Serious Adverse Events Reporting in Phase III Randomized Clinical Trials of Colorectal Cancer Treatments: A Systematic Analysis

Automatic tool for the reconciliation of serious adverse events for pharmacovigilance: design and implementation of Reconciliaid

Background

Reporting serious adverse events (SAEs) is crucial to reduce or avoid toxicities that can lead to major consequences for patient's health due to treatments tested in clinical trials. Its exhaustiveness is often inadequate, and we observe discrepancies between data published by pharmacovigilance organizations and clinical databases.

Objectives

While the process of reconciliation aims at reducing these differences, it remains a very time-consuming and imprecise task. We propose a tool to automate this process.

Design

We have developed and tested Reconciliaid, an application that compares the SAEs of the databases of clinical trials collected according to a standard inspired by the Clinical Data Interchange Standards Consortium, and of pharmacovigilance collected according to the international standards ICH-E2B (R3). It generates a reconciliation file that indicates precisely what information does not coincide in the two databases to facilitate the identification of inconsistencies.

Methods

Reconciliaid was tested to create 13 reconciliation files, containing 290 SAEs. We inspected these files to determine their ability in identifying the inconsistencies and compared the manual and semi-automated reconciliation time. Four users answered the System Usability Scale (SUS) to measure its usability.

Results

The application identified all variables of interest in all reconciliations. Different formats and libraries were automatically harmonized, allowing a perfect identification of inconsistencies for all variables. The matching of the same SAE in the two databases was correct in 97.2% of the reconciliations. Reconciliaid is six times faster than the manual approach for senior data managers (range = 3-24 times). A novice data manager performed three reconciliations 4.8 faster with the help of Reconciliaid than manually (29 min vs 134 min) and with fewer mistakes. Mean SUS score was 92.5.

Conclusion

Reconciliaid has a high level of usability, can increase the quality of reconciliation, and reduces considerably the reconciliation time, allowing to increase the frequency of reconciliation processes and to focus resources on patient safety and medical assessment.

Heterogeneity in adverse events related to atezolizumab-bevacizumab for hepatocellular carcinoma reported in real-world studies

Background & Aims

Safety data for patients with hepatocellular carcinoma (HCC) treated with atezolizumab-bevacizumab in the real-world setting remain uncertain. Thus, the aim of this study was to evaluate the incidence of adverse events (AEs) in patients with HCC treated with atezolizumab-bevacizumab in the literature.

Methods

In this systematic review and meta-analysis, we searched PubMed for original studies reporting percentages of AEs in patients with HCC receiving atezolizumab-bevacizumab between 2020 to 2023, using the search terms "Atezolizumab/Bevacizumab", "HCC" and "Adverse events". We summarized the incidence of AEs and performed a meta-analysis in order to evaluate the incidence of AEs reported in the literature.

Results

A total of 30 studies (3,867 patients) were included. The analysis revealed heterogeneity in AE reporting, with arterial hypertension, proteinuria, and fatigue being the most frequently reported AEs whereas incidence of bleeding was reported in 66.7% of the studies and rare immune-related AEs were reported in 26.7% of the studies. The meta-analysis revealed pooled incidence rates of 79% for any grade AEs: 56% for grade 1/2 and 30% for grade ≥3. While the pooled rates of hypertension, anorexia, bleeding, pruritus, rash, and thyroid dysfunction were similar to those reported in the IMbrave150 trial, higher rates were observed in the literature for proteinuria, fatigue, ALT and AST elevations and gastrointestinal perforation. For grade ≥3 AEs, the percentages were consistent with the IMbrave150 trial, except for lower incidences of arterial hypertension and thrombosis in the literature. The exposure-adjusted incidence rates for proteinuria (55.7%), hypertension (45.3%) and fatigue (33.6%) were high. Heterogeneity was observed in the analysis of AEs across articles within the same cohorts of patients.

Conclusion

We observed a significant variability in AE reporting for atezolizumab-bevacizumab treatment in HCC in the literature, underscoring the need for standardized reporting practices.

Impact and implications

Considering the demonstrated safety of atezolizumab-bevacizumab in randomized-controlled trials, this meta-analysis offers valuable insights into reported occurrences of adverse events. Our study highlights significant heterogeneity among studies, underscoring the need to improve adverse event recording. Understanding the incidence and severity of treatment-related adverse events beyond clinical trials is essential for prompt intervention and may help in preventing treatment discontinuation and complications, potentially leading to better outcomes without significantly compromising quality of life due to adverse events.