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Zuo W, Sun Y, Liu R, Du L, Yang N, Sun W, Wang P, Tang X, Liu Y, Ma Y, Meng M, Lei R, Yan X, Peng H, Chang Q, Pan H, Zhang B, Chen Y, Zhang S. Management guideline for the off-label use of medicine in China (2021). Expert Rev Clin Pharmacol 2022; 15:1253-1268. [PMID: 36047057 DOI: 10.1080/17512433.2022.2120468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Off-label drug use embodies a thorough clinical diagnosis and evaluation of treatment needs and should not be confused with unreasonable drug use, but it also faces potential risks with drug safety and legal issues. RESEARCH DESIGN AND METHODS We first established a guideline working group. Following the guideline development process recommended by the World Health Organization Handbook and the Chinese Medical Association, the key questions were determined through literature searches of PubMed, CNKI (Chinese National Knowledge Infrastructure) and other databases. Both the evidence and the clinicians' diagnosis and treatment workload were considered to formulate the initial recommendations. Finally, two rounds of Delphi surveys and one expert seminar were organized to determine the final recommendations of this guideline. Meanwhile, we graded the recommendations based on the body of evidence. RESULTS We determined nine questions and proposed a total of 23 recommendations regarding the definition of off-label use of drugs, applicable circumstances, classification of evidence, informed consent, legal basis, adverse drug reaction monitoring and evaluation, management procedure, responsibilities and obligations of different stakeholders, medical insurance reimbursement, and the national approval system. CONCLUSIONS This guideline standardized clinical off-label drug use and provided suggestions and references for the management of off-label drug use.
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Affiliation(s)
- Wei Zuo
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, 100730 China.,These authors are the first authors and contributed equally
| | - Yajia Sun
- School of Public Health, Lanzhou University, Lanzhou 730000, China.,Institute of Health Data Science, Lanzhou University, Lanzhou 730000, China.,These authors are the first authors and contributed equally
| | - Rongji Liu
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, 100730 China.,These authors are the first authors and contributed equally
| | - Liping Du
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, 100730 China
| | - Nan Yang
- Institute of Health Data Science, Lanzhou University, Lanzhou 730000, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Wenjuan Sun
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, 100730 China
| | - Ping Wang
- Institute of Health Data Science, Lanzhou University, Lanzhou 730000, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Xiaowan Tang
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, 100730 China
| | - Yunlan Liu
- School of Public Health, Lanzhou University, Lanzhou 730000, China.,Institute of Health Data Science, Lanzhou University, Lanzhou 730000, China
| | - Yuanyuan Ma
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, 100730 China
| | - Min Meng
- Department of Chevidence Lab Child & Adolescent Health, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.,Gansu Provincial Hospital, Lanzhou 730000, China
| | - Ruobing Lei
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.,Chevidence Lab Child & Adolescent Health, Department of Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Xuelian Yan
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, 100730 China
| | - Hua Peng
- Department of Medical Administration, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, 100730, China
| | - Qing Chang
- Department of Medical Administration, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, 100730, China
| | - Hui Pan
- Department of Medical Administration, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, 100730, China
| | - Bo Zhang
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, 100730 China
| | - Yaolong Chen
- School of Public Health, Lanzhou University, Lanzhou 730000, China.,Institute of Health Data Science, Lanzhou University, Lanzhou 730000, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China.,Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Shuyang Zhang
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
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Shen S, Yang J, Chen Y, Xie J, Huang Y, Lin W, Liao Y. Off-label indications of aspirin in gynaecology and obstetrics outpatients at two Chinese tertiary care hospitals: a retrospective cross-sectional study. BMJ Open 2022; 12:e050702. [PMID: 35190417 PMCID: PMC8860038 DOI: 10.1136/bmjopen-2021-050702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of off-label aspirin indications and the level of scientific support for off-label indications of aspirin in gynaecology and obstetrics outpatients. DESIGN A retrospective cross-sectional study. SETTING Two tertiary hospitals (a general hospital and a women and children's specialised hospital) in Xiamen, a city located on the southeastern coast of China. PARTICIPANTS A total of 4257 prescriptions were included for 2091 female patients aged >18 who visited the gynaecology and obstetrics outpatient clinics and received aspirin treatment. OUTCOME MEASURES The primary measure of this study was the proportion of off-label indications and of off-label indications supported by strong scientific evidence. Evidence from clinical guidelines and Micromedex is shown using descriptive statements. On-label indications of drugs in the same class as aspirin were also referred to for off-label aspirin use without strong evidence support. RESULTS All indications of aspirin on outpatient prescriptions were determined as off-label use in this study. The most frequent off-label indication was recurrent miscarriage (2244 prescriptions, 52.71%). Totally, 30.94% of the prescriptions were supported by strong evidence for indications, including recurrent miscarriage with antiphospholipid syndrome and prophylaxis for pre-eclampsia. No drugs in the same class as aspirin had on-label indications for off-label aspirin use without strong evidence support. CONCLUSIONS This study demonstrated that all indications of aspirin used in gynaecology and obstetrics outpatients at the two tertiary hospitals were off-label and not always supported by strong evidence, implicating that physicians should be cautious when issuing off-label prescriptions. More original clinical research on off-label aspirin use is needed to provide reference for routine clinical practice.
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Affiliation(s)
- Sijie Shen
- Department of Pharmacy, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Jianhui Yang
- Department of Pharmacy, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yao Chen
- Department of Pharmacy, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Jingxian Xie
- Department of Obstetrics, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yanni Huang
- Department of Gynaecology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Wubin Lin
- Department of Pharmacy, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yufang Liao
- Department of Pharmacy, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
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