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Hlavaty A, Roustit M, Montani D, Chaumais M, Guignabert C, Humbert M, Cracowski J, Khouri C. Identifying new drugs associated with pulmonary arterial hypertension: A WHO pharmacovigilance database disproportionality analysis. Br J Clin Pharmacol 2022; 88:5227-5237. [PMID: 35679331 PMCID: PMC9795981 DOI: 10.1111/bcp.15436] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/11/2022] [Accepted: 05/29/2022] [Indexed: 12/30/2022] Open
Abstract
Since the 1960s, several drugs have been linked to the onset or aggravation of pulmonary arterial hypertension (PAH): dasatinib, some amphetamine-like appetite suppressants (aminorex, fenfluramine, dexfenfluramine, benfluorex) and recreational drugs (methamphetamine). Moreover, in numerous cases, the implication of other drugs with PAH have been suggested, but the precise identification of iatrogenic aetiologies of PAH is challenging given the scarcity of this disease and the potential long latency period between drug intake and PAH onset. In this context, we used the World Health Organization's pharmacovigilance database, VigiBase, to generate new hypotheses about drug associated PAH. METHODS We used VigiBase, the largest pharmacovigilance database worldwide to generate disproportionality signals through the Bayesian neural network method. All disproportionality signals were further independently reviewed by experts in pulmonary arterial hypertension, pharmacovigilance and vascular pharmacology and their plausibility ranked according to World Health Organization causality categories. RESULTS We included 2184 idiopathic PAH cases, yielding a total of 93 disproportionality signals. Among them, 25 signals were considered very likely, 15 probable, 28 possible and 25 unlikely. Notably, we identified 4 new protein kinases inhibitors (lapatinib, lorlatinib, ponatinib and ruxolitinib), 1 angiogenesis inhibitor (bevacizumab), and several chemotherapeutics (etoposide, trastuzumab), antimetabolites (cytarabine, fludarabine, fluorouracil, gemcitabine) and immunosuppressants (leflunomide, thalidomide, ciclosporin). CONCLUSION Such signals represent plausible adverse drug reactions considering the knowledge of iatrogenic PAH, the drugs' biological and pharmacological activity and the characteristics of the reported case. Although confirmatory studies need to be performed, the signals identified may help clinicians envisage an iatrogenic aetiology when faced with a patient who develops PAH.
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Affiliation(s)
- Alex Hlavaty
- Pharmacovigilance UnitGrenoble Alpes University HospitalGrenobleFrance
| | - Matthieu Roustit
- Clinical Pharmacology Department INSERM CIC1406Grenoble Alpes University HospitalGrenobleFrance,HP2 Laboratory, Inserm U1300Grenoble Alpes University ‐ GrenobleFrance
| | - David Montani
- INSERM UMR_S 999 «Pulmonary Hypertension: Pathophysiology and Novel Therapies», Hôpital Marie LannelongueLe Plessis‐RobinsonFrance,Faculté de MédecineUniversité Paris‐SaclayLe Kremlin‐BicêtreFrance,Assistance Publique ‐ Hôpitaux de Paris (AP‐HP), Service de Pneumologie, Centre de référence Maladie Rares de l'Hypertension PulmonaireHôpital BicêtreLe Kremlin‐BicêtreFrance
| | - Marie‐Camille Chaumais
- INSERM UMR_S 999 «Pulmonary Hypertension: Pathophysiology and Novel Therapies», Hôpital Marie LannelongueLe Plessis‐RobinsonFrance,Faculté de PharmacieUniversité Paris‐SaclayChâtenay MalabryFrance,Assistance Publique ‐ Hôpitaux de Paris (AP‐HP), Service de PharmacieHôpital BicêtreLe Kremlin‐BicêtreFrance
| | - Christophe Guignabert
- INSERM UMR_S 999 «Pulmonary Hypertension: Pathophysiology and Novel Therapies», Hôpital Marie LannelongueLe Plessis‐RobinsonFrance,Faculté de MédecineUniversité Paris‐SaclayLe Kremlin‐BicêtreFrance
| | - Marc Humbert
- INSERM UMR_S 999 «Pulmonary Hypertension: Pathophysiology and Novel Therapies», Hôpital Marie LannelongueLe Plessis‐RobinsonFrance,Faculté de MédecineUniversité Paris‐SaclayLe Kremlin‐BicêtreFrance,Assistance Publique ‐ Hôpitaux de Paris (AP‐HP), Service de Pneumologie, Centre de référence Maladie Rares de l'Hypertension PulmonaireHôpital BicêtreLe Kremlin‐BicêtreFrance
| | - Jean‐Luc Cracowski
- Pharmacovigilance UnitGrenoble Alpes University HospitalGrenobleFrance,HP2 Laboratory, Inserm U1300Grenoble Alpes University ‐ GrenobleFrance
| | - Charles Khouri
- Pharmacovigilance UnitGrenoble Alpes University HospitalGrenobleFrance,Clinical Pharmacology Department INSERM CIC1406Grenoble Alpes University HospitalGrenobleFrance,HP2 Laboratory, Inserm U1300Grenoble Alpes University ‐ GrenobleFrance
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Quantitative Benefit-Risk Assessment of COVID-19 Vaccines Using the Multi-Criteria Decision Analysis. Vaccines (Basel) 2022; 10:vaccines10122029. [PMID: 36560439 PMCID: PMC9785565 DOI: 10.3390/vaccines10122029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
In the early SARS-CoV-2 (COVID-19) pandemic, four major vaccines were approved despite limited efficacy and safety data through short regulatory review periods. Thus, it is necessary to assess the benefit-risk (BR) profiles of the COVID-19 vaccines. We conducted a quantitative BR assessment for four COVID-19 vaccines (mRNA-based: mRNA-1273 and BNT162b2; viral vector-based: Ad26.COV.2 and ChAdOx1-S) using multi-criteria decision analysis. Three benefit criteria and two risk criteria were considered: preventing COVID-19 infection for (1) adults aged ≥18 years; (2) seniors aged 60 years or older; and (3) severe COVID-19, adverse events (AEs), and serious AEs. Data were retrieved from clinical trials, observational studies, and county-specific AE monitoring reports. Based on the collected data, vaccines were scored for each criterion. 22 professionals weighted each criterion. The overall BR score was calculated using scores and weights. mRNA-1273 was the most preferred vaccine in pre-authorization and BNT162b2 in post-authorization. We found that the mRNA vaccine had a good balance between the benefits and risks. Using this BR assessment, the benefit-risk profile of COVID-19 vaccines can be updated with cumulated data. It will contribute to building evidence for decision making by policy makers and health professionals.
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Rodríguez-Martín S, Barreira-Hernández D, Gil M, García-Lledó A, Izquierdo-Esteban L, De Abajo F. Influenza Vaccination and Risk of Ischemic Stroke: A Population-Based Case-Control Study. Neurology 2022; 99:e2149-e2160. [PMID: 36240087 DOI: 10.1212/wnl.0000000000201123] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To assess the relationship between influenza vaccination in the general population and risk of a first ischemic stroke (IS) during pre-epidemic, epidemic, and postepidemic periods. METHODS A nested case-control study was conducted in a Spanish primary care database over 2001-2015. Individuals aged 40-99 years with at least 1 year registry and no history of stroke or cancer were selected to conform the source cohort, from which incident IS cases were identified and classified as cardioembolic or noncardioembolic. Five controls per case were randomly selected, individually matched with cases for exact age, sex, and date of stroke diagnosis (index date). A patient was considered vaccinated when he/she had a recorded influenza vaccination at least 14 days before the index date within the same season. Adjusted odds ratios (aORs) and their respective 95% CIs were computed through a conditional logistic regression. Pneumococcal vaccination was used as a negative control. RESULTS From a cohort of 3,757,621 patients, we selected 14,322 incident IS cases (9,542 noncardioembolic and 4,780 cardioembolic) and 71,610 matched controls. Of them, 41.4% and 40.5%, respectively, were vaccinated yielding a crude OR of 1.05 (95% CI 1.01-1.10). Vaccinated patients presented a higher prevalence of vascular risk factors, diseases, and comedication than those nonvaccinated, and after full adjustment, the association of influenza vaccination with IS yielded an aOR of 0.88 (95% CI 0.84-0.92), appearing early (aOR15-30 days 0.79; 95% CI 0.69-0.92) and slightly declining over time (aOR>150 days 0.92; 95% CI 0.87-0.98). A reduced risk of similar magnitude was observed with both types of IS, in the 3 epidemic periods, and in all subgroups analyzed (men, women, individuals younger and older than 65 years of age, and those with intermediate and high vascular risk). By contrast, pneumococcal vaccination was not associated with a reduced risk of IS (aOR 1.08; 95% CI 1.04-1.13). DISCUSSION Results are compatible with a moderate protective effect of influenza vaccine on IS appearing early after vaccination. The finding that a reduced risk was also observed in pre-epidemic periods suggests that either the "protection" is not totally linked to prevention of influenza infection or it may be partly explained by unmeasured confounding factors.
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Affiliation(s)
- Sara Rodríguez-Martín
- From the Department of Biomedical Sciences (Pharmacology Sector) (S.R.-M., D.B.-H., F.J.D.A.), School of Medicine, University of Alcalá (IRYCIS); Clinical Pharmacology Unit (S.R.-M., D.B.-H., F.J.D.A.), University Hospital Príncipe de Asturias, Alcalá de Henares; Division of Pharmacoepidemiology and Pharmacovigilance (M.G.), Spanish Agency for Medicines and Medical Devices; Cardiology Department (A.G.-L.), University Hospital Príncipe de Asturias, Alcalá de Henares; Department of Medicine (A.G.-L.), School of Medicine, University of Alcalá; and Stroke Unit (L.I.-E.), Department of Neurology, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Diana Barreira-Hernández
- From the Department of Biomedical Sciences (Pharmacology Sector) (S.R.-M., D.B.-H., F.J.D.A.), School of Medicine, University of Alcalá (IRYCIS); Clinical Pharmacology Unit (S.R.-M., D.B.-H., F.J.D.A.), University Hospital Príncipe de Asturias, Alcalá de Henares; Division of Pharmacoepidemiology and Pharmacovigilance (M.G.), Spanish Agency for Medicines and Medical Devices; Cardiology Department (A.G.-L.), University Hospital Príncipe de Asturias, Alcalá de Henares; Department of Medicine (A.G.-L.), School of Medicine, University of Alcalá; and Stroke Unit (L.I.-E.), Department of Neurology, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Miguel Gil
- From the Department of Biomedical Sciences (Pharmacology Sector) (S.R.-M., D.B.-H., F.J.D.A.), School of Medicine, University of Alcalá (IRYCIS); Clinical Pharmacology Unit (S.R.-M., D.B.-H., F.J.D.A.), University Hospital Príncipe de Asturias, Alcalá de Henares; Division of Pharmacoepidemiology and Pharmacovigilance (M.G.), Spanish Agency for Medicines and Medical Devices; Cardiology Department (A.G.-L.), University Hospital Príncipe de Asturias, Alcalá de Henares; Department of Medicine (A.G.-L.), School of Medicine, University of Alcalá; and Stroke Unit (L.I.-E.), Department of Neurology, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Alberto García-Lledó
- From the Department of Biomedical Sciences (Pharmacology Sector) (S.R.-M., D.B.-H., F.J.D.A.), School of Medicine, University of Alcalá (IRYCIS); Clinical Pharmacology Unit (S.R.-M., D.B.-H., F.J.D.A.), University Hospital Príncipe de Asturias, Alcalá de Henares; Division of Pharmacoepidemiology and Pharmacovigilance (M.G.), Spanish Agency for Medicines and Medical Devices; Cardiology Department (A.G.-L.), University Hospital Príncipe de Asturias, Alcalá de Henares; Department of Medicine (A.G.-L.), School of Medicine, University of Alcalá; and Stroke Unit (L.I.-E.), Department of Neurology, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Laura Izquierdo-Esteban
- From the Department of Biomedical Sciences (Pharmacology Sector) (S.R.-M., D.B.-H., F.J.D.A.), School of Medicine, University of Alcalá (IRYCIS); Clinical Pharmacology Unit (S.R.-M., D.B.-H., F.J.D.A.), University Hospital Príncipe de Asturias, Alcalá de Henares; Division of Pharmacoepidemiology and Pharmacovigilance (M.G.), Spanish Agency for Medicines and Medical Devices; Cardiology Department (A.G.-L.), University Hospital Príncipe de Asturias, Alcalá de Henares; Department of Medicine (A.G.-L.), School of Medicine, University of Alcalá; and Stroke Unit (L.I.-E.), Department of Neurology, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Francisco De Abajo
- From the Department of Biomedical Sciences (Pharmacology Sector) (S.R.-M., D.B.-H., F.J.D.A.), School of Medicine, University of Alcalá (IRYCIS); Clinical Pharmacology Unit (S.R.-M., D.B.-H., F.J.D.A.), University Hospital Príncipe de Asturias, Alcalá de Henares; Division of Pharmacoepidemiology and Pharmacovigilance (M.G.), Spanish Agency for Medicines and Medical Devices; Cardiology Department (A.G.-L.), University Hospital Príncipe de Asturias, Alcalá de Henares; Department of Medicine (A.G.-L.), School of Medicine, University of Alcalá; and Stroke Unit (L.I.-E.), Department of Neurology, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
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Thurin NH, Lassalle R, Schuemie M, Pénichon M, Gagne JJ, Rassen JA, Benichou J, Weill A, Blin P, Moore N, Droz-Perroteau C. Empirical assessment of case-based methods for identification of drugs associated with acute liver injury in the French National Healthcare System database (SNDS). Pharmacoepidemiol Drug Saf 2020; 30:320-333. [PMID: 33099844 DOI: 10.1002/pds.5161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/10/2022]
Abstract
PURPOSES Drug induced acute liver injury (ALI) is a frequent cause of liver failure. Case-based designs were empirically assessed and calibrated in the French National claims database (SNDS), aiming to identify the optimum design for drug safety alert generation associated with ALI. METHODS All cases of ALI were extracted from SNDS (2009-2014) using specific and sensitive definitions. Positive and negative drug controls were used to compare 196 self-controlled case series (SCCS), case-control (CC), and case-population (CP) design variants, using area under the receiver operating curve (AUC), mean square error (MSE) and coverage probability. Parameters that had major impacts on results were identified through logistic regression. RESULTS Using a specific ALI definition, AUCs ranged from 0.78 to 0.94, 0.64 to 0.92 and 0.48 to 0.85, for SCCS, CC and CP, respectively. MSE ranged from 0.12 to 0.40, 0.22 to 0.39 and 1.03 to 5.29, respectively. Variants adjusting for multiple drug use had higher coverage probabilities. Univariate regressions showed that high AUCs were achieved with SCCS using exposed time as the risk window. The top SCCS variant yielded an AUC = 0.93 and MSE = 0.22 and coverage = 86%, with 1/7 negative and 13/18 positive controls presenting significant estimates. CONCLUSIONS SCCS adjusting for multiple drugs and using exposed time as the risk window performed best in generating ALI-related drug safety alert and providing estimates of the magnitude of the risk. This approach may be useful for ad-hoc pharmacoepidemiology studies to support regulatory actions.
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Affiliation(s)
- Nicolas H Thurin
- Univ. Bordeaux, INSERM CIC-P1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Régis Lassalle
- Univ. Bordeaux, INSERM CIC-P1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Martijn Schuemie
- Epidemiology Analytics, Janssen Research and Development, Titusville, New Jersey, USA.,Observational Health Data Sciences and Informatics (OHDSI), New York, New York, USA
| | - Marine Pénichon
- Univ. Bordeaux, INSERM CIC-P1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Joshua J Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jacques Benichou
- Department of Biostatistics and Clinical Research, Rouen University Hospital, Rouen, France.,INSERM U1181, Paris, France
| | - Alain Weill
- Caisse Nationale de l'Assurance Maladie, Paris, France
| | - Patrick Blin
- Univ. Bordeaux, INSERM CIC-P1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Nicholas Moore
- Univ. Bordeaux, INSERM CIC-P1401, Bordeaux PharmacoEpi, Bordeaux, France.,CHU de Bordeaux, Bordeaux, France
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Dedman D, Cabecinha M, Williams R, Evans SJW, Bhaskaran K, Douglas IJ. Approaches for combining primary care electronic health record data from multiple sources: a systematic review of observational studies. BMJ Open 2020; 10:e037405. [PMID: 33055114 PMCID: PMC7559041 DOI: 10.1136/bmjopen-2020-037405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To identify observational studies which used data from more than one primary care electronic health record (EHR) database, and summarise key characteristics including: objective and rationale for using multiple data sources; methods used to manage, analyse and (where applicable) combine data; and approaches used to assess and report heterogeneity between data sources. DESIGN A systematic review of published studies. DATA SOURCES Pubmed and Embase databases were searched using list of named primary care EHR databases; supplementary hand searches of reference list of studies were retained after initial screening. STUDY SELECTION Observational studies published between January 2000 and May 2018 were selected, which included at least two different primary care EHR databases. RESULTS 6054 studies were identified from database and hand searches, and 109 were included in the final review, the majority published between 2014 and 2018. Included studies used 38 different primary care EHR data sources. Forty-seven studies (44%) were descriptive or methodological. Of 62 analytical studies, 22 (36%) presented separate results from each database, with no attempt to combine them; 29 (48%) combined individual patient data in a one-stage meta-analysis and 21 (34%) combined estimates from each database using two-stage meta-analysis. Discussion and exploration of heterogeneity was inconsistent across studies. CONCLUSIONS Comparing patterns and trends in different populations, or in different primary care EHR databases from the same populations, is important and a common objective for multi-database studies. When combining results from several databases using meta-analysis, provision of separate results from each database is helpful for interpretation. We found that these were often missing, particularly for studies using one-stage approaches, which also often lacked details of any statistical adjustment for heterogeneity and/or clustering. For two-stage meta-analysis, a clear rationale should be provided for choice of fixed effect and/or random effects or other models.
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Affiliation(s)
- Daniel Dedman
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Melissa Cabecinha
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Rachael Williams
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Stephen J W Evans
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Krishnan Bhaskaran
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ian J Douglas
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Alqdwah-Fattouh R, Rodríguez-Martín S, de Abajo FJ, González-Bermejo D, Gil M, García-Lledó A, Bolúmar F. Differential effects of antidepressant subgroups on risk of acute myocardial infarction: A nested case-control study. Br J Clin Pharmacol 2020; 86:2040-2050. [PMID: 32250461 DOI: 10.1111/bcp.14299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/17/2020] [Accepted: 03/21/2020] [Indexed: 01/20/2023] Open
Abstract
The primary objective of this study was to investigate the association between antidepressants use and the risk of acute myocardial infarction (AMI). METHODS We conducted a nested case-control study using a primary care database over the period 2002-2015. From a cohort of patients aged 40-99 years, we identified incident AMI cases and randomly selected 5 controls per case, matched to cases for exact age, sex and index date. Exposure to antidepressants were categorised as current, recent, past and nonusers. Adjusted odds ratio (AOR) and 95% confidence interval (CI) were computed using conditional logistic regression to assess the association between the current use of different antidepressants subgroups and AMI as compared to nonuse. Dose and duration effects were explored. RESULTS Totals of 24 155 incident AMI cases and 120 775 controls were included. The current use of antidepressants as a group was associated with a reduced risk (AOR = 0.86; 95% CI: 0.81-0.91), but mainly driven by selective serotonin reuptake inhibitors (AOR = 0.86; 95% CI:0.81-0.93). A reduced risk was also observed with trazodone (AOR = 0.76;95% CI: 0.64-0.91), and clomipramine (AOR = 0.62; 95% CI: 0.40-0.96), whereas no significant effect was observed with other antidepressants. A duration-dependent effect was suggested for selective serotonin reuptake inhibitors, trazodone and clomipramine, while there was no clear dose-dependency. CONCLUSION This study suggests that current use of antidepressants interfering selectively with the reuptake of serotonin, and those antagonizing the 5-HT2A receptor, are associated with a decrease in AMI risk and should be the antidepressants of choice in patients at cardiovascular risk.
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Affiliation(s)
- Rasha Alqdwah-Fattouh
- Unit of Epidemiology and Public Health. School of Medicine, University of Alcalá, Madrid, Spain
| | - Sara Rodríguez-Martín
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.,Department of Biomedical Sciences (Pharmacology Sector), School of Medicine, University of Alcalá (IRYCIS), Alcalá de Henares, Madrid, Spain
| | - Francisco J de Abajo
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.,Department of Biomedical Sciences (Pharmacology Sector), School of Medicine, University of Alcalá (IRYCIS), Alcalá de Henares, Madrid, Spain
| | - Diana González-Bermejo
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices, Madrid, Spain
| | - Miguel Gil
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices, Madrid, Spain
| | - Alberto García-Lledó
- Cardiology Department, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.,Department of Medicine, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Francisco Bolúmar
- Unit of Epidemiology and Public Health. School of Medicine, University of Alcalá, Madrid, Spain.,Department of Epidemiology and Biostatistics. Graduate School of Public Health, City University of New York, New York, NY, USA.,Ciberesp, Spain
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Thurin NH, Lassalle R, Schuemie M, Pénichon M, Gagne JJ, Rassen JA, Benichou J, Weill A, Blin P, Moore N, Droz-Perroteau C. Empirical assessment of case-based methods for drug safety alert identification in the French National Healthcare System database (SNDS): Methodology of the ALCAPONE project. Pharmacoepidemiol Drug Saf 2020; 29:993-1000. [PMID: 32133717 DOI: 10.1002/pds.4983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 01/02/2020] [Accepted: 02/12/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To introduce the methodology of the ALCAPONE project. BACKGROUND The French National Healthcare System Database (SNDS), covering 99% of the French population, provides a potentially valuable opportunity for drug safety alert generation. ALCAPONE aimed to assess empirically in the SNDS case-based designs for alert generation related to four health outcomes of interest. METHODS ALCAPONE used a reference set adapted from observational medical outcomes partnership (OMOP) and Exploring and Understanding Adverse Drug Reactions (EU-ADR) project, with four outcomes-acute liver injury (ALI), myocardial infarction (MI), acute kidney injury (AKI), and upper gastrointestinal bleeding (UGIB)-and positive and negative drug controls. ALCAPONE consisted of four main phases: (1) data preparation to fit the OMOP Common Data Model and select the drug controls; (2) detection of the selected controls via three case-based designs: case-population, case-control, and self-controlled case series, including design variants (varying risk window, adjustment strategy, etc.); (3) comparison of design variant performance (area under the ROC curve, mean square error, etc.); and (4) selection of the optimal design variants and their calibration for each outcome. RESULTS Over 2009-2014, 5225 cases of ALI, 354 109 MI, 12 633 AKI, and 156 057 UGIB were identified using specific definitions. The number of detectable drugs ranged from 61 for MI to 25 for ALI. Design variants generated more than 50 000 points estimates. Results by outcome will be published in forthcoming papers. CONCLUSIONS ALCAPONE has shown the interest of the empirical assessment of pharmacoepidemiological approaches for drug safety alert generation and may encourage other researchers to do the same in other databases.
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Affiliation(s)
- Nicolas H Thurin
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, Bordeaux, France.,INSERM U1219, Université de Bordeaux, Bordeaux, France
| | - Régis Lassalle
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, Bordeaux, France
| | - Martijn Schuemie
- Epidemiology Analytics, Janssen Research and Development, Titusville, New Jersey, USA.,Observational Health Data Sciences and Informatics (OHDSI), New York, New York, USA
| | - Marine Pénichon
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, Bordeaux, France
| | - Joshua J Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jacques Benichou
- Department of Biostatistics and Clinical Research, Rouen University Hospital, Rouen, France.,INSERM U1181, Paris, France
| | - Alain Weill
- Caisse Nationale de l'Assurance Maladie, Paris, France
| | - Patrick Blin
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, Bordeaux, France
| | - Nicholas Moore
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, Bordeaux, France.,INSERM U1219, Université de Bordeaux, Bordeaux, France.,CHU de Bordeaux, Bordeaux, France
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Clinical Infections by Herpesviruses in Patients Treated with Valproic Acid: A Nested Case-Control Study in the Spanish Primary Care Database, BIFAP. J Clin Med 2019; 8:jcm8091442. [PMID: 31514402 PMCID: PMC6780826 DOI: 10.3390/jcm8091442] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/05/2019] [Accepted: 09/09/2019] [Indexed: 02/08/2023] Open
Abstract
The objective of this study is to evaluate the risk of clinical infections by herpesviruses in patients exposed to valproic acid (VPA). We performed a case-control study nested in a primary cohort selected from the Spanish primary care population-based research database BIFAP (Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria) over the period 2001–2015. The events of interest were those diseases caused by any herpesviruses known to infect humans. For each case, up to 10 controls per case matched by age, gender, and calendar date were randomly selected. A conditional logistic regression was used to compute adjusted odds ratios (OR) and their 95% confidence intervals (95% CI). Current use of VPA was associated with a trend towards a reduced risk of clinical infections by herpesviruses as compared with non-users (OR 0.84; CI 95% 0.7–1.0; p = 0.057). Among current users, a trend to a decreased risk with treatment durations longer than 90 days was also observed. The results show a trend to a reduced risk of clinical infection by herpesviruses in patients exposed to VPA. These results are consistent with those in vitro studies showing that, in cultured cells, VPA can inhibit the production of the infectious progeny of herpesviruses. This study also shows the efficient use of electronic healthcare records for clinical exploratory research studies.
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Rodríguez-Miguel A, García-Rodríguez LA, Gil M, Montoya H, Rodríguez-Martín S, de Abajo FJ. Clopidogrel and Low-Dose Aspirin, Alone or Together, Reduce Risk of Colorectal Cancer. Clin Gastroenterol Hepatol 2019; 17:2024-2033.e2. [PMID: 30580092 DOI: 10.1016/j.cgh.2018.12.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/09/2018] [Accepted: 12/16/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The antiplatelet effect of low-dose aspirin, via inhibition of cyclooxygenase-1, might contribute to its ability to reduce the risk of colorectal cancer (CRC). Antiplatelet agents with a different mechanism, such as clopidogrel, might have the same effects. We aimed to quantify the effects of low-dose aspirin and clopidogrel on the risk of CRC in a Mediterranean population. METHODS We performed a nested case-control study using a primary care database (Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria) in Spain. We collected data, from 2001 through 2014, on 15,491 incident cases of CRC and 60,000 randomly selected individuals (controls), frequency-matched to cases by age, sex, and year. To estimate the association between exposure to different antiplatelet agents and the risk of colorectal cancer, we built multiple logistic regression models and computed the adjusted-odds ratios (AORs) and their respective 95% CIs. RESULTS Use of low-dose aspirin was associated with a reduced risk of CRC overall (AOR, 0.83; 95% CI, 0.78-0.89) and in patients receiving treatment for more than 1 year (AOR, 0.79; 95% CI, 0.73-0.85). Use of clopidogrel was associated with a decreased risk of CRC overall (AOR, 0.8; 95% CI, 0.69-0.93) and in patients receiving treatment for more than 1 year (AOR, 0.65; 95% CI, 0.55-0.78). Dual antiplatelet therapy had the same effect as either drug taken as monotherapy. No modification by sex or age was observed. CONCLUSIONS In a nested case-control study of a primary care database in Spain, we found clopidogrel use, alone or in combination with low-dose aspirin, to reduce the risk of CRC by 20% to 30%, a magnitude similar to that of low-dose aspirin alone. These data support the concept that inhibiting platelets is an effective strategy for prevention of CRC.
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Affiliation(s)
- Antonio Rodríguez-Miguel
- Clinical Pharmacology Unit, University Hospital "Príncipe de Asturias," Alcalá de Henares, Madrid, Spain; Pharmacology Unit, Department of Biomedical Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain; Ramón y Cajal Institute for Health Research (IRYCIS), Madrid, Spain
| | | | - Miguel Gil
- Pharmacoepidemiology and Pharmacovigilance Division, Spanish Agency for Medicines and Clinical Devices, Madrid, Spain
| | - Héctor Montoya
- School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Sara Rodríguez-Martín
- Clinical Pharmacology Unit, University Hospital "Príncipe de Asturias," Alcalá de Henares, Madrid, Spain; Pharmacology Unit, Department of Biomedical Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain; Ramón y Cajal Institute for Health Research (IRYCIS), Madrid, Spain
| | - Francisco J de Abajo
- Clinical Pharmacology Unit, University Hospital "Príncipe de Asturias," Alcalá de Henares, Madrid, Spain; Pharmacology Unit, Department of Biomedical Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain; Ramón y Cajal Institute for Health Research (IRYCIS), Madrid, Spain.
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Rodríguez-Miguel A, García-Rodríguez LA, Gil M, Barreira-Hernández D, Rodríguez-Martín S, de Abajo FJ. Population-based case-control study: chemoprotection of colorectal cancer with non-aspirin nonsteroidal anti-inflammatory drugs and other drugs for pain control. Aliment Pharmacol Ther 2019; 50:295-305. [PMID: 31313358 DOI: 10.1111/apt.15333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 04/16/2019] [Accepted: 05/13/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Inflammation and overexpression of cyclooxygenase-2 (COX-2) have been described to play a key role in the progression from nonpathologic intestinal mucosa to colorectal cancer (CRC). AIMS To assess the chemoprotective effect of non-aspirin nonsteroidal anti-inflammatory drugs (NA-NSAIDs) under different patterns of use in a Mediterranean population and to explore the potential effect of symptomatic slow-acting drugs for osteoarthritis (SYSADOAs; chondroitin sulfate and glucosamine) and metamizole (or dipyrone), also reported to influence COX-2 activity. METHODS We performed a case-control study nested in a cohort extracted from the primary care database, BIFAP. From 2001 to 2014, we included 15 491 incident cases and 60 000 random controls. To estimate the association between the drugs of interest and CRC, we built logistic regression models to compute the adjusted-odds ratios (AOR) and 95% confidence intervals (CI). RESULTS NA-NSAIDs use was associated with a reduced risk of CRC (AOR = 0.67; 95% CI: 0.63-0.71) and increased linearly with duration of treatment (p for trend <0.001). The effect diminished upon discontinuation but persisted statistically significant up to 1 year. All individual NA-NSAIDs examined showed a decreased risk. The concomitant use of proton-pump inhibitors (PPI) had no impact on the protective effect of NA-NSAIDs; AORPPI + NSAID = 0.64; 0.58-0.71. SYSADOA use was associated with a reduced risk (0.79; 0.69-0.90) but disappeared after the exclusion of NSAID users during the previous 1 or 3 years (0.85; 0.70-1.04 and 1.00; 0.76-1.31 respectively). Metamizole did not show a chemoprotective effect. CONCLUSIONS NA-NSAID use is associated with a duration-dependent risk reduction of CRC not shared by SYSADOAs or metamizole.
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Affiliation(s)
- Antonio Rodríguez-Miguel
- Clinical Pharmacology Unit, University Hospital "Príncipe de Asturias", Madrid, Spain.,Department of Biomedical Sciences, Pharmacology Unit, School of Medicine, University of Alcalá (IRYCIS), Madrid, Spain
| | | | - Miguel Gil
- BIFAP Unit, Pharmacoepidemiology and Pharmacovigilance Division, Spanish Agency for Medicines and Clinical Devices (AEMPS), Madrid, Spain
| | - Diana Barreira-Hernández
- Clinical Pharmacology Unit, University Hospital "Príncipe de Asturias", Madrid, Spain.,Department of Biomedical Sciences, Pharmacology Unit, School of Medicine, University of Alcalá (IRYCIS), Madrid, Spain
| | - Sara Rodríguez-Martín
- Clinical Pharmacology Unit, University Hospital "Príncipe de Asturias", Madrid, Spain.,Department of Biomedical Sciences, Pharmacology Unit, School of Medicine, University of Alcalá (IRYCIS), Madrid, Spain
| | - Francisco J de Abajo
- Clinical Pharmacology Unit, University Hospital "Príncipe de Asturias", Madrid, Spain.,Department of Biomedical Sciences, Pharmacology Unit, School of Medicine, University of Alcalá (IRYCIS), Madrid, Spain
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11
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Timmer A, de Sordi D, Kappen S, Kohse KP, Schink T, Perez-Gutthann S, Jacquot E, Deltour N, Pladevall M. Validity of hospital ICD-10-GM codes to identify acute liver injury in Germany. Pharmacoepidemiol Drug Saf 2019; 28:1344-1352. [PMID: 31373108 DOI: 10.1002/pds.4855] [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: 09/28/2018] [Revised: 05/28/2019] [Accepted: 06/10/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE Acute liver injury (ALI) is an important adverse drug reaction. We estimated the positive predictive values (PPVs) of ICD-10-GM codes of ALI used in an international postauthorisation safety study (PASS). METHODS Analyses used routine data (2007 to 2016, adults) from a German academic hospital in a cross-sectional design. Two algorithms from the PASS were applied to extract potential cases from the hospital information system: specific end point (A) (discharge diagnosis of liver disease-specific codes) and less specific end point (B) (discharge and outpatient-specific and nonspecific codes suggestive of liver injury). ALI cases were confirmed on the basis of plasma liver enzyme activity elevation. Secondary analysis was performed following exclusion of cases with known cancer, chronic liver, biliary and pancreatic disease, heart failure, and alcohol-related disorders, as applied in the PASS. RESULTS On the basis of ICD codes: outcome A, 154 cases (143 with case notes and lab data for case verification); outcome B, 485 cases (357 with case notes and lab data). ALI was confirmed in 71 outcome A cases, PPV of 49.7% (95% confidence interval [CI], 41.2%-58.1%), and 100 outcome B cases, PPV of 28.0% (95% CI, 23.4%-33.0%). Applying exclusion criteria increased PPV (95% CI) to 62.7% (50.0%-74.2%) for outcome A and 45.7% (37.2%-54.3%) for outcome B. CONCLUSIONS In safety studies on hepatotoxicity based on routine data using ICD-10-GM discharge codes and when validation of potential cases is not feasible, only the more specific codes should be used to describe ALI, and competing diagnoses for liver injury should be excluded to avoid substantial misclassification.
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Affiliation(s)
- Antje Timmer
- Division of Epidemiology and Biometry, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Dominik de Sordi
- Division of Epidemiology and Biometry, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Sanny Kappen
- Division of Epidemiology and Biometry, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Klaus Peter Kohse
- Institute for Laboratory Medicine and Microbiology, Klinikum Oldenburg, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Tania Schink
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | | | | | | | - Manel Pladevall
- Epidemiology, RTI Health Solutions, Barcelona, Spain.,The Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
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12
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Pedrós C, Ávila M, Gómez-Lumbreras A, Manríquez M, Morros R. Lactic acidosis associated with metformin in patients with moderate to severe chronic kidney disease: study protocol for a multicenter population-based case-control study using health databases. BMC Nephrol 2019; 20:193. [PMID: 31146690 PMCID: PMC6543584 DOI: 10.1186/s12882-019-1389-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of metformin in patients with type 2 diabetes mellitus has been associated with lactic acidosis. However, the information available in patients with moderate-severe chronic kidney disease is scarce. METHODS The ALIMAR-C2 study is a case-control study to assess the association between metformin and lactic acidosis in patients with type 2 diabetes mellitus and moderate-severe chronic kidney disease. The study will be performed with computerized registered electronic health records from eight Spanish hospitals linked to their corresponding primary care health areas from 2010 to 2016, comprising approximately 22.1 million person-years of follow-up. Logistic regression will be used to assess the crude and adjusted risk of lactic acidosis associated with metformin use overall and stratifying by use and dose categories, and chronic kidney disease stage. The overall case fatality rate of lactic acidosis, as well as the case fatality rate stratified by chronic kidney disease stage, will be calculated. DISCUSSION The ALIMAR-C2 study will provide useful information about the risk of lactic acidosis in type 2 diabetes mellitus patients with renal impairment using metformin.
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Affiliation(s)
- Consuelo Pedrós
- Clinical Pharmacology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Mónica Ávila
- Clinical Research and Clinical Trials Unit, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Ainhoa Gómez-Lumbreras
- Medicines Research Unit, Foundation University Institute for Primary Health Care Research Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Department of Medical Sciences, Girona University, Girona, Spain
| | - Marcela Manríquez
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Rosa Morros
- Medicines Research Unit, Foundation University Institute for Primary Health Care Research Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Barcelona, Spain.,Catalan Health Institute, Barcelona, Spain
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Bate A, Chuang-Stein C, Roddam A, Jones B. Lessons from meta-analyses of randomized clinical trials for analysis of distributed networks of observational databases. Pharm Stat 2018; 18:65-77. [PMID: 30362223 DOI: 10.1002/pst.1908] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 09/13/2018] [Accepted: 09/20/2018] [Indexed: 12/20/2022]
Abstract
Networks of constellations of longitudinal observational databases, often electronic medical records or transactional insurance claims or both, are increasingly being used for studying the effects of medicinal products in real-world use. Such databases are frequently configured as distributed networks. That is, patient-level data are kept behind firewalls and not communicated outside of the data vendor other than in aggregate form. Instead, data are standardized across the network, and queries of the network are executed locally by data partners, and summary results provided to a central research partner(s) for amalgamation, aggregation, and summarization. Such networks can be huge covering years of data on upwards of 100 million patients. Examples of such networks include the FDA Sentinel Network, ASPEN, CNODES, and EU-ADR. As this is a new emerging field, we note in this paper the conceptual similarities and differences between the analysis of distributed networks and the now well-established field of meta-analysis of randomized clinical trials (RCTs). We recommend, wherever appropriate, to apply learnings from meta-analysis to help guide the development of distributed network analyses of longitudinal observational databases.
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Affiliation(s)
- Andrew Bate
- Pfizer, Tadworth, UK.,New York University, New York, NY, USA
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Yang Y, Zhou X, Gao S, Lin H, Xie Y, Feng Y, Huang K, Zhan S. Evaluation of Electronic Healthcare Databases for Post-Marketing Drug Safety Surveillance and Pharmacoepidemiology in China. Drug Saf 2018; 41:125-137. [PMID: 28815480 DOI: 10.1007/s40264-017-0589-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Electronic healthcare databases (EHDs) are used increasingly for post-marketing drug safety surveillance and pharmacoepidemiology in Europe and North America. However, few studies have examined the potential of these data sources in China. METHODS Three major types of EHDs in China (i.e., a regional community-based database, a national claims database, and an electronic medical records [EMR] database) were selected for evaluation. Forty core variables were derived based on the US Mini-Sentinel (MS) Common Data Model (CDM) as well as the data features in China that would be desirable to support drug safety surveillance. An email survey of these core variables and eight general questions as well as follow-up inquiries on additional variables was conducted. These 40 core variables across the three EHDs and all variables in each EHD along with those in the US MS CDM and Observational Medical Outcomes Partnership (OMOP) CDM were compared for availability and labeled based on specific standards. RESULTS All of the EHDs' custodians confirmed their willingness to share their databases with academic institutions after appropriate approval was obtained. The regional community-based database contained 1.19 million people in 2015 with 85% of core variables. Resampled annually nationwide, the national claims database included 5.4 million people in 2014 with 55% of core variables, and the EMR database included 3 million inpatients from 60 hospitals in 2015 with 80% of core variables. Compared with MS CDM or OMOP CDM, the proportion of variables across the three EHDs available or able to be transformed/derived from the original sources are 24-83% or 45-73%, respectively. CONCLUSIONS These EHDs provide potential value to post-marketing drug safety surveillance and pharmacoepidemiology in China. Future research is warranted to assess the quality and completeness of these EHDs or additional data sources in China.
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Affiliation(s)
- Yu Yang
- Department of Epidemiology and Bio-Statistics, School of Public Health, Peking University Health Science Center, No.38 Xueyuan Road, Haidian District, Beijing, China
| | | | - Shuangqing Gao
- Beijing Brainpower Pharmacy Consulting Co. Ltd, Beijing, China
| | - Hongbo Lin
- Center for Disease Control of Yinzhou, Ningbo, China
| | - Yanming Xie
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuji Feng
- Chinese Medical Doctor Association, Beijing, China
- Epidemiology and Real-World Data Analytics, Pfizer Investment Co. Ltd., Beijing, China
| | - Kui Huang
- Epidemiology, Pfizer Inc., New York, NY, USA
| | - Siyan Zhan
- Department of Epidemiology and Bio-Statistics, School of Public Health, Peking University Health Science Center, No.38 Xueyuan Road, Haidian District, Beijing, China.
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15
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Pacurariu A, Plueschke K, McGettigan P, Morales DR, Slattery J, Vogl D, Goedecke T, Kurz X, Cave A. Electronic healthcare databases in Europe: descriptive analysis of characteristics and potential for use in medicines regulation. BMJ Open 2018; 8:e023090. [PMID: 30185579 PMCID: PMC6129090 DOI: 10.1136/bmjopen-2018-023090] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Electronic healthcare databases (EHDs) are useful tools for drug development and safety evaluation but their heterogeneity of structure, validity and access across Europe complicates the conduct of multidatabase studies. In this paper, we provide insight into available EHDs to support regulatory decisions on medicines. METHODS EHDs were identified from publicly available information from the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance resources database, textbooks and web-based searches. Databases were selected using criteria related to accessibility, longitudinal dimension, recording of exposure and outcomes, and generalisability. Extracted information was verified with the database owners. RESULTS A total of 34 EHDs were selected after applying key criteria relevant for regulatory purposes. The most represented regions were Northern, Central and Western Europe. The most frequent types of data source were electronic medical records (44.1%) and record linkage systems (29.4%). The median number of patients registered in the 34 data sources was 5 million (range 0.07-15 million) while the median time covered by a database was 18.5 years. Paediatric patients were included in 32 databases (94%). Completeness of information on drug exposure was variable. Published validation studies were found for only 17 databases (50%). Some level of access exists for 25 databases (73.5%), and 23 databases (67.6%) can be linked through a personal identification number to other databases with parent-child linkage possible in 7 (21%) databases. Eight databases (23.5%) were already transformed or were in the process of being transformed into a common data model that could facilitate multidatabase studies. CONCLUSION A Few European databases meet minimal regulatory requirements and are readily available to be used in a regulatory context. Accessibility and validity information of the included information needs to be improved. This study confirmed the fragmentation, heterogeneity and lack of transparency existing in many European EHDs.
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Affiliation(s)
- Alexandra Pacurariu
- Department of Surveillance and Epidemiology Service, European Medicines Agency, London, UK
| | - Kelly Plueschke
- Department of Surveillance and Epidemiology Service, European Medicines Agency, London, UK
| | - Patricia McGettigan
- Department of Surveillance and Epidemiology Service, European Medicines Agency, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Daniel R Morales
- Department of Surveillance and Epidemiology Service, European Medicines Agency, London, UK
- Division of Population Health Sciences, University of Dundee, Dundee, UK
| | - Jim Slattery
- Department of Surveillance and Epidemiology Service, European Medicines Agency, London, UK
| | - Dagmar Vogl
- Department of Surveillance and Epidemiology Service, European Medicines Agency, London, UK
| | - Thomas Goedecke
- Department of Surveillance and Epidemiology Service, European Medicines Agency, London, UK
| | - Xavier Kurz
- Department of Surveillance and Epidemiology Service, European Medicines Agency, London, UK
| | - Alison Cave
- Department of Surveillance and Epidemiology Service, European Medicines Agency, London, UK
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Lewis JR, Kerridge I, Lipworth W. Use of Real-World Data for the Research, Development, and Evaluation of Oncology Precision Medicines. JCO Precis Oncol 2017; 1:1-11. [DOI: 10.1200/po.17.00157] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Although randomized controlled trials remain the scientific ideal for determining the efficacy and safety of new treatments, they are sometimes insufficient to address the evidentiary requirements of regulators and payers. This is particularly the case when it comes to precision medicines because trials are often small, deliver incomplete insights into outcomes of most interest to policymakers (eg, overall survival), and may fail to address other complex diagnostic and treatment-related questions. Additional methods, both experimental and observational, are increasingly being used to fill critical evidentiary gaps. A number of modified early- and late-phase trial designs have been proposed to better support earlier biomarker validation, patient identification, and selection for regulatory studies, but there is still a need for confirmatory evidence from real-world data sources. These data are usually provided through observational, postapproval, phase IIIB and IV studies, which rely heavily on registries and other electronic data sets—most notably data from electronic health records. It is, therefore, crucial to understand what ethical, practical, and scientific challenges are raised by the use of electronic health records to generate evidence about precision medicines.
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Affiliation(s)
- Jan R.R. Lewis
- All authors: Sydney Health Ethics, University of Sydney, Sydney, New South Wales, Australia
| | - Ian Kerridge
- All authors: Sydney Health Ethics, University of Sydney, Sydney, New South Wales, Australia
| | - Wendy Lipworth
- All authors: Sydney Health Ethics, University of Sydney, Sydney, New South Wales, Australia
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17
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Faillie JL, Ferrer P, Gouverneur A, Driot D, Berkemeyer S, Vidal X, Martínez-Zapata MJ, Huerta C, Castells X, Rottenkolber M, Schmiedl S, Sabaté M, Ballarín E, Ibáñez L. A new risk of bias checklist applicable to randomized trials, observational studies, and systematic reviews was developed and validated to be used for systematic reviews focusing on drug adverse events. J Clin Epidemiol 2017; 86:168-175. [PMID: 28487158 DOI: 10.1016/j.jclinepi.2017.04.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 03/30/2017] [Accepted: 04/25/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The objective of the study was to develop and validate an adequate tool to evaluate the risk of bias of randomized controlled trials, observational studies, and systematic reviews assessing drug adverse events. STUDY DESIGN AND SETTING We developed a structured risk of bias checklist applicable to randomized trials, cohort, case-control and nested case-control studies, and systematic reviews focusing on drug safety. Face and content validity was judged by three experienced reviewers. Interrater and intrarater reliability were determined using 20 randomly selected studies, assessed by three other independent reviewers including one performing a 3-week retest. RESULTS The developed checklist examines eight domains: study design and objectives, selection bias, attrition, adverse events information bias, other information bias, statistical methods to control confounding, other statistical methods, and conflicts of interest. The total number of questions varied from 10 to 32 depending on the study design. Interrater and intrarater agreements were fair with Kendall's W of 0.70 and 0.74, respectively. Median time to complete the checklist was 8.5 minutes. CONCLUSION The developed checklist showed face and content validity and acceptable reliability to assess the risk of bias for studies analyzing drug adverse events. Hence, it might be considered as a novel useful tool for systematic reviews and meta-analyses focusing on drug safety.
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Affiliation(s)
- Jean-Luc Faillie
- Laboratory of Biostatistics, Epidemiology and Public Health (EA2415), Faculty of Medicine, Institut Universitaire de Recherche Clinique, University of Montpellier, 641 Avenue du Doyen Gaston Giraud, Montpellier 34093, France; Department of Medical Pharmacology and Toxicology, CHU Montpellier University Hospital, 371 Avenue du Doyen Gaston Giraud, Montpellier 34295, France
| | - Pili Ferrer
- Catalan Institute of Pharmacology Foundation (FICF), Department of Pharmacology Therapeutics and Toxicology, Autonomous University of Barcelona, Clinical Pharmacology Unit, Vall d'Hebron University Hospital, Pg. Vall d'Hebron 119-129, Barcelona 08035, Spain
| | - Amandine Gouverneur
- Univ. Bordeaux, Inserm UMR 1219, CHU de Bordeaux, Pôle de Santé Publique, Service de l'Information Médicale, 146 Rue Léo Saignat, Bordeaux 33076, France
| | - Damien Driot
- Department of Clinical and Medical Pharmacology, CHU Toulouse University Hospital, University of Toulouse, 37 Allées Jules-Guesde, Toulouse 31000, France
| | - Shoma Berkemeyer
- Department of Community Health, Hochschule fuer Gesundheit, Gesundheitscampus 6-8, North Rhine-Westphalia, Bochum 44801, Germany
| | - Xavier Vidal
- Catalan Institute of Pharmacology Foundation (FICF), Department of Pharmacology Therapeutics and Toxicology, Autonomous University of Barcelona, Clinical Pharmacology Unit, Vall d'Hebron University Hospital, Pg. Vall d'Hebron 119-129, Barcelona 08035, Spain
| | - Maria José Martínez-Zapata
- Iberoamerican Cochrane Centre, Institute of Biomedical Research (IIB Sant Pau), Barcelona, CIBER de Epidemiología y Salud Pública (CIBERESP), Sant Antoni Maria Claret 167, Barcelona 08025, Spain
| | - Consuelo Huerta
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency of Medicinal Products and Medical Devices (AEMPS), Calle Campezo 1, Madrid E28022, Spain
| | - Xavier Castells
- TransLab Research Group, Department of Medical Sciences, University of Girona, Girona, Spain
| | - Marietta Rottenkolber
- Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Klinikum der Universitaet, Pettenkoferstrasse 8A, Munich 81377, Germany
| | - Sven Schmiedl
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, Witten D-58448, Germany; Philipp Klee-Institute for Clinical Pharmacology, HELIOS Clinic Wuppertal, Heusnerstrasse 40, Wuppertal D-42283, Germany
| | - Mònica Sabaté
- Catalan Institute of Pharmacology Foundation (FICF), Department of Pharmacology Therapeutics and Toxicology, Autonomous University of Barcelona, Clinical Pharmacology Unit, Vall d'Hebron University Hospital, Pg. Vall d'Hebron 119-129, Barcelona 08035, Spain
| | - Elena Ballarín
- Catalan Institute of Pharmacology Foundation (FICF), Department of Pharmacology Therapeutics and Toxicology, Autonomous University of Barcelona, Clinical Pharmacology Unit, Vall d'Hebron University Hospital, Pg. Vall d'Hebron 119-129, Barcelona 08035, Spain
| | - Luisa Ibáñez
- Catalan Institute of Pharmacology Foundation (FICF), Department of Pharmacology Therapeutics and Toxicology, Autonomous University of Barcelona, Clinical Pharmacology Unit, Vall d'Hebron University Hospital, Pg. Vall d'Hebron 119-129, Barcelona 08035, Spain.
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18
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Asselbergs FW, Visseren FLJ, Bots ML, de Borst GJ, Buijsrogge MP, Dieleman JM, van Dinther BGF, Doevendans PA, Hoefer IE, Hollander M, de Jong PA, Koenen SV, Pasterkamp G, Ruigrok YM, van der Schouw YT, Verhaar MC, Grobbee DE. Uniform data collection in routine clinical practice in cardiovascular patients for optimal care, quality control and research: The Utrecht Cardiovascular Cohort. Eur J Prev Cardiol 2017; 24:840-847. [DOI: 10.1177/2047487317690284] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Folkert W Asselbergs
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
- Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, the Netherlands
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank LJ Visseren
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Vascular Medicine, University Medical Center Utrecht, the Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gert J de Borst
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | - Marc P Buijsrogge
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, the Netherlands
| | - Jan M Dieleman
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Anaesthesiology and Intensive Care, University Medical Center Utrecht, the Netherlands
| | - Baukje GF van Dinther
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, the Netherlands
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Imo E Hoefer
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
- Experimental Cardiology Laboratory, University Medical Center Utrecht, the Netherlands
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, the Netherlands
| | - Monika Hollander
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pim A de Jong
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Radiology, University Medical Center Utrecht, the Netherlands
| | - Steven V Koenen
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Obstetrics, University Medical Center Utrecht, the Netherlands
| | - Gerard Pasterkamp
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
- Experimental Cardiology Laboratory, University Medical Center Utrecht, the Netherlands
| | - Ynte M Ruigrok
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Nephrology and Hypertension, University Medical Center Utrecht, the Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
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19
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Reynolds RF, Kurz X, de Groot MCH, Schlienger RG, Grimaldi-Bensouda L, Tcherny-Lessenot S, Klungel OH. The IMI PROTECT project: purpose, organizational structure, and procedures. Pharmacoepidemiol Drug Saf 2017; 25 Suppl 1:5-10. [PMID: 27038353 DOI: 10.1002/pds.3933] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 11/05/2015] [Accepted: 11/06/2015] [Indexed: 12/13/2022]
Abstract
The Pharmacoepidemiological Research on Outcomes of Therapeutics by a European ConsorTium (PROTECT) initiative was a collaborative European project that sought to address limitations of current methods in the field of pharmacoepidemiology and pharmacovigilance. Initiated in 2009 and ending in 2015, PROTECT was part of the Innovative Medicines Initiative, a joint undertaking by the European Union and pharmaceutical industry. Thirty-five partners including academics, regulators, small and medium enterprises, and European Federation of Pharmaceuticals Industries and Associations companies contributed to PROTECT. Two work packages within PROTECT implemented research examining the extent to which differences in the study design, methodology, and choice of data source can contribute to producing discrepant results from observational studies on drug safety. To evaluate the effect of these differences, the project applied different designs and analytic methodology for six drug-adverse event pairs across several electronic healthcare databases and registries. This papers introduces the organizational structure and procedures of PROTECT, including how drug-adverse event and data sources were selected, study design and analyses documents were developed, and results managed centrally.
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Affiliation(s)
| | | | - Mark C H de Groot
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands.,Department of Clinical Chemistry and Haematology, Division of Laboratory and Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | | | - Olaf H Klungel
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht, the Netherlands
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20
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Souverein PC, Abbing-Karahagopian V, Martin E, Huerta C, de Abajo F, Leufkens HGM, Candore G, Alvarez Y, Slattery J, Miret M, Requena G, Gil MJ, Groenwold RHH, Reynolds R, Schlienger RG, Logie JW, de Groot MCH, Klungel OH, van Staa TP, Egberts TCG, De Bruin ML, Gardarsdottir H. Understanding inconsistency in the results from observational pharmacoepidemiological studies: the case of antidepressant use and risk of hip/femur fractures. Pharmacoepidemiol Drug Saf 2017; 25 Suppl 1:88-102. [PMID: 27038355 DOI: 10.1002/pds.3862] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 07/27/2015] [Accepted: 07/29/2015] [Indexed: 11/09/2022]
Abstract
PURPOSE Results from observational studies on the same exposure-outcome association may be inconsistent because of variations in methodological factors, clinical factors or health care systems. We evaluated the consistency of results assessing the association between antidepressant use and the risk of hip/femur fractures in three European primary care databases using two different study designs. METHODS Cohort and nested case control studies were conducted in three European primary care databases (Spanish BIFAP, Dutch Mondriaan and UK THIN) to assess the association between use of antidepressants and hip/femur fracture. A common protocol and statistical analysis plan was applied to harmonize study design and conduct between data sources. RESULTS Current use of antidepressants was consistently associated with a 1.5 to 2.5-fold increased risk of hip/femur fractures in all data sources with both designs, with estimates for SSRIs generally higher than those for TCAs. In general, risk estimates in Mondriaan, the smallest data source, were higher compared to the other data sources. This difference may be partially explained by an interaction between SSRI and age in Mondriaan. Adjustment for GP-recorded lifestyle factors and matching on general practice had negligible impact on adjusted relative risk estimates. CONCLUSION We found a consistent increased risk of hip/femur fracture with current use of antidepressants across different databases and different designs. Applying similar pharmacoepidemiological study methods resulted in similar risks for TCA use and some variation for SSRI use. Some of these differences may express real (or natural) variance in the exposure-outcome co-occurrences.
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Affiliation(s)
- Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, The Netherlands
| | | | - Elisa Martin
- BIFAP Research Unit, Division of Pharmacoepidemiology and Pharmacovigilance, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Consuelo Huerta
- BIFAP Research Unit, Division of Pharmacoepidemiology and Pharmacovigilance, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Francisco de Abajo
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Madrid, Spain.,Department of Biomedical Sciences, School of Medicine and Health Sciences, University of Alcalá, Spain
| | - Hubert G M Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, The Netherlands.,MEB, Medicines Evaluation Board, Utrecht, The Netherlands
| | | | | | - Jim Slattery
- EMA, European Medicines Agency, London, United Kingdom
| | | | - Gema Requena
- Department of Biomedical Sciences, School of Medicine and Health Sciences, University of Alcalá, Spain
| | - Miguel J Gil
- BIFAP Research Unit, Division of Pharmacoepidemiology and Pharmacovigilance, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Rolf H H Groenwold
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - John W Logie
- Institute of Population Health, University of Manchester, Manchester, United Kingdom
| | - Mark C H de Groot
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, The Netherlands
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tjeerd P van Staa
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, The Netherlands.,Worldwide Epidemiology, GlaxoSmithKline, Stockley Park, United Kingdom
| | - Toine C G Egberts
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, The Netherlands.,Department of Clinical Pharmacy, Division of Laboratory and Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marie L De Bruin
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, The Netherlands.,Department of Biomedical Sciences, School of Medicine and Health Sciences, University of Alcalá, Spain
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, The Netherlands.,Department of Clinical Pharmacy, Division of Laboratory and Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
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21
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Klungel OH, Kurz X, de Groot MCH, Schlienger RG, Tcherny-Lessenot S, Grimaldi L, Ibáñez L, Groenwold RHH, Reynolds RF. Multi-centre, multi-database studies with common protocols: lessons learnt from the IMI PROTECT project. Pharmacoepidemiol Drug Saf 2017; 25 Suppl 1:156-65. [PMID: 27038361 DOI: 10.1002/pds.3968] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 12/09/2015] [Accepted: 12/11/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE To assess the impact of a variety of methodological parameters on the association between six drug classes and five key adverse events in multiple databases. METHODS The selection of Drug-Adverse Event pairs was based on public health impact, regulatory relevance, and the possibility to study a broad range of methodological issues. Common protocols and data analytical specifications were jointly developed and independently and blindly executed in different databases in Europe with replications in the same and different databases. RESULTS The association between antibiotics and acute liver injury, benzodiazepines and hip fracture, antidepressants and hip fracture, inhaled long-acting beta2-agonists and acute myocardial infarction was consistent in direction across multiple designs, databases and methods to control for confounding. Some variation in magnitude of the associations was observed depending on design, exposure and outcome definitions, but none of the differences were statistically significant. The association between anti-epileptics and suicidality was inconsistent across the UK CPRD, Danish National registries and the French PGRx system. Calcium channel blockers were not associated with the risk of cancer in the UK CPRD, and this was consistent across different classes of calcium channel blockers, cumulative durations of use up to >10 years and different types of cancer. CONCLUSIONS A network for observational drug effect studies allowing the execution of common protocols in multiple databases was created. Increased consistency of findings across multiple designs and databases in different countries will increase confidence in findings from observational drug research and benefit/risk assessment of medicines.
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Affiliation(s)
- Olaf H Klungel
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht, the Netherlands
| | - Xavier Kurz
- European Medicines Agency (EMA), London, United Kingdom
| | - Mark C H de Groot
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands.,Department of Clinical Chemistry and Haematology, Division of Laboratory and Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | - Lamiae Grimaldi
- LA-SER and Pasteur Institute (Pharmacoepidemiology and Infectious Diseases Unit), Paris, France
| | - Luisa Ibáñez
- Fundació Institut Català de Farmacologia (FICF), Barcelona, Spain
| | - Rolf H H Groenwold
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht, the Netherlands
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22
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Ali MS, Groenwold RHH, Belitser SV, Souverein PC, Martín E, Gatto NM, Huerta C, Gardarsdottir H, Roes KCB, Hoes AW, de Boer A, Klungel OH. Methodological comparison of marginal structural model, time-varying Cox regression, and propensity score methods: the example of antidepressant use and the risk of hip fracture. Pharmacoepidemiol Drug Saf 2017; 25 Suppl 1:114-21. [PMID: 27038357 DOI: 10.1002/pds.3864] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 07/31/2015] [Accepted: 07/31/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Observational studies including time-varying treatments are prone to confounding. We compared time-varying Cox regression analysis, propensity score (PS) methods, and marginal structural models (MSMs) in a study of antidepressant [selective serotonin reuptake inhibitors (SSRIs)] use and the risk of hip fracture. METHODS A cohort of patients with a first prescription for antidepressants (SSRI or tricyclic antidepressants) was extracted from the Dutch Mondriaan and Spanish Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP) general practice databases for the period 2001-2009. The net (total) effect of SSRI versus no SSRI on the risk of hip fracture was estimated using time-varying Cox regression, stratification and covariate adjustment using the PS, and MSM. In MSM, censoring was accounted for by inverse probability of censoring weights. RESULTS The crude hazard ratio (HR) of SSRI use versus no SSRI use on hip fracture was 1.75 (95%CI: 1.12, 2.72) in Mondriaan and 2.09 (1.89, 2.32) in BIFAP. After confounding adjustment using time-varying Cox regression, stratification, and covariate adjustment using the PS, HRs increased in Mondriaan [2.59 (1.63, 4.12), 2.64 (1.63, 4.25), and 2.82 (1.63, 4.25), respectively] and decreased in BIFAP [1.56 (1.40, 1.73), 1.54 (1.39, 1.71), and 1.61 (1.45, 1.78), respectively]. MSMs with stabilized weights yielded HR 2.15 (1.30, 3.55) in Mondriaan and 1.63 (1.28, 2.07) in BIFAP when accounting for censoring and 2.13 (1.32, 3.45) in Mondriaan and 1.66 (1.30, 2.12) in BIFAP without accounting for censoring. CONCLUSIONS In this empirical study, differences between the different methods to control for time-dependent confounding were small. The observed differences in treatment effect estimates between the databases are likely attributable to different confounding information in the datasets, illustrating that adequate information on (time-varying) confounding is crucial to prevent bias.
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Affiliation(s)
- M Sanni Ali
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rolf H H Groenwold
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Svetlana V Belitser
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Utrecht, the Netherlands
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Utrecht, the Netherlands
| | - Elisa Martín
- BIFAP Research Unit, Division of Pharmacoepidemiology and Pharmacovigilance, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Nicolle M Gatto
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.,Epidemiology, Worldwide Safety and Regulatory, Pfizer Inc., New York, NY, USA
| | - Consuelo Huerta
- BIFAP Research Unit, Division of Pharmacoepidemiology and Pharmacovigilance, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Utrecht, the Netherlands.,Department of Clinical Pharmacy, Division of Laboratory and Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kit C B Roes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Antonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Utrecht, the Netherlands
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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23
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Grimaldi-Bensouda L, Nordon C, Rossignol M, Jardon V, Boss V, Warembourg F, Reynolds R, Kurz X, Rouillon F, Abenhaim L. Antiepileptic drugs and risk of suicide attempts: a case-control study exploring the impact of underlying medical conditions. Pharmacoepidemiol Drug Saf 2017; 26:239-247. [DOI: 10.1002/pds.4160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 10/05/2016] [Accepted: 12/05/2016] [Indexed: 01/19/2023]
Affiliation(s)
| | | | - Michel Rossignol
- Department of Epidemiology, Biostatistics and Occupational Health; McGill University; Montreal Canada
| | - Vincent Jardon
- Service de Psychiatrie; Centre Hospitalier Régional Universitaire de Lille; Lille France
| | - Virginie Boss
- Service de Psychiatrie; Centre Hospitalier Régional Universitaire de Lille; Lille France
| | - Frédérique Warembourg
- Service de Psychiatrie; Centre Hospitalier Régional Universitaire de Lille; Lille France
| | | | - Xavier Kurz
- Inspections & Human Medicines, Monitoring & Incident Management; European Medicines Agency; London UK
| | - Frédéric Rouillon
- Clinique des Maladies Mentales et de l'Encéphale, Centre Hospitalier Sainte Anne; Université Paris V René Descartes; Paris France
| | - Lucien Abenhaim
- LASER Research; Paris France
- Department of Epidemiology; London School of Hygiene & Tropical Medicine; London UK
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24
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de Jong RGPJ, Gallagher AM, Herrett E, Masclee AAM, Janssen-Heijnen MLG, de Vries F. Comparability of the age and sex distribution of the UK Clinical Practice Research Datalink and the total Dutch population. Pharmacoepidemiol Drug Saf 2016; 25:1460-1464. [PMID: 27465256 DOI: 10.1002/pds.4074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/05/2016] [Accepted: 07/08/2016] [Indexed: 12/23/2022]
Abstract
PURPOSE The UK Clinical Practice Research Datalink (CPRD) is increasingly being used by Dutch researchers in epidemiology and pharmacoepidemiology. It is however unclear if the UK CPRD is representative of the Dutch population and whether study results would apply to the Dutch population. Therefore, as first step, our objective was to compare the age and sex distribution of the CPRD with the total Dutch population. METHODS As a measure of representativeness, the age and sex distribution of the UK CPRD were visually and numerically compared with Dutch census data from the StatLine database of the Dutch National Bureau of Statistics in 2011. RESULTS The age distribution of men and women in the CPRD population was comparable to the Dutch male and female population. Differences of more than 10% only occurred in older age categories (75+ in men and 80+ in women). CONCLUSIONS Results from observational studies that have used CPRD data are applicable to the Dutch population, and a useful resource for decision making in the Netherlands. Nevertheless, differences in drug exposure likelihood between countries should be kept in mind, as these could still cause variations in the actual population studied, thereby decreasing its generalizability. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Roy G P J de Jong
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands.,Department of Internal Medicine, Division of Gastroenterology and Hepatology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Arlene M Gallagher
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, United Kingdom.,Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Emily Herrett
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, United Kingdom.,Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ad A M Masclee
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Maryska L G Janssen-Heijnen
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - Frank de Vries
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre+, Maastricht, The Netherlands.,MRC Life-course Epidemiology Unit, University of Southampton, Southampton, United Kingdom
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25
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Menditto E, Bolufer De Gea A, Cahir C, Marengoni A, Riegler S, Fico G, Costa E, Monaco A, Pecorelli S, Pani L, Prados-Torres A. Scaling up health knowledge at European level requires sharing integrated data: an approach for collection of database specification. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:253-65. [PMID: 27358570 PMCID: PMC4912318 DOI: 10.2147/ceor.s97548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Computerized health care databases have been widely described as an excellent opportunity for research. The availability of "big data" has brought about a wave of innovation in projects when conducting health services research. Most of the available secondary data sources are restricted to the geographical scope of a given country and present heterogeneous structure and content. Under the umbrella of the European Innovation Partnership on Active and Healthy Ageing, collaborative work conducted by the partners of the group on "adherence to prescription and medical plans" identified the use of observational and large-population databases to monitor medication-taking behavior in the elderly. This article describes the methodology used to gather the information from available databases among the Adherence Action Group partners with the aim of improving data sharing on a European level. A total of six databases belonging to three different European countries (Spain, Republic of Ireland, and Italy) were included in the analysis. Preliminary results suggest that there are some similarities. However, these results should be applied in different contexts and European countries, supporting the idea that large European studies should be designed in order to get the most of already available databases.
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Affiliation(s)
- Enrica Menditto
- School of Pharmacy, CIRFF/Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy
| | - Angela Bolufer De Gea
- Directorate-General for Health and Food Safety, European Commission, Brussels, Belgium
| | - Caitriona Cahir
- Division of Population Health Sciences, Royal College of Surgeons in Ireland; Department of Pharmacology and Therapeutics, St James's Hospital, Dublin, Ireland
| | | | - Salvatore Riegler
- School of Pharmacy, CIRFF/Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy
| | - Giuseppe Fico
- Life Supporting Technologies, Photonics Technology and Bioengineering Department, School of Telecomunications Engineering, Polytechnic University of Madrid, Madrid, Spain
| | - Elisio Costa
- Faculty of Pharmacy, University of Porto, Porto, Portugal
| | | | - Sergio Pecorelli
- Department of Clinical and Experimental Science, University of Brescia, Brescia
| | - Luca Pani
- Italian Medicines Agency - AIFA, Rome, Italy
| | - Alexandra Prados-Torres
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón REDISSEC ISCIII, Miguel Servet University Hospital, University of Zaragoza, Zaragoza, Spain
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26
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A methodological comparison of two European primary care databases and replication in a US claims database: inhaled long-acting beta-2-agonists and the risk of acute myocardial infarction. Eur J Clin Pharmacol 2016; 72:1105-16. [PMID: 27216032 DOI: 10.1007/s00228-016-2071-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Results from observational studies on inhaled long-acting beta-2-agonists (LABA) and acute myocardial infarction (AMI) risk are conflicting, presumably due to variation in methodology. We aimed to evaluate the impact of applying a common study protocol on consistency of results in three databases. METHODS In the primary analysis, we included patients from two GP databases (Dutch-Mondriaan, UK-CPRD GOLD) with a diagnosis of asthma and/or COPD and at least one inhaled LABA or a "non-LABA inhaled bronchodilator medication" (short-acting beta-2-agonist or short-/long-acting muscarinic antagonist) prescription between 2002 and 2009. A claims database (USA-Clinformatics) was used for replication. LABA use was divided into current, recent (first 91 days following the end of a treatment episode), and past use (after more than 91 days following the end of a treatment episode). Adjusted hazard ratios (AMI-aHR) and 95 % confidence intervals (95 % CI) were estimated using time-dependent multivariable Cox regression models stratified by recorded diagnoses (asthma, COPD, or both asthma and COPD). RESULTS For asthma or COPD patients, no statistically significant AMI-aHRs (age- and sex-adjusted) were found in the primary analysis. For patients with both diagnoses, a decreased AMI-aHR was found for current vs. recent LABA use in the CPRD GOLD (0.78; 95 % CI 0.68-0.90) and in Mondriaan (0.55; 95 % CI 0.28-1.08), too. The replication study yielded similar results. Adjusting for concomitant medication use and comorbidities, in addition to age and sex, had little impact on the results. CONCLUSIONS By using a common protocol, we observed similar results in the primary analysis performed in two GP databases and in the replication study in a claims database. Regarding differences between databases, a common protocol facilitates interpreting results due to minimized methodological variations. However, results of multinational comparative observational studies might be affected by bias not fully addressed by a common protocol.
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de Groot MCH, Candore G, Uddin MJ, Souverein PC, Ali MS, Belitser SV, Huerta C, Groenwold RHH, Alvarez Y, Slattery J, Korevaar J, Hoes AW, Roes KCB, de Boer A, Douglas IJ, Schlienger RG, Reynolds R, Klungel OH, Gardarsdottir H. Case-only designs for studying the association of antidepressants and hip or femur fracture. Pharmacoepidemiol Drug Saf 2016; 25 Suppl 1:103-13. [DOI: 10.1002/pds.3850] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 07/08/2015] [Accepted: 07/09/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Mark C. H. de Groot
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht The Netherlands
- Department of Clinical Chemistry and Haematology, Division of Laboratory and Pharmacy; University Medical Center Utrecht; Utrecht The Netherlands
| | | | - Md. Jamal Uddin
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht The Netherlands
- Department of Statistics; Shahjalal University of Science and Technology; Sylhet Bangladesh
| | - Patrick C. Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht The Netherlands
| | - M. Sanni Ali
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht The Netherlands
| | - Svetlana V. Belitser
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht The Netherlands
| | - Consuelo Huerta
- BIFAP Research Unit, Division of Pharmacoepidemiology and Pharmacovigilance; Agencia Española de Medicamentos y Productos Sanitarios (AEMPS); Madrid Spain
| | - Rolf H. H. Groenwold
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht The Netherlands
| | | | | | - Joke Korevaar
- NIVEL; Netherlands Institute for Health Services Research; Utrecht The Netherlands
| | - Arno W. Hoes
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht The Netherlands
| | - Kit C. B. Roes
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht The Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht The Netherlands
| | - Ian J. Douglas
- London School of Hygiene and Tropical Medicine (LSHTM); London UK
| | | | | | - Olaf H. Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht The Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht The Netherlands
- Department of Clinical Pharmacy, Division of Laboratory and Pharmacy; University Medical Center Utrecht; Utrecht The Netherlands
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Abstract
What has been learned about electronic health data as a primary data source for regulatory decisions regarding the harms of drugs? Observational studies with electronic health data for postmarket risk assessment can now be conducted in Europe and the US in patient populations numbering in the tens of millions compared with a few hundred patients in a typical clinical trial. With standard protocols, results can be obtained in a few months; however, extensive research published by scores of investigators has illuminated the many obstacles that prevent obtaining robust, reproducible results that are reliable enough to be a primary source for drug safety decisions involving the health and safety of millions of patients. The most widely used terminology for coding patient interactions with medical providers for payment has proved ill-suited to identifying the adverse effects of drugs. Directly conflicting results were reported in otherwise similar patient health databases, even using identical event definitions and research methods. Evaluation of some accepted statistical methods revealed systematic bias, while others appeared to be unreliable. When electronic health data studies detected no drug risk, there were no robust and accepted standards to judge whether the drug was unlikely to cause the adverse effect or whether the study was incapable of detecting it. Substantial investment and careful thinking is needed to improve the reliability of risk assessments based on electronic health data, and current limitations need to be fully understood.
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Affiliation(s)
- Thomas J Moore
- Institute for Safe Medication Practices, 101 N. Columbus St, Suite 410, Alexandria, VA, 22214, USA,
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29
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Ferrer P, Amelio J, Ballarín E, Sabaté M, Vidal X, Rottenkolber M, Schmiedl S, Laporte JR, Ibáñez L. Systematic Review and Meta-Analysis: Macrolides- and Amoxicillin/Clavulanate-induced Acute Liver Injury. Basic Clin Pharmacol Toxicol 2016; 119:3-9. [PMID: 26707367 DOI: 10.1111/bcpt.12550] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/12/2015] [Indexed: 12/12/2022]
Abstract
Antibacterials are frequently associated with idiosyncratic drug-induced liver injury (DILI). The objective of this study was to estimate the risk of macrolides and amoxicillin/clavulanate (AMC) on DILI. We conducted a systematic review (SR) and meta-analysis (MA) with studies retrieved from PubMed, Cochrane Library Plus, Web of Knowledge, clinicaltrials.gov, Livertox and Toxline (1980-2014). We searched for macrolides, AMC and MeSH and synonym terms for DILI. We included all study designs except case reports/series, all population ages and studies with a placebo/non-user comparator. We summarized the evidence with a random-effects MA. Quality of the studies was appraised with a checklist developed for SR of adverse effects. Heterogeneity and publication bias were assessed with different exploratory tools. We finally included 10 (two randomized clinical trials, six case-control, one cohort and one case-population studies) and 9 (case-population excluded) articles in the SR and MA, respectively. The overall summary relative risk of DILI for macrolides was 2.85 [95% confidence interval (CI) 1.81-4.47], p < 0.0001, I(2) = 57%. Three studies were perceived to be missing in the area of low statistical significance. Year of study and selected exposure window partly explained the variability between studies. For AMC, the risk of DILI was 9.38 (95% CI 0.65-135.41) p = 0.3, I2 = 95%. In conclusion, although spontaneous reports and case series have long established an association between macrolides and AMC with acute liver injury, these SR and MA have assessed the magnitude of this association. The low incidence of DILI and the therapeutic place of these antibiotics might tilt the balance in favour of their benefits.
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Affiliation(s)
- Pili Ferrer
- Foundation Catalan Institute of Pharmacology, Barcelona, Spain
| | | | - Elena Ballarín
- Foundation Catalan Institute of Pharmacology, Barcelona, Spain.,Department of Clinical Pharmacology, University Hospital Vall d'Hebron, Barcelona, Spain.,Department of Pharmacology, Toxicology and Therapeutics, Autonomous University of Barcelona, Barcelona, Spain
| | - Mònica Sabaté
- Foundation Catalan Institute of Pharmacology, Barcelona, Spain.,Department of Clinical Pharmacology, University Hospital Vall d'Hebron, Barcelona, Spain.,Department of Pharmacology, Toxicology and Therapeutics, Autonomous University of Barcelona, Barcelona, Spain
| | - Xavi Vidal
- Foundation Catalan Institute of Pharmacology, Barcelona, Spain.,Department of Clinical Pharmacology, University Hospital Vall d'Hebron, Barcelona, Spain.,Department of Pharmacology, Toxicology and Therapeutics, Autonomous University of Barcelona, Barcelona, Spain
| | - Marietta Rottenkolber
- Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig-Maximilians Universitaet-Muenchen, Munich, Germany
| | - Sven Schmiedl
- Philipp Klee-Institute for Clinical Pharmacology, Helios Klinik Wuppertal, Wuppertal, Germany.,Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten-Herdecke University, Witten, Germany
| | - Joan-Ramon Laporte
- Foundation Catalan Institute of Pharmacology, Barcelona, Spain.,Department of Clinical Pharmacology, University Hospital Vall d'Hebron, Barcelona, Spain.,Department of Pharmacology, Toxicology and Therapeutics, Autonomous University of Barcelona, Barcelona, Spain
| | - Luisa Ibáñez
- Foundation Catalan Institute of Pharmacology, Barcelona, Spain.,Department of Clinical Pharmacology, University Hospital Vall d'Hebron, Barcelona, Spain.,Department of Pharmacology, Toxicology and Therapeutics, Autonomous University of Barcelona, Barcelona, Spain
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30
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Layton D. Vulnerable Patients and Potential Harms: The Contribution of Observational Research. Drug Saf 2016; 39:277-80. [PMID: 26821180 DOI: 10.1007/s40264-016-0395-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Deborah Layton
- Drug Safety Research Unit, Bursledon Hall, Blundell Lane, Southampton, SO31 1AA, UK.
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31
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Grimaldi-Bensouda L, Klungel O, Kurz X, de Groot MCH, Maciel Afonso AS, de Bruin ML, Reynolds R, Rossignol M. Calcium channel blockers and cancer: a risk analysis using the UK Clinical Practice Research Datalink (CPRD). BMJ Open 2016; 6:e009147. [PMID: 26747033 PMCID: PMC4716173 DOI: 10.1136/bmjopen-2015-009147] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The evidence of an association between calcium channel blockers (CCBs) and cancer is conflicting. The objective of the present study was to evaluate the risk of cancer (all, breast, prostate and colon cancers) in association with exposure to CCB. METHODS This is a population-based cohort study in patients exposed to CCBs from across the UK, using two comparison cohorts: (1) patients with no exposure to CCB (non-CCB) matched on age and gender and (2) unmatched patients unexposed to CCB and at least one other antihypertensive (AHT) prescription. Cancer incidence rates computed in the exposed and the two unexposed groups were compared using HRs and 95% CIs obtained from multivariate Cox regression analyses. RESULTS Overall, 150,750, 557,931 and 156,966 patients were included, respectively, in the CCB, non-CCB and AHT cohorts. Crude cancer incidence rates per 1000 person-years were 16.51, 15.75 and 10.62 for the three cohorts, respectively. Adjusted HRs (CI) for all cancers comparing CCB, non-CCB and AHT cohorts were 0.88 (0.86 to 0.89) and 1.01 (0.98 to 1.04), respectively. Compared to the AHT cohort, adjusted HRs (CI) for breast, prostate and colon cancer for the CCB cohort were 0.95 (0.87 to 1.04), 1.07 (0.98 to 1.16) and 0.89 (0.81 to 0.98), respectively. Analyses by duration of exposure to CCB did not show excess risk. CONCLUSIONS This large population-based study provides strong evidence that CCB use is not associated with an increased risk of cancer. The analyses yielded robust results across all types of cancer and different durations of exposure to CCBs.
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Affiliation(s)
| | - Olaf Klungel
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Mark C H de Groot
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ana S Maciel Afonso
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Marie L de Bruin
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Robert Reynolds
- Pfizer Epidemiology, New York, New York, USA
- Tulane University, New Orleans, Louisiana, USA
| | - Michel Rossignol
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
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Designing and incorporating a real world data approach to international drug development and use: what the UK offers. Drug Discov Today 2015; 21:400-5. [PMID: 26694021 DOI: 10.1016/j.drudis.2015.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 11/20/2015] [Accepted: 12/02/2015] [Indexed: 12/30/2022]
Abstract
Assessments of the safety, efficacy and appropriate use of new medicines lie at the heart of treatment development and subsequent adoption in clinical practice. Highly controlled randomised clinical trials routinely inform decisions on the approval, coverage and use of a medicine. Researchers and decision makers have become increasingly aware that these experimental data alone are insufficient to address those decisions fully. Real world data recorded from routine healthcare delivery by healthcare professionals and patients help provide a more complete picture of care. The UK, with its connectivity and rich longitudinal patient records, accumulated research and informatics experience and National Health Service, provides an exemplar of how real world data address a wide range of challenges across drug development.
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Ferrer P, Sabaté M, Ballarín E, Fortuny J, Rottenkolber M, Schmiedl S, Laporte JR, Ibáñez L. Sales of macrolides, lincosamides, streptogramins, and amoxicillin/clavulanate in the in- and outpatient setting in 10 European countries, 2007-2010. SPRINGERPLUS 2015; 4:612. [PMID: 26543747 PMCID: PMC4628133 DOI: 10.1186/s40064-015-1398-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 10/05/2015] [Indexed: 11/21/2022]
Abstract
Monitoring the use of antibiotics is relevant due to the public health impact of microbial resistance, adverse effects, and costs. We present data on the consumption of macrolides, lincosamides, streptogramins and amoxicillin/clavulanate (AMC) between 2007 and 2010 in the in-and outpatient healthcare setting in 10 European countries provided by IMS Health. Antibiotics were classified according to the anatomical therapeutic chemical classification and consumption was expressed in defined daily doses/1000 inhabitants/day (DIDs). We analysed the number of prescriptions by diagnostic codes between 2008 and 2010, based on the International Classification of Diseases, 10th revision (ICD-10). These ICD-10 codes were grouped into four main categories: respiratory infections, genitourinary infections, other infections and other diagnoses. In 2010, the consumption of macrolides and lincosamides ranged from 0.45 DIDs (Sweden) to 5.46 DIDs (Italy), and from 0.04 DIDs (Denmark) to 1.00 DID (Germany), respectively. Streptogramins were available in France, Germany, Italy, Norway, Spain and United Kingdom with a consumption of <0.001 DID exclusively in the hospital setting. The consumption of AMC ranged from <0.001 DIDs (Norway) to 11.67 DIDs (Spain). During the study period, the consumption of macrolides decreased, the consumption of AMC increased in most of European countries, and lincosamides varied very slightly. Macrolides and AMC were mainly prescribed for respiratory infections in all countries but United Kingdom, where most of the prescriptions were assigned to diagnostic codes not clearly related with an infection. Lincosamides were prescribed for the respiratory infections and other infections groups. There was a wide inter-country variability in the percentage of the prescriptions assigned to each of the diagnostic categories. The inter-country differences in the consumption of these antibiotics and their prescription by diagnostic categories point to an inappropriate use of antibiotics.
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Affiliation(s)
- Pili Ferrer
- Fundació Institut Català de Farmacologia, Pg Vall d'Hebron 119-129, 08029 Barcelona, Spain
| | - Mònica Sabaté
- Fundació Institut Català de Farmacologia, Pg Vall d'Hebron 119-129, 08029 Barcelona, Spain ; Department of Clinical Pharmacology, University Hospital Vall d'Hebron, Pg Vall d'Hebron 119-129, 08029 Barcelona, Spain ; Department of Pharmacology, Toxicology and Clinical Therapeutics, Hospital Universitari Vall d' Hebron, Univ Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
| | - Elena Ballarín
- Fundació Institut Català de Farmacologia, Pg Vall d'Hebron 119-129, 08029 Barcelona, Spain ; Department of Clinical Pharmacology, University Hospital Vall d'Hebron, Pg Vall d'Hebron 119-129, 08029 Barcelona, Spain ; Department of Pharmacology, Toxicology and Clinical Therapeutics, Hospital Universitari Vall d' Hebron, Univ Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
| | - Joan Fortuny
- DS&E, Global Clinical Epidemiology, Novartis Farmaceutica S.A., Gran Via Corts Catalanes 764, 08013 Barcelona, Spain ; RTI Health Solutions, Barcelona, Spain
| | - Marietta Rottenkolber
- Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig-Maximilians Universitaet- Muenchen, Marchioninistrasse 15, 81377 Munich, Germany ; Diabetes Research Group, Medical Department 4, University Hospital Munich, Campus Innenstadt, Ludwig-Maximilians-Universität, Ziemssenstr 1, 80336 Munich, Germany
| | - Sven Schmiedl
- Philipp Klee-Institute for Clinical Pharmacology, Helios Klinik Wuppertal, Heusnerstrasse 40, 42283 Wuppertal, Germany ; Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten-Herdecke University, Alfred Herrhausen-Strasse 50, 58448 Witten, Germany
| | - Joan-Ramon Laporte
- Fundació Institut Català de Farmacologia, Pg Vall d'Hebron 119-129, 08029 Barcelona, Spain ; Department of Clinical Pharmacology, University Hospital Vall d'Hebron, Pg Vall d'Hebron 119-129, 08029 Barcelona, Spain ; Department of Pharmacology, Toxicology and Clinical Therapeutics, Hospital Universitari Vall d' Hebron, Univ Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
| | - Luisa Ibáñez
- Fundació Institut Català de Farmacologia, Pg Vall d'Hebron 119-129, 08029 Barcelona, Spain ; Department of Clinical Pharmacology, University Hospital Vall d'Hebron, Pg Vall d'Hebron 119-129, 08029 Barcelona, Spain ; Department of Pharmacology, Toxicology and Clinical Therapeutics, Hospital Universitari Vall d' Hebron, Univ Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
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Brauer R, Ruigómez A, Klungel O, Reynolds R, Feudjo Tepie M, Smeeth L, Douglas I. The risk of acute liver injury among users of antibiotic medications: a comparison of case-only studies. Pharmacoepidemiol Drug Saf 2015; 25 Suppl 1:39-46. [PMID: 26248609 PMCID: PMC4916501 DOI: 10.1002/pds.3846] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 07/06/2015] [Accepted: 07/07/2015] [Indexed: 11/12/2022]
Abstract
PURPOSE The aims of this study were two-fold: (i) to investigate the effect of exposure to antibiotic agents on the risk of acute liver injury using a self-controlled case series and case-crossover study and (ii) to compare the results between the case-only studies. METHODS For the self-controlled case series study relative incidence ratios (IRR) were calculated by dividing the rate of acute liver injury experienced during patients' periods of exposure to antibiotics to patients' rate of events during non-exposed time using conditional Poisson regression. For the case-crossover analysis we calculated Odds Ratios (OR) using conditional logistic regression by comparing exposure during 14- and 30-day risk windows with exposure during control moments. RESULTS Using the self-controlled case series approach, the IRR was highest during the first 7 days after receipt of a prescription (10.01, 95% CI 6.59-15.18). Omitting post-exposure washout periods lowered the IRR to 7.2. The highest estimate in the case-crossover analysis was found when two 30-day control periods 1 year prior to the 30-day ALI risk period were retained in the analysis: OR = 6.5 (95% CI, 3.95-10.71). The lowest estimate was found when exposure in the 14-day risk period was compared to exposure in four consecutive 14-day control periods immediately prior to the risk period (OR = 3.05, 95% CI, 2.06-4.53). CONCLUSION An increased relative risk of acute liver injury was consistently observed using both self-controlled case series and case-crossover designs. Case-only designs can be used as a viable alternative study design to study the risk of acute liver injury, albeit with some limitations.
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Affiliation(s)
- Ruth Brauer
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ana Ruigómez
- Fundación Centro Español de Investigación Farmacoepidemiológica, (CEIFE), Madrid, Spain
| | - Olaf Klungel
- Faculty of Science, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Robert Reynolds
- Epidemiology, Pfizer Research and Development, New York, USA
| | | | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ian Douglas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Udo R, Tcherny-Lessenot S, Brauer R, Dolin P, Irvine D, Wang Y, Auclert L, Juhaeri J, Kurz X, Abenhaim L, Grimaldi L, De Bruin ML. The risk of acute liver injury associated with the use of antibiotics-evaluating robustness of results in the pharmacoepidemiological research on outcomes of therapeutics by a European consortium (PROTECT) project. Pharmacoepidemiol Drug Saf 2015; 25 Suppl 1:47-55. [DOI: 10.1002/pds.3841] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 06/24/2015] [Accepted: 06/25/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Renate Udo
- Utrecht Institute for Pharmaceutical Sciences; Utrecht University; The Netherlands
| | | | - Ruth Brauer
- London School of Hygiene and Tropical Medicine; Faculty of Epidemiology and Population Health; London United Kingdom
| | - Paul Dolin
- Takeda Development Centre Europe; London United Kingdom
| | - David Irvine
- Takeda Development Centre Europe; London United Kingdom
| | - Yunxun Wang
- Global Pharmacovigilance and Epidemiology; Sanofi; Chilly-Mazarin France
| | - Laurent Auclert
- Global Pharmacovigilance and Epidemiology; Sanofi; Chilly-Mazarin France
| | - Juhaeri Juhaeri
- Global Pharmacovigilance and Epidemiology; Sanofi; Chilly-Mazarin France
| | - Xavier Kurz
- European Medicines Agency (EMA); London United Kingdom
| | | | | | - Marie L. De Bruin
- Utrecht Institute for Pharmaceutical Sciences; Utrecht University; The Netherlands
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36
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Huerta C, Abbing-Karahagopian V, Requena G, Oliva B, Alvarez Y, Gardarsdottir H, Miret M, Schneider C, Gil M, Souverein PC, De Bruin ML, Slattery J, De Groot MCH, Hesse U, Rottenkolber M, Schmiedl S, Montero D, Bate A, Ruigomez A, García-Rodríguez LA, Johansson S, de Vries F, Schlienger RG, Reynolds RF, Klungel OH, de Abajo FJ. Exposure to benzodiazepines (anxiolytics, hypnotics and related drugs) in seven European electronic healthcare databases: a cross-national descriptive study from the PROTECT-EU Project. Pharmacoepidemiol Drug Saf 2015; 25 Suppl 1:56-65. [DOI: 10.1002/pds.3825] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 04/23/2015] [Accepted: 04/28/2015] [Indexed: 01/28/2023]
Affiliation(s)
- Consuelo Huerta
- Division of Pharmacoepidemiology and Pharmacovigilance, Medicines for Human Use Department; Spanish Agency for Medicines and Medical Devices (AEMPS); Madrid Spain
| | - Victoria Abbing-Karahagopian
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht University; Utrecht The Netherlands
| | - Gema Requena
- Pharmacology Unit, Department of Biomedical Sciences II, School of Medicine and Health Sciences; University of Alcalá; Madrid Spain
| | - Belén Oliva
- Division of Pharmacoepidemiology and Pharmacovigilance, Medicines for Human Use Department; Spanish Agency for Medicines and Medical Devices (AEMPS); Madrid Spain
| | | | - Helga Gardarsdottir
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht University; Utrecht The Netherlands
- Department of Clinical Pharmacy, Division Laboratory and Pharmacy; University Medical Center Utrecht; Utrecht The Netherlands
| | | | - Cornelia Schneider
- Division Clinical Pharmacy and Epidemiology; University of Basel; Switzerland
| | - Miguel Gil
- Division of Pharmacoepidemiology and Pharmacovigilance, Medicines for Human Use Department; Spanish Agency for Medicines and Medical Devices (AEMPS); Madrid Spain
| | - Patrick C. Souverein
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht University; Utrecht The Netherlands
| | - Marie L. De Bruin
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht University; Utrecht The Netherlands
| | | | - Mark C. H. De Groot
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht University; Utrecht The Netherlands
| | - Ulrik Hesse
- National Institute for Health Data and Disease Control; Copenhagen Denmark
| | - Marietta Rottenkolber
- Institute for Medical Information Sciences, Epidemiology, and Biometry; Ludwig-Maximilians-Universitaet München; Munich Germany
| | - Sven Schmiedl
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health; Witten/Herdecke University; Witten Germany
- Philipp Klee-Institute for Clinical Pharmacology; HELIOS Clinic Wuppertal; Wuppertal Germany
| | - Dolores Montero
- Division of Pharmacoepidemiology and Pharmacovigilance, Medicines for Human Use Department; Spanish Agency for Medicines and Medical Devices (AEMPS); Madrid Spain
| | | | - Ana Ruigomez
- Spanish Center for Pharmacoepidemiological Research (CEIFE); Madrid Spain
| | | | | | - Frank de Vries
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht University; Utrecht The Netherlands
- MRC Epidemiology Resource Centre; Southampton General Hospital; Southampton UK
- School CAPHRI; Maastricht University; The Netherlands
| | | | | | - Olaf H. Klungel
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht University; Utrecht The Netherlands
- University Medical Center Utrecht (UMCU); Julius Center for Health Sciences and Primary Care; The Netherlands
| | - Francisco José de Abajo
- Pharmacology Unit, Department of Biomedical Sciences II, School of Medicine and Health Sciences; University of Alcalá; Madrid Spain
- Clinical Pharmacology Unit; University Hospital Príncipe de Asturias; Madrid Spain
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Requena G, Logie J, Martin E, Boudiaf N, González González R, Huerta C, Alvarez A, Webb D, Bate A, García Rodríguez LA, Reynolds R, Schlienger R, Gardarsdottir H, de Groot M, Klungel OH, de Abajo F, Douglas IJ. Do case-only designs yield consistent results across design and different databases? A case study of hip fractures and benzodiazepines. Pharmacoepidemiol Drug Saf 2015; 25 Suppl 1:79-87. [PMID: 26112821 PMCID: PMC4949640 DOI: 10.1002/pds.3822] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 05/27/2015] [Accepted: 05/29/2015] [Indexed: 01/04/2023]
Abstract
Background The case‐crossover (CXO) and self‐controlled case series (SCCS) designs are increasingly used in pharmacoepidemiology. In both, relative risk estimates are obtained within persons, implicitly controlling for time‐fixed confounding variables. Objectives To examine the consistency of relative risk estimates of hip/femur fractures (HFF) associated with the use of benzodiazepines (BZD) across case‐only designs in two databases (DBs), when a common protocol was applied. Methods CXO and SCCS studies were conducted in BIFAP (Spain) and CPRD (UK). Exposure to BZD was divided into non‐use, current, recent and past use. For CXO, odds ratios (OR; 95%CI) of current use versus non‐use/past were estimated using conditional logistic regression adjusted for co‐medications (AOR). For the SCCS, conditional Poisson regression was used to estimate incidence rate ratios (IRR; 95%CI) of current use versus non/past‐use, adjusted for age. To investigate possible event‐exposure dependence the relative risk in the 30 days prior to first BZD exposure was also evaluated. Results In the CXO current use of BZD was associated with an increased risk of HFF in both DBs, AORBIFAP = 1.47 (1.29–1.67) and AORCPRD = 1.55 (1.41–1.70). In the SCCS, IRRs for current exposure was 0.79 (0.72–0.86) in BIFAP and 1.21 (1.13–1.30) in CPRD. However, when we considered separately the 30‐day pre‐exposure period, the IRR for current period was 1.43 (1.31–1.57) in BIFAP and 1.37 (1.27–1.47) in CPRD. Conclusions CXO designs yielded consistent results across DBs, while initial SCCS analyses did not. Accounting for event‐exposure dependence, estimates derived from SCCS were more consistent across DBs and designs. © 2015 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.
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Affiliation(s)
- Gema Requena
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine, University of Alcalá, Madrid, Spain
| | - John Logie
- Worldwide Epidemiology, GlaxoSmithKline, Research and Development, Uxbridge, Middlesex, UK
| | - Elisa Martin
- BIFAP Research Unit, Spanish Agency of Medicines and Medical Devices, Madrid, Spain
| | - Nada Boudiaf
- Worldwide Epidemiology, GlaxoSmithKline, Research and Development, Uxbridge, Middlesex, UK
| | | | - Consuelo Huerta
- BIFAP Research Unit, Spanish Agency of Medicines and Medical Devices, Madrid, Spain
| | - Arturo Alvarez
- BIFAP Research Unit, Spanish Agency of Medicines and Medical Devices, Madrid, Spain
| | - David Webb
- Worldwide Epidemiology, GlaxoSmithKline, Research and Development, Uxbridge, Middlesex, UK
| | | | | | - Robert Reynolds
- Epidemiology, Pfizer Research and Development, New York, USA
| | | | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Mark de Groot
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Fancisco de Abajo
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine, University of Alcalá, Madrid, Spain.,Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Madrid, Spain
| | - Ian J Douglas
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
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Requena G, Huerta C, Gardarsdottir H, Logie J, González-González R, Abbing-Karahagopian V, Miret M, Schneider C, Souverein PC, Webb D, Afonso A, Boudiaf N, Martin E, Oliva B, Alvarez A, De Groot MCH, Bate A, Johansson S, Schlienger R, Reynolds R, Klungel OH, de Abajo FJ. Hip/femur fractures associated with the use of benzodiazepines (anxiolytics, hypnotics and related drugs): a methodological approach to assess consistencies across databases from the PROTECT-EU project. Pharmacoepidemiol Drug Saf 2015; 25 Suppl 1:66-78. [PMID: 26100105 DOI: 10.1002/pds.3816] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 05/13/2015] [Accepted: 05/20/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Results from observational studies may be inconsistent because of variations in methodological and clinical factors that may be intrinsically related to the database (DB) where the study is performed. OBJECTIVES The objectives of this paper were to evaluate the impact of applying a common study protocol to study benzodiazepines (BZDs) (anxiolytics, hypnotics, and related drugs) and the risk of hip/femur fracture (HFF) across three European primary care DBs and to investigate any resulting discrepancies. METHODS To measure the risk of HFF among adult users of BZDs during 2001-2009, three cohort and nested case control (NCC) studies were performed in Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP) (Spain), Clinical Practice Research Datalink (CPRD) (UK), and Mondriaan (The Netherlands). Four different models (A-D) with increasing levels of adjustment were analyzed. The risk according to duration and type of BZD was also explored. Adjusted hazard ratios (cohort), odds ratios (NCC), and their 95% confidence intervals were estimated. RESULTS Adjusted hazard ratios (Model C) were 1.34 (1.23-1.47) in BIFAP, 1.66 (1.54-1.78) in CPRD, and 2.22 (1.55-3.29) in Mondriaan in cohort studies. Adjusted odds ratios (Model C) were 1.28 (1.16-1.42) in BIFAP, 1.60 (1.49-1.72) in CPRD, and 1.48 (0.89-2.48) in Mondriaan in NCC studies. A short-term effect was suggested in Mondriaan, but not in CPRD or BIFAP. All DBs showed an increased risk with the concomitant use of anxiolytic and hypnotic drugs. CONCLUSIONS Applying similar study methods to different populations and DBs showed an increased risk of HFF in BZDs users but differed in the magnitude of the risk, which may be because of inherent differences between DBs.
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Affiliation(s)
- Gema Requena
- Pharmacology Section, Department of Biomedical Sciences, School of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
| | - Consuelo Huerta
- BIFAP Research Unit, Division of Pharmacoepidemiology and Pharmacovigilance, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Helga Gardarsdottir
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - John Logie
- Worldwide Epidemiology, GlaxoSmithKline Research and Development, Uxbridge, Middlesex, UK
| | - Rocío González-González
- BIFAP Research Unit, Division of Pharmacoepidemiology and Pharmacovigilance, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Victoria Abbing-Karahagopian
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | | | - Cornelia Schneider
- Division of Clinical Pharmacy & Epidemiology, University of Basel, Basel, Switzerland
| | - Patrick C Souverein
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Dave Webb
- Worldwide Epidemiology, GlaxoSmithKline Research and Development, Uxbridge, Middlesex, UK
| | - Ana Afonso
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Nada Boudiaf
- Worldwide Epidemiology, GlaxoSmithKline Research and Development, Uxbridge, Middlesex, UK
| | - Elisa Martin
- BIFAP Research Unit, Division of Pharmacoepidemiology and Pharmacovigilance, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Belén Oliva
- BIFAP Research Unit, Division of Pharmacoepidemiology and Pharmacovigilance, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Arturo Alvarez
- BIFAP Research Unit, Division of Pharmacoepidemiology and Pharmacovigilance, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Mark C H De Groot
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | | | | | | | | | - Olaf H Klungel
- Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Francisco J de Abajo
- Pharmacology Section, Department of Biomedical Sciences, School of Medicine and Health Sciences, University of Alcalá, Madrid, Spain.,Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Madrid, Spain
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Garbe E, Pigeot I. [Benefits of large healthcare databases for drug risk research]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 58:829-837. [PMID: 26092163 DOI: 10.1007/s00103-015-2185-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Large electronic healthcare databases have become an important worldwide data resource for drug safety research after approval. Signal generation methods and drug safety studies based on these data facilitate the prospective monitoring of drug safety after approval, as has been recently required by EU law and the German Medicines Act. Despite its large size, a single healthcare database may include insufficient patients for the study of a very small number of drug-exposed patients or the investigation of very rare drug risks. For that reason, in the United States, efforts have been made to work on models that provide the linkage of data from different electronic healthcare databases for monitoring the safety of medicines after authorization in (i) the Sentinel Initiative and (ii) the Observational Medical Outcomes Partnership (OMOP). In July 2014, the pilot project Mini-Sentinel included a total of 178 million people from 18 different US databases. The merging of the data is based on a distributed data network with a common data model. In the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCEPP) there has been no comparable merging of data from different databases; however, first experiences have been gained in various EU drug safety projects. In Germany, the data of the statutory health insurance providers constitute the most important resource for establishing a large healthcare database. Their use for this purpose has so far been severely restricted by the Code of Social Law (Section 75, Book 10). Therefore, a reform of this section is absolutely necessary.
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Affiliation(s)
- Edeltraut Garbe
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Achterstraße 30, 28359, Bremen, Deutschland. .,Wissenschaftsschwerpunkt "Gesundheitswissenschaften", Universität Bremen, Bremen, Deutschland.
| | - Iris Pigeot
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Achterstraße 30, 28359, Bremen, Deutschland.,Institut für Statistik, Fachbereich Mathematik und Informatik, Universität Bremen, Bremen, Deutschland
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Poole SG, Bell JS, Jokanovic N, Kirkpatrick CM, Dooley MJ. A systematic review of medication exposure assessment in prospective cohort studies of community dwelling older australians. PLoS One 2015; 10:e0124247. [PMID: 25909191 PMCID: PMC4409061 DOI: 10.1371/journal.pone.0124247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 02/27/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction It is not known to what extent medication use has been comprehensively assessed in prospective cohort studies of older Australians. Understanding the varying methods to assess medication use is necessary to establish comparability and to understand the opportunities for pharmacoepidemiological analysis. The objective of this review was to compare and contrast how medication-related data have been collected in prospective cohorts of community-dwelling older Australians. Methods MEDLINE and EMBASE (1990–2014) were systematically searched to identify prospective cohorts of ≥1000 older participants that commenced recruitment after 1990. The data collection tools used to assess medication use in each cohort were independently examined by two investigators using a structured approach. Results Thirteen eligible cohorts were included. Baseline medication use was assessed in participant self-completed surveys (n = 3), by an investigator inspecting medications brought to a clinic interview (n = 7), and by interviewing participants in their home (n = 3). Five cohorts sought participant consent to access administrative claims data. Six cohorts used multiple methods to assess medication use across one or more study waves. All cohorts assessed medication use at baseline and 12 cohorts in follow-up waves. Twelve cohorts recorded prescription medications by trade or generic name; 12 cohorts recorded medication strength; and 9 recorded the daily medication dose in at least one wave of the cohort. Seven cohorts asked participants about their “current” medication use without providing a definition of “current”; and nine cohorts asked participants to report medication use over recall periods ranging from 1-week to 3-months in at least one wave of the cohort. Sixty-five original publications, that reported the prevalence or outcomes of medication use, in the 13 cohorts were identified (median = 3, range 1–21). Conclusion There has been considerable variability in the assessment of medication use within and between cohorts. This may limit the comparability of medication data collected in these cohorts.
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Affiliation(s)
- Susan G. Poole
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia
- * E-mail:
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Natali Jokanovic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia
| | - Carl M. Kirkpatrick
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael J. Dooley
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia
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Time trends of period prevalence rates of patients with inhaled long-acting beta-2-agonists-containing prescriptions: a European comparative database study. PLoS One 2015; 10:e0117628. [PMID: 25706152 PMCID: PMC4338187 DOI: 10.1371/journal.pone.0117628] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 12/29/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Inhaled, long-acting beta-2-adrenoceptor agonists (LABA) have well-established roles in asthma and/or COPD treatment. Drug utilisation patterns for LABA have been described, but few studies have directly compared LABA use in different countries. We aimed to compare the prevalence of LABA-containing prescriptions in five European countries using a standardised methodology. METHODS A common study protocol was applied to seven European healthcare record databases (Denmark, Germany, Spain, the Netherlands (2), and the UK (2)) to calculate crude and age- and sex-standardised annual period prevalence rates (PPRs) of LABA-containing prescriptions from 2002-2009. Annual PPRs were stratified by sex, age, and indication (asthma, COPD, asthma and COPD). RESULTS From 2002-2009, age- and sex-standardised PPRs of patients with LABA-containing medications increased in all databases (58.2%-185.1%). Highest PPRs were found in men ≥ 80 years old and women 70-79 years old. Regarding the three indications, the highest age- and sex-standardised PPRs in all databases were found in patients with "asthma and COPD" but with large inter-country variation. In those with asthma or COPD, lower PPRs and smaller inter-country variations were found. For all three indications, PPRs for LABA-containing prescriptions increased with age. CONCLUSIONS Using a standardised protocol that allowed direct inter-country comparisons, we found highest rates of LABA-containing prescriptions in elderly patients and distinct differences in the increased utilisation of LABA-containing prescriptions within the study period throughout the five European countries.
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Seasonal changes in prescribing of long-acting beta-2-agonists-containing drugs. Respir Med 2015; 109:828-37. [PMID: 25976384 DOI: 10.1016/j.rmed.2015.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 01/15/2015] [Accepted: 01/22/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND For patients with asthma, COPD, or asthma-COPD overlap syndrome (ACOS), inter-country comparisons of seasonal changes in drug prescriptions are scarce or missing. Hence, we aimed to compare seasonal changes in prescription rates of long-acting beta-2-agonist (LABA) in four European countries. METHODS A common study protocol was applied to six health care databases (Germany, Spain, the Netherlands (2), and the UK (2)) to calculate age- and sex-standardized point prevalence rates (PPRs) of LABA-containing prescriptions by the 1st of March, June, September, and December of each year during the study period 2002-2009. Seasonal variation of PPRs was quantified using seasonal indexes (SIs; based on the ratio-to-moving-average-method) and SIs averaged over the study period (aSI) stratified by sex, age, and indication (asthma, COPD, or ACOS). RESULTS There was a moderate seasonal change in LABA-containing prescriptions which was more pronounced in asthma or COPD patients compared to ACOS patients. For asthma and ACOS patients, highest seasonal variation was found for patients living in Spain (aSI: 87.3-110.7, aSI: 93.2-103.1) whereas for COPD highest seasonal variation was revealed for the NPCRD database (the Netherlands) (aSI: 92.2-105.6). Regarding age and sex, highest seasonal variation was found in Spanish boys under 10 years of age having a diagnosis of asthma. CONCLUSIONS By applying a common analysis in six databases, we could observe moderate overall seasonal changes in LABA-containing prescription rates in patients with asthma, COPD, or ACOS.
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Ascertainment of acute liver injury in two European primary care databases. Eur J Clin Pharmacol 2014; 70:1227-35. [PMID: 25066450 DOI: 10.1007/s00228-014-1721-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 07/16/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to ascertain acute liver injury (ALI) in primary care databases using different computer algorithms. The aim of this investigation was to study and compare the incidence of ALI in different primary care databases and using different definitions of ALI. METHODS The Clinical Practice Research Datalink (CPRD) in UK and the Spanish "Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria" (BIFAP) were used. Both are primary care databases from which we selected individuals of all ages registered between January 2004 and December 2009. We developed two case definitions of idiopathic ALI using computer algorithms: (i) restrictive definition (definite cases) and (ii) broad definition (definite and probable cases). Patients presenting prior liver conditions were excluded. Manual review of potential cases was performed to confirm diagnosis, in a sample in CPRD (21%) and all potential cases in BIFAP. Incidence rates of ALI by age, sex and calendar year were calculated. RESULTS In BIFAP, all cases considered definite after manual review had been detected with the computer algorithm as potential cases, and none came from the non-cases group. The restrictive definition of ALI had a low sensitivity but a very high specificity (95% in BIFAP) and showed higher rates of agreement between computer search and manual review compared to the broad definition. Higher incidence rates of definite ALI in 2008 were observed in BIFAP (3.01 (95% confidence interval (CI) 2.13-4.25) per 100,000 person-years than CPRD (1.35 (95% CI 1.03-1.78)). CONCLUSIONS This study shows that it is feasible to identify ALI cases if restrictive selection criteria are used and the possibility to review additional information to rule out differential diagnoses. Our results confirm that idiopathic ALI is a very rare disease in the general population. Finally, the construction of a standard definition with predefined criteria facilitates the timely comparison across databases.
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Requena G, Abbing-Karahagopian V, Huerta C, De Bruin ML, Alvarez Y, Miret M, Hesse U, Gardarsdottir H, Souverein PC, Slattery J, Schneider C, Rottenkolber M, Schmiedl S, Gil M, De Groot MCH, Bate A, Ruigómez A, García Rodríguez LA, Johansson S, de Vries F, Montero D, Schlienger R, Reynolds R, Klungel OH, de Abajo FJ. Incidence rates and trends of hip/femur fractures in five European countries: comparison using e-healthcare records databases. Calcif Tissue Int 2014; 94:580-9. [PMID: 24687523 DOI: 10.1007/s00223-014-9850-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/10/2014] [Indexed: 10/25/2022]
Abstract
Hip fractures represent a major public health challenge worldwide. Multinational studies using a common methodology are scarce. We aimed to estimate the incidence rates (IRs) and trends of hip/femur fractures over the period 2003-2009 in five European countries. The study was performed using seven electronic health-care records databases (DBs) from Denmark, The Netherlands, Germany, Spain, and the United Kingdom, based on the same protocol. Yearly IRs of hip/femur fractures were calculated for the general population and for those aged ≥50 years. Trends over time were evaluated using linear regression analysis for both crude and standardized IRs. Sex- and age-standardized IRs for the UK, Netherlands, and Spanish DBs varied from 9 to 11 per 10,000 person-years for the general population and from 22 to 26 for those ≥50 years old; the German DB showed slightly higher IRs (about 13 and 30, respectively), whereas the Danish DB yielded IRs twofold higher (19 and 52, respectively). IRs increased exponentially with age in both sexes. The ratio of females to males was ≥2 for patients aged ≥70-79 years in most DBs. Statistically significant trends over time were only shown for the UK DB (CPRD) (+0.7% per year, P < 0.01) and the Danish DB (-1.4% per year, P < 0.01). IRs of hip/femur fractures varied greatly across European countries. With the exception of Denmark, no decreasing trend was observed over the study period.
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Affiliation(s)
- G Requena
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, University of Alcalá, Madrid, Spain,
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Antidepressant prescribing in five European countries: application of common definitions to assess the prevalence, clinical observations, and methodological implications. Eur J Clin Pharmacol 2014; 70:849-57. [PMID: 24793010 DOI: 10.1007/s00228-014-1676-z] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 03/30/2014] [Indexed: 12/23/2022]
Abstract
PURPOSE Drug utilization studies have applied different methods to various data types to describe medication use, which hampers comparisons across populations. The aim of this study was to describe the time trends in antidepressant prescribing in the last decade and the variation in the prevalence, calculated in a uniform manner, in seven European electronic healthcare databases. METHODS Annual prevalence per 10,000 person-years (PYs) was calculated for 2001-2009 in databases from Spain, Germany, Denmark, the United Kingdom (UK), and the Netherlands. Prevalence data were stratified according to age, sex, antidepressant type (selective serotonin re-uptake inhibitors [SSRIs] or tricyclic antidepressants [TCAs]) and major indications. RESULTS The age- and sex-standardized prevalence was lowest in the two Dutch (391 and 429 users per 10,000 PYs) and highest in the two UK (913 and 936 users per 10,000 PYs) populations in 2008. The prevalence in the Danish, German, and Spanish populations was 637, 618, and 644 users per 10,000 PY respectively. Antidepressants were prescribed most often in 20- to 60-year-olds in the two UK populations compared with the others. SSRIs were prescribed more often than TCAs in all except the German population. In the majority of countries we observed an increasing trend of antidepressant prescribing over time. Two different methods identifying recorded indications yielded different ranges of proportions of patients recorded with the specific indication (15-57% and 39-69% for depression respectively). CONCLUSION Despite applying uniform methods, variations in the prevalence of antidepressant prescribing were obvious in the different populations. Database characteristics and clinical factors may both explain these variations.
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Sabaté M, Pacheco JF, Ballarín E, Ferrer P, Petri H, Hasford J, Schoonen MW, Rottenkolber M, Fortuny J, Laporte JR, Ibáñez L. A compilation of research working groups on drug utilisation across Europe. BMC Res Notes 2014; 7:143. [PMID: 24625054 PMCID: PMC4008312 DOI: 10.1186/1756-0500-7-143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 03/01/2014] [Indexed: 11/12/2022] Open
Abstract
Background The assessment of the benefit-risk of medicines needs careful consideration concerning their patterns of utilization. Systems for the monitoring of medicines consumption have been established in many European countries, and several international groups have identified and described them. No other compilation of European working groups has been published. As part of the PROTECT project, as a first step in searching for European data sources on the consumption of five selected groups of medicines, we aimed to identify and describe the main characteristics of the existing collaborative European working groups. Findings Google and bibliographic searches (PubMed) of articles containing information on databases and other sources of drug consumption data were conducted. For each working group the main characteristics were recorded. Nineteen selected groups were identified, focusing on: a) general drug utilisation (DU) research (EuroDURG, CNC, ISPE’S SIG-DUR, EURO-MED-STAT, PIPERSKA Group, NorPEN, ENCePP, DURQUIM), b) specific DU research: b.1) antimicrobial drugs (ARPAC, ESAC, ARPEC, ESGAP, HAPPY AUDIT), b.2) cardiovascular disease (ARITMO, EUROASPIRE), b.3) paediatrics (TEDDY), and b.4) mental health/central nervous system effects (ESEMeD, DRUID, TUPP/EUPoMMe). Information on their aims, methods and activities is presented. Conclusions We assembled and updated information on European working groups in DU research and in the utilisation of five selected groups of drugs for the PROTECT project. This information should be useful for academic researchers, regulatory and health authorities, and pharmaceutical companies conducting and interpreting post-authorisation and safety studies. European health authorities should encourage national research and collaborations in this important field for public health.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Luisa Ibáñez
- Fundació Institut Català de Farmacologia, Pg, Valld'Hebron 119-129, Barcelona 08035, Spain.
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