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Sarayani A, Albogami Y, Thai TN, Smolinski NE, Patel P, Wang Y, Nduaguba S, Rasmussen SA, Winterstein AG. Prenatal exposure to teratogenic medications in the era of Risk Evaluation and Mitigation Strategies. Am J Obstet Gynecol 2022; 227:263.e1-263.e38. [PMID: 35032444 DOI: 10.1016/j.ajog.2022.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Prevention of prenatal exposures to teratogenic drugs is a significant clinical and public health concern. With the enactment of the US Food and Drug Administration Amendments Act in 2007, the US Food and Drug Administration has begun to require manufacturers to implement Risk Evaluation and Mitigation Strategies to prevent prenatal exposures. Among 12 risk evaluation and mitigation strategy drugs, several had predecessor risk mitigation plans (eg, isotretinoin) and some were newly required (eg, mycophenolate). Only a small proportion of teratogenic drugs are currently subject to Risk Evaluation and Mitigation Strategies, and the extent of prenatal exposure to the universe of teratogenic drugs compared with drugs subject to Risk Evaluation and Mitigation Strategies is unknown. Moreover, the effectiveness of such advanced risk mitigation programs in preventing prenatal exposure is not clear. OBJECTIVE This study aimed to characterize the epidemiology of prenatal exposures to definite and potential teratogens during the risk evaluation and mitigation strategy era. STUDY DESIGN We constructed a time-series of pregnancies identified from a national private insurance claims database (IBM MarketScan) to estimate prenatal exposures to teratogenic drugs (2006-2017). Pregnancy outcomes, gestational age, and the onset of pregnancy were determined with previously validated algorithms. The Teratology Information Service and Clinical Pharmacology databases were used to identify drugs with definite (n=141) or potential (n=65) teratogenic effects, and drugs with debatable risks such as benzodiazepines, statins, tetracyclines, sex hormones, infertility treatments, and gonadotropin-releasing hormone analogs were excluded. We defined prenatal exposure as ≥1 prescription fill or medical encounter involving administration of drugs with a definite teratogenic risk (including 12 for which there is a "current or discontinued" risk evaluation and mitigation strategy) or a potential teratogenic risk. We evaluated secular trends and modeled the effects of age, preconception exposure, and state healthcare quality rankings on prenatal exposure, adjusting for demographic factors and clinical conditions. RESULTS The cohort included 3,445,612 pregnancies (2,532,444 live deliveries). Prenatal exposures to definite teratogens decreased slightly during the study years from 1.86 to 1.24 per 100 pregnancies between 2006 and 2017, whereas exposure increased for potential teratogens from 3.40% to 5.33%. Prenatal exposure prevalences were higher during the first trimester and for pregnancies that ended in nonlive outcomes. Drugs subject to Risk Evaluation and Mitigation Strategies had low background utilization and contributed to a small proportion of prenatal exposures (15.1 per 100,000 pregnancies). We also observed fewer prenatal exposures to risk evaluation and mitigation strategy drugs among women of childbearing age who used these treatments (0.14% vs 0.36% for any definite teratogen). Age extremes and low state-level healthcare quality rankings were independent predictors of prenatal exposure. CONCLUSION Fetuses in more than 1 in 16 pregnancies continued to be exposed to teratogenic drugs during the past decade. Drugs with Risk Evaluation and Mitigation Strategies imposed a small burden of prenatal exposure because of the low background utilization rates and lower pregnancy prevalence among women of childbearing age who used these drugs. Although the declining exposure rates to teratogenic drugs with definite risk are encouraging, the rising prenatal exposure to drugs with potential risk calls for more assessments. Future research is needed to elucidate the health outcomes of fetuses exposed to potential risk drugs, understand the effectiveness of risk evaluation and mitigation strategy programs, and prioritize teratogenic drugs for advanced risk mitigation.
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Abbasian H, Yousefi-Zenouz R, Abdollahiasl A, Toroski M, Nikfar S, Siahi-Shadbad M, Kebriaeezadeh A. Risk Factors of Supply Chain in Biopharmaceutical Companies in Iran. PHARMACEUTICAL SCIENCES 2020. [DOI: 10.34172/ps.2020.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Supply chain risk management can help companies detect potential hazards,mitigate potential risks, and thereby increase supply chain efficiency. The biopharmaceuticalindustry in Iran has a generic-based pharmerging market. Therefore, identifying risksassociated with the supply chain of those drugs can significantly boost the possibility of successof biopharmaceutical companies. This study is conducted to determine the supply chain riskfactors of biopharmaceuticals companies in Iran. Methods: The current research work is a qualitative-quantitative study. A systematic review andinterview with experts (n=14) were conducted to identify potential supply chain risks in thebiopharmaceutical industries. To determine the significance of identified risks, Fuzzy screeningmethod was employed to collect the opinions of experts (n=16) in the biopharmaceuticalindustries. Results: By systematic review and interviews with the biopharmaceutical industry experts, 100potential risks in the biopharmaceutical industry supply chain were identified. These risks weredivided into two general categories namely macro and micro risks. Based on experts’ judgment,77 out of 100 identified risks were eliminated and 23 significant risks were determined. Themost important risks are the Ministry of health (as the regulatory body) conflict of interest, USsanctions, lack of domestic suppliers of essential materials, pseudo-productivity, and moneytransfer related to the bank’s sanctions. Conclusion: Due to the multitude of present risks and the impossibility of controlling all ofthem, it is recommended that managers and producers focus more on controlling the identifiedsignificant risks.
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Affiliation(s)
- Hadi Abbasian
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Yousefi-Zenouz
- Department of Information Technology Management, Kharazmi University, Tehran, Iran
| | - Akbar Abdollahiasl
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Toroski
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Shekoufeh Nikfar
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Abbas Kebriaeezadeh
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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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] [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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Desselle SP, Shane P, Berhane H, Samuel Y, Tran T. The effectiveness of written communication for decision support in clinical practice. Res Social Adm Pharm 2020; 16:383-389. [DOI: 10.1016/j.sapharm.2019.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 06/12/2019] [Indexed: 11/24/2022]
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Sarayani A, Albogami Y, Elkhider M, Hincapie-Castillo JM, Brumback BA, Winterstein AG. Comparative effectiveness of risk mitigation strategies to prevent fetal exposure to mycophenolate. BMJ Qual Saf 2019; 29:636-644. [DOI: 10.1136/bmjqs-2019-010098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/03/2019] [Accepted: 10/13/2019] [Indexed: 12/22/2022]
Abstract
BackgroundIn 2012, the US Food and Drug Administration approved a Risk Evaluation and Mitigation Strategy (REMS) programme including mandatory prescriber training and a patient/provider acknowledgement form to prevent fetal exposure to mycophenolate. Prior to the REMS, the teratogenic risk was solely mitigated via written information (black box warning, medication guide (MG period)). To date, there is no evidence on the effectiveness of the REMS.MethodsWe used a national private health insurance claims database to identify women aged 15–44 who filled ≥1 mycophenolate prescription. To compare fetal exposure during REMS with the MG period, we estimated the prevalence of pregnancy at treatment initiation in a pre/post comparison (analysis 1) and the rate of conception during treatment in a retrospective cohort study (analysis 2). Pregnancy episodes were measured based on diagnosis and procedure codes for pregnancy outcomes or prenatal screening. We used generalised estimating equation models with inverse probability of treatment weighting to calculate risk estimates.ResultsThe adjusted proportion of existing pregnancy per 1000 treatment initiations was 1.7 (95% CI 1.0 to 2.9) vs 4.1 (95% CI 3.2 to 5.4) during the REMS and MG period. The adjusted prevalence ratio and prevalence difference were 0.42 (95% CI 0.24 to 0.74) and −2.4 (95% CI −3.8 to −1.0), respectively. In analysis 2, the adjusted rate of conception was 12.5 (95% CI 8.9 to 17.6) vs 12.9 (95% CI 9.9 to 16.9) per 1000 years of mycophenolate exposure time in the REMS versus MG periods. The adjusted risk ratio and risk difference were 0.97 (95% CI 0.63 to 1.49) and −0.4 (95% CI −5.9 to 5.0), respectively. Sensitivity analyses on the estimated conception date demonstrated robustness of our findings.ConclusionWhile the REMS programme achieved less pregnancies at treatment initiation, it failed to prevent the onset of pregnancy during treatment. Enhanced approaches to ensure effective contraception during treatment should be considered.
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Cummings J, Ritter A, Zhong K. Clinical Trials for Disease-Modifying Therapies in Alzheimer's Disease: A Primer, Lessons Learned, and a Blueprint for the Future. J Alzheimers Dis 2019; 64:S3-S22. [PMID: 29562511 PMCID: PMC6004914 DOI: 10.3233/jad-179901] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Alzheimer’s disease (AD) has no currently approved disease-modifying therapies (DMTs), and treatments to prevent, delay the onset, or slow the progression are urgently needed. A delay of 5 years if available by 2025 would decrease the total number of patients with AD by 50% in 2050. To meet the definition of DMT, an agent must produce an enduring change in the course of AD; clinical trials of DMTs have the goal of demonstrating this effect. AD drug discovery entails target identification followed by high throughput screening and lead optimization of drug-like compounds. Once an optimized agent is available and has been assessed for efficacy and toxicity in animals, it progresses through Phase I testing with healthy volunteers, Phase II learning trials to establish proof-of-mechanism and dose, and Phase III confirmatory trials to demonstrate efficacy and safety in larger populations. Phase III is followed by Food and Drug Administration review and, if appropriate, market access. Trial populations include cognitively normal at-risk participants in prevention trials, mildly impaired participants with biomarker evidence of AD in prodromal AD trials, and subjects with cognitive and functional impairment in AD dementia trials. Biomarkers are critical in trials of DMTs, assisting in participant characterization and diagnosis, target engagement and proof-of-pharmacology, demonstration of disease-modification, and monitoring side effects. Clinical trial designs include randomized, parallel group; delayed start; staggered withdrawal; and adaptive. Lessons learned from completed trials inform future trials and increase the likelihood of success.
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Affiliation(s)
- Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Aaron Ritter
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Kate Zhong
- Global Alzheimer Platform, Washington, DC, USA
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Tetteh EK. Reducing avoidable medication-related harm: What will it take? Res Social Adm Pharm 2019; 15:827-840. [PMID: 30981449 DOI: 10.1016/j.sapharm.2019.04.002] [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] [Received: 07/16/2018] [Revised: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022]
Abstract
Consumption of quality-assured medicines is expected to maintain or improve population health. Yet in a number of situations, what is realized is lower health benefits or magnified safety risks. Recognizing the public health implications of safety risks or medication-related harm, and that some types of harm are avoidable, the World Health Organization has initiated the third Global Patient Safety challenge on Medication Safety. Under the term "Medication Without Harm", this Challenge aims to assess the scope and nature of avoidable medication-related harm, create a framework for intervention and develop national guidance and tools to support safer medication use. The global target under the Challenge is to reduce the level of severe avoidable medication-related harm by 50% over a five-year period or within the next five years. Given a higher morbidity and mortality due to medication-related harm in low-income countries, this paper evaluates what needs to be done in low-income countries in order to achieve the global target. The ideal solution advocated requires that health planners in each low-income country determine what fraction of safety risks or harm can be prevented; and the relationship between number or frequency of avoidable harm or safety risks and the resource costs of treatment or prevention. In the absence of such information, this paper discusses a number of prevention strategies that might help; arguing that the period over which avoidable medication-related harm can be reduced by 50% will depend on whether significant continuous investments in health-system strengthening are made prior to and within that period.
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Affiliation(s)
- Ebenezer Kwabena Tetteh
- Department of Pharmacy Practice & Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.
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Torka M, Mintzes B, Bhasale A, Fabbri A, Perry L, Lexchin J. Secret safety warnings on medicines: A case study of information access requests. Pharmacoepidemiol Drug Saf 2019; 28:551-555. [PMID: 30840349 DOI: 10.1002/pds.4762] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/14/2019] [Accepted: 02/11/2019] [Indexed: 11/05/2022]
Abstract
PURPOSE There has been less attention to the transparency of postmarket evidence of harmful effects of medicines than of premarket clinical trial data. This is a case study of requests for Australian "direct health professional communications" (DHPCs). These letters are used by regulators and manufacturers to inform clinicians of emergent evidence of harm. DHPCs are not made public by Australia's Therapeutic Goods Administration (TGA). METHODS We requested all DHPCs sent out in Australia from 2007 to 2016 inclusive for 207 drugs that were subject to safety advisories over this decade in Canada, the United Kingdom, and/or the United States. We contacted 39 manufacturers (February to May 2018), with repeat requests to nonrespondents, and a follow-up freedom-of-information (FOI) request to the TGA. RESULTS Fifteen companies provided information, either sending DHPCs (n = 4, on five drugs) or affirming none were sent out (n = 11). The remaining 24 of 39 (62%) companies did not provide DHPCs: nine (23%) refused the request, often citing commercial confidentiality; the rest provided no answer despite repeat requests. In total, we had no information for 170 of 207 (82%) of the drugs. Our FOI request to the TGA was unsuccessful. CONCLUSIONS Our experience highlights unacceptable secrecy concerning safety warnings previously sent to thousands of Australian clinicians. In the absence of explicit regulatory policy supporting disclosure, companies differed in their response. These letters warn of serious and often life-threatening harm and guide safer care; full ongoing public access is needed, ideally in searchable online databases.
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Affiliation(s)
- Marc Torka
- School of Pharmacy, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, Australia.,Department of Sociology, Macquarie University, Sydney, Australia
| | - Barbara Mintzes
- School of Pharmacy, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Alice Bhasale
- School of Pharmacy, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Alice Fabbri
- School of Pharmacy, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Lucy Perry
- School of Pharmacy, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Joel Lexchin
- Faculty of Health, York University, Toronto, Canada
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Kwon CS, Seoane-Vazquez E, Rodriguez-Monguio R. FDA safety actions for antidiabetic drugs marketed in the US, 1980–2015. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2017; 28:197-211. [DOI: 10.3233/jrs-170734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Christina S. Kwon
- International Center for Pharmaceutical Economics and Policy, MCPHS University, Boston, MA, USA
| | - Enrique Seoane-Vazquez
- International Center for Pharmaceutical Economics and Policy, MCPHS University, Boston, MA, USA
- Brigham and Women’s Hospital, Division of General Medicine and Primary Care, Boston, MA, USA
| | - Rosa Rodriguez-Monguio
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
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Barth KS, Guille C, McCauley J, Brady KT. Targeting practitioners: A review of guidelines, training, and policy in pain management. Drug Alcohol Depend 2017; 173 Suppl 1:S22-S30. [PMID: 28363316 PMCID: PMC5555357 DOI: 10.1016/j.drugalcdep.2016.08.641] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/31/2016] [Accepted: 08/31/2016] [Indexed: 01/03/2023]
Abstract
This paper reviews the current literature on clinical guidelines, practitioner training, and government/payer policies that have come forth in response to the national rise in prescription opioid overdoses. A review of clinical opioid prescribing guidelines highlights the need for more research on safe and effective treatment options for chronic pain, improved guidance for the best management of post-operative pain, and evaluation of the implementation and impact of guideline recommendations on patient risk and outcomes. Although there is increasing attention to training in pain management in medical schools and medical residency programs, educational opportunities remain highly variable, and the need for additional clinician training in the recognition and treatment of pain as well as opioid use disorder has been recognized. Mandated use of private, federal and state educational and clinical initiatives such as Risk Evaluation and Mitigation Strategies (REMS) and Prescription Drug Monitoring Programs (PDMPs) generally increase utilization of these initiatives, but more research is needed to determine the impact of these initiatives on provider behaviors, treatment access, and patient outcomes. Finally, there is an acute need for more research on safe and effective treatments for chronic pain as well as an increased multi-level focus on improving training and access to evidence-based treatment for opioid use disorder as well as non-pharmacologic and non-interventional chronic pain treatments, so that these guideline-recommended interventions can become mainstream, accessible, first-line interventions for chronic pain and/or opioid use disorders.
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Affiliation(s)
- Kelly S Barth
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Jenna McCauley
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
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Blanchette CM, Nunes AP, Lin ND, Mortimer KM, Noone J, Tangirala K, Johnston S, Gutierrez B. Adherence to risk evaluation and mitigation strategies (REMS) requirements for monthly testing of liver function. Drugs Context 2015; 4:dic-4-212272. [PMID: 25709706 PMCID: PMC4335780 DOI: 10.7573/dic.212272] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 12/29/2014] [Accepted: 12/08/2014] [Indexed: 12/13/2022] Open
Abstract
Background: Risk evaluation and mitigation strategies (REMS), as mandated by the US Food and Drug Administration (FDA) for medications with the potential for harm, are increasingly incorporating rigid protocols for patient evaluation, but little is known about compliance with these programs. Despite the inherent limitations, data on administrative claims may provide an opportunity to investigate adherence to these programs. Methods: We assessed adherence to liver function test (LFT) requirements included in the REMS program for bosentan through use of administrative claims. Patients observed in the Optum Research Database who were initiators of bosentan from November 20, 2001 to March 31, 2013 were included. Adherence to LFTs was calculated using pharmacy claims for bosentan dispensation and medical claims for laboratory services, and was assessed at the time of drug initiation and within specified time intervals throughout follow-up. Results: Of 742 patients, 523 (70.5%) had ≥1 qualifying LFT. Among patients with ≥12 dispensations, claims for LFTs at individual dispensations were 53.2–64.0%. Median proportion of dispensations with ≥1 LFT was 0.8 among patients with ≥6 (interquartile range, 0.7–1.0) or ≥12 (0.7–0.9) dispensations. Adherence was 90–100% for 33.3% of all initiators, whereas 29.3% of initiators were non-adherent (defined as <50% of on-therapy LFTs). Conclusions: Analyses of administrative claims suggest that the REMS program for bosentan may not have adequately guaranteed adherence to the program’s monthly monitoring of LFTs. Such investigations of existing REMS programs may provide insight on how to accomplish more successful evaluation of REMS.
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Affiliation(s)
| | | | | | | | - Joshua Noone
- University of North Carolina, Charlotte, NC, USA
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Frank C, Himmelstein DU, Woolhandler S, Bor DH, Wolfe SM, Heymann O, Zallman L, Lasser KE. Era Of Faster FDA Drug Approval Has Also Seen Increased Black-Box Warnings And Market Withdrawals. Health Aff (Millwood) 2014; 33:1453-9. [DOI: 10.1377/hlthaff.2014.0122] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Cassie Frank
- Cassie Frank ( ) is an instructor of medicine at Cambridge Health Alliance and Harvard Medical School, in Boston, Massachusetts
| | - David U. Himmelstein
- David U. Himmelstein is a professor at the School of Public Health, City University of New York (CUNY)
| | | | - David H. Bor
- David H. Bor is an associate professor of medicine at Cambridge Health Alliance and Harvard Medical School
| | - Sidney M. Wolfe
- Sidney M. Wolfe is a senior adviser at the Health Research Group, Public Citizen, in Washington, D.C
| | - Orlaith Heymann
- Orlaith Heymann is a research assistant at Boston Medical Center and the School of Medicine, Boston University, in Massachusetts
| | - Leah Zallman
- Leah Zallman is an instructor of medicine at Cambridge Health Alliance and Harvard Medical School
| | - Karen E. Lasser
- Karen E. Lasser is an associate professor of medicine at Boston Medical Center and the School of Medicine, Boston University
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