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Sultana J, Crisafulli S, Almas M, Antonazzo IC, Baan E, Bartolini C, Bertuccio MP, Bonifazi F, Capuano A, Didio A, Ehrenstein V, Felisi M, Ferrajolo C, Fontana A, Francisca R, Fourrier-Reglat A, Fortuny J, Gini R, Hyeraci G, Hoeve C, Kontogiorgis C, Isgrò V, Lalagkas PN, L'Abbate L, Layton D, Landi A, Narduzzi S, Pereira LR, Poulentzas G, Rafaniello C, Roberto G, Scondotto G, Sportiello L, Toma M, Toussi M, Verhamme K, Volpe E, Trifirò G. Overview of the EU PAS register post-authorization studies performed in Europe from September 2010 to December 2018. Pharmacoepidemiol Drug Saf 2022; 31:689-705. [PMID: 35092329 PMCID: PMC9303697 DOI: 10.1002/pds.5413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 12/09/2021] [Accepted: 01/24/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The European post-authorisation study (EU PAS) register is a repository launched in 2010 by the European Medicines Agency (EMA). All EMA-requested PAS, commonly observational studies, must be recorded in this register. Multi-database studies (MDS) leveraging secondary data have become an important strategy to conduct PAS in recent years, as reflected by the type of studies registered in the EU PAS register. OBJECTIVES To analyse and describe PAS in the EU PAS register, with focus on MDS. METHODS Studies in the EU PAS register from inception to 31st December 2018 were described concerning transparency, regulatory obligations, scope, study type (e.g. observational study, clinical trial, survey, systematic review/meta-analysis), study design, type of data collection and target population. MDS were defined as studies conducted through secondary use of >1 data source not linked at patient-level. Data extraction was carried out independently by 14 centres with expertise in pharmacoepidemiology, using publicly available information in the EU PAS register including study protocol, whenever available, using a standardised data collection form. For validation purposes, a second revision of key fields for a 15% random sample of studies was carried out by a different centre. The inter-rater reliability (IRR) was then calculated. Finally, to identify predictors of primary data collection-based studies /vs those based on secondary use of healthcare databases) or MDS (vs. non-MDS), odds ratios (OR) and 95% confidence intervals (CI) were calculated fitting univariate logistic regression models. RESULTS Overall, 1,426 studies were identified. Clinical trials (N=30; 2%), systematic reviews/meta-analyses (N=16; 1%) and miscellaneous study designs (N=46; 3%) were much less common than observational studies (N=1,227; 86%). The protocol was available for 63% (N=360) of 572 observational studies requested by a competent authority. Overall, 36% (N=446) of observational studies were based fully or partially on primary data collection. Of 757 observational studies based on secondary use of data alone, 282 (37%) were MDS. Drug utilisation was significantly more common as a study scope in MDS compared to non-MDS studies. The overall percentage agreement among collaborating centres that collected the data concerning study variables was highest for study type (93.5%) and lowest for type of secondary data (67.8%). CONCLUSIONS Observational studies were the most common type of studies in the EU PAS register, but 30% used primary data, which is more resource-intensive. Almost half of observational studies using secondary data were MDS. Data recording in the EU PAS register may be improved further, including more widespread availability of study protocols to improve transparency.
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Affiliation(s)
- Janet Sultana
- Pharmacy Department, Mater Dei Hospital, Malta.,Exeter College of Medicine and Health, Exeter
| | - Salvatore Crisafulli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Mariana Almas
- Real World Solutions Department, IQVIA, Lisbon, Portugal
| | - Ippazio Cosimo Antonazzo
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy.,Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Esme Baan
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Maria Paola Bertuccio
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Fedele Bonifazi
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Annalisa Capuano
- Department of Experimental Medicine, University of Campania "Vanvitelli", Naples, Italy.,Campania Regional Center of Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
| | - Antonella Didio
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mariagrazia Felisi
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,CVBF Consorzio per Valutazioni Biologiche e Farmacologiche, Pavia, Italy
| | - Carmen Ferrajolo
- Department of Experimental Medicine, University of Campania "Vanvitelli", Naples, Italy.,Campania Regional Center of Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Remy Francisca
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Annie Fourrier-Reglat
- Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, Team of Pharmacoepidemiology, UMR 1219, Bordeaux, France
| | | | - Rosa Gini
- Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Giulia Hyeraci
- Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Christel Hoeve
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Valentina Isgrò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Luca L'Abbate
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Deborah Layton
- Data Science Hub, Real World Solutions, IQVIA, London, United Kingdom
| | - Annalisa Landi
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Silvia Narduzzi
- Data Science Hub, Real World Solutions, IQVIA, London, United Kingdom
| | - Leonardo Roque Pereira
- University Medical Center Utrecht, Department of Datascience & Biostatistics, Utrecht, the Netherlands
| | | | - Concetta Rafaniello
- Department of Experimental Medicine, University of Campania "Vanvitelli", Naples, Italy.,Campania Regional Center of Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
| | | | - Giulia Scondotto
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Liberata Sportiello
- Department of Experimental Medicine, University of Campania "Vanvitelli", Naples, Italy.,Campania Regional Center of Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
| | - Maddalena Toma
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Massoud Toussi
- Data Science Hub, Real World Solutions, IQVIA, London, United Kingdom
| | - Katia Verhamme
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Elisabetta Volpe
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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