A Comparison of Instructions for Use Documents and Manufacturer Produced Administration Videos for Biological Products

OBJECTIVES

To compare Instructions for Use (IFU) and Manufacturer Produced Administration Videos (MPAV) for biological products to describe if they are highly similar or different. To identify differences between the two that may lead to medication errors and to point out possible solutions to optimize safety.

METHODS

We screened 139 biological products having both an IFU and a MPAV. Differences between the IFU and MPAV of each biological product were noted and categorized by importance and how likely it would cause harm to patients. Strategies were discussed based on differences observed.

RESULTS

Of the products screened, 51 had an IFU and a MPAV available for evaluation. They were primarily made to support the use of auto-injectors (n = 25) and pre-filled syringes (n = 19). Of this group, we found that 11 had no differences between the IFU and MPAV, while the other 40 had at least one or more identifiable differences. Differences were stratified into the following sub-categories from most to least prevalent: word choice differences, supplementary information, missing information, and unaligned directions. We looked at the distribution of differences per biological product and found an average of two differences per MPAV (IQR 1-3).

CONCLUSION

We suggest that when sponsors create or update MPAVs, to focus on aligning critical content between the respective IFU and MPAV. We believe that it is possible for MPAVs to potentially reduce medication errors as a non-text-based media form and that care should be taken to avoid substantial differences in critical content between the IFU and MPAV.

Cytotoxic activity of a recombinant GnRH-PAP fusion toxin on human tumor cell lines

Pokeweed antiviral protein (PAP), a ribosome-inactivating protein isolated from the leaves of Phytolacca americana, reveals potent antiviral activity against viruses or cytotoxic action against cells once inside the cytoplasm. Therefore PAP is a good candidate to be used as an immunotoxin. We constructed a bacterial expression plasmid encoding PAP as a fusion protein with gonadotropin-releasing hormone (GnRH), a neuropeptide with receptor sites on several gynaecologic tumors. The resulting recombinant toxin was produced in Escherichia coli and accumulated in inclusion bodies. After purification under denaturing conditions, renaturated GnRH-PAP shows an IC(50) of 3 nM on in vitro translation assays and selectively inhibits the growth of the GnRH receptor positive Ishikawa cell line (ID(50) of 15 nM); on the other hand, neither GnRH nor PAP alone had any effect.

[Color-coded duplex sonography (angiodynography) in comparison with phlebography]

To verify the suspected diagnosis of deep thrombosis in the pelvic and/or the leg veins or to clarify the causes of pulmonary embolism, 84 patients were examined prospectively by color-coded duplex-sonography. The findings in the 103 legs examined were subsequently compared to those of an ascending phlebography. The deep veins from the region of the vena iliaca communis down to the lower leg were visualized, and blood flow, lumen and compressibility were checked. This procedure enabled the identification of totally occluding thrombi as well as partial thrombi with the circumfluent blood. The sensitivity of thrombus identification was 92.9%, the specificity was about 97% in the different segments. The results show that color-coded duplex sonography is a sensitive diagnostic instrument for follow-up in conservative therapy. Also, in postthrombotic changes, fresh clots can be identified for the most part. Color-coded duplex sonography can replace phlebography in most cases, if special attention is paid to regions which are difficult to visualize, such as the pelvic veins, the Hunter's channel and the veins of the lower leg.