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Abtahi S, Pajouheshnia R, Durán CE, Riera-Arnau J, Gamba M, Alsina E, Hoxhaj V, Andersen M, Bartolini C, Kristiansen SB, Brown J, Hallgreen CE, Garcia-Poza P, Gardarsdottir H, Gini R, Girardi A, Holthuis E, Huerta C, Ibánez L, Limoncella G, Martín-Pérez M, Paoletti O, Roberto G, Souverein P, Swart KMA, Wing K, Sturkenboom M, Klungel O. Impact of 2018 EU Risk Minimisation Measures and Revised Pregnancy Prevention Programme on Utilisation and Prescribing Trends of Medicinal Products Containing Valproate: An Interrupted Time Series Study. Drug Saf 2023:10.1007/s40264-023-01314-3. [PMID: 37294532 DOI: 10.1007/s40264-023-01314-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Due to established teratogenicity of valproates, the EU risk minimisation measures (RMMs) with a pregnancy prevention programme (PPP) for valproate were updated in March 2018. OBJECTIVES To investigate the effectiveness of the 2018 EU RMMs on valproate utilisation in five European countries/regions. METHODS A multi-database, times series study of females of childbearing potential (12-55 years) was conducted using electronic medical records from five countries/regions (01.01.2010-31.12.2020): Denmark, Tuscany (Italy), Spain, the Netherlands, and the UK. Clinical and demographic information from each database was transformed to the ConcePTION Common Data Model, quality checks were conducted and a distributed analysis was performed using common scripts. Incident and prevalent use of valproate, proportion of discontinuers and switchers to alternative medicine, frequency of contraception coverage during valproate use, and occurrence of pregnancies during valproate exposure were estimated per month. Interrupted time series analyses were conducted to estimate the level or trend change in the outcome measures. RESULTS We included 69,533 valproate users from 9,699,371 females of childbearing potential from the five participating centres. A significant decline in prevalent use of valproates was observed in Tuscany, Italy (mean difference post-intervention -7.7%), Spain (-11.3%), and UK (-5.9%) and a non-significant decline in the Netherlands (-3.3%), but no decline in incident use after the 2018 RMMs compared to the period before. The monthly proportion of compliant valproate prescriptions/dispensings with a contraceptive coverage was low (<25%), with an increase after the 2018 RMMs only in the Netherlands (mean difference post-intervention 12%). There was no significant increase in switching rates from valproates to alternative medicine after the 2018 intervention in any of the countries/regions. We observed a substantial number of concurrent pregnancies during valproate exposure, but with a declining rate after the 2018 RMMs in Tuscany, Italy (0.70 per 1000 valproate users pre- and 0.27 post-intervention), Spain (0.48 and 0.13), the Netherlands (0.34 and 0.00), and an increasing rate in UK (1.13 and 5.07). CONCLUSION There was a small impact of the 2018 RMMs on valproate use in the studied European countries/regions. The substantial number of concurrent pregnancies with valproate exposure warrants a careful monitoring of implementation of the existing PPP for valproate in clinical practice in Europe, to see if there is any need for additional measures in the future.
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Affiliation(s)
- Shahab Abtahi
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Romin Pajouheshnia
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Carlos E Durán
- Julius Global Health, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Judit Riera-Arnau
- Julius Global Health, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
- Clinical Pharmacology Department, Hospital Universitari de la Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Magdalena Gamba
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Ema Alsina
- Julius Global Health, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Vjola Hoxhaj
- Julius Global Health, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Morten Andersen
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Sarah Brøgger Kristiansen
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeremy Brown
- London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Christine Erikstrup Hallgreen
- Copenhagen Centre for Regulatory Science, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
- Department of Clinical Pharmacy, UMCU, Utrecht, The Netherlands
| | - Rosa Gini
- Agenzia Regionale di Sanità della Toscana (ARS), Firenze, Italy
| | - Anna Girardi
- Agenzia Regionale di Sanità della Toscana (ARS), Firenze, Italy
| | - Emily Holthuis
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Consuelo Huerta
- Department of Public Health, Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Luisa Ibánez
- Clinical Pharmacology Department, Hospital Universitari de la Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | - Mar Martín-Pérez
- Agencia Espanola de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Olga Paoletti
- Agenzia Regionale di Sanità della Toscana (ARS), Firenze, Italy
| | | | - Patrick Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Karin M A Swart
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Kevin Wing
- London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Miriam Sturkenboom
- Julius Global Health, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Olaf Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands.
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2
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Wang SV, Pottegård A, Crown W, Arlett P, Ashcroft DM, Benchimol EI, Berger ML, Crane G, Goettsch W, Hua W, Kabadi S, Kern DM, Kurz X, Langan S, Nonaka T, Orsini L, Perez-Gutthann S, Pinheiro S, Pratt N, Schneeweiss S, Toussi M, Williams RJ. HARmonized Protocol Template to Enhance Reproducibility of hypothesis evaluating real-world evidence studies on treatment effects: A good practices report of a joint ISPE/ISPOR task force. Pharmacoepidemiol Drug Saf 2023; 32:44-55. [PMID: 36215113 PMCID: PMC9771861 DOI: 10.1002/pds.5507] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/17/2022] [Accepted: 06/28/2022] [Indexed: 02/06/2023]
Abstract
PROBLEM Ambiguity in communication of key study parameters limits the utility of real-world evidence (RWE) studies in healthcare decision-making. Clear communication about data provenance, design, analysis, and implementation is needed. This would facilitate reproducibility, replication in independent data, and assessment of potential sources of bias. WHAT WE DID The International Society for Pharmacoepidemiology (ISPE) and ISPOR-The Professional Society for Health Economics and Outcomes Research (ISPOR) convened a joint task force, including representation from key international stakeholders, to create a harmonized protocol template for RWE studies that evaluate a treatment effect and are intended to inform decision-making. The template builds on existing efforts to improve transparency and incorporates recent insights regarding the level of detail needed to enable RWE study reproducibility. The overarching principle was to reach for sufficient clarity regarding data, design, analysis, and implementation to achieve 3 main goals. One, to help investigators thoroughly consider, then document their choices and rationale for key study parameters that define the causal question (e.g., target estimand), two, to facilitate decision-making by enabling reviewers to readily assess potential for biases related to these choices, and three, to facilitate reproducibility. STRATEGIES TO DISSEMINATE AND FACILITATE USE Recognizing that the impact of this harmonized template relies on uptake, we have outlined a plan to introduce and pilot the template with key international stakeholders over the next 2 years. CONCLUSION The HARmonized Protocol Template to Enhance Reproducibility (HARPER) helps to create a shared understanding of intended scientific decisions through a common text, tabular and visual structure. The template provides a set of core recommendations for clear and reproducible RWE study protocols and is intended to be used as a backbone throughout the research process from developing a valid study protocol, to registration, through implementation and reporting on those implementation decisions.
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Affiliation(s)
| | | | | | | | | | - Eric I Benchimol
- 1. Department of Paediatrics and Institute of Health Policy, Management and Evaluation, The Hospital for Sick Children, University of Toronto, Toronto, Canada,2. Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada,3. ICES, Toronto, Canada
| | | | | | - Wim Goettsch
- The National Health Care Institute, Diemen, and Utrecht University, Utrecht, the Netherlands
| | - Wei Hua
- US Food and Drug Administration
| | | | | | | | | | | | | | | | | | - Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia
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3
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Wang SV, Pottegård A, Crown W, Arlett P, Ashcroft DM, Benchimol EI, Berger ML, Crane G, Goettsch W, Hua W, Kabadi S, Kern DM, Kurz X, Langan S, Nonaka T, Orsini L, Perez-Gutthann S, Pinheiro S, Pratt N, Schneeweiss S, Toussi M, Williams RJ. HARmonized Protocol Template to Enhance Reproducibility of Hypothesis Evaluating Real-World Evidence Studies on Treatment Effects: A Good Practices Report of a Joint ISPE/ISPOR Task Force. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1663-1672. [PMID: 36241338 DOI: 10.1016/j.jval.2022.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Ambiguity in communication of key study parameters limits the utility of real-world evidence (RWE) studies in healthcare decision-making. Clear communication about data provenance, design, analysis, and implementation is needed. This would facilitate reproducibility, replication in independent data, and assessment of potential sources of bias. METHODS The International Society for Pharmacoepidemiology (ISPE) and ISPOR-The Professional Society for Health Economics and Outcomes Research (ISPOR) convened a joint task force, including representation from key international stakeholders, to create a harmonized protocol template for RWE studies that evaluate a treatment effect and are intended to inform decision-making. The template builds on existing efforts to improve transparency and incorporates recent insights regarding the level of detail needed to enable RWE study reproducibility. The over-arching principle was to reach for sufficient clarity regarding data, design, analysis, and implementation to achieve 3 main goals. One, to help investigators thoroughly consider, then document their choices and rationale for key study parameters that define the causal question (e.g., target estimand), two, to facilitate decision-making by enabling reviewers to readily assess potential for biases related to these choices, and three, to facilitate reproducibility. STRATEGIES TO DISSEMINATE AND FACILITATE USE Recognizing that the impact of this harmonized template relies on uptake, we have outlined a plan to introduce and pilot the template with key international stakeholders over the next 2 years. CONCLUSION The HARmonized Protocol Template to Enhance Reproducibility (HARPER) helps to create a shared understanding of intended scientific decisions through a common text, tabular and visual structure. The template provides a set of core recommendations for clear and reproducible RWE study protocols and is intended to be used as a backbone throughout the research process from developing a valid study protocol, to registration, through implementation and reporting on those implementation decisions.
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Affiliation(s)
- Shirley V Wang
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | | | | | | | | | - Eric I Benchimol
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Department of Paediatrics and Institute of Health Policy, Management and Evaluation, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Wim Goettsch
- The National Health Care Institute, Diemen, The Netherlands; Utrecht University, Utrecht, The Netherlands
| | - Wei Hua
- US Food and Drug Administration, Silver Springs, Maryland, USA
| | - Shaum Kabadi
- Sanofi-Aventis US LLC, North Potomac, Maryland, USA
| | - David M Kern
- Janssen Research & Development, LLC, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | - Simone Pinheiro
- US Food and Drug Administration, Silver Springs, Maryland, USA
| | - Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, South Australia, Australia
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4
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Sultana J, Crisafulli S, Almas M, Antonazzo IC, Baan E, Bartolini C, Bertuccio MP, Bonifazi F, Capuano A, Didio A, Ehrenstein V, Felisi M, Ferrajolo C, Fontana A, Francisca R, Fourrier-Reglat A, Fortuny J, Gini R, Hyeraci G, Hoeve C, Kontogiorgis C, Isgrò V, Lalagkas PN, L'Abbate L, Layton D, Landi A, Narduzzi S, Pereira LR, Poulentzas G, Rafaniello C, Roberto G, Scondotto G, Sportiello L, Toma M, Toussi M, Verhamme K, Volpe E, Trifirò G. Overview of the EU PAS register post-authorization studies performed in Europe from September 2010 to December 2018. Pharmacoepidemiol Drug Saf 2022; 31:689-705. [PMID: 35092329 PMCID: PMC9303697 DOI: 10.1002/pds.5413] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 12/09/2021] [Accepted: 01/24/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The European post-authorisation study (EU PAS) register is a repository launched in 2010 by the European Medicines Agency (EMA). All EMA-requested PAS, commonly observational studies, must be recorded in this register. Multi-database studies (MDS) leveraging secondary data have become an important strategy to conduct PAS in recent years, as reflected by the type of studies registered in the EU PAS register. OBJECTIVES To analyse and describe PAS in the EU PAS register, with focus on MDS. METHODS Studies in the EU PAS register from inception to 31st December 2018 were described concerning transparency, regulatory obligations, scope, study type (e.g. observational study, clinical trial, survey, systematic review/meta-analysis), study design, type of data collection and target population. MDS were defined as studies conducted through secondary use of >1 data source not linked at patient-level. Data extraction was carried out independently by 14 centres with expertise in pharmacoepidemiology, using publicly available information in the EU PAS register including study protocol, whenever available, using a standardised data collection form. For validation purposes, a second revision of key fields for a 15% random sample of studies was carried out by a different centre. The inter-rater reliability (IRR) was then calculated. Finally, to identify predictors of primary data collection-based studies /vs those based on secondary use of healthcare databases) or MDS (vs. non-MDS), odds ratios (OR) and 95% confidence intervals (CI) were calculated fitting univariate logistic regression models. RESULTS Overall, 1,426 studies were identified. Clinical trials (N=30; 2%), systematic reviews/meta-analyses (N=16; 1%) and miscellaneous study designs (N=46; 3%) were much less common than observational studies (N=1,227; 86%). The protocol was available for 63% (N=360) of 572 observational studies requested by a competent authority. Overall, 36% (N=446) of observational studies were based fully or partially on primary data collection. Of 757 observational studies based on secondary use of data alone, 282 (37%) were MDS. Drug utilisation was significantly more common as a study scope in MDS compared to non-MDS studies. The overall percentage agreement among collaborating centres that collected the data concerning study variables was highest for study type (93.5%) and lowest for type of secondary data (67.8%). CONCLUSIONS Observational studies were the most common type of studies in the EU PAS register, but 30% used primary data, which is more resource-intensive. Almost half of observational studies using secondary data were MDS. Data recording in the EU PAS register may be improved further, including more widespread availability of study protocols to improve transparency.
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Affiliation(s)
- Janet Sultana
- Pharmacy Department, Mater Dei Hospital, Malta.,Exeter College of Medicine and Health, Exeter
| | - Salvatore Crisafulli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Mariana Almas
- Real World Solutions Department, IQVIA, Lisbon, Portugal
| | - Ippazio Cosimo Antonazzo
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy.,Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Esme Baan
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Maria Paola Bertuccio
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Fedele Bonifazi
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Annalisa Capuano
- Department of Experimental Medicine, University of Campania "Vanvitelli", Naples, Italy.,Campania Regional Center of Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
| | - Antonella Didio
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mariagrazia Felisi
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,CVBF Consorzio per Valutazioni Biologiche e Farmacologiche, Pavia, Italy
| | - Carmen Ferrajolo
- Department of Experimental Medicine, University of Campania "Vanvitelli", Naples, Italy.,Campania Regional Center of Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Remy Francisca
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Annie Fourrier-Reglat
- Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, Team of Pharmacoepidemiology, UMR 1219, Bordeaux, France
| | | | - Rosa Gini
- Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Giulia Hyeraci
- Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Christel Hoeve
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Valentina Isgrò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Luca L'Abbate
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Deborah Layton
- Data Science Hub, Real World Solutions, IQVIA, London, United Kingdom
| | - Annalisa Landi
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Silvia Narduzzi
- Data Science Hub, Real World Solutions, IQVIA, London, United Kingdom
| | - Leonardo Roque Pereira
- University Medical Center Utrecht, Department of Datascience & Biostatistics, Utrecht, the Netherlands
| | | | - Concetta Rafaniello
- Department of Experimental Medicine, University of Campania "Vanvitelli", Naples, Italy.,Campania Regional Center of Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
| | | | - Giulia Scondotto
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Liberata Sportiello
- Department of Experimental Medicine, University of Campania "Vanvitelli", Naples, Italy.,Campania Regional Center of Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
| | - Maddalena Toma
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Massoud Toussi
- Data Science Hub, Real World Solutions, IQVIA, London, United Kingdom
| | - Katia Verhamme
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Elisabetta Volpe
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Wang SV, Pinheiro S, Hua W, Arlett P, Uyama Y, Berlin JA, Bartels DB, Kahler KH, Bessette LG, Schneeweiss S. STaRT-RWE: structured template for planning and reporting on the implementation of real world evidence studies. BMJ 2021; 372:m4856. [PMID: 33436424 PMCID: PMC8489282 DOI: 10.1136/bmj.m4856] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Shirley V Wang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Simone Pinheiro
- Division of Epidemiology, Office of Surveillance and Epidemiology, Food and Drug Administration, Silver Spring, MD, USA
| | - Wei Hua
- Division of Epidemiology, Office of Surveillance and Epidemiology, Food and Drug Administration, Silver Spring, MD, USA
| | - Peter Arlett
- Data Analytics and Methods Taskforce, European Medicines Agency, London, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Yoshiaki Uyama
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | | | | | | | - Lily G Bessette
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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6
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Kurz X, Arlett P, Eichler HG, Nolte A, Straus S, Rasi G. Increasing the impact of Post Authorisation Safety Studies: transparency is key. Eur J Intern Med 2021; 83:6-7. [PMID: 33277138 DOI: 10.1016/j.ejim.2020.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Xavier Kurz
- European Medicines Agency (EMA), Amsterdam, The Netherlands.
| | - Peter Arlett
- EMA, Amsterdam, The Netherlands and London School of Hygiene and Tropical Medicine, London, UK
| | - Hans-Georg Eichler
- EMA, Amsterdam, The Netherlands, and Medical University of Vienna, Vienna, Austria
| | - Alexis Nolte
- European Medicines Agency (EMA), Amsterdam, The Netherlands
| | - Sabine Straus
- Medicines Evaluation Board (MEB), Utrecht, The Netherlands and EMA Pharmacovigilance and Risk Assessment Committee (PRAC), Amsterdam, The Netherlands
| | - Guido Rasi
- EMA, Amsterdam, The Netherlands, and University Tor Vergata, Rome, Italy
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7
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Bollaerts K, de Smedt T, McGee C, Emborg HD, Villa M, Alexandridou M, Duarte-Salles T, Gini R, Bartolini C, de Lusignan S, Tin Tin Htar M, Titievsky L, Sturkenboom M, Bauchau V. ADVANCE: Towards near real-time monitoring of vaccination coverage, benefits and risks using European electronic health record databases. Vaccine 2020; 38 Suppl 2:B76-B83. [DOI: 10.1016/j.vaccine.2019.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/01/2019] [Accepted: 08/07/2019] [Indexed: 12/15/2022]
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8
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Gini R, Sturkenboom MCJ, Sultana J, Cave A, Landi A, Pacurariu A, Roberto G, Schink T, Candore G, Slattery J, Trifirò G. Different Strategies to Execute Multi-Database Studies for Medicines Surveillance in Real-World Setting: A Reflection on the European Model. Clin Pharmacol Ther 2020; 108:228-235. [PMID: 32243569 PMCID: PMC7484985 DOI: 10.1002/cpt.1833] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/13/2020] [Indexed: 12/18/2022]
Abstract
Although postmarketing studies conducted in population‐based databases often contain information on patients in the order of millions, they can still be underpowered if outcomes or exposure of interest is rare, or the interest is in subgroup effects. Combining several databases might provide the statistical power needed. A multi‐database study (MDS) uses at least two healthcare databases, which are not linked with each other at an individual person level, with analyses carried out in parallel across each database applying a common study protocol. Although many MDSs have been performed in Europe in the past 10 years, there is a lack of clarity on the peculiarities and implications of the existing strategies to conduct them. In this review, we identify four strategies to execute MDSs, classified according to specific choices in the execution: (A) local analyses, where data are extracted and analyzed locally, with programs developed by each site; (B) sharing of raw data, where raw data are locally extracted and transferred without analysis to a central partner, where all the data are pooled and analyzed; (C) use of a common data model with study‐specific data, where study‐specific data are locally extracted, loaded into a common data model, and processed locally with centrally developed programs; and (D) use of general common data model, where all local data are extracted and loaded into a common data model, prior to and independent of any study protocol, and protocols are incorporated in centrally developed programs that run locally. We illustrate differences between strategies and analyze potential implications.
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Affiliation(s)
- Rona Gini
- Agenzia regionale di sanità della Toscana, Florence, Italy
| | | | | | - Alison Cave
- European Medicines Agency, Amsterdam, The Netherlands
| | - Annalisa Landi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano, Italy.,Teddy European Network of Excellence for Paediatric Clinical Research, Pavia, Italy
| | | | | | - Tania Schink
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | | | - Jim Slattery
- European Medicines Agency, Amsterdam, The Netherlands
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Università di Messina, Messina, Italy
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Gini R, Fournie X, Dolk H, Kurz X, Verpillat P, Simondon F, Strassmann V, Apostolidis K, Goedecke T. The ENCePP Code of Conduct: A best practise for scientific independence and transparency in noninterventional postauthorisation studies. Pharmacoepidemiol Drug Saf 2019; 28:422-433. [PMID: 30838708 PMCID: PMC6594014 DOI: 10.1002/pds.4763] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/08/2019] [Accepted: 02/12/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The ENCePP Code of Conduct provides a framework for scientifically independent and transparent pharmacoepidemiological research. Despite becoming a landmark reference, practical implementation of key provisions was still limited. The fourth revision defines scientific independence and clarifies uncertainties on the applicability to postauthorisation safety studies requested by regulators. To separate the influence of the funder from the investigator's scientific responsibility, the Code now requires that the lead investigator is not employed by the funding institution. METHOD To assess how the revised Code fits the ecosystem of noninterventional pharmacoepidemiology research in Europe, we first mapped key recommendations of the revised Code against ISPE Good Pharmacoepidemiology Practices and the ADVANCE Code of Conduct. We surveyed stakeholders to understand perceptions on its value and practical applicability. Representatives from the different stakeholders' groups described their experience and expectations. RESULTS Unmet needs in pharmacoepidemiological research are fulfilled by providing unique guidance on roles and responsibilities to support scientific independence. The principles of scientific independence and transparency are well understood and reinforce trust in study results; however, around 70% of survey respondents still found some provisions difficult to apply. Representatives from stakeholders' groups found the new version promising, although limitations still exist. CONCLUSION By clarifying definitions and roles, the latest revision of the Code sets a new standard in the relationship between investigators and funders to support scientific independence of pharmacoepidemiological research. Disseminating and training on the provisions of the Code would help stakeholders to better understand its advantages and promote its adoption in noninterventional research.
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Affiliation(s)
- Rosa Gini
- Osservatorio di EpidemiologiaAgenzia regionale di sanità della ToscanaFlorenceItaly
| | - Xavier Fournie
- Global Medical AffairsICON Commercialisation & OutcomesLyonFrance
| | - Helen Dolk
- Faculty of Life and Health SciencesUniversity of Ulster at JordanstownJordanstownUK
| | - Xavier Kurz
- Pharmacovigilance and Epidemiology Department, Inspections, Human Medicines Pharmacovigilance and Committees DivisionEuropean Medicines AgencyAmsterdamThe Netherlands
| | | | - François Simondon
- Mother and Child Health Research Unit IRDUniversite Paris DescartesParisFrance
| | - Valerie Strassmann
- PharmacovigilanzBundesinstitut für Arzneimittel und Medizinprodukte (BfArM)BonnGermany
| | - Kathi Apostolidis
- Vice PresidentEuropean Cancer Patient Coalition (ECPC)BrusselsBelgium
| | - Thomas Goedecke
- Pharmacovigilance and Epidemiology Department, Inspections, Human Medicines Pharmacovigilance and Committees DivisionEuropean Medicines AgencyAmsterdamThe Netherlands
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