The way towards adverse event monitoring in clinical trials

Meta-analysis of blinded and unblinded studies for ongoing aggregate safety monitoring and evaluation

During the course of clinical development, ongoing aggregate safety monitoring and evaluation are needed to understand the evolving safety profile and to ensure effective risk-management strategies for medicinal products. CIOMS reports and global regulatory guidance (including from ICH, US FDA, and EMA) compel sponsors for assessment of safety based on aggregate data. To identify and characterize the risks of medicinal products at a program level in a more timely and informed manner, aggregate safety evaluations should combine all available information, including from ongoing blinded trials, completed unblinded trials, and other data sources. In this article, we propose two Bayesian meta-analytic approaches for synthesizing blinded and unblinded studies in order to characterize the evolving safety profile of medicinal products at the program level. With the proposed approaches, sponsors can dynamically update knowledge of their product safety profiles as data accrue. Application of the procedures to a real and a hypothetical clinical trial program are provided to illustrate how the proposed approaches can be used to analyze a pre-specified event of interest and to screen for risk-elevated events.

[Ceará State Pharmacovigilance System: a year of experience]

This paper summarizes the first year of activity of the Ceará State Pharmacovigilance System (SIFACE) as a strategy to discuss practical and methodological problems related to developing pharmacovigilance in Brazil. Siface is being structured by the Group for the Prevention of Improper Use of Pharmaceuticals (GPUIM), based on hospital pharmacies. A total of 63 reports (119 suspected adverse drug reactions, or ADRs) were processed, the majority among women (55.7%) and children (34.4%). Antibiotics were the drug group most frequently involved, and the most common reactions were dermatological. In 20% of the cases, patients had been re-exposed to drugs previously reported as producing adverse reactions, thus highlighting the importance of pharmacovigilance to prevent ADRs.