, Gini R, Huerta C, Martín-Merino E, McGee C, de Lusignan S, Roberto G, Villa M, Weibel D, Titievsky L, Sturkenboom MCJM. Incidence Rates of Autoimmune Diseases in European Healthcare Databases: A Contribution of the ADVANCE Project. Drug Saf 2021; 44:383-395. [PMID: 33462778 PMCID: PMC7892524 DOI: 10.1007/s40264-020-01031-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The public-private ADVANCE collaboration developed and tested a system to generate evidence on vaccine benefits and risks using European electronic healthcare databases. In the safety of vaccines, background incidence rates are key to allow proper monitoring and assessment. The goals of this study were to compute age-, sex-, and calendar-year stratified incidence rates of nine autoimmune diseases in seven European healthcare databases from four countries and to assess validity by comparing with published data. METHODS Event rates were calculated for the following outcomes: acute disseminated encephalomyelitis, Bell's palsy, Guillain-Barré syndrome, immune thrombocytopenia purpura, Kawasaki disease, optic neuritis, narcolepsy, systemic lupus erythematosus, and transverse myelitis. Cases were identified by diagnosis codes. Participating organizations/databases originated from Denmark, Italy, Spain, and the UK. The source population comprised all persons registered, with at least 1 year of data prior to the study start, or follow-up from birth. Stratified incidence rates were computed per database over the period 2003 to 2014. RESULTS Between 2003 and 2014, 148,947 incident cases of nine autoimmune diseases were identified. Crude incidence rates were highest for Bell's palsy [23.8/100,000 person-years (PYs), 95% confidence interval (CI) 23.6-24.1] and lowest for Kawasaki disease (0.7/100,000 PYs, 95% CI 0.6-0.7). Specific patterns were observed by sex, age, calendar time, and data sources. Rates were comparable with published estimates. CONCLUSION A range of autoimmune events could be identified in the ADVANCE system. Estimation of rates indicated consistency across selected European healthcare databases, as well as consistency with US published data.
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Affiliation(s)
- Corinne Willame
- Julius Global Health, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands.
| | - Caitlin Dodd
- Julius Global Health, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
| | - Lieke van der Aa
- Sciensano, Rue Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Gino Picelli
- Epidemiological Information for Clinical Research from an Italian Network of Family Paediatricians (Pedianet), Padua, Italy
| | - Hanne-Dorthe Emborg
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen, Denmark
| | - Johnny Kahlert
- Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus, Denmark
| | - Rosa Gini
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy
| | - Consuelo Huerta
- Spanish Agency of Medicines and Medical Devices-AEMPS, Madrid, Spain
| | | | - Chris McGee
- University of Surrey, Oxford, UK
- Royal College of General Practitioners, Research and Surveillance Centre, 30 Euston Square, London, UK
| | - Simon de Lusignan
- University of Surrey, Oxford, UK
- Royal College of General Practitioners, Research and Surveillance Centre, 30 Euston Square, London, UK
| | - Giuseppe Roberto
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy
| | | | - Daniel Weibel
- VACCINE.GRID, Basel, Switzerland
- Erasmus University Medical Center, PO Box 2014, 3000 CA, Rotterdam, The Netherlands
| | | | - Miriam C J M Sturkenboom
- Julius Global Health, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
- VACCINE.GRID, Basel, Switzerland
- P-95, Koning Leopold III laan 1 3001, Heverlee, Leuven, Belgium
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Hoeve CE, de Vries E, Mol PGM, Sturkenboom MCJM, Straus SMJM. Dissemination of Direct Healthcare Professional Communications on Medication Errors for Medicinal Products in the EU: An Explorative Study on Relevant Factors. Drug Saf 2020; 44:73-82. [PMID: 33355904 PMCID: PMC7813691 DOI: 10.1007/s40264-020-00995-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction When serious medication errors (ME) are identified, communication to the field may be necessary. In the EU, communication of serious safety issues, such as medication errors associated with adverse drug reactions, is done through direct healthcare professional communications (DHPCs). We aimed to identify how often DHPCs about medication errors are distributed, and we explored factors associated with these ME DHPCs. Methods We performed a descriptive study of all centrally authorised products (CAPs) approved before 1 May 2019 in the EU. All DHPCs issued between 1 January 2001 and 1 May 2019 were reviewed for ME content. Characteristics of CAPs were collected from the website of the European Medicines Agency. A Kaplan–Meier survival analysis was performed to estimate the 5- and 10-year probability of the occurrence of a first ME DHPC. A logistic regression was performed to explore risk factors for ME DHPCs. Results A total of 678 CAPs were included, of which 35 required an ME DHPC during the study period. The 5-year probability for a CAP to have a first ME DHPC was 2.5% (95% CI 1.1–3.9) and the 10-year probability was 4.4% (95% CI 2.2–6.5). Among products with an ME DHPC, the 5-year probability of a second ME DHPC was 21.3% (95% CI 0.2–38.0). The risk of ME DHPCs was increased for products with multiple pharmaceutical formulations, enteral liquid or parenteral injection preparations, and products classified as nervous system agents or antineoplastic and immunomodulating agents. Conclusions The absolute number of ME DHPCs for CAPs is low and does not give rise to immediate concern. We identified potential risk factors for ME DHPCs that should be taken into account during approval procedures or line extensions. Electronic supplementary material The online version of this article (10.1007/s40264-020-00995-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christina E Hoeve
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands. .,Medicines Evaluation Board, Utrecht, The Netherlands.
| | - Esther de Vries
- Medicines Evaluation Board, Utrecht, The Netherlands.,University Medical Center Groningen, Groningen, The Netherlands
| | - Peter G M Mol
- Medicines Evaluation Board, Utrecht, The Netherlands.,University Medical Center Groningen, Groningen, The Netherlands
| | | | - Sabine M J M Straus
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands.,Medicines Evaluation Board, Utrecht, The Netherlands
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15
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Kajungu D, Muhoozi M, Stark J, Weibel D, Sturkenboom MCJM. Vaccines safety and maternal knowledge for enhanced maternal immunization acceptability in rural Uganda: A qualitative study approach. PLoS One 2020; 15:e0243834. [PMID: 33301495 PMCID: PMC7728220 DOI: 10.1371/journal.pone.0243834] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 11/26/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Maternal immunization is a successful and cost-effective public health strategy. It protects pregnant women and their infants from vaccine-preventable diseases. Uganda is exploring new vaccines for pregnant women like replacing Tetanus Toxoid (TT) with Tetanus-Diphtheria (Td). Research on knowledge, attitudes, beliefs, and willingness among pregnant women is needed before the introduction of vaccines for pregnant women. This study was aimed at exploring maternal knowledge, attitudes, willingness, and beliefs towards maternal immunization among pregnant women in rural Uganda. METHODS This was a qualitative descriptive study. Ten focus group discussions (FGDs) were conducted at antenatal care (ANC) clinics and in a rural community of Uganda. Five key informant interviews (KIIs) were done with health workers, for triangulation. Considering context and research characteristics, data were collected and thematically analyzed. RESULTS Women were familiar with the importance of maternal vaccines, had positive attitudes, and expressed willingness to take them. Acceptance of a new vaccine could be affected by worries of pregnant women and that of their partners, who influence health seeking decisions in a home concerning adverse events, following the maternal immunization (AEFI). There were misconceptions about introduction of vaccines such as the belief that vaccines treat malaria and general body weakness, and being used as guinea pigs to test for the vaccine before its introduction to the larger population. CONCLUSION A range of diverse sentiments and beliefs may affect uptake and acceptability of vaccines that are introduced in communities. For instance, ignoring vaccine safety concerns may impede maternal immunization acceptability, because pregnant women and their husbands are concerned about AEFI. Moreover, husbands make all health-seeking decisions at home, and their opinion is key, when considering such interventions.
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Affiliation(s)
- Dan Kajungu
- Makerere University Center for Health and Population Research (MUCHAP), Kampala, Uganda
- Julius Global Health, University Utrecht Medical Center, Utrecht, The Netherlands
- * E-mail:
| | - Michael Muhoozi
- Makerere University Center for Health and Population Research (MUCHAP), Kampala, Uganda
| | - James Stark
- Putnam Associates, Boston, Massachusetts, United States of America
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16
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Hoeve CE, Francisca RDC, Zomerdijk I, Sturkenboom MCJM, Straus SMJM. Description of the Risk Management of Medication Errors for Centrally Authorised Products in the European Union. Drug Saf 2020; 43:45-55. [PMID: 31617081 PMCID: PMC6965336 DOI: 10.1007/s40264-019-00874-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction Medication errors can have serious consequences for patients. To prevent the occurrence of medication errors in clinical practice, safety concerns may be included in the risk management plan and subsequently be addressed with routine and/or additional risk minimisation measures. Objective This study aims to describe safety concerns around medication errors and the risk minimisation measures for centrally authorised products in the European Union. Methods All safety concerns included in the risk management plans of originator centrally authorised products, authorised between 1 January, 2010 and 31 December, 2017, were collected from the European Public Assessment Report registry. Medication error safety concerns were categorised by Anatomical Therapeutic Classification code, year of authorisation, type of medication error and type of risk minimisation measure. Results During the study period, 311 centrally authorised products were approved, of which 84 had at least one medication error safety concern. The proportion of centrally authorised products with medication error safety concerns showed variation between 2010 and 2017 ranging from 15.2% to 36.4%. In total, 95 medication error safety concerns were identified. The type of medication error was highly variable, drug administration error was listed most frequently (n = 17). For 27 out of 95 medication error safety concerns, corresponding to 23 centrally authorised products, additional risk minimisation measures were required. All additional risk minimisation measures consisted of educational material targeted at healthcare professionals (85.2%) and/or patients (51.9%). For 78.3% of centrally authorised products with additional risk minimisation measures for medication errors, studies to evaluate the effectiveness of the additional risk minimisation measures were agreed upon. Conclusions Medication error safety concerns were listed for almost a quarter of centrally authorised products approved during the study period. Further research is needed to evaluate the effectiveness and continued need for additional risk minimisation measures for medication errors. Electronic supplementary material The online version of this article (10.1007/s40264-019-00874-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christina E Hoeve
- Medicines Evaluation Board, Utrecht, The Netherlands. .,Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Reynold D C Francisca
- Medicines Evaluation Board, Utrecht, The Netherlands.,Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Inge Zomerdijk
- Medicines Evaluation Board, Utrecht, The Netherlands.,Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Sabine M J M Straus
- Medicines Evaluation Board, Utrecht, The Netherlands.,Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
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17
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Baan EJ, de Smet VA, Hoeve CE, Pacurariu AC, Sturkenboom MCJM, de Jongste JC, Janssens HM, Verhamme KMC. Exploratory Study of Signals for Asthma Drugs in Children, Using the EudraVigilance Database of Spontaneous Reports. Drug Saf 2020; 43:7-16. [PMID: 31617080 PMCID: PMC6965046 DOI: 10.1007/s40264-019-00870-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction As asthma medications are frequently prescribed for children, knowledge of the safety of these drugs in the paediatric population is important. Although spontaneous reports cannot be used to prove causality of adverse events, they are important in the detection of safety signals. Objective Our objective was to provide an overview of adverse drug events associated with asthma medications in children from a spontaneous reports database and to identify new signals. Methods Spontaneous reports concerning asthma drugs were obtained from EudraVigilance, the European Medicine Agency’s database for suspected adverse drug reactions. For each drug–event combination, we calculated the proportional reporting ratio (PRR) in the study period 2011–2017. Signals in children (aged 0–17 years) were compared with signals in the whole population. Analyses were repeated for different age categories, by sex and by therapeutic area. Results In total, 372,345 reports in children resulted in 385 different signals concerning asthma therapy. The largest group consisted of psychiatric events (65 signals). Only 30 signals were new, with seven, including herpes viral infections, associated with omalizumab. Stratification by age, sex and therapeutic area provided additional new signals, such as hypertrichoses with budesonide and encephalopathies with theophylline. Of all signals in children, 60 (16%) did not appear in the whole population. Conclusions The majority of signals regarding asthma therapy in children were already known, but we also identified new signals. We showed that signals can be masked if age stratification is not conducted. Further exploration is needed to investigate the risk and causality of the newly found signals. Electronic supplementary material The online version of this article (10.1007/s40264-019-00870-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Esmé J Baan
- Department of Medical Informatics, Erasmus Medical Centre, Erasmus University, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands.
| | | | - Christina E Hoeve
- Department of Medical Informatics, Erasmus Medical Centre, Erasmus University, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands
| | - Alexandra C Pacurariu
- Department of Medical Informatics, Erasmus Medical Centre, Erasmus University, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands
| | | | - Johan C de Jongste
- Department of Pediatrics/Respiratory Medicine, Erasmus University/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Hettie M Janssens
- Department of Pediatrics/Respiratory Medicine, Erasmus University/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Katia M C Verhamme
- Department of Medical Informatics, Erasmus Medical Centre, Erasmus University, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands.,Department of Pharmacy, Ghent University Hospital, Ghent, Belgium.,Department of Infection Control and Epidemiology, OLV Hospital, Aalst, Belgium
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18
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Pane J, Verhamme KMC, Shrum L, Rebollo I, Sturkenboom MCJM. Blockchain technology applications to postmarket surveillance of medical devices. Expert Rev Med Devices 2020; 17:1123-1132. [PMID: 32954855 DOI: 10.1080/17434440.2020.1825073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The amount of mandatory data that needs to be analyzed as part of a medical device postmarket surveillance (PMS) system has grown exponentially in recent times. This is a consequence of increasingly demanding and complex regulatory requirements from Health Authorities, aimed at a better understanding of the medical device safety evaluation. Proactive approaches to PMS processes are becoming more necessary as regulators increase the scrutiny of device safety. New technologies have been explored to address some of the challenges associated with this changing regulatory environment. AREAS COVERED This paper focuses on the different technical aspects of blockchain and how this new technology has the potential to support the ongoing efforts to improve the PMS system for medical devices. EXPERT OPINION To address these challenges, we suggest to generate a private PMS data permissioned blockchain with a proof-of-authority consensus mechanism, to which only a restricted number of designated and audited participants have authorization to validate transactions and add them to the PMS data blockchain ledger. Blockchain has the potential to support a more efficient approach, which could offer many advantages to the different stakeholders involved in the PMS process, such as supporting with new regulatory initiatives.
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Affiliation(s)
- Josep Pane
- Department of Medical Informatics, Erasmus Medical Center University of Rotterdam , Rotterdam, Netherlands
| | - Katia M C Verhamme
- Department of Medical Informatics, Erasmus Medical Center University of Rotterdam , Rotterdam, Netherlands
| | | | - Irene Rebollo
- Department of CMO & Patient Safety, Novartis , Barcelona, Spain
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19
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Francisca RDC, Baba E, Hoeve CE, Zomerdijk IM, Sturkenboom MCJM, Straus SMJM. Introduction or Discontinuation of Additional Risk Minimisation Measures During the Life Cycle of Medicines in Europe. Drug Saf 2020; 44:63-72. [PMID: 33000427 PMCID: PMC7813721 DOI: 10.1007/s40264-020-00993-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction Additional risk minimisation measures (aRMMs) may be required to minimise important risks of medicines. aRMMs may be required at the time of authorisation, but may also be introduced or discontinued during the product life cycle as new safety information arises. The aim of this study is to describe post-authorisation introductions of new aRMMs and discontinuations of existing aRMMs for medicines authorised in the European Union (EU). Methods We performed a retrospective cohort study that included all new active substances authorised through the EU centralised procedure between January 1st 2006 and December 31st 2017. Data was extracted from European Public Assessment Reports available on the website of the European Medicines Agency (ema.europa.eu). Medicines were followed up from the date of marketing authorisation (MA) until first introduction or discontinuation of aRMMs, excluding Direct Healthcare Professional Communications (DHPCs), withdrawal/suspension/revocation of the MA, or July 1st 2018, when data extraction took place. Descriptive statistics were used to analyse frequency data, and survival analysis was used to calculate 5- and 10-year probability of introduction or discontinuation of aRMMs. Results A total of 476 medicines were authorised during the study period. The probability of getting aRMMs after authorisation for products authorised without aRMMs was 3.5% [95% confidence interval (CI) 1.2–5.7] within 5 years after authorisation and 6.9% (95% CI 2.6–11) within 10 years after authorisation. For products authorised with aRMMs, the probability of discontinuation of aRMMs was 0.9% (95% CI 0–2.6) within 5 years and 8.3% (95% CI 0–16.1) within 10 years after authorisation. Conclusions We found low probabilities of introduction and discontinuation of aRMMs (excluding DHPCs) during the product life cycle for medicines authorised between 2006 and 2017. The low rate of discontinuation may potentially be due to a lack of robust data on effectiveness of aRMMs. Further research is needed to get more insight into the dynamics of aRMMs during the medicine life cycle.
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Affiliation(s)
- Reynold D C Francisca
- Erasmus Medical Centre, Department of Medical Informatics, Rotterdam, The Netherlands.
- Medicines Evaluation Board, Department of Pharmacovigilance, Utrecht, The Netherlands.
| | - Emna Baba
- Medicines Evaluation Board, Department of Pharmacovigilance, Utrecht, The Netherlands
| | - Christina E Hoeve
- Erasmus Medical Centre, Department of Medical Informatics, Rotterdam, The Netherlands
- Medicines Evaluation Board, Department of Pharmacovigilance, Utrecht, The Netherlands
| | - Inge M Zomerdijk
- Erasmus Medical Centre, Department of Medical Informatics, Rotterdam, The Netherlands
- Medicines Evaluation Board, Department of Pharmacovigilance, Utrecht, The Netherlands
| | | | - Sabine M J M Straus
- Erasmus Medical Centre, Department of Medical Informatics, Rotterdam, The Netherlands
- Medicines Evaluation Board, Department of Pharmacovigilance, Utrecht, The Netherlands
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20
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Engelkes M, Baan EJ, de Ridder MAJ, Svensson E, Prieto-Alhambra D, Lapi F, Giaquinto C, Picelli G, Boudiaf N, Albers F, Evitt LA, Cockle S, Bradford E, Van Dyke MK, Suruki R, Rijnbeek P, Sturkenboom MCJM, Janssens HM, Verhamme KMC. Incidence, risk factors and re-exacerbation rate of severe asthma exacerbations in a multinational, multidatabase pediatric cohort study. Pediatr Allergy Immunol 2020; 31:496-505. [PMID: 32115766 PMCID: PMC7496431 DOI: 10.1111/pai.13237] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND There are sparse real-world data on severe asthma exacerbations (SAE) in children. This multinational cohort study assessed the incidence of and risk factors for SAE and the incidence of asthma-related rehospitalization in children with asthma. METHODS Asthma patients 5-17 years old with ≥1 year of follow-up were identified in six European electronic databases from the Netherlands, Italy, the UK, Denmark and Spain in 2008-2013. Asthma was defined as ≥1 asthma-specific disease code within 3 months of prescriptions/dispensing of asthma medication. Severe asthma was defined as high-dosed inhaled corticosteroids plus a second controller. SAE was defined by systemic corticosteroids, emergency department visit and/or hospitalization all for reason of asthma. Risk factors for SAE were estimated by Poisson regression analyses. RESULTS The cohort consisted of 212 060 paediatric asthma patients contributing to 678 625 patient-years (PY). SAE rates ranged between 17 and 198/1000 PY and were higher in severe asthma and highest in severe asthma patients with a history of exacerbations. Prior SAE (incidence rate ratio 3-45) and younger age increased the SAE risk in all countries, whereas obesity, atopy and GERD were a risk factor in some but not all countries. Rehospitalization rates were up to 79% within 1 year. CONCLUSIONS In a real-world setting, SAE rates were highest in children with severe asthma with a history of exacerbations. Many severe asthma patients were rehospitalized within 1 year. Asthma management focusing on prevention of SAE is important to reduce the burden of asthma.
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Affiliation(s)
| | - Esme J Baan
- Medical Informatics, ErasmusMC, Rotterdam, The Netherlands
| | | | | | - Daniel Prieto-Alhambra
- Jordi Gol Primary Care Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain.,Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | | | | | | | - Nada Boudiaf
- Research and Development, GlaxoSmithKline, Middlesex, UK
| | - Frank Albers
- Research and Development, GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Lee A Evitt
- Research and Development, GlaxoSmithKline, Brentford, UK
| | - Sarah Cockle
- Research and Development, GlaxoSmithKline, Brentford, UK
| | - Eric Bradford
- Research and Development, GlaxoSmithKline, Brentford, UK
| | | | | | - Peter Rijnbeek
- Medical Informatics, ErasmusMC, Rotterdam, The Netherlands
| | | | - Hettie M Janssens
- Pediatrics div Respiratory Medicine and Allergology, ErasmusMC- /Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Katia M C Verhamme
- Medical Informatics, ErasmusMC, Rotterdam, The Netherlands.,Department of Infection Control & Epidemiology, OLV Hospital, Aalst, Belgium
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21
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Berencsi K, Sami A, Ali MS, Marinier K, Deltour N, Perez-Gutthann S, Pedersen L, Rijnbeek P, Van der Lei J, Lapi F, Simonetti M, Reyes C, Sturkenboom MCJM, Prieto-Alhambra D. Correction to: Impact of risk minimisation measures on the use of strontium ranelate in Europe: a multi-national cohort study in 5 EU countries by the EU-ADR Alliance. Osteoporos Int 2020; 31:799. [PMID: 32025756 DOI: 10.1007/s00198-020-05314-2] [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: 10/25/2022]
Abstract
The original version of this article, published on 26 November 2019 contained a mistake.
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Affiliation(s)
- K Berencsi
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - A Sami
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - M S Ali
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - K Marinier
- Department of Pharmacoepidemiology, Servier, Suresnes, France
| | - N Deltour
- Department of Pharmacoepidemiology, Servier, Suresnes, France
| | | | - L Pedersen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - P Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J Van der Lei
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - F Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - M Simonetti
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - C Reyes
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
| | | | - D Prieto-Alhambra
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK.
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain.
- Botnar Research Centre, Oxford, UK.
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22
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Berencsi K, Sami A, Ali MS, Marinier K, Deltour N, Perez-Gutthann S, Pedersen L, Rijnbeek P, Van der Lei J, Lapi F, Simonetti M, Reyes C, Sturkenboom MCJM, Prieto-Alhambra D. Impact of risk minimisation measures on the use of strontium ranelate in Europe: a multi-national cohort study in 5 EU countries by the EU-ADR Alliance. Osteoporos Int 2020; 31:721-755. [PMID: 31696274 DOI: 10.1007/s00198-019-05181-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/19/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION In May 2013 and March 2014, the European Medicines Agency (EMA) issued two decisions restricting the use of strontium ranelate (SR). These risk minimisation measures (RMM) introduced new contraindications and limited the indications of SR therapy. The EMA required an assessment of the impact of RMMs on the use of SR in Europe. Methods design: multi-national, multi-database cohort Setting: electronic medical record databases based on hospital (Denmark) and primary care provenance (Italy, Spain, the Netherlands, UK). PARTICIPANTS the database source populations were included for population-based analyses, and SR users for patient-level analyses. INTERVENTION New RMMs included contraindications (ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, uncontrolled hypertension) and restricted SR indication to severe osteoporosis with initiation by experienced physician and not as first line anti-osteoporosis therapy. METHODS Prevalence and incidence rates of SR use in the population; prevalence of contraindications and restricted indications in SR users, plus 1-year therapy persistence. Drug use measures were calculated in three periods for comparison: reference (2004 to May 2013), transition (June 2013 to March 2014) and assessment (from April 2014 to end 2016). RESULTS The study population included 143 million person-years(PY) of follow-up and 76,141 incident episodes of SR treatment. Average monthly prevalence rates of SR use dropped by 86.4% from 62.6/10,000 PY (95 CI 62.4-62.9) in the reference to 8.5 (8.5-8.6) in the assessment period. Similarly, the incidence rate of SR use fell by 97.3% from 7.4/10,000 PY (7.4-7.4) to 0.2 (0.2-0.2) between the reference and assessment period. The prevalence of any contraindication decreased, whilst the prevalence of restricted indications increased in these periods. One-year persistence decreased in the assessment compared with reference period. CONCLUSIONS Our study demonstrates a substantial impact of the regulatory action to restrict use of SR in Europe: SR utilisation overall decreased strongly. The proportion of patients fulfilling the restricted indications, without contraindications, increased after the proposed RMMs.
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Affiliation(s)
- K Berencsi
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - A Sami
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - M S Ali
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - K Marinier
- Department of Pharmacoepidemiology, Servier, Suresnes, France
| | - N Deltour
- Department of Pharmacoepidemiology, Servier, Suresnes, France
| | | | - L Pedersen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - P Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J Van der Lei
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - F Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - M Simonetti
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - C Reyes
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
| | | | - D Prieto-Alhambra
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK.
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain.
- Botnar Research Centre, Windmill Road, Oxford, OX37LD, UK.
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Pane J, Verhamme KMC, Rebollo I, Sturkenboom MCJM. Descriptive analysis of postmarket surveillance data for hip implants. Pharmacoepidemiol Drug Saf 2020; 29:380-387. [PMID: 32128913 PMCID: PMC7216945 DOI: 10.1002/pds.4971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/07/2019] [Revised: 12/03/2019] [Accepted: 01/31/2020] [Indexed: 11/17/2022]
Abstract
Purpose Recent safety issues involving medical devices have highlighted the need for better postmarket surveillance (PMS) evaluation. This article aims to describe and to assess the quality of the PMS data for a medical device and, finally, to provide recommendations to improve the data gathering process. Methods A descriptive analysis of medical device reports (MDRs) on the use of MRA, a specific type of hip implant replacement submitted to the Food and Drug Administration Manufacturer and User Facility Device Experience database from 1 January 2008 to 31 December 2017. The number of reports was described as the number of MDRs per unique MDR number and stratified by different variables. The quality was assessed by the level of completeness of the collected PMS data. Results The total number of reports related to MRA was 2377, and the number of MDRs per year ranged between 84 in 2009 and 452 in 2017. Most of the reports were reported by manufacturer Depuy Johnson & Johnson and were reported by a physician. In 44.9% of the reports, the device problem was reported as “Unknown.” When the device problem was known, in the majority of cases, it was related to an implant fracture. The quality of the collected data was assessed as low due to missing information. Conclusion The underlying data should meet high quality standards to generate more evidence and to ensure a timely signal generation. This case study shows that the completeness and quality of the MDRs can be improved. The authors propose the development of tools to ensure a more dynamic complaint data collection to contribute to this enhancement.
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Affiliation(s)
- Josep Pane
- Department of Medical Informatics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands.,Eu2P European Programme in Pharmacovigilance and Pharmacoepidemiology, University of Bordeaux Segalen, Bordeaux, France
| | - Katia M C Verhamme
- Department of Medical Informatics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Irene Rebollo
- Eu2P European Programme in Pharmacovigilance and Pharmacoepidemiology, University of Bordeaux Segalen, Bordeaux, France
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McMahon AW, Cooper WO, Brown JS, Carleton B, Doshi-Velez F, Kohane I, Goldman JL, Hoffman MA, Kamaleswaran R, Sakiyama M, Sekine S, Sturkenboom MCJM, Turner MA, Califf RM. Big Data in the Assessment of Pediatric Medication Safety. Pediatrics 2020; 145:peds.2019-0562. [PMID: 31937606 DOI: 10.1542/peds.2019-0562] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Accepted: 11/13/2019] [Indexed: 11/24/2022] Open
Abstract
Big data (BD) in pediatric medication safety research provides many opportunities to improve the safety and health of children. The number of pediatric medication and device trials has increased in part because of the past 20 years of US legislation requiring and incentivizing study of the effects of medical products in children (Food and Drug Administration Modernization Act of 1997, Pediatric Rule in 1998, Best Pharmaceuticals for Children Act of 2002, and Pediatric Research Equity Act of 2003). There are some limitations of traditional approaches to studying medication safety in children. Randomized clinical trials within the regulatory context may not enroll patients who are representative of the general pediatric population, provide the power to detect rare safety signals, or provide long-term safety data. BD sources may have these capabilities. In recent years, medical records have become digitized, and cell phones and personal devices have proliferated. In this process, the field of biomedical science has progressively used BD from those records coupled with other data sources, both digital and traditional. Additionally, large distributed databases that include pediatric-specific outcome variables are available. A workshop entitled "Advancing the Development of Pediatric Therapeutics: Application of 'Big Data' to Pediatric Safety Studies" held September 18 to 19, 2017, in Silver Spring, Maryland, formed the basis of many of the ideas outlined in this article, which are intended to identify key examples, critical issues, and future directions in this early phase of an anticipated dramatic change in the availability and use of BD.
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Affiliation(s)
- Ann W McMahon
- Office of Pediatric Therapeutics, US Food and Drug Administration, Rockville, Maryland;
| | - William O Cooper
- Departments of Pediatrics and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey S Brown
- Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Insititute, Boston, Massachusetts
| | - Bruce Carleton
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Finale Doshi-Velez
- Paulson School of Engineering and Applied Sciences, Harvard University, Boston, Massachusetts
| | - Isaac Kohane
- Departments of Biomedical Informatics, Pediatrics, and
| | - Jennifer L Goldman
- Divisions of Pediatric Infectious Diseases and Clinical Parmacology, Department of Pediatrics, and
| | - Mark A Hoffman
- Departments of Biomedical Informatics, Pediatrics, and Emergency Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | | | - Michiyo Sakiyama
- Office of New Drug IV, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan.,Department of Epidemiology, Julius Center Research Program Cardiovascular Edpidemiology, Utrecht University Medical Center, Utrecht, Netherlands
| | - Shohko Sekine
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; and
| | - Miriam C J M Sturkenboom
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Center for Health Science, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Mark A Turner
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; and
| | - Robert M Califf
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Center for Health Science, Duke Clinical Research Institute, Duke University, Durham, North Carolina
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25
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Baan EJ, van den Akker ELT, Engelkes M, de Rijke YB, de Jongste JC, Sturkenboom MCJM, Verhamme KM, Janssens HM. Hair cortisol and inhaled corticosteroid use in asthmatic children. Pediatr Pulmonol 2020; 55:316-321. [PMID: 31651095 PMCID: PMC7003950 DOI: 10.1002/ppul.24551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/26/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Adrenal suppression is a side effect of long-term use of inhaled corticosteroids (ICS). Hair cortisol concentration (HCC) measurement is a noninvasive tool for measuring adrenal function that may be useful for asthmatic patients who are on long-term ICS treatment. The aim of this study was to compare HCC between children with and without asthma and to explore the association between HCC and ICS dose in asthmatic children. METHODS A cross-sectional observational study in subjects with or without asthma (n = 72 and 226, respectively, age 6-21 years). Hair samples were obtained from the posterior vertex for each subject and data on medication use were collected using questionnaires. HCC was analyzed by liquid chromatography-mass spectrometry in the most proximal 3 cm of hair. RESULTS Median HCC was significantly lower in subjects with asthma than in subjects without asthma: 1.83 pg/mg and 2.39 pg/mg, respectively (P value after adjustment for age, sex, and body mass index: .036). Median HCC was 1.98 pg/mg in asthmatics using no ICS, 1.84 pg/mg in those using a low dose, 1.75 pg/mg in those on a medium dose, and 1.46 in those using a high ICS dose (P = .54). CONCLUSION We observed a significantly lower HCC in asthmatics than in healthy controls and a nonsignificant trend of lower HCC with increasing ICS dose. Whether HCC measurement may be used to detect individuals at risk for hypocortisolism and may be useful to monitor adrenal function in asthmatic children using ICS needs to be further investigated.
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Affiliation(s)
- Esmé J Baan
- Department of Medical Informatics, Erasmus MC-Sophia Children's Hospital, University Hospital Rotterdam, Rotterdam, The Netherlands
| | - Erica L T van den Akker
- Department of Pediatrics, Division of Endocrinology, Erasmus MC-Sophia Children's Hospital, University Hospital Rotterdam, Rotterdam, The Netherlands
| | - Marjolein Engelkes
- Department of Medical Informatics, Erasmus MC-Sophia Children's Hospital, University Hospital Rotterdam, Rotterdam, The Netherlands
| | - Yolanda B de Rijke
- Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johan C de Jongste
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC-Sophia Children's Hospital, University Hospital Rotterdam, Rotterdam, The Netherlands
| | | | - Katia M Verhamme
- Department of Medical Informatics, Erasmus MC-Sophia Children's Hospital, University Hospital Rotterdam, Rotterdam, The Netherlands
| | - Hettie M Janssens
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC-Sophia Children's Hospital, University Hospital Rotterdam, Rotterdam, The Netherlands
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26
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Pane J, Francisca RDC, Verhamme KMC, Orozco M, Viroux H, Rebollo I, Sturkenboom MCJM. EU postmarket surveillance plans for medical devices. Pharmacoepidemiol Drug Saf 2019; 28:1155-1165. [PMID: 31318470 PMCID: PMC6771951 DOI: 10.1002/pds.4859] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 07/27/2018] [Revised: 04/02/2019] [Accepted: 06/06/2019] [Indexed: 11/17/2022]
Abstract
Purpose Recent public health safety issues involving medical devices have led to a growing demand to improve the current passive‐reactive postmarket surveillance (PMS) system. Various European Union (EU) national competent authorities have started to focus on strengthening the postmarket risk evaluation. As a consequence, the new EU medical device regulation was published; it includes the concept of a PMS Plan. Methods This publication reviewed Annex III Technical Documentation on PMS and Annex XIV Part B: Postmarket clinical follow‐up from the new Regulation (EU) 2017/745 of the European Parliament and of the Council on medical devices. Results The results of the PMS activities will be described in the PMS plan and will be used to update other related documents. A modular approach to structure the contents of the PMS plan will help to consistently update other PMS information. It is our suggestion that the PMS plan should consist of a PMS plan Core and a PMS plan Supplement. The PMS plan Core document will describe the PMS system, and the PMS plan Supplement will outline the specific activities performed by the manufacturer for a particular medical device. Conclusions The PMS plan may serve as a thorough tool for the benefit‐risk evaluation of medical devices. If properly developed and implemented, it will function as a key player in the establishment of a new framework for proactive safety evaluation of medical devices.
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Affiliation(s)
- Josep Pane
- Department of Medical Informatics, Erasmus Medical Center - University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Patient Safety, Alcon, Fort Worth, Texas.,Eu2P European Programme in Pharmacovigilance and Pharmacoepidemiology, University of Bordeaux Segalen, Bordeaux, France
| | - Reynold D C Francisca
- Department of Medical Informatics, Erasmus Medical Center - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Katia M C Verhamme
- Department of Medical Informatics, Erasmus Medical Center - University Medical Center Rotterdam, Rotterdam, Netherlands.,Eu2P European Programme in Pharmacovigilance and Pharmacoepidemiology, University of Bordeaux Segalen, Bordeaux, France
| | - Marcia Orozco
- Department of Patient Safety, Alcon, Fort Worth, Texas
| | - Hilde Viroux
- Department of Regulatory Affairs, HCL Technologies, Frisco, Texas
| | - Irene Rebollo
- Eu2P European Programme in Pharmacovigilance and Pharmacoepidemiology, University of Bordeaux Segalen, Bordeaux, France.,Department of Patient Safety, Novartis, Barcelona, Spain
| | - Miriam C J M Sturkenboom
- Department of Global Health, University Medical Center Utrecht, Utrecht, Netherlands.,Eu2P European Programme in Pharmacovigilance and Pharmacoepidemiology, University of Bordeaux Segalen, Bordeaux, France
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27
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Afzal Z, Masclee GMC, Sturkenboom MCJM, Kors JA, Schuemie MJ. Generating and evaluating a propensity model using textual features from electronic medical records. PLoS One 2019; 14:e0212999. [PMID: 30830923 PMCID: PMC6398864 DOI: 10.1371/journal.pone.0212999] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/13/2019] [Indexed: 12/31/2022] Open
Abstract
Background Propensity score (PS) methods are commonly used to control for confounding in comparative effectiveness studies. Electronic health records (EHRs) contain much unstructured data that could be used as proxies for potential confounding factors. The goal of this study was to assess whether the unstructured information can also be used to construct PS models that would allow to properly deal with confounding. We used an example of coxibs (Cox-2 inhibitors) vs. traditional NSAIDs and the risk of upper gastro-intestinal bleeding as example, since this association is often confounded due to channeling of coxibs to patients at higher risk of upper gastro-intestinal bleeding. Methods In a cohort study of new users of nonsteroidal anti-inflammatory drugs (NSAIDs) from the Dutch Integrated Primary Care Information (IPCI) database, we identified all patients who experienced an upper gastrointestinal bleeding (UGIB). We used a large-scale regularized regression to fit two PS models using all structured and unstructured information in the EHR. We calculated hazard ratios (HRs) to estimate the risk of UGIB among selective cyclo-oxygenase-2 (COX-2) inhibitor users compared to nonselective NSAID (nsNSAID) users. Results The crude hazard ratio of UGIB for COX-2 inhibitors compared to nsNSAIDs was 0.50 (95% confidence interval 0.18–1.36). Matching only on age resulted in an HR of 0.36 (0.11–1.16), and of 0.35 (0.11–1.11) when further adjusted for sex. Matching on PS only, the first model yielded an HR of 0.42 (0.13–1.38), which reduced to 0.35 (0.96–1.25) when adjusted for age and sex. The second model resulted in an HR of 0.42 (0.13–1.39), which dropped to 0.31 (0.09–1.08) after adjustment for age and sex. Conclusions PS models can be created using unstructured information in EHRs. An incremental benefit was observed by matching on PS over traditional matching and adjustment for covariates.
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Affiliation(s)
- Zubair Afzal
- Department of Medical Informatics, Erasmus University Medical Center, CA Rotterdam, Netherlands
- * E-mail:
| | - Gwen M. C. Masclee
- Department of Medical Informatics, Erasmus University Medical Center, CA Rotterdam, Netherlands
| | | | - Jan A. Kors
- Department of Medical Informatics, Erasmus University Medical Center, CA Rotterdam, Netherlands
| | - Martijn J. Schuemie
- Janssen Research and Development LLC, Titusville, NJ, United States of America
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28
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Baan EJ, Janssens HM, Kerckaert T, Bindels PJE, de Jongste JC, Sturkenboom MCJM, Verhamme KMC. Antibiotic use in children with asthma: cohort study in UK and Dutch primary care databases. BMJ Open 2018; 8:e022979. [PMID: 30498039 PMCID: PMC6278808 DOI: 10.1136/bmjopen-2018-022979] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 10/23/2018] [Accepted: 10/25/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To compare the rate, indications and type of antibiotic prescriptions in children with and without asthma. DESIGN A retrospective cohort study. SETTING Two population-based primary care databases: Integrated Primary Care Information database (IPCI; the Netherlands) and The Health Improvement Network (THIN; the UK). PARTICIPANTS Children aged 5-18 years were included from January 2000 to December 2014. A child was categorised as having asthma if there were ≥2 prescriptions of respiratory drugs in the year following a code for asthma. Children were labelled as non-asthmatic if no asthma code was recorded in the patient file. MAIN OUTCOME MEASURES Rate of antibiotic prescriptions, related indications and type of antibiotic drugs. RESULTS The cohorts in IPCI and THIN consisted of 946 143 and 7 241 271 person years (PY), respectively. In both cohorts, antibiotic use was significantly higher in asthmatic children (IPCI: 197vs126 users/1000 PY, THIN: 374vs250 users/1000 PY). In children with asthma, part of antibiotic prescriptions were for an asthma exacerbation only (IPCI: 14%, THIN: 4%) and prescriptions were more often due to lower respiratory tract infections then in non-asthmatic children (IPCI: 18%vs13%, THIN: 21%vs12%). Drug type and quality indicators depended more on age, gender and database than on asthma status. CONCLUSIONS Use of antibiotics was higher in asthmatic children compared with non-asthmatic children. This was mostly due to diseases for which antibiotics are normally not indicated according to guidelines. Further awareness among physicians and patients is needed to minimise antibiotic overuse and limit antibiotic resistance.
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Affiliation(s)
- Esmé J Baan
- Department of Medical Informatics, Erasmus University, Rotterdam, The Netherlands
| | - Hettie M Janssens
- Department of Pediatric Pulmonology, Erasmus University/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Tine Kerckaert
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Patrick J E Bindels
- Department of General Practice, Erasmus University, Rotterdam, The Netherlands
| | - Johan C de Jongste
- Department of Pediatric Pulmonology, Erasmus University/Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Katia M C Verhamme
- Department of Medical Informatics, Erasmus University, Rotterdam, The Netherlands
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Infection Control and Epidemiology, OLV Hospital, Aalst, Belgium
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29
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Gadroen K, Dodd CN, Masclee GMC, de Ridder MAJ, Weibel D, Mina MJ, Grenfell BT, Sturkenboom MCJM, van de Vijver DAMC, de Swart RL. Impact and longevity of measles-associated immune suppression: a matched cohort study using data from the THIN general practice database in the UK. BMJ Open 2018; 8:e021465. [PMID: 30413497 PMCID: PMC6231568 DOI: 10.1136/bmjopen-2017-021465] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To test the hypothesis that measles infection increases the incidence of non-measles infectious diseases over a prolonged period of time. DESIGN A population-based matched cohort study. DATA SOURCES This study examined children aged 1-15 years in The Health Improvement Network UK general practice medical records database. Participants included 2228 patients diagnosed with measles between 1990 and 2014, which were matched on age, sex, general practitioner practice and calendar year with 19 930 children without measles. All controls had received at least one measles vaccination. Children with a history of immune-compromising conditions or with immune-suppressive treatment were excluded. PRIMARY OUTCOME MEASURES Incidence rate ratio (IRR) of infections, anti-infective prescriptions and all-cause hospitalisations following measles in predetermined periods using multivariate analysis to adjust for confounding variables. RESULTS In children with measles, the incidence rate for non-measles infectious disease was significantly increased in each time period assessed up to 5 years postmeasles: 43% in the first month (IRR: 1.43; 95% CI 1.22 to 1.68), 22% from month one to the first year (IRR: 1.22; 95% CI 1.14 to 1.31), 10% from year 1 to 2.5 years (IRR: 1.10; 95% CI 1.02 to 1.19) and 15% (IRR: 1.15; 95% CI 1.06 to 1.25) in years 2.5 to 5 years of follow-up. Children with measles were more than three times as likely to receive an anti-infective prescription in the first month and 15%-24% more likely between the first month and 5 years. The rate of hospitalisation in children with measles was increased only in the month following diagnosis but not thereafter (IRR: 2.83; 95% CI 1.72 to 4.67). CONCLUSION Following measles, children had increased rates of diagnosed infections, requiring increased prescribing of antimicrobial therapies. This population-based matched cohort study supports the hypothesis that measles has a prolonged impact on host resistance to non-measles infectious diseases.
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Affiliation(s)
- Kartini Gadroen
- Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
| | - Caitlin N Dodd
- Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
| | - Gwen M C Masclee
- Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
| | | | - Daniel Weibel
- Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
| | - Michael J Mina
- Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Bryan T Grenfell
- Department of Ecology and Evolutionary Biology, Princeton University, Guyot, New Jersey, USA
| | | | | | - Rik L de Swart
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
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30
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Masclee GMC, Straatman H, Arfè A, Castellsague J, Garbe E, Herings R, Kollhorst B, Lucchi S, Perez-Gutthann S, Romio S, Schade R, Schink T, Schuemie MJ, Scotti L, Varas-Lorenzo C, Valkhoff VE, Villa M, Sturkenboom MCJM. Risk of acute myocardial infarction during use of individual NSAIDs: A nested case-control study from the SOS project. PLoS One 2018; 13:e0204746. [PMID: 30383755 PMCID: PMC6211656 DOI: 10.1371/journal.pone.0204746] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 09/13/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Use of selective COX-2 non-steroidal anti-inflammatory drugs (NSAIDs) (coxibs) has been associated with an increased risk of acute myocardial infarction (AMI). However, the risk of AMI has only been studied for very few NSAIDs that are frequently used. OBJECTIVES To estimate the risk of AMI for individual NSAIDs. METHODS A nested case-control study was performed from a cohort of new NSAID users ≥18 years (1999-2011) matching cases to a maximum of 100 controls on database, sex, age, and calendar time. Data were retrieved from six healthcare databases. Adjusted odds ratios (ORs) of current use of individual NSAIDs compared to past use were estimated per database. Pooling was done by two-stage pooling using a random effects model (ORmeta) and by one-stage pooling (ORpool). RESULTS Among 8.5 million new NSAID users, 79,553 AMI cases were identified. The risk was elevated for current use of ketorolac (ORmeta 2.06;95%CI 1.83-2.32, ORpool 1.80; 1.49-2.18) followed, in descending order of point estimate, by indometacin, etoricoxib, rofecoxib, diclofenac, fixed combination of diclofenac with misoprostol, piroxicam, ibuprofen, naproxen, celecoxib, meloxicam, nimesulide and ketoprofen (ORmeta 1.12; 1.03-1.22, ORpool 1.00;0.86-1.16). Higher doses showed higher risk estimates than lower doses. CONCLUSIONS The relative risk estimates of AMI differed slightly between 28 individual NSAIDs. The relative risk was highest for ketorolac and was correlated with COX-2 potency, but not restricted to coxibs.
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Affiliation(s)
- Gwen M. C. Masclee
- Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, the Netherlands
| | | | - Andrea Arfè
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University Milano-Bicocca, Milano, Italy
| | | | - Edeltraut Garbe
- Leibniz Institute of Prevention Research and Epidemiology, Bremen, Germany
| | | | - Bianca Kollhorst
- Leibniz Institute of Prevention Research and Epidemiology, Bremen, Germany
| | | | | | - Silvana Romio
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University Milano-Bicocca, Milano, Italy
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - René Schade
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tania Schink
- Leibniz Institute of Prevention Research and Epidemiology, Bremen, Germany
| | - Martijn J. Schuemie
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lorenza Scotti
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University Milano-Bicocca, Milano, Italy
| | | | - Vera E. Valkhoff
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marco Villa
- Local Health Authority ASL Cremona, Cremona, Italy
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31
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Dukanovic J, Osokogu OU, Patel K, Ferrajolo C, Sturkenboom MCJM. Comparing drug effectiveness in children: A systematic review. Pharmacoepidemiol Drug Saf 2018; 27:1295-1301. [PMID: 30379371 DOI: 10.1002/pds.4676] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 07/31/2018] [Accepted: 09/11/2018] [Indexed: 11/10/2022]
Abstract
PURPOSE The purpose of the study is to assess the current state of the art in pediatric comparative effectiveness research, potential gaps, and areas for improvement. METHODS Relevant articles from inception to February 2015 were retrieved from Embase and Medline. We sequentially screened titles, abstracts, and full texts, with independent validation. Data regarding general information and study methods including statistical analysis were extracted. Study quality was assessed using Newcastle-Ottawa Scale (NOS). Investigated drugs were ranked and compared with data on the prevalence of pediatric drug use. RESULTS Three thousand nine hundred twenty-six abstracts were screened for eligibility and inclusion, and 164 articles were included in the review. Most studies were from North America (46.7%). Only 78 studies (47.6%) reported the design: 90.8% were cohort studies. Neonates were least frequently investigated. The drugs that were most often studied included systemic antibacterials (11.4%), psycholeptics (7.9%), and antiepileptics (7.6%). Adjustment for confounding was made using propensity scores in 8.5% of the studies. Studies that did not report the design were of lower quality. Many effectiveness studies were done on antineoplastic agents, which are not frequently used and few studies on analgesics and drugs for obstructive airway diseases which are frequently prescribed. CONCLUSIONS There is ample opportunity to improve comparative effectiveness research for drugs used in pediatrics. Routinely prescribed drugs were seldom investigated. Modern methods for confounding adjustment, such as propensity scores, were rarely used.
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Affiliation(s)
- Julijana Dukanovic
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, 3015 GE, Netherlands
| | - Osemeke U Osokogu
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, 3015 GE, Netherlands
| | - Krupa Patel
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, 3015 GE, Netherlands
| | - Carmen Ferrajolo
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, 3015 GE, Netherlands
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32
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Francisca RDC, Zomerdijk IM, Sturkenboom MCJM, Straus SMJM. Measuring the impact of the 2012 European pharmacovigilance legislation on additional risk minimization measures. Expert Opin Drug Saf 2018; 17:975-982. [DOI: 10.1080/14740338.2018.1512579] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Reynold D. C. Francisca
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Pharmacovigilance, Medicines Evaluation Board, Utrecht, The Netherlands
| | - Inge M. Zomerdijk
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Pharmacovigilance, Medicines Evaluation Board, Utrecht, The Netherlands
| | - Miriam C. J. M. Sturkenboom
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
- Julius Global Health, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Sabine M. J. M. Straus
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Pharmacovigilance, Medicines Evaluation Board, Utrecht, The Netherlands
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Osokogu OU, Pacurariu A, Mosseveld M, Rijnbeek P, Weibel D, Verhamme K, Sturkenboom MCJM. Impact of different assumptions on estimates of childhood diseases obtained from health care data: A retrospective cohort study. Pharmacoepidemiol Drug Saf 2018; 27:612-620. [PMID: 29691919 PMCID: PMC6001570 DOI: 10.1002/pds.4413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/29/2018] [Accepted: 02/04/2018] [Indexed: 11/17/2022]
Abstract
Purpose Accurate estimates of disease incidence in children are required to support pediatric drug development. Analysis of electronic health care records (EHR) may yield such estimates but pediatric‐specific methods are lacking. We aimed to understand the impact of assumptions regarding duration of disease episode and length of run‐in period on incidence estimates from EHRs. Methods Children aged 0 to 17 years (5–17 years for asthma) registered in the Integrated Primary Care Information database between 2002 and 2014 were studied. We tested the impact of the following: maximum duration of disease episode (0, 14, 30, 60, and 90 days) on recurrent diseases (acute otitis media [common] and acute pyelonephritis [rare]); and database run‐in period on chronic diseases—asthma (common) and type 1 diabetes (DM) (rare). We calculated incidence rate ratios with 95% confidence intervals and stratified using 1‐year age categories. Results Altogether, 503 495 children were registered. The incidence of acute otitis media was highest in <2‐year‐old children; using 30 days disease duration as reference, the rate increased with 8% if the duration was 14 days and decreased with 8% when extended to 60 days. Disease duration did not impact acute pyelonephritis (rare). No run‐in (to exclude prevalent cases) versus 24‐month run‐in period overestimated the incidence rate for asthma and DM by a factor of 2. Conclusions Analysis of EHR allows for estimation of disease incidence in children, but assumptions regarding episode length and run‐in period impact the incidence estimates. Such assumptions may be routinely explored.
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Affiliation(s)
- Osemeke U Osokogu
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Alexandra Pacurariu
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Mees Mosseveld
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Peter Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Daniel Weibel
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Katia Verhamme
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
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Osokogu OU, Khan J, Nakato S, Weibel D, de Ridder M, Sturkenboom MCJM, Verhamme K. Choice of time period to identify confounders for propensity score matching, affected the estimate: a retrospective cohort study of drug effectiveness in asthmatic children. J Clin Epidemiol 2018; 101:107-115.e3. [PMID: 29378305 DOI: 10.1016/j.jclinepi.2018.01.008] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/05/2018] [Accepted: 01/19/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To control for confounding by indication in comparative (drug) effectiveness studies, propensity score (PS) methods may be used. Since childhood diseases or outcomes often present as acute events, we compared the effect of using different look-back periods in electronic health-care data, to construct PSs. This was applied in our research on the effect of a combination of inhaled corticosteroids/long-acting beta-2 agonists (ICS + LABA), either as fixed combination or used as loose combination (2 separate inhaler devices) in the prevention of severe asthma exacerbations. METHODS We created a cohort of children (5-17 years) diagnosed with asthma from the Dutch Integrated Primary Care information database. Within this cohort, we identified new users of ICS + LABA, either as fixed combination or loose combination (2 separate inhaler devices). The outcome of interest was severe asthma exacerbations. PSs for type of treatment were created using comorbidity and drug use history in different time windows: 1 week, 1 month, 3 months, 1 year, and full history prior to the start of treatment. PSs were used for matching subjects in both exposure groups. Time to first asthma exacerbation was analyzed with Cox proportional hazard regression. The results were compared with published clinical trials. RESULTS Of 39,682 asthmatic children, 3,500 (8.8%) were new users of either ICS + LABA fixed (3,324 [95.0%]) or loose (176 [5.0%]). The crude hazard ratio (HR) for a severe asthma exacerbation, comparing ICS + LABA fixed to loose was 0.37 (95% confidence interval [CI]: 0.20-0.66). PS-matched HRs (1 week, 1 month, 3 month, 1 year, and full history) were 0.48 (95% CI: 0.22-1.04); 0.60 (95% CI: 0.26-1.38), 0.69 (95% CI: 0.31-1.57), 0.56 (CI: 0.25-1.24), and 0.58 (CI: 0.24-1.36), respectively. CONCLUSIONS PS matching can be used to control for confounding in pediatric comparative (drug) effectiveness studies, the impact of different look-back periods to implement the PS is important. Controlling for confounders occurring in the 3 months preceding drug exposure may yield results comparable to clinical trial results.
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Affiliation(s)
- Osemeke U Osokogu
- Department of Medical Informatics, Erasmus University Medical Center, 3015 GE Rotterdam, The Netherlands.
| | - Javeed Khan
- Department of Medical Informatics, Erasmus University Medical Center, 3015 GE Rotterdam, The Netherlands; Department of Statistics, Universiteit Hasselt, BE 3590 Diepenbeek, Belgium
| | - Swabra Nakato
- Department of Medical Informatics, Erasmus University Medical Center, 3015 GE Rotterdam, The Netherlands
| | - Daniel Weibel
- Department of Medical Informatics, Erasmus University Medical Center, 3015 GE Rotterdam, The Netherlands
| | - Maria de Ridder
- Department of Medical Informatics, Erasmus University Medical Center, 3015 GE Rotterdam, The Netherlands
| | - Miriam C J M Sturkenboom
- Department of Medical Informatics, Erasmus University Medical Center, 3015 GE Rotterdam, The Netherlands
| | - Katia Verhamme
- Department of Medical Informatics, Erasmus University Medical Center, 3015 GE Rotterdam, The Netherlands; Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Universiteit Gent, Gent, Belgium
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Pacurariu AC, Hoeve CE, Arlett P, Genov G, Slattery J, Sturkenboom MCJM, Straus SMJM. Is patient exposure preapproval and postapproval a determinant of the timing and frequency of occurrence of safety issues? Pharmacoepidemiol Drug Saf 2017; 27:168-173. [PMID: 29278866 DOI: 10.1002/pds.4359] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/20/2017] [Accepted: 10/25/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND The amount of drug exposure, pre and post approval, is considered to be a direct determinant of knowledge about the safety of a drug. A larger pre-approval exposed population is supposed to reduce the risk of unanticipated safety issues post-approval. The amount of use in the postapproval population is also expected to influence the occurrence and timing of safety issues. We investigated how the amount of pre and post approval exposure influences the detection of post-approval safety issues. METHODS A cohort of innovative drugs approved in Europe was followed for the period of 2012-2016. The main outcome of interest was a new safety issue in the period. Post-approval exposure was collected at 6 month intervals, and pre-approval exposure was collected at the moment of authorisation. Other characteristics collected for the included drugs were anatomical therapeutical chemical (ATC) class, biological status, orphan status and type of approval. We used Cox proportional hazards regression to investigate the association between exposure and the hazard of having a first safety issue. RESULTS The pre-approval exposure was not associated with the risk of safety issues after adjusting for ATC class, biological status, and treatment duration. Higher post-approval exposure was associated with more new safety issues identified (HR = 2.44 (95% CI = 1.12-5.31)) for drugs with more than 1,000 patient-years of cumulative exposure compared to drugs with less than 1,000 patient years of exposure. CONCLUSION Our results suggest that postapproval exposure influences the detection of safety issues.
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Affiliation(s)
- Alexandra C Pacurariu
- Medicines Evaluation Board, Utrecht, The Netherlands.,Erasmus University Medical Center, Rotterdam, The Netherlands.,European Medicines Agency, London, UK
| | - Christina E Hoeve
- Medicines Evaluation Board, Utrecht, The Netherlands.,Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | - Sabine M J M Straus
- Medicines Evaluation Board, Utrecht, The Netherlands.,Erasmus University Medical Center, Rotterdam, The Netherlands
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Ferrajolo C, Verhamme KMC, Trifirò G, 't Jong GW, Picelli G, Giaquinto C, Mazzaglia G, Stricker BH, Rossi F, Capuano A, Sturkenboom MCJM. Antibiotic-Induced Liver Injury in Paediatric Outpatients: A Case-Control Study in Primary Care Databases. Drug Saf 2017; 40:305-315. [PMID: 28025733 PMCID: PMC5362651 DOI: 10.1007/s40264-016-0493-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction Antibiotics are the most commonly prescribed drug class in children. Real-world data mining on the paediatric population showed potential associations between antibiotic use and acute liver injury. Objective We assessed risk estimates of liver injury associated with antibiotic use in children and adolescent outpatients. Methods A large, multi-database, population-based, case-control study was performed in people <18 years of age from two European countries (Italy and The Netherlands) during the period 2000–2008. All potential cases of liver injury were automatically extracted from three databases and then manually validated based on Council for International Organizations of Medical Sciences (CIOMS) criteria and by exclusion of all competing causes for liver injury. Up to 100 control participants were sampled for each case and were matched on index date of the event, age, sex and database. Based on prescription data, antibiotic exposure was categorized as current, recent or past use by calculating the time period between the end of prescription and the index date. Multivariate conditional logistic regression analyses were applied to calculate odds ratios (ORs) as a measure of the association (with 95% confidence interval [CI]). Results We identified 938 cases of liver injury and matched to 93,665 controls. Current use of overall antibiotics is associated with a threefold increased risk of liver injury compared with past use (adjusted OR [ORadj] 3.22, 95% CI 2.57–4.03). With regard to individual antibiotics, the risk is significantly increased for current use of each antibiotic (p < 0.005), except for azithromycin. Risk estimates vary from the lowest ORadj of 1.86 (95% CI 1.08–3.21) for amoxicillin to the highest ORadj of 24.16 (95% CI 11.78–49.54) for cotrimoxazole (i.e. sulphamethoxazole/trimethoprim) and 26.70 (95% CI 12.09–58.96) for ceftriaxone. Sensitivity analyses confirm the associations for ceftriaxone, cotrimoxazole, and clarithromycin. Conclusion Antibiotic-induced liver injury in children is heterogeneous across the use of individual antibiotics. When prescribing ceftriaxone, cotrimoxazole and clarithromycin in children, paediatricians should definitely be aware of their potential risk of liver injury, even if for short periods. Electronic supplementary material The online version of this article (doi:10.1007/s40264-016-0493-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carmen Ferrajolo
- Department of Experimental Medicine, Pharmacology Section, Campania Regional Centre of Pharmacovigilance and Pharmacoepidemiology, University of Campania, Via Santa Maria di Costantinopoli, 16, 80138, Naples, Italy.
- Department of Medical Informatics, Erasmus University Medical Centre, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands.
| | - Katia M C Verhamme
- Department of Medical Informatics, Erasmus University Medical Centre, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands
| | - Gianluca Trifirò
- Department of Medical Informatics, Erasmus University Medical Centre, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Geert W 't Jong
- Department of Medical Informatics, Erasmus University Medical Centre, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Gino Picelli
- Pedianet-Società Servizi Telematici SRL, Padua, Italy
| | - Carlo Giaquinto
- Pedianet-Società Servizi Telematici SRL, Padua, Italy
- Department of Paediatrics, University of Padua, Padua, Italy
| | - Giampiero Mazzaglia
- Health Search-IMS HEALTH LPD (Longitudinal Patient Database), Italian College of General Practitioners, Florence, Italy
| | - Bruno H Stricker
- Department of Epidemiology and Biostatistics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Francesco Rossi
- Department of Experimental Medicine, Pharmacology Section, Campania Regional Centre of Pharmacovigilance and Pharmacoepidemiology, University of Campania, Via Santa Maria di Costantinopoli, 16, 80138, Naples, Italy
| | - Annalisa Capuano
- Department of Experimental Medicine, Pharmacology Section, Campania Regional Centre of Pharmacovigilance and Pharmacoepidemiology, University of Campania, Via Santa Maria di Costantinopoli, 16, 80138, Naples, Italy
| | - Miriam C J M Sturkenboom
- Department of Medical Informatics, Erasmus University Medical Centre, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands
- Department of Epidemiology and Biostatistics, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Man KKC, Chan EW, Ip P, Coghill D, Simonoff E, Chan PKL, Lau WCY, Schuemie MJ, Sturkenboom MCJM, Wong ICK. Prenatal antidepressant exposure and the risk of attention-deficit hyperactivity disorder in children: A systematic review and meta-analysis. Neurosci Biobehav Rev 2017; 86:1-11. [PMID: 29247762 DOI: 10.1016/j.neubiorev.2017.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 08/08/2017] [Revised: 12/01/2017] [Accepted: 12/09/2017] [Indexed: 12/28/2022]
Abstract
This systematic review assesses the association between prenatal antidepressant exposure and risk of ADHD in children. Electronic databases were searched up to 25 July 2017. Observational studies examining this association were included in the review and meta-analysis was conducted where appropriate. Eight relevant studies were identified. The seven studies included in the meta-analysis comprised a total of 2,886,502 children. The pooled estimates comparing prenatal exposure to non-exposure showed an adjusted rate ratio (aRR) of 1.39 (95%CI 1.21-1.61). Similarly, an increased risk was found comparing previous antidepressant users and non-users: aRR = 1.56 (95%CI 1.25-1.95). The relationship between maternal psychiatric conditions and ADHD in children yielded an aRR of 1.90 (95%CI 1.47-2.45). Three studies conducted sibling-matched analyses with aRR of 0.94 (95%CI 0.75-1.16). These data suggest that the observed association between prenatal use of antidepressants and risk of ADHD in offspring can be partially explained by confounding by indication because the results from sibling-matched analyses do not support an increased risk of ADHD in discordant exposed siblings.
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Affiliation(s)
- Kenneth K C Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom; Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Social Work and Social Administration, Faculty of Social Science, The University of Hong Kong, Hong Kong
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - David Coghill
- Division of Neuroscience, Medical Research Institute, University of Dundee, Dundee, United Kingdom; Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Emily Simonoff
- King's College London, Institute of Psychiatry, Psychology and Neuroscience and NIHR Biomedical Research Centre for Mental Health, De Crespigny Park, London, United Kingdom
| | | | - Wallis C Y Lau
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | | | - Miriam C J M Sturkenboom
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom.
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Engelkes M, van Blijderveen JC, Overbeek JA, Kuiper J, Herings RCM, Sturkenboom MCJM, de Jongste JC, Verhamme KMC, Janssens HM. Brand and generic use of inhalation medication and frequency of switching in children and adults: A population-based cohort study. J Asthma 2017; 55:1086-1094. [PMID: 29185812 DOI: 10.1080/02770903.2017.1396468] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The expiration of patents of brand inhalation medications and the ongoing pressure on healthcare budgets resulted in a growing market for generics. AIM To study the use of brand and generic inhalation medication and the frequency of switching between brand and generic and between devices. In addition, we investigated whether switching affected adherence. METHODS From dispensing data from the Dutch PHARMO Database Network a cohort aged ≥ 5 years, using ≥ 1 year of inhalation medication between 2003 and 2012 was selected. Switching was defined as changing from brand to generic or vice versa. In addition, we studied change in aerosol delivery device type (e.g., DPI, pMDI, and nebulizers). Adherence was calculated using the medication possession ratio (MPR). RESULTS The total cohort comprised 70,053 patients with 1,604,488 dispensations. Per calendar year, 5% switched between brand and generic inhalation medication and 5% switched between devices. Median MPRs over the first 12 months ranged between 33 and 55%. Median MPR over the total period was lower after switch from brand to generic and vice versa for formoterol (44.5 vs. 42.1 and 63.5 vs. 53.8) and beclomethasone (93.8 vs. 59.8 and 81.3 vs. 55.9). CONCLUSION Per year, switching between brand and generic inhalation medication was limited to 5% of the patients, switching between device types was observed in 5% as well. Adherence to both generic and brand inhalation medication was low. Effect of switching on adherence was contradictory; depending on time period, medication and type, and direction of switching. Further research on reasons for switching and potential impact on clinical outcomes is warranted.
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Affiliation(s)
- Marjolein Engelkes
- a Department of Medical Informatics , Erasmus MC , Rotterdam , the Netherlands
| | | | - Jetty A Overbeek
- b PHARMO , Institute for Drug Outcomes Research , Utrecht , the Netherlands
| | - Josephine Kuiper
- b PHARMO , Institute for Drug Outcomes Research , Utrecht , the Netherlands
| | - Ron C M Herings
- b PHARMO , Institute for Drug Outcomes Research , Utrecht , the Netherlands
| | | | - Johan C de Jongste
- c Department of Pediatrics, Division of Respiratory Medicine and Allergology , Erasmus MC Sophia , Rotterdam , the Netherlands
| | - Katia M C Verhamme
- a Department of Medical Informatics , Erasmus MC , Rotterdam , the Netherlands.,d Department of Bioanalysis, Faculty of Pharmaceutical Sciences , Ghent University , Belgium
| | - Hettie M Janssens
- c Department of Pediatrics, Division of Respiratory Medicine and Allergology , Erasmus MC Sophia , Rotterdam , the Netherlands
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Man KKC, Coghill D, Chan EW, Lau WCY, Hollis C, Liddle E, Banaschewski T, McCarthy S, Neubert A, Sayal K, Ip P, Schuemie MJ, Sturkenboom MCJM, Sonuga-Barke E, Buitelaar J, Carucci S, Zuddas A, Kovshoff H, Garas P, Nagy P, Inglis SK, Konrad K, Häge A, Rosenthal E, Wong ICK. Association of Risk of Suicide Attempts With Methylphenidate Treatment. JAMA Psychiatry 2017; 74:1048-1055. [PMID: 28746699 PMCID: PMC5710471 DOI: 10.1001/jamapsychiatry.2017.2183] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [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: 01/28/2023]
Abstract
IMPORTANCE Patients with attention-deficit/hyperactivity disorder (ADHD) are at an increased risk of attempting suicide. Stimulants, such as methylphenidate hydrochloride, are the most common treatment for ADHD, but the association between their therapeutic use and suicide is unclear. OBJECTIVE To investigate the association between methylphenidate and the risk of suicide attempts. DESIGN, SETTING, AND PARTICIPANTS A population-based, electronic medical records database from the Hong Kong Clinical Data Analysis & Reporting System was used to identify 25 629 individuals aged 6 to 25 years who were treated with methylphenidate between January 1, 2001, and December 31, 2015. Those who had attempted suicide were included in the analysis. A self-controlled case series design was used to control for time-invariant characteristics of the patients. MAIN OUTCOMES AND MEASURES Relative incidence of suicide attempt during periods when patients were exposed to methylphenidate compared with nonexposed periods. RESULTS Among 25 629 patients with methylphenidate prescriptions, 154 had their first recorded suicide attempt within the study period; of these individuals, 111 (72.1%) were male; mean (SD) age at baseline was 7.15 (2.19) years. The overall incidence of suicide attempts during methylphenidate treatment was 9.27 per 10 000 patient-years. An increased risk of suicide attempts was detected during the 90-day period before methylphenidate was initiated, with an incidence rate ratio (IRR) of 6.55 (95% CI, 3.37-12.72). The IRR remained elevated during the first 90 days of treatment (IRR, 3.91; 95% CI, 1.62-9.42) before returning to baseline levels during ongoing treatment (IRR, 1.35; 95% CI, 0.77-2.38). When the risk during the first 90 days of treatment was compared with the 90 days preceding first treatment, the incidence of suicide attempts was not elevated (IRR, 0.78; 95% CI, 0.26-2.35). CONCLUSIONS AND RELEVANCE The incidence of suicide attempts was higher in the period immediately before the start of methylphenidate treatment. The risk remained elevated immediately after the start of methylphenidate treatment and returned to baseline levels during continuation of methylphenidate treatment. The observed higher risk of suicide attempts before treatment may reflect emerging psychiatric symptoms that trigger medical consultations that result in a decision to begin ADHD treatment. Therefore, this study's results do not support a causal association between methylphenidate treatment and suicide attempts.
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Affiliation(s)
- Kenneth K. C. Man
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong,Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands,The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium
| | - David Coghill
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Division of Neuroscience, School of Medicine, University of Dundee, Dundee, Scotland,Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Esther W. Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Wallis C. Y. Lau
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Chris Hollis
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Centre for ADHD and Neuro-developmental Disorders Across the Lifespan, Institute of Mental Health, Nottingham, England,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, England
| | - Elizabeth Liddle
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Centre for ADHD and Neuro-developmental Disorders Across the Lifespan, Institute of Mental Health, Nottingham, England,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, England
| | - Tobias Banaschewski
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Suzanne McCarthy
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,School of Pharmacy, University College Cork, Cork, Ireland
| | - Antje Neubert
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Kapil Sayal
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Centre for ADHD and Neuro-developmental Disorders Across the Lifespan, Institute of Mental Health, Nottingham, England,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, England
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | | | | | - Edmund Sonuga-Barke
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Department of Psychology, University of Southampton, Southampton, England
| | - Jan Buitelaar
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, and Karakter Child and Adolescent Psychiatry, Nijmegen, the Netherlands
| | - Sara Carucci
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Department of Biomedical Sciences, Section Of Neuroscience and Clinical Pharmacology, University of Cagliari, and Child and Adolescent Neuropsychiatry Unit, G. Brotzu Hospital Trust, Cagliari, Italy
| | - Alessandro Zuddas
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Department of Biomedical Sciences, Section Of Neuroscience and Clinical Pharmacology, University of Cagliari, and Child and Adolescent Neuropsychiatry Unit, G. Brotzu Hospital Trust, Cagliari, Italy
| | - Hanna Kovshoff
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Department of Psychology, University of Southampton, Southampton, England
| | - Peter Garas
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Peter Nagy
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Sarah K. Inglis
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Division of Neuroscience, School of Medicine, University of Dundee, Dundee, Scotland,Tayside Clinical Trials Unit, University of Dundee, Dundee, Scotland
| | - Kerstin Konrad
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Alexander Häge
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Eric Rosenthal
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Evelina London Children’s Hospital, London, England
| | - Ian C. K. Wong
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong,The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Research Department of Practice and Policy, University College London School of Pharmacy, London, England
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Becker BFH, Avillach P, Romio S, van Mulligen EM, Weibel D, Sturkenboom MCJM, Kors JA. CodeMapper: semiautomatic coding of case definitions. A contribution from the ADVANCE project. Pharmacoepidemiol Drug Saf 2017; 26:998-1005. [PMID: 28657162 PMCID: PMC5575526 DOI: 10.1002/pds.4245] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 09/23/2016] [Revised: 04/03/2017] [Accepted: 05/23/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Assessment of drug and vaccine effects by combining information from different healthcare databases in the European Union requires extensive efforts in the harmonization of codes as different vocabularies are being used across countries. In this paper, we present a web application called CodeMapper, which assists in the mapping of case definitions to codes from different vocabularies, while keeping a transparent record of the complete mapping process. METHODS CodeMapper builds upon coding vocabularies contained in the Metathesaurus of the Unified Medical Language System. The mapping approach consists of three phases. First, medical concepts are automatically identified in a free-text case definition. Second, the user revises the set of medical concepts by adding or removing concepts, or expanding them to related concepts that are more general or more specific. Finally, the selected concepts are projected to codes from the targeted coding vocabularies. We evaluated the application by comparing codes that were automatically generated from case definitions by applying CodeMapper's concept identification and successive concept expansion, with reference codes that were manually created in a previous epidemiological study. RESULTS Automated concept identification alone had a sensitivity of 0.246 and positive predictive value (PPV) of 0.420 for reproducing the reference codes. Three successive steps of concept expansion increased sensitivity to 0.953 and PPV to 0.616. CONCLUSIONS Automatic concept identification in the case definition alone was insufficient to reproduce the reference codes, but CodeMapper's operations for concept expansion provide an effective, efficient, and transparent way for reproducing the reference codes.
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Affiliation(s)
- Benedikt F H Becker
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Paul Avillach
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Silvana Romio
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Erik M van Mulligen
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Daniel Weibel
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Miriam C J M Sturkenboom
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan A Kors
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
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Man KKC, Chan EW, Ip P, Coghill D, Simonoff E, Chan PKL, Lau WCY, Schuemie MJ, Sturkenboom MCJM, Wong ICK. Prenatal antidepressant use and risk of attention-deficit/hyperactivity disorder in offspring: population based cohort study. BMJ 2017; 357:j2350. [PMID: 28566274 PMCID: PMC5450015 DOI: 10.1136/bmj.j2350] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective To assess the potential association between prenatal use of antidepressants and the risk of attention-deficit/hyperactivity disorder (ADHD) in offspring.Design Population based cohort study.Setting Data from the Hong Kong population based electronic medical records on the Clinical Data Analysis and Reporting System.Participants 190 618 children born in Hong Kong public hospitals between January 2001 and December 2009 and followed-up to December 2015.Main outcome measure Hazard ratio of maternal antidepressant use during pregnancy and ADHD in children aged 6 to 14 years, with an average follow-up time of 9.3 years (range 7.4-11.0 years).Results Among 190 618 children, 1252 had a mother who used prenatal antidepressants. 5659 children (3.0%) were given a diagnosis of ADHD or received treatment for ADHD. The crude hazard ratio of maternal antidepressant use during pregnancy was 2.26 (P<0.01) compared with non-use. After adjustment for potential confounding factors, including maternal psychiatric disorders and use of other psychiatric drugs, the adjusted hazard ratio was reduced to 1.39 (95% confidence interval 1.07 to 1.82, P=0.01). Likewise, similar results were observed when comparing children of mothers who had used antidepressants before pregnancy with those who were never users (1.76, 1.36 to 2.30, P<0.01). The risk of ADHD in the children of mothers with psychiatric disorders was higher compared with the children of mothers without psychiatric disorders even if the mothers had never used antidepressants (1.84, 1.54 to 2.18, P<0.01). All sensitivity analyses yielded similar results. Sibling matched analysis identified no significant difference in risk of ADHD in siblings exposed to antidepressants during gestation and those not exposed during gestation (0.54, 0.17 to 1.74, P=0.30).Conclusions The findings suggest that the association between prenatal use of antidepressants and risk of ADHD in offspring can be partially explained by confounding by indication of antidepressants. If there is a causal association, the size of the effect is probably smaller than that reported previously.
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Affiliation(s)
- Kenneth K C Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Centre for Paediatric Pharmacy Research, Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - David Coghill
- Division of Neuroscience, Medical Research Institute, University of Dundee, Dundee, UK
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Emily Simonoff
- King's College London, Institute of Psychiatry and NIHR Biomedical Research Centre for Mental Health, London, UK
| | | | - Wallis C Y Lau
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | | | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Centre for Paediatric Pharmacy Research, Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
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Trifirò G, de Ridder M, Sultana J, Oteri A, Rijnbeek P, Pecchioli S, Mazzaglia G, Bezemer I, Garbe E, Schink T, Poluzzi E, Frøslev T, Molokhia M, Diemberger I, Sturkenboom MCJM. Use of azithromycin and risk of ventricular arrhythmia. CMAJ 2017; 189:E560-E568. [PMID: 28420680 DOI: 10.1503/cmaj.160355] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND There are conflicting findings from observational studies of the arrhythrogenic potential of azithromycin. Our aim was to quantify the association between azithromycin use and the risk of ventricular arrhythmia. METHODS We conducted a nested case-control study within a cohort of new antibiotic users identified from a network of 7 population-based health care databases in Denmark, Germany, Italy, the Netherlands and the United Kingdom for the period 1997-2010. Up to 100 controls per case were selected and matched by age, sex and database. Recency of antibiotic use and type of drug (azithromycin was the exposure of interest) at the index date (occurrence of ventricular arrhythmia) were identified. We estimated the odds of ventricular arrhythmia associated with current azithromycin use relative to current amoxicillin use or nonuse of antibiotics (≥ 365 d without antibiotic exposure) using conditional logistic regression, adjusting for confounders. RESULTS We identified 14 040 688 new antibiotic users who met the inclusion criteria. Ventricular arrhythmia developed in 12 874, of whom 30 were current azithromycin users. The mean age of the cases and controls was 63 years, and two-thirds were male. In the pooled data analyses across databases, azithromycin use was associated with an increased risk of ventricular arrhythmia relative to nonuse of antibiotics (adjusted odds ratio [OR] 1.97, 95% confidence interval [CI] 1.35-2.86). This increased risk disappeared when current amoxicillin use was the comparator (adjusted OR 0.90, 95% CI 0.48-1.71). Database-specific estimates and meta-analysis confirmed results from the pooled data analysis. INTERPRETATION Current azithromycin use was associated with an increased risk of ventricular arrhythmia when compared with nonuse of antibiotics, but not when compared with current amoxicillin use. The decreased risk with an active comparator suggests significant confounding by indication.
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Affiliation(s)
- Gianluca Trifirò
- Department of Medical Informatics (Trifirò, de Ridder, Sultana, Oteri, Rijnbeek, Sturkenboom), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Biomedical and Dental Sciences and Morpho-functional Imaging (Trifirò), and Department of Clinical and Experimental Medicine (Sultana), University of Messina, Messina, Italy; Health Search, Italian College of General Practitioners (Pecchioli, Mazzaglia), Florence, Italy; PHARMO Institute for Drug Outcomes Research (Bezemer), Utrecht, Netherlands; Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH (Garbe, Schink), Bremen, Germany; Department of Medical and Surgical Sciences (Poluzzi), University of Bologna, Bologna, Italy; Department of Clinical Epidemiology (Frøslev), Aarhus University Hospital, Aarhus, Denmark; Department of Primary Care and Public Health Sciences (Molokhia), King's College, London, United Kingdom; Department of Experimental, Diagnostic and Specialty Medicine (Diemberger), University of Bologna, Bologna, Italy
| | - Maria de Ridder
- Department of Medical Informatics (Trifirò, de Ridder, Sultana, Oteri, Rijnbeek, Sturkenboom), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Biomedical and Dental Sciences and Morpho-functional Imaging (Trifirò), and Department of Clinical and Experimental Medicine (Sultana), University of Messina, Messina, Italy; Health Search, Italian College of General Practitioners (Pecchioli, Mazzaglia), Florence, Italy; PHARMO Institute for Drug Outcomes Research (Bezemer), Utrecht, Netherlands; Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH (Garbe, Schink), Bremen, Germany; Department of Medical and Surgical Sciences (Poluzzi), University of Bologna, Bologna, Italy; Department of Clinical Epidemiology (Frøslev), Aarhus University Hospital, Aarhus, Denmark; Department of Primary Care and Public Health Sciences (Molokhia), King's College, London, United Kingdom; Department of Experimental, Diagnostic and Specialty Medicine (Diemberger), University of Bologna, Bologna, Italy
| | - Janet Sultana
- Department of Medical Informatics (Trifirò, de Ridder, Sultana, Oteri, Rijnbeek, Sturkenboom), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Biomedical and Dental Sciences and Morpho-functional Imaging (Trifirò), and Department of Clinical and Experimental Medicine (Sultana), University of Messina, Messina, Italy; Health Search, Italian College of General Practitioners (Pecchioli, Mazzaglia), Florence, Italy; PHARMO Institute for Drug Outcomes Research (Bezemer), Utrecht, Netherlands; Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH (Garbe, Schink), Bremen, Germany; Department of Medical and Surgical Sciences (Poluzzi), University of Bologna, Bologna, Italy; Department of Clinical Epidemiology (Frøslev), Aarhus University Hospital, Aarhus, Denmark; Department of Primary Care and Public Health Sciences (Molokhia), King's College, London, United Kingdom; Department of Experimental, Diagnostic and Specialty Medicine (Diemberger), University of Bologna, Bologna, Italy
| | - Alessandro Oteri
- Department of Medical Informatics (Trifirò, de Ridder, Sultana, Oteri, Rijnbeek, Sturkenboom), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Biomedical and Dental Sciences and Morpho-functional Imaging (Trifirò), and Department of Clinical and Experimental Medicine (Sultana), University of Messina, Messina, Italy; Health Search, Italian College of General Practitioners (Pecchioli, Mazzaglia), Florence, Italy; PHARMO Institute for Drug Outcomes Research (Bezemer), Utrecht, Netherlands; Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH (Garbe, Schink), Bremen, Germany; Department of Medical and Surgical Sciences (Poluzzi), University of Bologna, Bologna, Italy; Department of Clinical Epidemiology (Frøslev), Aarhus University Hospital, Aarhus, Denmark; Department of Primary Care and Public Health Sciences (Molokhia), King's College, London, United Kingdom; Department of Experimental, Diagnostic and Specialty Medicine (Diemberger), University of Bologna, Bologna, Italy
| | - Peter Rijnbeek
- Department of Medical Informatics (Trifirò, de Ridder, Sultana, Oteri, Rijnbeek, Sturkenboom), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Biomedical and Dental Sciences and Morpho-functional Imaging (Trifirò), and Department of Clinical and Experimental Medicine (Sultana), University of Messina, Messina, Italy; Health Search, Italian College of General Practitioners (Pecchioli, Mazzaglia), Florence, Italy; PHARMO Institute for Drug Outcomes Research (Bezemer), Utrecht, Netherlands; Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH (Garbe, Schink), Bremen, Germany; Department of Medical and Surgical Sciences (Poluzzi), University of Bologna, Bologna, Italy; Department of Clinical Epidemiology (Frøslev), Aarhus University Hospital, Aarhus, Denmark; Department of Primary Care and Public Health Sciences (Molokhia), King's College, London, United Kingdom; Department of Experimental, Diagnostic and Specialty Medicine (Diemberger), University of Bologna, Bologna, Italy
| | - Serena Pecchioli
- Department of Medical Informatics (Trifirò, de Ridder, Sultana, Oteri, Rijnbeek, Sturkenboom), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Biomedical and Dental Sciences and Morpho-functional Imaging (Trifirò), and Department of Clinical and Experimental Medicine (Sultana), University of Messina, Messina, Italy; Health Search, Italian College of General Practitioners (Pecchioli, Mazzaglia), Florence, Italy; PHARMO Institute for Drug Outcomes Research (Bezemer), Utrecht, Netherlands; Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH (Garbe, Schink), Bremen, Germany; Department of Medical and Surgical Sciences (Poluzzi), University of Bologna, Bologna, Italy; Department of Clinical Epidemiology (Frøslev), Aarhus University Hospital, Aarhus, Denmark; Department of Primary Care and Public Health Sciences (Molokhia), King's College, London, United Kingdom; Department of Experimental, Diagnostic and Specialty Medicine (Diemberger), University of Bologna, Bologna, Italy
| | - Giampiero Mazzaglia
- Department of Medical Informatics (Trifirò, de Ridder, Sultana, Oteri, Rijnbeek, Sturkenboom), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Biomedical and Dental Sciences and Morpho-functional Imaging (Trifirò), and Department of Clinical and Experimental Medicine (Sultana), University of Messina, Messina, Italy; Health Search, Italian College of General Practitioners (Pecchioli, Mazzaglia), Florence, Italy; PHARMO Institute for Drug Outcomes Research (Bezemer), Utrecht, Netherlands; Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH (Garbe, Schink), Bremen, Germany; Department of Medical and Surgical Sciences (Poluzzi), University of Bologna, Bologna, Italy; Department of Clinical Epidemiology (Frøslev), Aarhus University Hospital, Aarhus, Denmark; Department of Primary Care and Public Health Sciences (Molokhia), King's College, London, United Kingdom; Department of Experimental, Diagnostic and Specialty Medicine (Diemberger), University of Bologna, Bologna, Italy
| | - Irene Bezemer
- Department of Medical Informatics (Trifirò, de Ridder, Sultana, Oteri, Rijnbeek, Sturkenboom), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Biomedical and Dental Sciences and Morpho-functional Imaging (Trifirò), and Department of Clinical and Experimental Medicine (Sultana), University of Messina, Messina, Italy; Health Search, Italian College of General Practitioners (Pecchioli, Mazzaglia), Florence, Italy; PHARMO Institute for Drug Outcomes Research (Bezemer), Utrecht, Netherlands; Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH (Garbe, Schink), Bremen, Germany; Department of Medical and Surgical Sciences (Poluzzi), University of Bologna, Bologna, Italy; Department of Clinical Epidemiology (Frøslev), Aarhus University Hospital, Aarhus, Denmark; Department of Primary Care and Public Health Sciences (Molokhia), King's College, London, United Kingdom; Department of Experimental, Diagnostic and Specialty Medicine (Diemberger), University of Bologna, Bologna, Italy
| | - Edeltraut Garbe
- Department of Medical Informatics (Trifirò, de Ridder, Sultana, Oteri, Rijnbeek, Sturkenboom), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Biomedical and Dental Sciences and Morpho-functional Imaging (Trifirò), and Department of Clinical and Experimental Medicine (Sultana), University of Messina, Messina, Italy; Health Search, Italian College of General Practitioners (Pecchioli, Mazzaglia), Florence, Italy; PHARMO Institute for Drug Outcomes Research (Bezemer), Utrecht, Netherlands; Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH (Garbe, Schink), Bremen, Germany; Department of Medical and Surgical Sciences (Poluzzi), University of Bologna, Bologna, Italy; Department of Clinical Epidemiology (Frøslev), Aarhus University Hospital, Aarhus, Denmark; Department of Primary Care and Public Health Sciences (Molokhia), King's College, London, United Kingdom; Department of Experimental, Diagnostic and Specialty Medicine (Diemberger), University of Bologna, Bologna, Italy
| | - Tania Schink
- Department of Medical Informatics (Trifirò, de Ridder, Sultana, Oteri, Rijnbeek, Sturkenboom), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Biomedical and Dental Sciences and Morpho-functional Imaging (Trifirò), and Department of Clinical and Experimental Medicine (Sultana), University of Messina, Messina, Italy; Health Search, Italian College of General Practitioners (Pecchioli, Mazzaglia), Florence, Italy; PHARMO Institute for Drug Outcomes Research (Bezemer), Utrecht, Netherlands; Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH (Garbe, Schink), Bremen, Germany; Department of Medical and Surgical Sciences (Poluzzi), University of Bologna, Bologna, Italy; Department of Clinical Epidemiology (Frøslev), Aarhus University Hospital, Aarhus, Denmark; Department of Primary Care and Public Health Sciences (Molokhia), King's College, London, United Kingdom; Department of Experimental, Diagnostic and Specialty Medicine (Diemberger), University of Bologna, Bologna, Italy
| | - Elisabetta Poluzzi
- Department of Medical Informatics (Trifirò, de Ridder, Sultana, Oteri, Rijnbeek, Sturkenboom), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Biomedical and Dental Sciences and Morpho-functional Imaging (Trifirò), and Department of Clinical and Experimental Medicine (Sultana), University of Messina, Messina, Italy; Health Search, Italian College of General Practitioners (Pecchioli, Mazzaglia), Florence, Italy; PHARMO Institute for Drug Outcomes Research (Bezemer), Utrecht, Netherlands; Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH (Garbe, Schink), Bremen, Germany; Department of Medical and Surgical Sciences (Poluzzi), University of Bologna, Bologna, Italy; Department of Clinical Epidemiology (Frøslev), Aarhus University Hospital, Aarhus, Denmark; Department of Primary Care and Public Health Sciences (Molokhia), King's College, London, United Kingdom; Department of Experimental, Diagnostic and Specialty Medicine (Diemberger), University of Bologna, Bologna, Italy
| | - Trine Frøslev
- Department of Medical Informatics (Trifirò, de Ridder, Sultana, Oteri, Rijnbeek, Sturkenboom), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Biomedical and Dental Sciences and Morpho-functional Imaging (Trifirò), and Department of Clinical and Experimental Medicine (Sultana), University of Messina, Messina, Italy; Health Search, Italian College of General Practitioners (Pecchioli, Mazzaglia), Florence, Italy; PHARMO Institute for Drug Outcomes Research (Bezemer), Utrecht, Netherlands; Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH (Garbe, Schink), Bremen, Germany; Department of Medical and Surgical Sciences (Poluzzi), University of Bologna, Bologna, Italy; Department of Clinical Epidemiology (Frøslev), Aarhus University Hospital, Aarhus, Denmark; Department of Primary Care and Public Health Sciences (Molokhia), King's College, London, United Kingdom; Department of Experimental, Diagnostic and Specialty Medicine (Diemberger), University of Bologna, Bologna, Italy
| | - Mariam Molokhia
- Department of Medical Informatics (Trifirò, de Ridder, Sultana, Oteri, Rijnbeek, Sturkenboom), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Biomedical and Dental Sciences and Morpho-functional Imaging (Trifirò), and Department of Clinical and Experimental Medicine (Sultana), University of Messina, Messina, Italy; Health Search, Italian College of General Practitioners (Pecchioli, Mazzaglia), Florence, Italy; PHARMO Institute for Drug Outcomes Research (Bezemer), Utrecht, Netherlands; Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH (Garbe, Schink), Bremen, Germany; Department of Medical and Surgical Sciences (Poluzzi), University of Bologna, Bologna, Italy; Department of Clinical Epidemiology (Frøslev), Aarhus University Hospital, Aarhus, Denmark; Department of Primary Care and Public Health Sciences (Molokhia), King's College, London, United Kingdom; Department of Experimental, Diagnostic and Specialty Medicine (Diemberger), University of Bologna, Bologna, Italy
| | - Igor Diemberger
- Department of Medical Informatics (Trifirò, de Ridder, Sultana, Oteri, Rijnbeek, Sturkenboom), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Biomedical and Dental Sciences and Morpho-functional Imaging (Trifirò), and Department of Clinical and Experimental Medicine (Sultana), University of Messina, Messina, Italy; Health Search, Italian College of General Practitioners (Pecchioli, Mazzaglia), Florence, Italy; PHARMO Institute for Drug Outcomes Research (Bezemer), Utrecht, Netherlands; Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH (Garbe, Schink), Bremen, Germany; Department of Medical and Surgical Sciences (Poluzzi), University of Bologna, Bologna, Italy; Department of Clinical Epidemiology (Frøslev), Aarhus University Hospital, Aarhus, Denmark; Department of Primary Care and Public Health Sciences (Molokhia), King's College, London, United Kingdom; Department of Experimental, Diagnostic and Specialty Medicine (Diemberger), University of Bologna, Bologna, Italy
| | - Miriam C J M Sturkenboom
- Department of Medical Informatics (Trifirò, de Ridder, Sultana, Oteri, Rijnbeek, Sturkenboom), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Biomedical and Dental Sciences and Morpho-functional Imaging (Trifirò), and Department of Clinical and Experimental Medicine (Sultana), University of Messina, Messina, Italy; Health Search, Italian College of General Practitioners (Pecchioli, Mazzaglia), Florence, Italy; PHARMO Institute for Drug Outcomes Research (Bezemer), Utrecht, Netherlands; Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH (Garbe, Schink), Bremen, Germany; Department of Medical and Surgical Sciences (Poluzzi), University of Bologna, Bologna, Italy; Department of Clinical Epidemiology (Frøslev), Aarhus University Hospital, Aarhus, Denmark; Department of Primary Care and Public Health Sciences (Molokhia), King's College, London, United Kingdom; Department of Experimental, Diagnostic and Specialty Medicine (Diemberger), University of Bologna, Bologna, Italy
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Huijgen NA, de Ridder MAJ, Verhamme KM, Dohle GR, Vanrolleghem AM, Sturkenboom MCJM, Laven JSE, Steegers-Theunissen RPM. Are proton-pump inhibitors harmful for the semen quality of men in couples who are planning pregnancy? Fertil Steril 2016; 106:1666-1672.e2. [PMID: 27743698 DOI: 10.1016/j.fertnstert.2016.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 06/25/2016] [Revised: 09/04/2016] [Accepted: 09/07/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine associations between proton-pump inhibitor (PPI) use and semen parameters in young men of couples who are planning pregnancy. DESIGN Case-control study of a population-based registry. SETTING Not applicable. PATIENT(S) General practitioner patients comprising 2,473 men from couples planning pregnancy with a recorded semen analysis: 241 with a low total motile sperm count (TMSC ≤1) and 714 with TMSC >1 as matched controls. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Exposure to PPI; PPI dosage. RESULT(S) The study of data from between 1996 and 2013 from the Integrated Primary Care Information database in the Netherlands, which incorporates the medical records of 1.5 million patients from 720 general practitioners, found that the use of PPIs in the period between 12 and 6 months before semen analysis was associated with a threefold higher risk of low TMSC (odds ratio 2.96; 95% confidence interval 1.26-6.97) adjusted for age and other medication. Use of PPIs during the 6 months immediately before the semen analysis was not statistically significantly associated with low TMSC. CONCLUSION(S) The use of PPIs in the period 12 to 6 months preceding semen analysis is associated with a threefold higher risk of low TMSC, which suggests that a long-term increase in gastric pH results in a decline of sperm quality. This finding emphasizes the need for more preconceptional research and counseling on the potential effects of medication use on semen quality.
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Affiliation(s)
- Nicole A Huijgen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Maria A J de Ridder
- Department of Medical Informatics, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Katia M Verhamme
- Department of Medical Informatics, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Gert R Dohle
- Department of Urology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Ann M Vanrolleghem
- Department of Medical Informatics, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Miriam C J M Sturkenboom
- Department of Medical Informatics, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Joop S E Laven
- Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Régine P M Steegers-Theunissen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands; Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.
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Gadroen K, Straus SMJM, Pacurariu A, Weibel D, Kurz X, Sturkenboom MCJM. Patterns of spontaneous reports on narcolepsy following administration of pandemic influenza vaccine; a case series of individual case safety reports in Eudravigilance. Vaccine 2016; 34:4892-4897. [PMID: 27577558 DOI: 10.1016/j.vaccine.2016.08.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 05/12/2016] [Revised: 08/21/2016] [Accepted: 08/22/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aims to describe the frequency and quality of spontaneous narcolepsy case reports following administration of pandemic influenza vaccine as captured in the Eudravigilance database. METHODS We conducted a retrospective descriptive study of spontaneous Individual Case Safety Reports (ICSRs), reporting narcolepsy following administration of pandemic influenza vaccine as received by Eudravigilance until July 2014. De-duplication was carried out by Eudravigilance. Frequency of reporting is described as number of ICSRs received per month over time. The quality of the ICSRs was evaluated by completeness of information and diagnostic certainty using the Automated Brighton Collaboration case definition tool (ABC-tool) for narcolepsy. RESULTS After de-duplication, a total of 1333 ICSRs of narcolepsy and/or cataplexy following pandemic influenza vaccine were identified, originating from 18 countries worldwide. Most of the ICSRs (61.9%) originated from the signaling countries, Sweden and Finland. Although de-duplication of case reports was carried out, it is suspected that many duplicates exist, in particular from Sweden. The majority of the ICSRs (95.3%), reported exposure to Pandemrix®. Only few reports were received for Arepanrix® (1.6%) or Focetria® (0.5%), and Celvapan® (0.1%). Of those ICSRs reporting age, 73.1% concerned persons below age of 20years. When using the ABC-tool, all ICSRs were classified as having insufficient information to meet the Brighton Collaboration case definition of narcolepsy. CONCLUSION An increase in reporting of narcolepsy appeared in Eudravigilance only after awareness was raised by the national authorities. Most narcolepsy reports were received from countries where the signal initially occurred, and were related to Pandemrix® in children/adolescents. Basic information about the patient and the exposure was present in most of the ICSRs. The ICSRs captured by Eudravigilance however, do not collect enough information to assess the diagnostic certainty according to the Brighton Collaboration case definition.
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Affiliation(s)
- Kartini Gadroen
- Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands; Medicines Evaluation Board, Utrecht (CBG-MEB), The Netherlands.
| | - Sabine M J M Straus
- Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands; Medicines Evaluation Board, Utrecht (CBG-MEB), The Netherlands
| | - Alexandra Pacurariu
- Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands; Medicines Evaluation Board, Utrecht (CBG-MEB), The Netherlands
| | - Daniel Weibel
- Medicines Evaluation Board, Utrecht (CBG-MEB), The Netherlands
| | - Xavier Kurz
- European Medicines Agency (EMA), London, United Kingdom
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Engelkes M, Janssens HM, de Ridder MAJ, Sturkenboom MCJM, de Jongste JC, Verhamme KMC. Real life data on incidence and risk factors of severe asthma exacerbations in children in primary care. Respir Med 2016; 119:48-54. [PMID: 27692147 DOI: 10.1016/j.rmed.2016.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/22/2016] [Accepted: 08/21/2016] [Indexed: 10/21/2022]
Abstract
Real-life data on the incidence rates (IR) and risk factors of severe asthma exacerbations in children are sparse. We aimed to assess IR and risk factors of severe asthma exacerbations in children in real life. We conducted a population-based cohort study using a Dutch GP database containing complete medical records of >1 million patients. All records of children with physician-diagnosed asthma aged 5-18 years between 2000 and 2012 were examined for exacerbations, defined as either hospitalization, emergency department visit or need of systemic steroids for asthma. IR was expressed as number of exacerbations per person year (PY). We identified 14,303 asthmatic children with 35,118 PY of follow-up and 732 exacerbations. The overall IR was 2.1/100PY (95% CI 1.9-2.2), 4.1/100PY (3.8-4.4) for children on asthma treatment. Re-exacerbation occurred in 2% (1.3-4.3) of patients within 1 month, in 25% (20.6-28.8) within 1 year. Predictors for (frequent) exacerbations were age, medication use and prior exacerbations (all p < 0.001). The overall IR of severe asthma exacerbations was 4/100PY in children on asthma treatment, highest in spring and fall. 25% of the patients with an exacerbation will experience a next exacerbation within 1 year. More severe asthma is a predictor of subsequent and future exacerbations.
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Affiliation(s)
- M Engelkes
- Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
| | - H M Janssens
- Department of Paediatrics, Division Respiratory Medicine and Allergology, Erasmus MC/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M A J de Ridder
- Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
| | | | - J C de Jongste
- Department of Paediatrics, Division Respiratory Medicine and Allergology, Erasmus MC/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - K M C Verhamme
- Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands.
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Osokogu OU, Dukanovic J, Ferrajolo C, Dodd C, Pacurariu AC, Bramer WM, 'tJong G, Weibel D, Sturkenboom MCJM, Kaguelidou F. Pharmacoepidemiological safety studies in children: a systematic review. Pharmacoepidemiol Drug Saf 2016; 25:861-70. [PMID: 27255559 PMCID: PMC5111763 DOI: 10.1002/pds.4041] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 02/24/2016] [Revised: 04/06/2016] [Accepted: 05/06/2016] [Indexed: 11/22/2022]
Abstract
Purpose In order to identify challenges in pediatric pharmacoepidemiological safety studies, we assessed the characteristics of such (published) studies. Methods Relevant articles from inception to 2013 were retrieved from Embase and Medline. We sequentially screened titles, abstracts and full texts with independent validation. We systematically collected data regarding general information, study methods and results. Results Out of 4825 unique articles, 268 full texts (5.6%) were retained; 147 (54.9%) pertained to drugs rather than vaccines. Considering the 268 studies, 202 (75.4%) concerned children and adolescents (2 to 11 years) and 14 (5.3%) included preterm newborns. Most studies originated from North America (154 [57.5%]) or Europe (92 [34.3%]). Only 47 studies (17.5%) were privately funded. The majority (174 [64.9%]) were cohort studies. Out of 268 studies, 196 (73.1%) collected data retrospectively; paper medical charts were the most common data source for the exposures (85 [31.7%]) and outcomes (122 [45.5%]). Only 3 (2.0%) drug‐only studies investigated rarely used drugs. Considering all 268 studies, only 27 (10.1%) reported sample size or power calculation. Most (75 [51.0%]) drug‐only studies corrected confounding by multivariate modeling unlike stratification in 66 (55.9%) vaccine‐only studies. Considering 75 child‐only studies without any statistically significant result, 41 (54.7%) did not discuss lack of power. Conclusions Although the field of pediatric pharmacoepidemiology is steadily developing evaluation seldom includes neonates, is mainly focused on few drug classes and safety outcomes and concerns mainly drug use in developed countries. Small study size is a specific challenge in pediatrics. Reporting should be improved. © 2016 The Authors. Pharmacoepidemiology and Drug Safety Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Osemeke U Osokogu
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Julijana Dukanovic
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Carmen Ferrajolo
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Caitlin Dodd
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alexandra C Pacurariu
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Geert 'tJong
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Daniel Weibel
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Miriam C J M Sturkenboom
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Florentia Kaguelidou
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Pediatric Pharmacology and Pharmacogenetics, Hôpital Robert Debré, APHP, Univ Paris 7-Diderot, Sorbonne Paris Cité, EA08, INSERM CIC1426, Paris, France
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Oteri A, Mazzaglia G, Pecchioli S, Molokhia M, Ulrichsen SP, Pedersen L, Poluzzi E, De Ponti F, Garbe E, Schink T, Herings R, Bezemer ID, Sturkenboom MCJM, Trifirò G. Prescribing pattern of antipsychotic drugs during the years 1996-2010: a population-based database study in Europe with a focus on torsadogenic drugs. Br J Clin Pharmacol 2016; 82:487-97. [PMID: 27061849 DOI: 10.1111/bcp.12955] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 10/20/2015] [Revised: 03/25/2016] [Accepted: 03/29/2016] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Antipsychotic drugs (APDs) are used to treat several mental illnesses. Some APDs have long been known to be associated with QT prolongation, potentially leading to torsades de pointes (TdP) and sudden cardiac death (SCD). In 2005, thioridazine was withdrawn because of the risk of SCD, bringing further attention to the arrhythmogenic potential of APDs. AIM The aim of the current study was to evaluate the use of APDs in five European countries during the years 1996-2010. METHODS A cohort study was conducted using prescription/dispensing data from seven healthcare databases [the AARHUS University Hospital Database (Denmark), the German Pharmacoepidemiological Research Database (GePaRD) (Germany), Health Search Database/Thales (HSD) and Emilia Romagna Regional Database (ERD) (Italy), PHARMO Database Network and Integrated Primary Care Information (IPCI) (the Netherlands) and The Health Improvement Network (THIN) (the UK), covering a population of 27 million individuals. The annual prescription rate of APDs was measured overall and for individual medications. APDs were classified as torsadogenic according to the Arizona-CERT list. All analyses were stratified by age, gender and calendar year. RESULTS A total of 559 276 person-years (PYs) of exposure to APDs was captured. The crude annual prescription rate of APD use ranged from 3.0/1000 PYs in ERD to 7.7/1000 PYs in AARHUS. Among APDs with established torsadogenic potential, thioridazine was the most frequently used medication in the UK. Haloperidol was commonly prescribed in Italy and the Netherlands. The use of APDs with torsadogenic potential was much higher in elderly patients. CONCLUSIONS Substantial use of APDs with torsadogenic potential has been reported in Europe in recent years, in spite of increasing concerns about their arrhythmogenic potential. This use was even greater in elderly patients, who are at higher risk of SCD.
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Affiliation(s)
- Alessandro Oteri
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Serena Pecchioli
- Health Search, Italian College of General Practitioners, Florence, Italy.,Regional Agency for Healthcare Services of Tuscany, Florence, Italy
| | - Mariam Molokhia
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | | | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Fabrizio De Ponti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Edeltraut Garbe
- Leibniz Institute for Epidemiology and Prevention Research - BIPS, Bremen, Germany
| | - Tania Schink
- Leibniz Institute for Epidemiology and Prevention Research - BIPS, Bremen, Germany
| | - Ron Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Irene D Bezemer
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Miriam C J M Sturkenboom
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gianluca Trifirò
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Engelkes M, Janssens HM, de Jongste JC, Sturkenboom MCJM, Verhamme KMC. Prescription patterns, adherence and characteristics of non-adherence in children with asthma in primary care. Pediatr Allergy Immunol 2016; 27:201-8. [PMID: 26928754 DOI: 10.1111/pai.12507] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2015] [Indexed: 12/24/2022]
Abstract
UNLABELLED Adherence to treatment remains important for successful asthma management. Knowledge about asthma medication use and adherence in real-life offers opportunities to improve asthma treatment in children. OBJECTIVE To describe prescription patterns, adherence and factors of adherence to drugs in children with asthma. METHODS Population-based cohort study in a Dutch primary care database (IPCI), containing medical records of 176,516 children, aged 5-18 years, between 2000 and 2012. From asthma medication prescriptions, age, gender, seasonal and calendar year rates were calculated. Adherence was calculated using medication possession ratio (MPR) and ratio of controller to total asthma drug (CTT). Characteristics of children with high-vs.-low adherence were compared. RESULTS The total asthma cohort (n = 14,303; 35,181 person-years (PY) of follow-up) was mainly treated with short-acting β2-agonists (SABA; 40 users/100 PY) and inhaled corticosteroids (ICS; 32/100 PY). Median MPR for ICS was 56%. Children with good adherence (Q4 = MPR > 87%) were younger at start of ICS, more often visited specialists and had more exacerbations during follow-up compared to children with low adherence (Q1 = MPR < 37%). CONCLUSION In Dutch primary care children with asthma were mainly prescribed SABA, and ICS. Adherence to ICS was relatively low. Characteristics of children with good adherence were compatible with more severe asthma, suggesting that adherence is driven by treatment need or intensity of medical follow-up.
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Affiliation(s)
- Marjolein Engelkes
- Department of Medical Informatics, Erasmus University, Rotterdam, The Netherlands
| | - Hettie M Janssens
- Department of Paediatrics Division of Respiratology and Allergology Medicine, Erasmus University/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Johan C de Jongste
- Department of Paediatrics Division of Respiratology and Allergology Medicine, Erasmus University/Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Katia M C Verhamme
- Department of Medical Informatics, Erasmus University, Rotterdam, The Netherlands
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van Leeuwen N, Lingsma HF, Vanrolleghem AM, Sturkenboom MCJM, van Doorn PA, Steyerberg EW, Jacobs BC. Hospital Admissions, Transfers and Costs of Guillain-Barré Syndrome. PLoS One 2016; 11:e0143837. [PMID: 26859880 PMCID: PMC4747559 DOI: 10.1371/journal.pone.0143837] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 04/14/2015] [Accepted: 11/10/2015] [Indexed: 11/18/2022] Open
Abstract
Background Guillain-Barré syndrome (GBS) has a highly variable clinical course, leading to frequent transfers within and between hospitals and high associated costs. We defined the current admissions, transfers and costs in relation to disease severity of GBS. Methods Dutch neurologists were requested to report patients diagnosed with GBS between November 2009 and November 2010. Information regarding clinical course and transfers was obtained via neurologists and general practitioners. Results 87 GBS patients were included with maximal GBS disability score of 1 or 2 (28%), 3 or 4 (53%), 5 (18%) and 6 (1%). Four mildly affected GBS patients were not hospital admitted. Of the 83 hospitalized patients 68 (82%) were initially admitted at a neurology department, 4 (5%) at an ICU, 4 (5%) at pediatrics, 4 (5%) at pediatrics neurology and 3 (4%) at internal medicine. Median hospital stay was 17 days (IQR 11–26 days, absolute range 1–133 days). Transfers between departments or hospitals occurred in 33 (40%) patients and 25 (30%) were transferred 2 times or more. From a cost-effectiveness perspective 21 (25%) of the admissions was suboptimal. Median costs for hospital admission of GBS patients were 15,060 Euro (IQR 11,226–23,683). Maximal GBS disability score was significantly correlated with total length of stay, number of transfers, ICU admission and costs. Conclusions Hospital admissions for GBS patients are highly heterogeneous, with frequent transfers and higher costs for those with more severe disease. Future research should aim to develop prediction models to early identify the most cost-effective allocation in individual patients.
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Affiliation(s)
- Nikki van Leeuwen
- Centre for Medical Decision Making, Department of Public Health, Erasmus Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- * E-mail:
| | - Hester F. Lingsma
- Centre for Medical Decision Making, Department of Public Health, Erasmus Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Ann M. Vanrolleghem
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | | | - Ewout W. Steyerberg
- Centre for Medical Decision Making, Department of Public Health, Erasmus Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Bart C. Jacobs
- Department of Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Immunology, Erasmus Medical Centre, Rotterdam, The Netherlands
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50
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Bezemer ID, Verhamme KMC, Gini R, Mosseveld M, Rijnbeek PR, Trifirò G, Sturkenboom MCJM, Penning-van Beest FJ, Herings RM. Use of oral contraceptives in three European countries: a population-based multi-database study. EUR J CONTRACEP REPR 2015; 21:81-7. [DOI: 10.3109/13625187.2015.1102220] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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