Phase IV research by pharmaceutical companies

Postmarketing Surveillance of Drugs: An Overview

The complete safety profile of a drug cannot be made before marketing because of the limited scope of the controlled clinical trials. Postmarketing surveillance (PMS) is the collection and analysis of information about a drug after it has been marketed. A PMS system ideally must be able to detect a rare event, determine its incidence, and validate the causality. Because an ideal system has not been devised, a combination of methods is used. The advantages and limitations of various methods of adverse drug reaction (ADE) reporting are described, and problems and concerns associated with ADE reporting are discussed. Postmarketing surveillance will continue to benefit from spontaneous reporting of ADEs by clinicians (ie, literature reports, reports to manufacturers and national regulatory agencies) to detect rare events and will be complemented by the selective use of formal PMS methods in appropriate circumstances. Increased clinician awareness of serious, potentially drug-related events together with comprehensive and complete reporting of these events will begin to address the problems of underreporting, assessment of causality, and misclassification of events.

Escitalopram in a working population: results from an observational study of 2378 outpatients in Austria

OBJECTIVE

The aim of this observational study was to evaluate the effectiveness of escitalopram in a naturalistic sample of employed people with mood and anxiety disorders.

METHOD

Days on sick leave 3 months prior and 3 months during treatment with escitalopram were recorded and compared (mirror study design) in 2378 patients (949 men and 1376 women). A further clinical examination including the clinical global impression of severity (CGI-S) and improvement (CGI-I) scales and assessments of tolerability were used to evaluate treatment effects in a subgroup of 807 study subjects.

RESULTS

Escitalopram treatment (mean final daily dosage: 12.4+/-5.0 mg) led to a significant reduction (baseline versus end of study) of sick leave (11.0+/-12.8 days versus 5.4+/-11.0 days; p<0.001). CGI-S scores decreased from 4.7+/-0.9 at baseline to 2.4+/-1.1 after 3 months (p<0.001), the CGI-I after 3 months was 1.9+/-0.9. The incidence of adverse events after initiation of treatment with escitalopram was 13.1%, with only 1.3% of patients experiencing severe adverse events interfering with patient functioning.

CONCLUSION

Our results suggest that escitalopram is an efficacious and overall well-tolerated treatment in a naturalistic sample of working patients. A decrease in the days on sick leave is indicative of indirect cost-effectiveness of this treatment.