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Hensel A, Bauer R, Heinrich M, Hempel G, Kelber O, Kraft K, Lehmann B, Medà MM, Nieber K, Roether B, Rollinger JM, Wiebelitz R. Rationalising Optimal Dosing of Phytotherapeutics For Use In Children: Current Status - Potential Solutions - Actions Needed. PLANTA MEDICA 2024; 90:416-425. [PMID: 38527490 DOI: 10.1055/a-2294-5259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
"Children are not small adults with respect to the treatment with medicinal products." This statement of the WHO was the basis for the initiative of the European Commission for the establishment of a paediatric regulation in 2007 to improve the health of children by facilitating the development of medicines for children and adolescents. Seventeen years later, in the field of herbal medicinal products, results are still sobering. Therefore, the Foundation Plants for Health, Society for Medicinal Plants and Natural Products Research, and German Society for Phytotherapy organised a symposium to assess the status quo for the paediatric use of herbal medicinal products (HMPs), to analyse the causes of the current situation, and to discuss strategies for establishing the proof of safe and efficacious HMPs for children.The current situation for HMPs and their use in children is not fulfilling the requirements of legislation. HMPs in paediatrics are effective and safe, but considering the needs of children is necessary. In European countries, the use, registration, and marketing of HMPs are different, depending on the respective national regulations and specific traditions. EU herbal monographs are the best common denominator for such procedures. Emerging safety discussions must be considered. New approaches with real-world data might be a solution. The regulatory framework is to be adapted. Defining rationalised dosing for HMPs can be achieved by the extrapolation of data from adults, by using existing clinical data for children, and by using RWD. Therefore, a strong need for revising restrictions for the use of HMPs in children and rationalising defined dosage regimes is obvious.
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Affiliation(s)
- Andreas Hensel
- Institute of Pharmaceutical Biology and Phytochemistry, University of Münster, Germany
| | - Rudolf Bauer
- Institut für Pharmazeutische Wissenschaften, Pharmakognosie, Universitaet Graz, Austria
| | - Michael Heinrich
- School of Pharmacy, University College London, United Kingdom of Great Britain and Northern Ireland
| | - Georg Hempel
- Pharmaceutical and Medical Chenistry, University of Münster, Germany
| | - Olaf Kelber
- Research and Development, Bayer Consumer Health, Steigerwald Arzneimittelwerk GmbH, Darmstadt, Germany
| | - Karin Kraft
- Centre of Internal Medicine, University Medicine Rostock, Germany
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Dong F, Guo W, Liu J, Patterson TA, Hong H. BERT-based language model for accurate drug adverse event extraction from social media: implementation, evaluation, and contributions to pharmacovigilance practices. Front Public Health 2024; 12:1392180. [PMID: 38716250 PMCID: PMC11074401 DOI: 10.3389/fpubh.2024.1392180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/11/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Social media platforms serve as a valuable resource for users to share health-related information, aiding in the monitoring of adverse events linked to medications and treatments in drug safety surveillance. However, extracting drug-related adverse events accurately and efficiently from social media poses challenges in both natural language processing research and the pharmacovigilance domain. Method Recognizing the lack of detailed implementation and evaluation of Bidirectional Encoder Representations from Transformers (BERT)-based models for drug adverse event extraction on social media, we developed a BERT-based language model tailored to identifying drug adverse events in this context. Our model utilized publicly available labeled adverse event data from the ADE-Corpus-V2. Constructing the BERT-based model involved optimizing key hyperparameters, such as the number of training epochs, batch size, and learning rate. Through ten hold-out evaluations on ADE-Corpus-V2 data and external social media datasets, our model consistently demonstrated high accuracy in drug adverse event detection. Result The hold-out evaluations resulted in average F1 scores of 0.8575, 0.9049, and 0.9813 for detecting words of adverse events, words in adverse events, and words not in adverse events, respectively. External validation using human-labeled adverse event tweets data from SMM4H further substantiated the effectiveness of our model, yielding F1 scores 0.8127, 0.8068, and 0.9790 for detecting words of adverse events, words in adverse events, and words not in adverse events, respectively. Discussion This study not only showcases the effectiveness of BERT-based language models in accurately identifying drug-related adverse events in the dynamic landscape of social media data, but also addresses the need for the implementation of a comprehensive study design and evaluation. By doing so, we contribute to the advancement of pharmacovigilance practices and methodologies in the context of emerging information sources like social media.
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Affiliation(s)
| | | | | | | | - Huixiao Hong
- National Center for Toxicological Research, US Food and Drug Administration, Jefferson, AR, United States
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Phan M, Cheng C, Dang V, Wu E, Muñoz MA. Characterization of Pediatric Reports in the US Food and Drug Administration Adverse Event Reporting System from 2010-2020: A Cross-Sectional Study. Ther Innov Regul Sci 2023; 57:1062-1073. [PMID: 37351842 PMCID: PMC10527885 DOI: 10.1007/s43441-023-00542-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/26/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION The Food and Drug Administration Adverse Event Reporting System (FAERS) is a database of adverse event (AE) and medication error reports for drugs and therapeutic biologics. Examining trends of reported individual case safety reports (ICSRs) provides context for evaluating safety concerns. OBJECTIVE Characterize pediatric FAERS ICSRs and compare trends (1) to adult reports; (2) within pediatric subgroups. METHODS This cross-sectional study examined FAERS ICSRs received between January 1, 2010, through December 31, 2020. Stratified age bands were neonates, infants, younger children, older children, adolescents, and adults. We characterized groups by patient demographic information, suspect products, AEs, and reporter type. RESULTS From 2010 to 2020, there were 11,258,995 FAERS ICSRs; 3.1% described pediatric patients. Compared to adults, pediatric ICSRs had higher proportions of all serious outcomes except death. Within pediatric subgroups, neonates had the highest proportions of serious outcomes (96.2%) compared to infants, younger children, older children, and adolescents (79.8%, 67.9%, 59.5%, and 52.7%, respectively). Younger pediatric age groups were more likely to have weight information than older age groups but were less likely to include gender information. The most frequently reported AE was off label use for pediatrics and drug ineffective for adults. Products and AEs reported also differed among pediatric subgroups. Neonates, infants, and adolescents had entirely distinct sets of top five product-event combinations. CONCLUSION Pediatric ICSRs represent a minority of FAERS reports but have distinctly different attributes relative to adult ICSRs. Reporting trends also vary within pediatric subgroups, which highlights the need for unique considerations for pediatric safety surveillance.
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Affiliation(s)
- Michael Phan
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
- Development, Seagen Inc., South San Francisco, CA, USA
| | - Carmen Cheng
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA.
| | - Vivian Dang
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Eileen Wu
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Monica A Muñoz
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
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Giangreco NP, Tatonetti NP. Evaluating risk detection methods to uncover ontogenic-mediated adverse drug effect mechanisms in children. BioData Min 2021; 14:34. [PMID: 34294093 PMCID: PMC8296590 DOI: 10.1186/s13040-021-00264-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/16/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Identifying adverse drugs effects (ADEs) in children, overall and within pediatric age groups, is essential for preventing disability and death from marketed drugs. At the same time, however, detection is challenging due to dynamic biological processes during growth and maturation, called ontogeny, that alter pharmacokinetics and pharmacodynamics. As a result, methodologies in pediatric drug safety have been limited to event surveillance and have not focused on investigating adverse event mechanisms. There is an opportunity to identify drug event patterns within observational databases for evaluating ontogenic-mediated adverse event mechanisms. The first step of which is to establish statistical models that can identify temporal trends of adverse effects across childhood. RESULTS Using simulation, we evaluated a population stratification method (the proportional reporting ratio or PRR) and a population modeling method (the generalized additive model or GAM) to identify and quantify ADE risk at varying reporting rates and dynamics. We found that GAMs showed improved performance over the PRR in detecting dynamic drug event reporting across child development stages. Moreover, GAMs exhibited normally distributed and robust ADE risk estimation at all development stages by sharing information across child development stages. CONCLUSIONS Our study underscores the opportunity for using population modeling techniques, which leverage drug event reporting across development stages, as biologically-inspired detection methods for evaluating ontogenic mechanisms.
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Affiliation(s)
- Nicholas P. Giangreco
- Departments of Systems Biology and Biomedical Informatics, Columbia University, 622 W. 168th Street, New York, NY 10032 USA
| | - Nicholas P. Tatonetti
- Departments of Systems Biology and Biomedical Informatics, Columbia University, 622 W. 168th Street, New York, NY 10032 USA
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Noda A, Obara T, Satoh M, Yagi N, Mano N, Kaneko K. Active Extraction of Experience of Adverse Drug Reactions in Children. J Pediatr Pharmacol Ther 2021; 26:352-360. [PMID: 34035679 DOI: 10.5863/1551-6776-26.4.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 10/31/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Safety information regarding the use of medication, over-the-counter drugs, and supplements for Japanese children is scarce. The aim of this study was to clarify adverse drug reaction (ADR) experiences in children and consider the method to collect ADRs efficiently. METHODS We conducted a questionnaire survey regarding the ADR experiences of 20,412 children who were attending a preschool or kindergarten in the cities of Warabi and Toda, Saitama Prefecture, in May 2013. RESULTS Responses were received from the guardians of 15,076 children (49.5% girls; 8.2 ± 3.5 yr). A total of 196 guardians (1.3%) responded that their children had experienced ADRs. Among them, a total of 243 suspected drugs and 284 ADRs were reported. Of the 243 suspected drugs, 2.5% were associated with a vaccine. The most frequently reported medication, reaction, and "medication-reaction pair" were antibacterials for systemic use, rash, and "antibacterials for systemic use and rash," respectively. CONCLUSIONS In this study, we clarified that there were many potential ADRs among children, but all "medication-reaction pairs" reported were consistent with adverse events reported in the clinical trials available in the prescribing information of each medication. This study provides data respective to the frequency of these adverse events in the general pediatric population. Additional education is needed to enlighten guardians of the importance to report ADRs through the Direct Patient Reporting System.
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Giangreco NP, Elias JE, Tatonetti NP. No population left behind: Improving paediatric drug safety using informatics and systems biology. Br J Clin Pharmacol 2020; 88:1464-1470. [PMID: 33332641 PMCID: PMC8209126 DOI: 10.1111/bcp.14705] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/26/2020] [Accepted: 12/05/2020] [Indexed: 12/12/2022] Open
Abstract
Adverse drugs effects (ADEs) in children are common and may result in disability and death. The current paediatric drug safety landscape, including clinical trials, is limited as it rarely includes children and relies on extrapolation from adults. Children are not small adults but go through an evolutionarily conserved and physiologically dynamic process of growth and maturation. Novel quantitative approaches, integrating observations from clinical trials and drug safety databases with dynamic mechanisms, can be used to systematically identify ADEs unique to childhood. In this perspective, we discuss three critical research directions using systems biology methodologies and novel informatics to improve paediatric drug safety, namely child versus adult drug safety profiles, age-dependent drug toxicities and genetic susceptibility of ADEs across childhood. We argue that a data-driven framework that leverages observational data, biomedical knowledge and systems biology modelling will reveal previously unknown mechanisms of pediatric adverse drug events and lead to improved paediatric drug safety.
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Affiliation(s)
- Nicholas P Giangreco
- Department of Biomedical Informatics and Systems Biology, Columbia University, New York, NY, USA
| | - Jonathan E Elias
- Department of Pediatrics, Instructor in Pediatrics, Assistant Medical Director of Information Services, Weill Cornell Medical & NYP Weill Cornell Medical Center, New York, NY, USA
| | - Nicholas P Tatonetti
- Department of Biomedical Informatics and Systems Biology, Columbia University, New York, NY, USA
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Noda A, Sakai T, Tsuchiya M, Oyanagi G, Obara T, Mano N. Characteristics of Adverse Events Following Immunization Reporting in Children: The Japanese Adverse Drug Event Report Database. Vaccines (Basel) 2020; 8:vaccines8030357. [PMID: 32635349 PMCID: PMC7564739 DOI: 10.3390/vaccines8030357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 01/30/2023] Open
Abstract
The present study aimed to describe the trends and characteristics of adverse events following immunization (AEFI) reporting for children in the Japanese Adverse Drug Event Report database (JADER). We used 6280 AEFI reports for children aged <19 years among 504,407 ADR reports included in the JADER from 2004 to 2017. The number of AEFI reports gradually increased among children aged <10 years and was the highest in 2011 among children aged 10–19 years. The number of suspected vaccines per AEFI report increased after 2011 among children aged <10 years. The percentage of “death” and “did not recover” as AEFI outcomes reported were 4.3% and 3.7% among children aged <10 years and 0.2% and 21.1% among children aged 10–19 years, respectively. The most frequently reported vaccine–reaction pair was Haemophilus influenzae type b conjugate vaccine and pyrexia among children aged <10 years and recombinant adsorbed bivalent human papillomavirus-like particle vaccine and a loss of consciousness among children aged 10–19 years. It is necessary to consider the Weber effects to understand the trend and characteristics of AEFI reporting because pharmacovigilance activity regarding vaccination is not sufficient in Japan.
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Affiliation(s)
- Aoi Noda
- Division of Preventive Medicine and Epidemiology, Tohoku University Tohoku Medical Megabank Organization, Sendai, Miyagi 980-8573, Japan;
- Division of Molecular Epidemiology, Environment and Genome Research Center, Graduate School of Medicine, Tohoku University, Sendai, Miyagi 980-8573, Japan
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Miyagi 980-8574, Japan; (G.O.); (N.M.)
| | - Takamasa Sakai
- Drug Informatics, Faculty of Pharmacy, Meijo University, Nagoya, Aichi 468-8503, Japan;
| | - Masami Tsuchiya
- Laboratory of Clinical Pharmacy, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Miyagi 980-8574, Japan;
- Department of Pharmacy, Miyagi Cancer Center, Natori 981-1293, Miyagi, Japan
| | - Gen Oyanagi
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Miyagi 980-8574, Japan; (G.O.); (N.M.)
| | - Taku Obara
- Division of Preventive Medicine and Epidemiology, Tohoku University Tohoku Medical Megabank Organization, Sendai, Miyagi 980-8573, Japan;
- Division of Molecular Epidemiology, Environment and Genome Research Center, Graduate School of Medicine, Tohoku University, Sendai, Miyagi 980-8573, Japan
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Miyagi 980-8574, Japan; (G.O.); (N.M.)
- Correspondence: ; Tel.: +81-22-717-8104; Fax: +81-22-717-8106
| | - Nariyasu Mano
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Miyagi 980-8574, Japan; (G.O.); (N.M.)
- Laboratory of Clinical Pharmacy, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Miyagi 980-8574, Japan;
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Rebelo Gomes E, Ribeiro-Vaz I, Santos CC, Herdeiro MT. Adverse drug reactions in adolescents: a review of reporting to a national pharmacovigilance system. Expert Opin Drug Saf 2020; 19:915-922. [DOI: 10.1080/14740338.2020.1771305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Eva Rebelo Gomes
- Allergy and Clinical Immunology Service, University Hospital Center of Porto, Porto, Portugal
| | - Inês Ribeiro-Vaz
- Porto Pharmacovigilance Centre, Faculty of Medicine of University of Porto, Porto, Portugal
- Faculty of Medicine of University of Porto, Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Cristina Costa Santos
- Faculty of Medicine of University of Porto, Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of University of Porto, Porto, Portugal
| | - Maria Teresa Herdeiro
- Department of Medical Sciences & Institute of Biomedicine – iBiMED, University of Aveiro, Aveiro, Portugal
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Hui TZ. Integrating Regulatory Drug Label Information to Facilitate Evaluation of Adverse Events in Pharmacovigilance. Curr Drug Saf 2020; 15:124-130. [DOI: 10.2174/1574886315666200224101011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/25/2019] [Accepted: 12/05/2019] [Indexed: 11/22/2022]
Abstract
Background:
Efficiency and accuracy for signal detection and evaluation activities are
integral components of routine Pharmacovigilance (PV) practices. However, an Individual Case
Safety Report (ICSR) may consist of a variety of confounders such as Concomitant Medications
(CM), Past Medical History (PMH), and concurrent medical conditions that influence a safety officer’s
evaluation of a potential Adverse Event (AE). Limited pharmacovigilance systems are currently available
as a tool designed to enhance the efficiency and accuracy of signal detection and management.
Objective:
To introduce a systemic approach to make critical safety information readily available
for users in order to discern possible interferences from CM and make informed decisions on the
signal evaluation process – saving time while improving quality.
Methods:
Oracle Empirica Signal software was utilized to extract cases with CM that are Known
Implicating Medications (KIM) for each AE according to public regulatory information from drug
labels – FDA Structured Product Labeling (SPL) or EMA Summary of Product Characteristics
(SPC). SAS Enterprise Guide was used to further process the data generated from Oracle Empirica
Signal software.
Results:
For any target drug being evaluated for safety purposes, a KIM reference table can be generated,
which summarizes all potential causality contributions from CMs.
Conclusion:
In addition to providing standalone KIM table as reference, adoption of this concept
and automation may also be fully integrated into commercial signal detection and management
software packages for easy use and accessibility and may even lead to reduced False Positive rate in
signal detection within the PV space.
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Affiliation(s)
- Tom Z. Hui
- Global Patient Safety Evaluation, Takeda Pharmaceuticals, Cambridge, MA 02139, United States
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Noda A, Sakai T, Obara T, Miyazaki M, Tsuchiya M, Oyanagi G, Murai Y, Mano N. Characteristics of pediatric adverse drug reaction reports in the Japanese Adverse Drug Event Report Database. BMC Pharmacol Toxicol 2020; 21:36. [PMID: 32448369 PMCID: PMC7245855 DOI: 10.1186/s40360-020-00412-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 05/12/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There are no reports on investigations of the characteristics of adverse drug reaction (ADR) reports for pediatric patients in the Japanese Adverse Drug Event Report database (JADER) and the utility of database for drug safety surveillance in these patients. METHOD We aimed to evaluate ADR reports for pediatric patients in the JADER. We used spontaneous ADR reports included in the JADER since April 1, 2004, to December 31, 2017, which was downloaded in April 2018. In a total of 504,407 ADR reports, the number of spontaneous reports was 386,400 (76.6%), in which 37,534 (7.4%) were unknown age reports. After extraction of 27,800 ADR reports for children aged < 10 and 10-19 years, we excepted for ADR reports associated with a vaccine (n = 6355) and no-suspected drug reports (n = 86). A total of 21,359 (4.2%) reports were finally included in this analysis. RESULTS More than half of the ADR reports were for children aged < 10 years. Approximately 30% of ADR reports had multiple suspected drugs, which did not differ by age. The percentages of fatal outcomes of ADRs among patients aged < 10 and 10-19 years were 4.7 and 3.9%, respectively. The most frequently reported drug, reaction, and drug-reaction pair were oseltamivir, abnormal behavior, and oseltamivir and abnormal behavior, respectively. CONCLUSION We clarified the characteristics of ADR reports for Japanese children by using the JADER. ADR report databases, especially those for pediatric patients, are valuable pharmacovigilance tools in Japan and other countries. Therefore, a proper understanding of the characteristics of the ADR reports in the JADER is important. Additionally, potential signals for ADRs in pediatric patients should be monitored continuously and carefully.
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Affiliation(s)
- Aoi Noda
- Division of Preventive Medicine and Epidemiology, Tohoku University Tohoku Medical Megabank Organization, Sendai, Miyagi, Japan.,Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Takamasa Sakai
- Drug Informatics, Faculty of Pharmacy, Meijo University, Nagoya, Aichi, Japan
| | - Taku Obara
- Division of Preventive Medicine and Epidemiology, Tohoku University Tohoku Medical Megabank Organization, Sendai, Miyagi, Japan. .,Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan. .,Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Miyagi, Japan.
| | - Makoto Miyazaki
- Laboratory of Clinical Pharmacy, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Miyagi, Japan
| | - Masami Tsuchiya
- Laboratory of Clinical Pharmacy, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Miyagi, Japan.,Department of Pharmacy, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Gen Oyanagi
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Yuriko Murai
- Department of Clinical Pharmaceutics, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Nariyasu Mano
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Miyagi, Japan.,Laboratory of Clinical Pharmacy, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Miyagi, Japan
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Lee H, Kim JH, Choe YJ, Shin JY. Safety Surveillance of Pneumococcal Vaccine Using Three Algorithms: Disproportionality Methods, Empirical Bayes Geometric Mean, and Tree-Based Scan Statistic. Vaccines (Basel) 2020; 8:E242. [PMID: 32456068 PMCID: PMC7349998 DOI: 10.3390/vaccines8020242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 12/05/2022] Open
Abstract
Introduction: Diverse algorithms for signal detection exist. However, inconsistent results are often encountered among the algorithms due to different levels of specificity used in defining the adverse events (AEs) and signal threshold. We aimed to explore potential safety signals for two pneumococcal vaccines in a spontaneous reporting database and compare the results and performances among the algorithms. Methods: Safety surveillance was conducted using the Korea national spontaneous reporting database from 1988 to 2017. Safety signals for pneumococcal vaccine and its subtypes were detected using the following the algorithms: disproportionality methods comprising of proportional reporting ratio (PRR), reporting odds ratio (ROR), and information component (IC); empirical Bayes geometric mean (EBGM); and tree-based scan statistics (TSS). Moreover, the performances of these algorithms were measured by comparing detected signals with the known AEs or pneumococcal vaccines (reference standard). Results: Among 10,380 vaccine-related AEs, 1135 reports and 101 AE terms were reported following pneumococcal vaccine. IC generated the most safety signals for pneumococcal vaccine (40/101), followed by PRR and ROR (19/101 each), TSS (15/101), and EBGM (1/101). Similar results were observed for its subtypes. Cellulitis was the only AE detected by all algorithms for pneumococcal vaccine. TSS showed the best balance in the performance: the highest in accuracy, negative predictive value, and area under the curve (70.3%, 67.4%, and 64.2%). Conclusion: Discrepancy in the number of detected signals was observed between algorithms. EBGM and TSS calibrated noise better than disproportionality methods, and TSS showed balanced performance. Nonetheless, these results should be interpreted with caution due to a lack of a gold standard for signal detection.
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Affiliation(s)
- Hyesung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Korea; (H.L.); (J.H.K.)
| | - Ju Hwan Kim
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Korea; (H.L.); (J.H.K.)
| | - Young June Choe
- College of Medicine, Hallym University, Chuncheon 24252, Korea;
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Korea; (H.L.); (J.H.K.)
- Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Korea
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12
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Nieber K, Raskopf E, Möller J, Kelber O, Fürst R, Shah-Hosseini K, Singh J, Kraft K, Mösgens R. Pharmaco-epidemiological research on herbal medicinal products in the paediatric population: data from the PhytoVIS study. Eur J Pediatr 2020; 179:507-512. [PMID: 31823076 PMCID: PMC7028796 DOI: 10.1007/s00431-019-03532-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 11/04/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
In paediatrics, clinical study data are limited, especially on herbal medicinal products. To address this gap, 2063 datasets from the paediatric population were evaluated in the PhytoVIS data base. By screening for paediatric data, information on indication, gender, treatment, co-medication and tolerability were evaluated. The majority of patients was treated because of common cold, fever, digestive complaints, skin diseases, sleep disturbances and anxiety. The perceived effect of the therapy was rated in 84% of the patients as very good or good without adverse events. The data shed light on a still neglected field of phyto-pharmacotherapy by giving information on the use of herbal medicines in an unselected cohort of paediatric patients. The results confirm the good clinical effects and safety of herbal medicinal products in this patient population and show that they are widely used in Germany.What is Known:• In Germany, about 85% of children receive one or more herbal medicinal products per year.• Despite international initiatives to promote clinical research in paediatrics, there are still many gaps of knowledge in the use of drugs in paediatrics.What is New:• The PhytoVIS project evaluated 2063 data sets from the paediatric population using herbal medicinal products.• The majority of patients was treated because of common cold, fever, digestive complaints, skin diseases, sleep disturbances and anxiety, and 84% of the patients rated the therapy as very good or good without adverse events.
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Affiliation(s)
- Karen Nieber
- Institute of Pharmacy, University of Leipzig, Brüderstr. 34, 04103, Leipzig, Germany. .,Kooperation Phytopharmaka GbR, Plittersdorfer Str. 218, 53173, Bonn, Germany.
| | - Esther Raskopf
- grid.6190.e0000 0000 8580 3777Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany ,ClinNovis GmbH, Genter Str. 7, 50672 Cologne, Germany
| | - Johanna Möller
- Bayer Consumer Health, Research & Development, Phytomedicines Supply and Development Center, Steigerwald Arzneimittelwerk GmbH, Havelstr. 5, 64295 Darmstadt, Germany
| | - Olaf Kelber
- Kooperation Phytopharmaka GbR, Plittersdorfer Str. 218, 53173 Bonn, Germany ,ClinNovis GmbH, Genter Str. 7, 50672 Cologne, Germany
| | - Robert Fürst
- Kooperation Phytopharmaka GbR, Plittersdorfer Str. 218, 53173 Bonn, Germany ,grid.7839.50000 0004 1936 9721Institute of Pharmaceutical Biology, Goethe University Frankfurt, Max-von-Laue-Str. 9, 60438 Frankfurt, Germany
| | - Kija Shah-Hosseini
- Kooperation Phytopharmaka GbR, Plittersdorfer Str. 218, 53173 Bonn, Germany
| | - Jaswinder Singh
- grid.6190.e0000 0000 8580 3777Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany ,ClinNovis GmbH, Genter Str. 7, 50672 Cologne, Germany
| | - Karin Kraft
- Kooperation Phytopharmaka GbR, Plittersdorfer Str. 218, 53173 Bonn, Germany ,grid.10493.3f0000000121858338Chair of Naturopathy, University Medicine Rostock, Ernst-Heydemann Str. 6, 18057 Rostock, Germany
| | - Ralph Mösgens
- grid.6190.e0000 0000 8580 3777Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany ,ClinNovis GmbH, Genter Str. 7, 50672 Cologne, Germany
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13
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Lima EDC, de Matos GC, de L. Vieira JM, da C.R. Gonçalves IC, Cabral LM, Turner MA. Suspected adverse drug reactions reported for Brazilian children: cross‐sectional study. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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14
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Lima EDC, Matos GCD, Vieira JMDL, Gonçalves ICDCR, Cabral LM, Turner MA. Suspected adverse drug reactions reported for Brazilian children: cross-sectional study. J Pediatr (Rio J) 2019; 95:682-688. [PMID: 30030984 DOI: 10.1016/j.jped.2018.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/17/2018] [Accepted: 05/29/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess spontaneous reports of suspected adverse drug reactions in children aged 0-12 years from the Brazilian Health Regulatory Agency between 2008 and 2013. METHODS A cross-sectional study on suspected adverse drug reactions reports related to medicines and health products in children was carried out for a six-year period (2008-2013). Year of report, origin of report by Brazilian state, gender, age, suspected drug, adverse reaction description and seriousness were included in the analysis. The data obtained was compared to the number of pediatric beds in health services and to global data from the VigiBase (World Health Organization). RESULTS A total of 3330 adverse drug reactions were reported in children in Brazil in the investigated period (54% were in boys). About 28% of suspected adverse drug reactions reports involved 0 to 1-year-old children. Almost 40% of reports came from the Southeast region. Approximately 60% were classified as serious events. There was death in 75 cases. Nearly 30% of deaths involved off-label use; 3875 medicines (465 active substances) were considered suspected drugs. Anti-infective (vancomycin, ceftriaxone, oxacillin, and amphotericin), nervous system (metamizole) and alimentary tract and metabolism medicines were more frequent in reports. CONCLUSIONS The distribution of suspected adverse drug reactions reports by sex and age group corresponded to the profile of children hospitalized in Brazil. Data about seriousness and medicines reported may be useful to encourage regulatory actions and improve the safe use of medicines in children.
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Affiliation(s)
- Elisangela da Costa Lima
- Universidade Federal do Rio de Janeiro, Faculdade de Farmácia, Observatório de Vigilância e Uso de Medicamentos, Rio de Janeiro, RJ, Brazil.
| | - Guacira Corrêa de Matos
- Universidade Federal do Rio de Janeiro, Faculdade de Farmácia, Observatório de Vigilância e Uso de Medicamentos, Rio de Janeiro, RJ, Brazil
| | - Jean M de L Vieira
- Universidade Federal do Rio de Janeiro, Faculdade de Farmácia, Programa de Pós Graduação em Ciência e Tecnologia Farmacêutica, Rio de Janeiro, RJ, Brazil
| | - Ivana C da C R Gonçalves
- Universidade Federal do Rio de Janeiro, Faculdade de Farmácia, Programa de Pós Graduação em Ciência e Tecnologia Farmacêutica, Rio de Janeiro, RJ, Brazil
| | - Lucio M Cabral
- Universidade Federal do Rio de Janeiro, Faculdade de Farmácia, Observatório de Vigilância e Uso de Medicamentos, Rio de Janeiro, RJ, Brazil
| | - Mark A Turner
- University of Liverpool, Institute of Translational Medicine, Department of Women's & Children's Health, Liverpool, United Kingdom
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15
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Abstract
Like much of the clinical research and health care provider enterprise, the data capture and archiving for harm, probability of harm, and impact of intervention-related events is fragmented, inconsistent, and lacks standards to perform the types of operations that could inform researchers, practitioners, and patients in a timely way of actions and policies. The entire system of assessments, terminology, data formats and structure, analyses, and dissemination would benefit from changes based on adherence to a process framework of detect, describe, analyze, and react in the context of recognizing the multiple pathways and factors that lead to any specific outcome or series of outcomes. Existing tools, if properly applied, can form the basis for the next generation of data systems, processes, analyses, and sharing to address most of the current challenges.
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Affiliation(s)
| | - Anne Zajicek
- 1 National Institutes of Health, Bethesda, MD, USA
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16
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Ampadu HH, Hoekman J, Arhinful D, Amoama-Dapaah M, Leufkens HGM, Dodoo ANO. Organizational capacities of national pharmacovigilance centres in Africa: assessment of resource elements associated with successful and unsuccessful pharmacovigilance experiences. Global Health 2018; 14:109. [PMID: 30445979 PMCID: PMC6240224 DOI: 10.1186/s12992-018-0431-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND National pharmacovigilance centres (national centres) are gradually gaining visibility as part of the healthcare delivery system in Africa. As does happen in high-income countries, it is assumed that national centres can play a central coordinating role in their national pharmacovigilance (PV) systems. However, there are no studies that have investigated whether national centres in Africa have sufficient organizational capacity to deliver on this mandate and previous studies have reported challenges such as lack of funding, political will and adequate human resources. We conducted interviews with strategic leaders in national centres in 18 African countries, to examine how they link the capacity of their organization to the outcomes of activities coordinated by their centres. Strategic leaders were asked to describe three situations in which activities conducted by their centre were deemed successful and unsuccessful. We analyzed these experiences for common themes and examined whether strategic leaders attributed particular types of resources and relationships with stakeholders to successful or unsuccessful activities. RESULTS We found that strategic leaders most often attributed successful experiences to the acquisition of political (e.g. legal mandate) or technical (e.g. active surveillance database) resources, while unsuccessful experiences were often attributed to the lack of financial and human resources. Stakeholders that were most often mentioned in association with successful experiences were national government and development partners, whereas national government and public health programmes (PHPs) were often mentioned in unsuccessful experiences. All 18 centres, regardless of maturity of their PV systems had similar challenges. CONCLUSIONS The study concludes that national centres in Africa are faced with 3 core challenges: (1) over-reliance on development partners, (2) seeming indifference of national governments to provide support after national centres have gained membership of the World Health Organization (WHO) Programme for International Drug Monitoring (PIDM) and (3) engaging public health programmes in a sustainable way.
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Affiliation(s)
- H Hilda Ampadu
- The African Collaborating Centre for Pharmacovigilance, 1 Vigilance Place, Mango Tree Avenue, Asylum Down, Accra, Ghana.
- WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3508 TB, Utrecht, the Netherlands.
| | - Jarno Hoekman
- Innovation Studies Group, Copernicus Institute for Sustainable Development, Faculty of Geosciences, Utrecht University, 3508 TB, Utrecht, the Netherlands
| | - Daniel Arhinful
- Noguchi Memorial Institute for Medical Research, University of Ghana, P. O Box LG 25, Accra, Ghana
| | - Marilyn Amoama-Dapaah
- The African Collaborating Centre for Pharmacovigilance, 1 Vigilance Place, Mango Tree Avenue, Asylum Down, Accra, Ghana
| | - Hubert G M Leufkens
- WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3508 TB, Utrecht, the Netherlands
| | - Alex N O Dodoo
- The African Collaborating Centre for Pharmacovigilance, 1 Vigilance Place, Mango Tree Avenue, Asylum Down, Accra, Ghana
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17
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Eugene AR, Eugene B. An opportunity for clinical pharmacology trained physicians to improve patient drug safety: A retrospective analysis of adverse drug reactions in teenagers. F1000Res 2018; 7:677. [PMID: 30271581 PMCID: PMC6143933 DOI: 10.12688/f1000research.14970.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2018] [Indexed: 01/06/2023] Open
Abstract
Background: Adverse drug reactions (ADRs) are a major cause of hospital admissions, prolonged hospital stays, morbidity, and drug-related mortality. In this study, we sought to identify the most frequently reported medications and associated side effects in adolescent-aged patients in an effort to prioritize clinical pharmacology consultation efforts for hospitals seeking to improve patient safety. Methods: Quarterly reported data were obtained from the United States Food and Drug Administration Adverse Events Reporting System (FAERS) from the third quarter of 2014 and ending in the third quarter of 2017. We then used the GeneCards database to map the pharmacogenomic biomarkers associated with the most reported FAERS drugs. Data homogenization and statistics analysis were all conducted in R for statistical programming. Results: We identified risperidone (10.64%) as the compound with the most reported ADRs from all reported cases. Males represented 90.1% of reported risperidone cases with gynecomastia being the most reported ADR. Ibuprofen OR=188 (95% CI, 105.00 – 335.00) and quetiapine fumarate OR=116 (95% CI, 48.40 – 278.00) were associated with the highest odds of completed suicide in teenagers. Ondansetron hydrochloride OR=7.12 (95% CI, 1.59 – 31.9) resulted in the highest odds of pneumothorax. Lastly, olanzapine (8.96%) represented the compound with the most reported drug-drug interactions cases, while valproic acid OR=221 (95% CI, 93.900 – 522.00) was associated with the highest odds of drug-drug interactions. Conclusion: Despite any data limitations, physicians prescribing risperidone in males should be aware of the high rates of adverse drug events and an alternative psychotropic should be considered in male patients. Further, patients with a history of pneumothorax or genetically predisposed to pneumothorax should be considered for an alternative antiemetic to ondansetron hydrochloride, due to increased odds associated with the drug and adverse event.
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Affiliation(s)
- Andy R Eugene
- Department of Pharmacogenomics, Bernard J. Dunn School of Pharmacy, Inova Center for Personalized Health, Shenandoah University, Fairfax, VA, 22031, USA.,Neurophysiology Unit, Department of Psychiatry, Medical University of Lublin, Aleje Racławickie 1, 20-059 Lublin, Poland
| | - Beata Eugene
- Marie-Curie Sklodowska University, Lublin, Poland
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18
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Bouquet É, Star K, Jonville-Béra AP, Durrieu G. Pharmacovigilance in pediatrics. Therapie 2018; 73:171-180. [DOI: 10.1016/j.therap.2017.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 11/15/2017] [Indexed: 12/20/2022]
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19
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Ferrajolo C, Verhamme KMC, Trifirò G, 't Jong GW, Picelli G, Giaquinto C, Mazzaglia G, Stricker BH, Rossi F, Capuano A, Sturkenboom MCJM. Antibiotic-Induced Liver Injury in Paediatric Outpatients: A Case-Control Study in Primary Care Databases. Drug Saf 2017; 40:305-315. [PMID: 28025733 PMCID: PMC5362651 DOI: 10.1007/s40264-016-0493-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction Antibiotics are the most commonly prescribed drug class in children. Real-world data mining on the paediatric population showed potential associations between antibiotic use and acute liver injury. Objective We assessed risk estimates of liver injury associated with antibiotic use in children and adolescent outpatients. Methods A large, multi-database, population-based, case-control study was performed in people <18 years of age from two European countries (Italy and The Netherlands) during the period 2000–2008. All potential cases of liver injury were automatically extracted from three databases and then manually validated based on Council for International Organizations of Medical Sciences (CIOMS) criteria and by exclusion of all competing causes for liver injury. Up to 100 control participants were sampled for each case and were matched on index date of the event, age, sex and database. Based on prescription data, antibiotic exposure was categorized as current, recent or past use by calculating the time period between the end of prescription and the index date. Multivariate conditional logistic regression analyses were applied to calculate odds ratios (ORs) as a measure of the association (with 95% confidence interval [CI]). Results We identified 938 cases of liver injury and matched to 93,665 controls. Current use of overall antibiotics is associated with a threefold increased risk of liver injury compared with past use (adjusted OR [ORadj] 3.22, 95% CI 2.57–4.03). With regard to individual antibiotics, the risk is significantly increased for current use of each antibiotic (p < 0.005), except for azithromycin. Risk estimates vary from the lowest ORadj of 1.86 (95% CI 1.08–3.21) for amoxicillin to the highest ORadj of 24.16 (95% CI 11.78–49.54) for cotrimoxazole (i.e. sulphamethoxazole/trimethoprim) and 26.70 (95% CI 12.09–58.96) for ceftriaxone. Sensitivity analyses confirm the associations for ceftriaxone, cotrimoxazole, and clarithromycin. Conclusion Antibiotic-induced liver injury in children is heterogeneous across the use of individual antibiotics. When prescribing ceftriaxone, cotrimoxazole and clarithromycin in children, paediatricians should definitely be aware of their potential risk of liver injury, even if for short periods. Electronic supplementary material The online version of this article (doi:10.1007/s40264-016-0493-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carmen Ferrajolo
- Department of Experimental Medicine, Pharmacology Section, Campania Regional Centre of Pharmacovigilance and Pharmacoepidemiology, University of Campania, Via Santa Maria di Costantinopoli, 16, 80138, Naples, Italy.
- Department of Medical Informatics, Erasmus University Medical Centre, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands.
| | - Katia M C Verhamme
- Department of Medical Informatics, Erasmus University Medical Centre, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands
| | - Gianluca Trifirò
- Department of Medical Informatics, Erasmus University Medical Centre, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Geert W 't Jong
- Department of Medical Informatics, Erasmus University Medical Centre, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Gino Picelli
- Pedianet-Società Servizi Telematici SRL, Padua, Italy
| | - Carlo Giaquinto
- Pedianet-Società Servizi Telematici SRL, Padua, Italy
- Department of Paediatrics, University of Padua, Padua, Italy
| | - Giampiero Mazzaglia
- Health Search-IMS HEALTH LPD (Longitudinal Patient Database), Italian College of General Practitioners, Florence, Italy
| | - Bruno H Stricker
- Department of Epidemiology and Biostatistics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Francesco Rossi
- Department of Experimental Medicine, Pharmacology Section, Campania Regional Centre of Pharmacovigilance and Pharmacoepidemiology, University of Campania, Via Santa Maria di Costantinopoli, 16, 80138, Naples, Italy
| | - Annalisa Capuano
- Department of Experimental Medicine, Pharmacology Section, Campania Regional Centre of Pharmacovigilance and Pharmacoepidemiology, University of Campania, Via Santa Maria di Costantinopoli, 16, 80138, Naples, Italy
| | - Miriam C J M Sturkenboom
- Department of Medical Informatics, Erasmus University Medical Centre, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands
- Department of Epidemiology and Biostatistics, Erasmus University Medical Centre, Rotterdam, The Netherlands
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20
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Drug Safety Monitoring in Children: Performance of Signal Detection Algorithms and Impact of Age Stratification. Drug Saf 2017; 39:873-81. [PMID: 27255487 PMCID: PMC4982893 DOI: 10.1007/s40264-016-0433-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Spontaneous reports of suspected adverse drug reactions (ADRs) can be analyzed to yield additional drug safety evidence for the pediatric population. Signal detection algorithms (SDAs) are required for these analyses; however, the performance of SDAs in the pediatric population specifically is unknown. We tested the performance of two SDAs on pediatric data from the US FDA Adverse Event Reporting System (FAERS) and investigated the impact of age stratification and age adjustment on the performance of SDAs. METHODS We tested the performance of two established SDAs: the proportional reporting ratio (PRR) and the empirical Bayes geometric mean (EBGM) on a pediatric dataset from FAERS (2004-2012). We compared the performance of the SDAs with a published pediatric-specific reference set by calculating diagnostic test-related statistics, including the area under the curve (AUC) of receiver operating characteristics. Impact of age stratification and age-adjustment on the performance of the SDAs was assessed. Age adjustment was performed by pooling (Mantel-Hanszel) stratum-specific estimates. RESULTS A total of 115,674 pediatric reports (patients aged 0-18 years) comprising 893,587 drug-event combinations (DECs) were analysed. Crude values of the AUC were similar for both SDAs: 0.731 (PRR) and 0.745 (EBGM). Stratification unmasked four DECs, e.g., 'ibuprofen and thrombocytopenia'. Age adjustment did not improve performance. CONCLUSION The performance of the two tested SDAs was similar in the pediatric population. Age adjustment does not improve performance and is therefore not recommended to be performed routinely. Stratification can reveal new associations, and therefore is recommended when either drug use is age-specific or when an age-specific risk is suspected.
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21
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Signal of Miscarriage with Aripiprazole: A Disproportionality Analysis of the Japanese Adverse Drug Event Report Database. Drug Saf 2017; 40:1141-1146. [DOI: 10.1007/s40264-017-0560-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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22
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Van Riet-Nales DA, Kozarewicz P, Aylward B, de Vries R, Egberts TCG, Rademaker CMA, Schobben AFAM. Paediatric Drug Development and Formulation Design-a European Perspective. AAPS PharmSciTech 2017; 18:241-249. [PMID: 27270905 DOI: 10.1208/s12249-016-0558-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/19/2016] [Indexed: 12/17/2022] Open
Abstract
The availability of licensed paediatric drugs is lagging behind those for adults, and there is a lack of safe formulations in suitable doses that children are able and willing to take. As a consequence, children are commonly treated with off-label or unlicensed drugs. As off-label and unlicensed drug use are associated with a greater risk for harm than on-label drug use, a range of global initiatives have been developed to realize "better" medicines for children. This review describes the challenges and achievements of the European Union to realize this goal, with a focus on paediatric drug development and formulation design. In 2007, a European Paediatric Regulation was installed enforcing companies to consider children in the early development of drugs with a new drug substance, for a new indication or with a new route of administration. The Regulation, e.g. requires companies to develop a paediatric investigation plan discussing the proposed clinical trials in children of different ages and the formulations for future marketing. Since 2013, the pharmaceutical design of any newly marketed paediatric drug should comply with the "Guideline on the Pharmaceutical Development of Medicines for Paediatric Use." Companies should, e.g. justify the route of administration, dosage form, formulation characteristics, safety of excipients, dosing frequency, container closure system, administration device, patient acceptability and user information. In this review, the guideline's key aspects are discussed with a focus on novel formulations such as mini-tablets and orodispersible films, excipients with a potential risk for harm such as azo dyes and adequate user instructions.
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Kaguelidou F, Beau-Salinas F, Jonville-Bera AP, Jacqz-Aigrain E. Neonatal adverse drug reactions: an analysis of reports to the French pharmacovigilance database. Br J Clin Pharmacol 2016; 82:1058-68. [PMID: 27276109 DOI: 10.1111/bcp.13034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 05/23/2016] [Accepted: 06/06/2016] [Indexed: 11/30/2022] Open
Abstract
AIM Term and preterm neonates are at high risk for serious adverse drug reactions (ADRs). METHODS A descriptive study of reports registered in the French pharmacovigilance database from 1986 to 2012 were obtained. All reports concerning neonates (≤1 month of life) with direct drug exposure were retrieved. Characteristics of the reports, including reported ADR(s), drug(s) and the causality assessment using the French causality assessment method, were described. RESULTS A total of 1688 reports were analyzed and more than half of them were classified as serious (n = 995). Median age at ADR occurrence was 9 days. Overall, 3127 ADRs were described in these reports in relation to 2238 suspect/interacting drugs. The most commonly reported system organ classes (SOCs) were injury, poisoning and procedural complications (16%), general disorders and administration site conditions (12.5%) and blood and lymphatic system disorders (12%). In the majority of ADRs reported (73%), infants fully recovered and less than 4% of neonates deceased as a consequence of the reported ADR. One out of five ADRs was associated with drug administration errors. Therapeutic classes commonly incriminated were anti-infectives, nervous system and alimentary tract drugs. Substances most frequently related to serious ADRs were zidovudine, ibuprofen and nevirapine. Among the 10 most frequently encountered drug-ADR pairs, two substances were mainly implicated, zidovudine in haematological adverse reactions and phytomenadione in maladministrations. CONCLUSIONS Anti-infective drugs, mainly antiretroviral therapy, account for the majority of ADRs reported in neonates. The specific issue of drug maladministration and medication errors remains to be addressed in neonates.
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Affiliation(s)
- Florentia Kaguelidou
- EA 08, University of Paris Diderot, Sorbonne Paris Cité, F-75010, Paris. .,Inserm, CIC 1426, F-75019, Paris. .,Department of Pediatric Pharmacology and Pharmacogenetics, AP-HP, Hôpital Robert Debré, F-75019, Paris.
| | - Frédérique Beau-Salinas
- CHRU of Tours, Department of Clinical Pharmacology, Regional Centre of Pharmacovigilance, F-37 044, Tours, France
| | - Annie Pierre Jonville-Bera
- CHRU of Tours, Department of Clinical Pharmacology, Regional Centre of Pharmacovigilance, F-37 044, Tours, France
| | - Evelyne Jacqz-Aigrain
- EA 08, University of Paris Diderot, Sorbonne Paris Cité, F-75010, Paris.,Inserm, CIC 1426, F-75019, Paris.,Department of Pediatric Pharmacology and Pharmacogenetics, AP-HP, Hôpital Robert Debré, F-75019, Paris
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24
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Osokogu OU, Dukanovic J, Ferrajolo C, Dodd C, Pacurariu AC, Bramer WM, 'tJong G, Weibel D, Sturkenboom MCJM, Kaguelidou F. Pharmacoepidemiological safety studies in children: a systematic review. Pharmacoepidemiol Drug Saf 2016; 25:861-70. [PMID: 27255559 PMCID: PMC5111763 DOI: 10.1002/pds.4041] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/06/2016] [Accepted: 05/06/2016] [Indexed: 11/22/2022]
Abstract
Purpose In order to identify challenges in pediatric pharmacoepidemiological safety studies, we assessed the characteristics of such (published) studies. Methods Relevant articles from inception to 2013 were retrieved from Embase and Medline. We sequentially screened titles, abstracts and full texts with independent validation. We systematically collected data regarding general information, study methods and results. Results Out of 4825 unique articles, 268 full texts (5.6%) were retained; 147 (54.9%) pertained to drugs rather than vaccines. Considering the 268 studies, 202 (75.4%) concerned children and adolescents (2 to 11 years) and 14 (5.3%) included preterm newborns. Most studies originated from North America (154 [57.5%]) or Europe (92 [34.3%]). Only 47 studies (17.5%) were privately funded. The majority (174 [64.9%]) were cohort studies. Out of 268 studies, 196 (73.1%) collected data retrospectively; paper medical charts were the most common data source for the exposures (85 [31.7%]) and outcomes (122 [45.5%]). Only 3 (2.0%) drug‐only studies investigated rarely used drugs. Considering all 268 studies, only 27 (10.1%) reported sample size or power calculation. Most (75 [51.0%]) drug‐only studies corrected confounding by multivariate modeling unlike stratification in 66 (55.9%) vaccine‐only studies. Considering 75 child‐only studies without any statistically significant result, 41 (54.7%) did not discuss lack of power. Conclusions Although the field of pediatric pharmacoepidemiology is steadily developing evaluation seldom includes neonates, is mainly focused on few drug classes and safety outcomes and concerns mainly drug use in developed countries. Small study size is a specific challenge in pediatrics. Reporting should be improved. © 2016 The Authors. Pharmacoepidemiology and Drug Safety Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Osemeke U Osokogu
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Julijana Dukanovic
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Carmen Ferrajolo
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Caitlin Dodd
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alexandra C Pacurariu
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Geert 'tJong
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Daniel Weibel
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Miriam C J M Sturkenboom
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Florentia Kaguelidou
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Pediatric Pharmacology and Pharmacogenetics, Hôpital Robert Debré, APHP, Univ Paris 7-Diderot, Sorbonne Paris Cité, EA08, INSERM CIC1426, Paris, France
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25
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Abstract
Observational studies have been recognised to be essential for investigating the safety profile of medications. Numerous observational studies have been conducted on the platform of large population databases, which provide adequate sample size and follow-up length to detect infrequent and/or delayed clinical outcomes. Cohort and case-control are well-accepted traditional methodologies for hypothesis testing, while within-individual study designs are developing and evolving, addressing previous known methodological limitations to reduce confounding and bias. Respective examples of observational studies of different study designs using medical databases are shown. Methodology characteristics, study assumptions, strengths and weaknesses of each method are discussed in this review.
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