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Postmarketing Safety Surveillance

Where does Signal Detection Using Electronic Healthcare Records Fit into the Big Picture?

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Abstract

The safety profile of a drug evolves over its lifetime on the market; there are bound to be changes in the circumstances of a drug’s clinical use which may give rise to previously unobserved adverse effects, hence necessitating surveillance postmarketing. Postmarketing surveillance has traditionally been carried out by systematic manual review of spontaneous reports of adverse drug reactions. Vast improvements in computing capabilities have provided opportunities to automate signal detection, and several worldwide initiatives are exploring new approaches to facilitate earlier detection, primarily through mining of routinely-collected data from electronic healthcare records (EHR). This paper provides an overview of ongoing initiatives exploring data from EHR for signal detection vis-à-vis established spontaneous reporting systems (SRS). We describe the role SRS has played in regulatory decision making with respect to safety issues, and evaluate the potential added value of EHR-based signal detection systems to the current practice of drug surveillance. Safety signal detection is both an iterative and dynamic process. It is in the best interest of public health to integrate and understand evidence from all possibly relevant information sources on drug safety. Proper evaluation and communication of potential signals identified remains an imperative and should accompany any signal detection activity.

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Acknowledgements

The authors would like to thank Dr. Hector Izurieta of the US FDA, and Dr. Jim Slattery of the European Medicines Agency for reviewing the manuscript.

Funding

No sources of funding were used to prepare this manuscript.

Conflict of interest

Miriam Sturkenboom is running a research group that occasionally performs studies for pharmaceutical companies according to unconditional grants. These companies include AstraZeneca, Pfizer, Lilly and Boehringer. She has also been a consultant to Pfizer, Novartis, Consumer Health, Servier, Celgene and Lundbeck on issues not related to this paper. Vaishali Patadia is an employee of Astellas Pharma; the views expressed in this paper are her personal views and do not reflect the views of Astellas Pharma. Preciosa M. Coloma and Gianluca Trifirò have no conflicts of interest to declare that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Ee-2116, Department of Medical Informatics, Erasmus Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherlands

    Preciosa M. Coloma

  2. Department of Medical Informatics, Erasmus Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherlands

    Gianluca Trifirò, Vaishali Patadia & Miriam Sturkenboom

  3. Department of Clinical and Experimental Medicine and Pharmacology, Section of Pharmacology, University of Messina, Messina, Italy

    Gianluca Trifirò

  4. Astellas Pharma, Deerfield, IL, USA

    Vaishali Patadia

  5. Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands

    Miriam Sturkenboom

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  1. Preciosa M. Coloma
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Correspondence to Preciosa M. Coloma.

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Coloma, P.M., Trifirò, G., Patadia, V. et al. Postmarketing Safety Surveillance. Drug Saf 36, 183–197 (2013). https://doi.org/10.1007/s40264-013-0018-x

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