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Regan AK, Fell DB, Wise LA, Vazquez-Benitez G, Håberg SE, Ogar C, Yland JJ, Wesselink AK, Zerbo O. Challenges & opportunities for the epidemiological evaluation of the effects of COVID-19 vaccination on reproduction and pregnancy. Vaccine 2023; 41:5931-5935. [PMID: 37659894 DOI: 10.1016/j.vaccine.2023.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 07/12/2023] [Accepted: 08/14/2023] [Indexed: 09/04/2023]
Affiliation(s)
- Annette K Regan
- School of Nursing and Health Professions, University of San Francisco, Orange, CA, United States; Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States.
| | - Deshayne B Fell
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Lauren A Wise
- Boston University School of Public Health, Boston, MA, United States
| | | | - Siri E Håberg
- Centre for Fertility and Health, The Norwegian Institute of Public Health, Oslo, Norway
| | - Comfort Ogar
- Brighton Collaboration, A Program of the Task Force for Global Health, Decatur, GA, United States
| | - Jennifer J Yland
- Boston University School of Public Health, Boston, MA, United States
| | | | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, United States
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2
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Zondi S, Naidoo P. Perceptions, practices and barriers to reporting of adverse drug reactions among HIV infected patients and their doctors in 3 public sector hospitals of the Ethekwini Metropolitan, Kwa-Zulu Natal: a cross sectional and retrospective analysis. BMC Health Serv Res 2022; 22:1054. [PMID: 35982442 PMCID: PMC9389709 DOI: 10.1186/s12913-022-08395-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 07/29/2022] [Indexed: 11/19/2022] Open
Abstract
Background Adverse drug reactions (ADRs) remain a global public health concern. Pharmacovigilance practises are essential in ensuring patients safety and post drug marketing surveillance. This study aimed to describe practices, perceptions and barriers towards ADR reporting practices amongst People Living with HIV/AIDS (PLWHA), who are on Highly Active Anti-Retroviral Therapy (HAART) and their doctors. Methods The study took place at 3 public sector hospitals. The first phase of the study was a quantitative cross-sectional study using a closed ended questionnaire that was given to PLWHA. Phase two was a retrospective analysis of these patients’ medical files, whilst phase 3 included a descriptive statistics to determine the frequencies and percentages for variables such as ADR reporting practices by doctors. Results Spontaneous reporting, was evident with 202 patients (48%) indicating that they reported experiencing ADRs to their doctors. Ten doctors (77%) indicated that they received PV training. Eight (62%) doctors indicated that the completed ADR reporting forms were submitted to the pharmacy manager in the hospital for forwarding to the regulatory authority, with 2 (15%) indicating that they submitted directly to the South African Health Products Regulatory Authority. Four (31%) doctors stated that the system of reporting ADRs is ineffective with the majority of the doctors 12 (92%) responding that the reporting of ADRs is very important/critical. A barrier cited by 4 patients (0.9%) for non-reporting of their ADRs was transport cost. Whilst doctors' barriers included reporting being time consuming (31%), and a lack of availability of reporting forms (31%). Conclusion Patients and doctors are reporting ADRs but more education and easier reporting process should be available to strengthen the knowledge and reporting of ADRs. Doctors agree that it is critical to report ADRs. Electronic reporting should be encouraged to lessen the time it takes to report ADRs.
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Affiliation(s)
- Sindiswa Zondi
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of Kwa-Zulu Natal, P.O. Box X5401, Durban, 4000, South Africa.
| | - Panjasaram Naidoo
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of Kwa-Zulu Natal, P.O. Box X5401, Durban, 4000, South Africa
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3
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Zhurkin D, Gurbanova E, Campbell JR, Menzies D, Setkina S, Hurevich H, Solodovnikova V, Viatushka D, Altraja A, Skrahina A. Safety of prolonged treatment with bedaquiline in programmatic conditions. ERJ Open Res 2022; 8:00685-2021. [PMID: 35586446 PMCID: PMC9108964 DOI: 10.1183/23120541.00685-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/17/2022] [Indexed: 11/05/2022] Open
Abstract
Bedaquiline is now considered a first-line medicine for treatment of rifampicin-resistant tuberculosis (RR-TB). We evaluated the safety of treatment with bedaquiline for longer than 190 days in individuals with RR-TB under programmatic conditions. In a prospective cohort study enrolling pulmonary RR-TB patients, we initiated bedaquiline-based treatment at a tertiary hospital in Belarus. We defined standard bedaquiline use as <190 days and prolonged as ≥190 days. We recorded adverse events (AEs) and classified their seriousness and relation to bedaquiline. Our primary outcome in regression analyses was the incidence of serious AEs occurring within 5 months of bedaquiline cessation. We used generalised estimating equations to estimate the adjusted incidence rate ratio (aIRR) of serious AEs between the prolonged and standard bedaquiline groups. We enrolled 113 patients, 83 (73%) of whom received standard and 30 (27%) received prolonged treatment. A total of 2030 AEs occurred during treatment. Of these, 63 (3.1%) were serious AEs occurring within 5 months of bedaquiline cessation; QTcF prolongation was the most common bedaquiline-related serious AE. The incidence of serious AEs per 100 person-months was 5.4 (3.9 to 7.2) in the standard group and 4.4 (2.6 to 7.0) in the prolonged group. In adjusted analyses, serious AEs were no different (aIRR: 0.82, 95% CI 0.42–1.61) in the prolonged group. One patient in the standard bedaquiline group died of acute cardiopulmonary failure deemed possibly related to bedaquiline. Prolonged use of bedaquiline under programmatic conditions appears safe. Clinicians should carefully monitor QTcF interval since its prolongation was commonly observed. This study demonstrated that prolonged use of bedaquiline under programmatic conditions appears to be safe. However, clinicians should carefully monitor QTcF interval throughout treatment with bedaquiline due to proven risk of QTcF prolongation.https://bit.ly/36UHHc3
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Iessa N, Macolic Sarinic V, Ghazaryan L, Romanova N, Alemu A, Rungapiromnan W, Jiamsuchon P, Pokhagul P, Castro JL, Macias Saint-Gerons D, Ghukasyan G, Teferi M, Gupta M, Pal SN. Smart Safety Surveillance (3S): Multi-Country Experience of Implementing the 3S Concepts and Principles. Drug Saf 2021; 44:1085-1098. [PMID: 34331675 PMCID: PMC8325038 DOI: 10.1007/s40264-021-01100-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2021] [Indexed: 11/29/2022]
Abstract
Introduction The Smart Safety Surveillance (3S) concept is based on the understanding that, when faced with competing pharmacovigilance priorities, countries will have to invest judiciously, by focusing on new priority products, sharing work and resources with other countries when possible and building national competence for those activities that cannot be delegated. Method The 3S principles were applied to Armenia, Brazil, Ethiopia, India, Peru and Thailand using three priority products: bedaquiline, rotavirus vaccine and tafenoquine. A baseline assessment of pharmacovigilance preparedness was used to identify gaps and establish a work plan. The impact was measured by comparing pre and post 3S-intervention outcomes, which included the number and quality of reports (completeness scores) in the WHO global database of Individual Case Safety Reports, VigiBase, and number of structural indicators met. The implementation period was 9–18 months, ranging from March 2018 (earliest started) until May 2020 (latest). Result An increase in adverse drug reaction (ADR) reporting was demonstrated in Armenia (bedaquiline), Brazil (TB and malaria medicines), India (rotavirus vaccine) and Ethiopia (TB medicines). Completeness scores were above 0.5 at baseline in all countries, and reports improved in quality for Brazil (TB), Peru (malaria), Thailand (malaria) and India (immunization). The number of structural indicators met increased by more than double for Ethiopia. Ethiopia and India demonstrated an increased capacity for signal detection and signal evaluation. Armenia, Brazil, Peru and Thailand showed increased capacity to assess risk management plans following the implementation of 3S principles. Conclusion The 3S concept has demonstrated success in different ways across the six countries. Activities focused on three products for a proof of concept of the 3S principles, with the expectation that the project impact will be sustained through strengthened systems, to guide pharmacovigilance activities of other products in the future. It is important to continue monitoring the countries to understand if the gains and successes of the current 3S project are sustainable. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-021-01100-z.
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Affiliation(s)
- Noha Iessa
- World Health Organization Headquarters, Geneva, Switzerland
| | | | - Lilit Ghazaryan
- Scientific Centre of Drug and Medical Technology Expertise of MoH, Yerevan, Armenia
| | - Naira Romanova
- Scientific Centre of Drug and Medical Technology Expertise of MoH, Yerevan, Armenia
| | - Asnakech Alemu
- Ethiopian Food and Drug Administration, Addis Ababa, Ethiopia
| | | | - Porntip Jiamsuchon
- Ministry of Public Health, Thai Food and Drug Administration, Nonthaburi, Thailand
| | - Pattreya Pokhagul
- Ministry of Public Health, Thai Food and Drug Administration, Nonthaburi, Thailand
| | | | | | | | | | | | - Shanthi Narayan Pal
- World Health Organization Headquarters, 20 Avenue Appia, 1202, Geneva, Switzerland.
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Osborne V, Lane S, Shakir SAW. The Role of the Contextual Cohort to Resolve Some Challenges and Limitations of Comparisons in Pharmacoepidemiology. Drug Saf 2021; 44:835-841. [PMID: 33961212 PMCID: PMC8279980 DOI: 10.1007/s40264-021-01074-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 12/12/2022]
Abstract
In pharmacoepidemiology, comparison studies can provide a useful estimate of the level of increased or decreased risk of specific events with a medication (through a measure of effect). A key focus of pharmacoepidemiological studies is the safety and effectiveness of medicines in their real-world use, and adequate comparisons of effect estimates are critical. However, consideration of guidelines, pharmacoeconomic assessments, and policies for reimbursement have made comparisons in pharmacoepidemiological studies far more difficult to conduct in recent years. Where certain subject characteristics influence the probability of being exposed to a treatment, this can introduce issues of selection bias and confounding. Methodologies are available to minimise selection bias (through case-only and randomised study designs) and deal with confounding (such as regression modelling or propensity score matching methods), however these each have their own limitations. Where prescribing guidelines are present, conducting comparisons in pharmacoepidemiology produces many challenges and not all of these can be easily overcome. Patient channelling can be more frequent with adherence to clinical guidelines compared with when prescribing decisions by doctors are based predominantly on their clinical judgement. Use of a contextual cohort could be considered as an option to characterise the adoption of new medications into clinical practice and describe the prevalence of clinical characteristics and risk factors in the two cohorts, rather than compare event rates and produce an estimate of effect.
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Affiliation(s)
- Vicki Osborne
- Drug Safety Research Unit, Bursledon Hall, Blundell Lane, Southampton, SO31 1AA, UK. .,School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK.
| | - Samantha Lane
- Drug Safety Research Unit, Bursledon Hall, Blundell Lane, Southampton, SO31 1AA, UK.,School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Saad A W Shakir
- Drug Safety Research Unit, Bursledon Hall, Blundell Lane, Southampton, SO31 1AA, UK.,School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
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The 2011–2020 Trends of Data-Driven Approaches in Medical Informatics for Active Pharmacovigilance. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11052249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Pharmacovigilance, the scientific discipline pertaining to drug safety, has been studied extensively and is progressing continuously. In this field, medical informatics techniques and interpretation play important roles, and appropriate approaches are required. In this study, we investigated and analyzed the trends of pharmacovigilance systems, especially the data collection, detection, assessment, and monitoring processes. We used PubMed to collect papers on pharmacovigilance published over the past 10 years, and analyzed a total of 40 significant papers to determine the characteristics of the databases and data analysis methods used to identify drug safety indicators. Through systematic reviews, we identified the difficulty of standardizing data and terminology and establishing an adverse drug reactions (ADR) evaluation system in pharmacovigilance, and their corresponding implications. We found that appropriate methods and guidelines for active pharmacovigilance using medical big data are still required and should continue to be developed.
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Evans A, Davies M, Osborne V, Roy D, Shakir S. Evaluation of the incidence of bleeding in patients prescribed rivaroxaban for the treatment and prevention of deep vein thrombosis and pulmonary embolism in UK secondary care: an observational cohort study. BMJ Open 2020; 10:e038102. [PMID: 33148732 PMCID: PMC7640735 DOI: 10.1136/bmjopen-2020-038102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To evaluate the short-term (12 weeks) safety and utilisation of rivaroxaban prescribed to new-user adult patients for the treatment of deep vein thrombosis and pulmonary embolism and for the prevention of recurrent deep vein thrombosis and pulmonary embolism in a secondary care setting in England and Wales. DESIGN An observational cohort study using the technique of Specialist Cohort Event Monitoring. SETTING The Rivaroxaban Observational Safety Evaluation study was conducted across 87 participating National Health Service secondary care trusts in England and Wales. PARTICIPANTS 1532 patients treated with rivaroxaban for the prevention and treatment of deep vein thrombosis/pulmonary embolism from September 2013 to January 2016. INTERVENTIONS Non-interventional postauthorisation safety study of rivaroxaban. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Risk of major bleeding in gastrointestinal, intracranial, and urogenital sites and (2) risk of all major and clinically relevant non-major bleeds. RESULTS Of a total of 4846 patients enrolled in the study from September 2013 to January 2016, 1532 were treated with rivaroxaban for the prevention and treatment of deep vein thrombosis/pulmonary embolism. The median age of the deep vein thrombosis/pulmonary embolism cohort was 63 years, and 54.6% were men. The risk of major bleeding within the gastrointestinal, urogenital and intracranial primary sites was 0.7% (n=11), 0.3% (n=5) and 0.1% (n=1), respectively. The risk of major bleeding in all sites was 1.5% (n=23) at a rate of 8.3 events per 100 patient-years. CONCLUSIONS In terms of the primary outcome risk of major bleeding in gastrointestinal, intracranial and urogenital sites, the risk estimates in the population using rivaroxaban for deep vein thrombosis/pulmonary embolism were low (<1%) and consistent with the risk estimated from clinical trial data and in routine clinical practice. TRIAL REGISTRATION NUMBERS ClinicalTrials.gov Registry (NCT01871194); ENCePP Registry (EUPAS3979).
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Affiliation(s)
- Alison Evans
- Drug Safety Research Unit, Southampton, UK
- University of Portsmouth, Portsmouth, UK
| | - Miranda Davies
- Drug Safety Research Unit, Southampton, UK
- University of Portsmouth, Portsmouth, UK
| | - Vicki Osborne
- Drug Safety Research Unit, Southampton, UK
- University of Portsmouth, Portsmouth, UK
| | - Debabrata Roy
- Drug Safety Research Unit, Southampton, UK
- University of Portsmouth, Portsmouth, UK
| | - Saad Shakir
- Drug Safety Research Unit, Southampton, UK
- University of Portsmouth, Portsmouth, UK
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8
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Evans A, Davies M, Osborne V, Roy D, Shakir S. Incidence of major and clinically relevant non-major bleeding in patients prescribed rivaroxaban for stroke prevention in non-valvular atrial fibrillation in secondary care: Results from the Rivaroxaban Observational Safety Evaluation (ROSE) study. PLoS One 2020; 15:e0240489. [PMID: 33035259 PMCID: PMC7546486 DOI: 10.1371/journal.pone.0240489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/25/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Although the direct oral anticoagulant rivaroxaban is recommended for stroke prevention in patients with non-valvular atrial fibrillation based on Phase III clinical trials, there is still a need for additional safety data from everyday clinical practice. The ROSE study was initiated to collect further information on the safety and utilisation of rivaroxaban in a broader range of patient groups in routine clinical practice. METHODS AND RESULTS The ROSE study was conducted in hospitals in England and Wales. Consenting adults with non-valvular atrial fibrillation newly started on rivaroxaban were eligible and followed up for 12 weeks. Data was derived through secondary use of medical records. The primary outcome was major bleeding within gastrointestinal, urogenital and intracranial sites. A total of 4846 patients were enrolled in the study September 2013 to January 2016, 965 of which were treated with rivaroxaban for non-valvular atrial fibrillation. The median age in the rivaroxaban non-valvular atrial fibrillation cohort was 76 years, 53.6% were male. The median HAS-BLED score was 2 and the median CHA2DS2-VASc score was 4. The risk of major bleeding within each of the primary sites of gastrointestinal, urogenital and intracranial during the 12 week observation period was low (0.2%; n = 2). The risk of major bleeding in all sites was 1.0% (n = 10) at a rate of 5.5 events per 100 patient years. CONCLUSION In terms of the primary outcome risk of major bleeding within gastrointestinal, urogenital and intracranial sites during the 12 week observation period, the risk estimates in the non-valvular atrial fibrillation rivaroxaban user population were low (<1%), and consistent with risk estimated from clinical trial data and in routine clinical practice.
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Affiliation(s)
- Alison Evans
- Drug Safety Research Unit, Southampton, United Kingdom
- University of Portsmouth, Portsmouth, United Kingdom
- * E-mail:
| | - Miranda Davies
- Drug Safety Research Unit, Southampton, United Kingdom
- University of Portsmouth, Portsmouth, United Kingdom
| | - Vicki Osborne
- Drug Safety Research Unit, Southampton, United Kingdom
- University of Portsmouth, Portsmouth, United Kingdom
| | - Debabrata Roy
- Drug Safety Research Unit, Southampton, United Kingdom
- University of Portsmouth, Portsmouth, United Kingdom
| | - Saad Shakir
- Drug Safety Research Unit, Southampton, United Kingdom
- University of Portsmouth, Portsmouth, United Kingdom
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García-Rodríguez LA, Wallander MA, Friberg L, Ruigomez A, Schink T, Bezemer I, Herings R, Shakir S, Evans A, Davies M, Suzart-Woischnik K, Vora P, Balabanova Y, Soriano-Gabarró M, Brobert G. Rationale and design of a European epidemiological post-authorization safety study (PASS) program: rivaroxaban use in routine clinical practice. Expert Opin Drug Saf 2020; 19:1513-1520. [PMID: 32700977 DOI: 10.1080/14740338.2020.1798928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rivaroxaban is a highly selective factor Xa inhibitor approved for use in Europe for multiple indications. STUDY DESIGN AND METHODS The European rivaroxaban epidemiological post-authorization safety study (PASS) program consists of seven complementary observational studies. For four of the studies, data are obtained from health-care databases in the UK, the Netherlands, Germany, and Sweden. These database studies describe patterns of rivaroxaban use and patient characteristics over time, and investigate safety and effectiveness outcomes in new users of rivaroxaban using a cohort analysis and nested case-control analysis. To put these results in context, safety outcomes are also analyzed in new users of standard of care. In addition, a modified prescription event monitoring study conducted in the early post-launch phase in primary care, and two specialist cohort event monitoring studies that investigated rivaroxaban use in the secondary care hospital setting, systematically collected drug utilization and safety data via questionnaires completed by health-care professionals in the UK. DISCUSSION The European rivaroxaban epidemiological PASS is a comprehensive program of complementary studies generating evidence from patients treated in routine clinical practice that will expand our understanding of the risk-benefit profile of rivaroxaban.
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Affiliation(s)
| | - Mari-Ann Wallander
- Department of Public Health and Caring Sciences, Uppsala University , Uppsala, Sweden
| | | | - Ana Ruigomez
- Spanish Centre for Pharmacoepidemiologic Research (CEIFE) , Madrid, Spain
| | - Tania Schink
- Leibniz Institute for Prevention Research and Epidemiology - BIPS , Bremen, Germany
| | - Irene Bezemer
- PHARMO Institute for Drug Outcomes Research , Utrecht, Netherlands
| | - Ron Herings
- PHARMO Institute for Drug Outcomes Research , Utrecht, Netherlands
| | - Saad Shakir
- Drug Safety Research Unit (DSRU) , Southampton, UK
| | - Alison Evans
- Drug Safety Research Unit (DSRU) , Southampton, UK
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Torre C, Cary M, Borges FC, Ferreira PS, Alarcão J, Leufkens HG, Costa J, Martins AP. Intensive Monitoring Studies for Assessing Medicines: A Systematic Review. Front Med (Lausanne) 2019; 6:147. [PMID: 31380375 PMCID: PMC6659411 DOI: 10.3389/fmed.2019.00147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 06/12/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction: Intensive monitoring (IM) is one of the methods of post-marketing active surveillance based upon event monitoring, which has received interest in the current medicines regulatory landscape. For a specific period of time, IM involves primary data collection and is actively focused on gathering longitudinal information, mainly safety, since the first day of drug use. Objectives: To describe IM systems and studies' data published over 11-years period (2006–2016). Specifically, we reviewed study population/event surveillance, methodological approaches, limitations, and its applications in the real-world evidence generation data. Methods: We completed a systematic search of MEDLINE and EMBASE to identify studies published from 2006 to 2016, that used IM methodology. We extracted data using a standardized form and results were analyzed descriptively. The methodological quality of selected studies was assessed using the modified Downs and Black checklist. Results: From 1,400 screened citations, we identified 86 papers, corresponding to 69 different studies. Seventy percent of reviewed studies corresponded to established IM systems, of which, more than half were prescription event monitoring (PEM) and modified-PEM. Among non-established IM systems, vaccines were the most common studied drugs (n = 14). The median cohort size ranged from 488 (hospitals) to 10,479 (PEM) patients. Patients and caregivers were the event data source in 39.1% of studies. The mean overall quality score was similar between established and non-established IM. Conclusions: Over the study period, IM studies were implemented in 26 countries with different maturity levels of post-marketing surveillance systems. We identified two major limitations: only 20% of studies were conducted at hospital-level, which is a matter of concern, insofar as healthcare systems are facing a lack of access to new medicines at ambulatory care level. Additionally, IM access to data of drug exposure cohorts, either at identification or at follow-up stages, could somehow constitute a barrier, given the complexity of managerial, linkable, and privacy data issues.
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Affiliation(s)
- Carla Torre
- Centre for Health Evaluation and Research (CEFAR), National Association of Pharmacies, Lisbon, Portugal.,Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Maria Cary
- Centre for Health Evaluation and Research (CEFAR), National Association of Pharmacies, Lisbon, Portugal
| | - Fábio Cardoso Borges
- Department of Epidemiology and National Cancer Registry (RON), Portuguese Institute of Oncology, Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Paula S Ferreira
- Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal.,Setubal and Santarem Regional Pharmacovigilance Unit, Lisbon, Portugal
| | - Joana Alarcão
- Faculty of Medicine, Center for Evidence-Based Medicine, University of Lisbon, Lisbon, Portugal
| | - Hubert G Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - João Costa
- Faculty of Medicine, Center for Evidence-Based Medicine, University of Lisbon, Lisbon, Portugal.,Faculty of Medicine, Institute of Molecular Medicine and Laboratory of Clinical Pharmacology and Therapeutics, University of Lisbon, Lisbon, Portugal
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'Engagement' of patients and healthcare professionals in regulatory pharmacovigilance: establishing a conceptual and methodological framework. Eur J Clin Pharmacol 2019; 75:1181-1192. [PMID: 31240364 DOI: 10.1007/s00228-019-02705-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/04/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Engagement of patients and healthcare professionals is increasingly considered as fundamental to pharmacovigilance and risk minimisation activities. Few empirical studies of engagement exist and a lack of explicit conceptualisations impedes effective measurement, research and the development of evidence-based engagement interventions. AIMS This article (1) develops a widely applicable conceptualisation, (2) considers various methodological challenges to researching engagement, proposing some solutions, and (3) outlines a basis for converting the conceptualisation into specific measures and indicators of engagement among stakeholders. METHOD We synthesise social science work on risk governance and public understandings of science with insights from studies in the pharmacovigilance field. FINDINGS This leads us to define engagement as an ongoing process of knowledge exchange among stakeholders, with the adoption of this knowledge as the outcome which may feed back into engagement processes over time. We conceptualise this process via three dimensions; breadth, depth and texture. In addressing challenges to capturing each dimension, we emphasise the importance of combining survey approaches with qualitative studies and secondary data on medicines use, prescribing, adverse reaction reporting and health outcomes. A framework for evaluating engagement intervention processes and outcomes is proposed. Alongside measuring engagement via breadth and depth, we highlight the need to research the engagement process through attentiveness to texture-what engagement feels like, what it means to people, and how this shapes motivations based on values, emotions, trust and rationales. CONCLUSION Capturing all three dimensions of engagement is vital to develop valid understandings of what works and why, thus informing engagement interventions of patients and healthcare professionals to given regulatory pharmacovigilance scenarios.
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12
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Mendes D, Rigueiro G, Silva RS, Penedones A, Alves C, Sousa G, Batel-Marques F. Intensive safety monitoring program of antineoplastic medicines: A pilot study in a Portuguese oncology hospital. J Oncol Pharm Pract 2019; 26:133-140. [PMID: 31117914 DOI: 10.1177/1078155219849277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of this study was to test the feasibility and the usefulness of an intensive safety monitoring program to identify adverse drug reactions for medicines under additional monitoring that are used to treat cancer patients within a Portuguese oncology hospital. METHODS This pilot intensive safety monitoring program was a three-month prospective, observational study. Patients undergoing treatment with one of the following medicines were included: nivolumab, olaparib, palbociclib, pembrolizumab, pertuzumab, ramucirumab, ribociclib, trastuzumab emtansine, or trifluridine/tipiracil. Potential eligible patients were identified by pharmacists based on prescription data. Clinicians used proper paper-based reporting forms to record adverse drug reactions. Clinical secretariats sent those reports through an electronic platform to the pharmacovigilance department for analysis. RESULTS Seventy-five patients were on treatment with selected medicines. Of those, 33 (44%) experienced adverse drug reactions: 23 (69.7%) cases were serious and 5 (15.2%) unexpected. Considering the number of patients exposed to each medicine and the number of patients experiencing adverse drug reactions, trifluridine/tipiracil (72.7%; 8/11) was associated with the highest rate of toxicity, followed by olaparib (66.7%; 2/3), trastuzumab emtansine (50.0%; 3/6), pertuzumab (47.8%; 11/23), pembrolizumab (45.5%; 5/11), palbociclib (25.0%; 1/4), and nivolumab (18.8%; 3/16). A total of 59 adverse drug reactions were identified (i.e. 1.8 adverse drug reactions/patient), mainly gastrointestinal disorders (n = 15; 25.4%), and blood and lymphatic system disorders (n = 14; 23.7%). CONCLUSION This intensive safety monitoring program was feasible and allowed identifying serious and unexpected adverse drug reactions, adding value to pharmacovigilance and therefore contributing to improve patient safety. Further research is needed to confirm the findings of this pilot study.
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Affiliation(s)
- Diogo Mendes
- DruSER.Net - Drug Safety and Effectiveness Research Network, Coimbra, Portugal.,AIBILI - Association for Innovation and Biomedical Research on Light and Image, CHAD - Centre for Health Technology Assessment and Drug Research, Coimbra Regional Pharmacovigilance Unit (UFC), Coimbra, Portugal
| | - Graça Rigueiro
- DruSER.Net - Drug Safety and Effectiveness Research Network, Coimbra, Portugal.,IPO-C - Instituto Português Oncologia de Coimbra Francisco Gentil, E. P. E., Coimbra, Portugal
| | - Rui S Silva
- DruSER.Net - Drug Safety and Effectiveness Research Network, Coimbra, Portugal.,IPO-C - Instituto Português Oncologia de Coimbra Francisco Gentil, E. P. E., Coimbra, Portugal
| | - Ana Penedones
- DruSER.Net - Drug Safety and Effectiveness Research Network, Coimbra, Portugal.,AIBILI - Association for Innovation and Biomedical Research on Light and Image, CHAD - Centre for Health Technology Assessment and Drug Research, Coimbra Regional Pharmacovigilance Unit (UFC), Coimbra, Portugal.,Laboratory of Social Pharmacy and Public Health, School of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Carlos Alves
- DruSER.Net - Drug Safety and Effectiveness Research Network, Coimbra, Portugal.,AIBILI - Association for Innovation and Biomedical Research on Light and Image, CHAD - Centre for Health Technology Assessment and Drug Research, Coimbra Regional Pharmacovigilance Unit (UFC), Coimbra, Portugal.,Laboratory of Social Pharmacy and Public Health, School of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Gabriela Sousa
- DruSER.Net - Drug Safety and Effectiveness Research Network, Coimbra, Portugal.,IPO-C - Instituto Português Oncologia de Coimbra Francisco Gentil, E. P. E., Coimbra, Portugal
| | - Francisco Batel-Marques
- DruSER.Net - Drug Safety and Effectiveness Research Network, Coimbra, Portugal.,AIBILI - Association for Innovation and Biomedical Research on Light and Image, CHAD - Centre for Health Technology Assessment and Drug Research, Coimbra Regional Pharmacovigilance Unit (UFC), Coimbra, Portugal.,Laboratory of Social Pharmacy and Public Health, School of Pharmacy, University of Coimbra, Coimbra, Portugal
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13
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Affiliation(s)
- Alexander N O Dodoo
- Ghana Standards Authority, Accra, Ghana.
- African Collaborating Centre for Pharmacovigilance, Accra, Ghana.
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14
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Safety Experience During Real-World Use of Injectable Artesunate in Public Health Facilities in Ghana and Uganda: Outcomes of a Modified Cohort Event Monitoring Study (CEMISA). Drug Saf 2018; 41:871-880. [PMID: 29696507 PMCID: PMC6061362 DOI: 10.1007/s40264-018-0667-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction Injectable artesunate (Inj AS) is the World Health Organization (WHO)-recommended product for treating severe malaria. However, despite widespread usage, there are few published safety studies involving large populations in real-world settings. In this study, we sought to assess the incidence of common adverse events (AEs) following the intake of Inj AS in real-life settings. Methods This is a modified cohort event monitoring study involving patients who were administered with Inj AS at eight sites (four each in Ghana and Uganda) between May and December 2016. Patients were eligible for inclusion if they had severe/complicated malaria and were able and willing to participate in the study. Eligible patients were followed up by telephone or hospital or home visit on Days 7, 14, 21 and 28 after drug administration to document AEs and serious AEs (SAEs). Patients were also encouraged to report all AEs at any time during the study period. The Kaplan–Meier method was used to estimate the proportion of patients with any AEs by end of Day 28. Causality assessment was made on all AEs/SAEs using the WHO/UMC (Uppsala Monitoring Centre) causality method. Results A total of 1103 eligible patients were administered Inj AS, of which 360 patients were in Ghana and 743 in Uganda. The incidence of any AE by the end of follow-up among patients treated with AS was estimated to be 17.9% (197/1103) (95% confidence interval [CI] 15.8–20.3). The median time-to-onset of any AEs was 9 days (interquartile range (IQR) = 4, 14). The top five AEs recorded among patients treated with AS were pyrexia (3.5%), abdominal pain (2.5%), diarrhoea (1.7%), cough (1.5%) and asthenia (1.5%). Most of these top five AEs occurred in the first 14 days following treatment. Regarding the relatedness of these AEs to Inj AS, 78.9% of pyrexia (30/38), 63.0% of pain (17/27), 68.4% of diarrhoea (13/19), 85.5% of cough (14/16) and 75.0% of asthenia (12/16) were assessed as ‘possibly’ related. There were 17 SAEs including 13 deaths. Two of the deaths are ‘possibly’ related to Inj AS, as were three non-fatal SAEs: severe abdominal pain, failure of therapy and severe anaemia. Conclusion The incidence of common AEs among patients treated with Inj AS in real-world settings was found to be relatively low. Future studies should consider larger cohorts to document rare AEs as well. ClinicalTrials.gov Identifier NCT02817919.
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15
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Raschi E, Bianchin M, Ageno W, De Ponti R, De Ponti F. Risk-Benefit Profile of Direct-Acting Oral Anticoagulants in Established Therapeutic Indications: An Overview of Systematic Reviews and Observational Studies. Drug Saf 2016; 39:1175-1187. [PMID: 27696300 PMCID: PMC5107188 DOI: 10.1007/s40264-016-0464-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Since 2008, the direct-acting oral anticoagulants (DOACs) have expanded the therapeutic options of cardiovascular diseases with recognized clinical and epidemiological impact, such as non-valvular atrial fibrillation (NVAF) and venous thromboembolism (VTE), and also in the preventive setting of orthopedic surgical patients. The large body of evidence, not only from pivotal clinical trials but also from 'real-world' postmarketing observational findings (e.g. analytical epidemiological studies and registry data) gathered to date allow for a first attempt at verifying a posteriori whether or not the pharmacological advantages of the DOACs actually translate into therapeutic innovation, with relevant implications for clinicians, regulators and patients. This review aims to synthesize the risk-benefit profile of DOACs in the aforementioned consolidated indications through an 'evidence summary' approach gathering the existent evidence-based data, particularly systematic reviews with meta-analyses of randomized controlled trials, as well as observational studies, comparing DOACs with vitamin K antagonists. Clinical evidence will be discussed and compared with major international guidelines to identify whether an update is needed. Controversial clinically relevant safety issues will be also examined in order to highlight current challenges and unsettled questions (e.g. actual bleeding risk in susceptible populations). It is anticipated that the large number of publications on NVAF or VTE (44 systematic reviews with meta-analyses and 12 observational studies retained in our analysis) suggests the potential existence of overlapping studies and calls for common criteria to qualitatively and quantitatively assess discordances, thus guiding future research.
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Affiliation(s)
- Emanuel Raschi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Irnerio, 48, I-40126, Bologna, Italy
| | - Matteo Bianchin
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Irnerio, 48, I-40126, Bologna, Italy
| | - Walter Ageno
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - Roberto De Ponti
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - Fabrizio De Ponti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Irnerio, 48, I-40126, Bologna, Italy.
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16
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Raschi E, De Ponti F. Drug- and herb-induced liver injury: Progress, current challenges and emerging signals of post-marketing risk. World J Hepatol 2015; 7:1761-1771. [PMID: 26167249 PMCID: PMC4491905 DOI: 10.4254/wjh.v7.i13.1761] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/21/2015] [Accepted: 06/19/2015] [Indexed: 02/06/2023] Open
Abstract
Drug-induced liver injury (DILI) and herb-induced liver injury is a hot topic for clinicians, academia, drug companies and regulators, as shown by the steadily increasing number of publications in the past 15 years. This review will first provide clues for clinicians to suspect idiosyncratic (unpredictable) DILI and succeed in diagnosis. Causality assessment remains challenging and requires careful medical history as well as awareness of multifaceted aspects, especially for herbs. Drug discontinuation and therapy reconciliation remain the mainstay in patent’s management to minimize occurrence of acute liver failure. The second section will address novel agents associated with liver injury in 2014 (referred to as “signals”), especially in terms of clinical, research and drug development implications. Insights will be provided into recent trends by highlighting the contribution of different post-marketing data, especially registries and spontaneous reporting systems. This literature scrutiny suggests: (1) the importance of post-marketing databases as tools of clinical evidence to detect signals of DILI risk; and (2) the need for joining efforts in improving predictivity of pre-clinical assays, continuing post-marketing surveillance and design ad hoc post-authorization safety studies. In this context, ongoing European/United States research consortia and novel pharmaco-epidemiological tools (e.g., specialist prescription event monitoring) will support innovation in this field. Direct oral anticoagulants and herbal/dietary supplements appear as key research priorities.
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