Drug Safety

, Volume 36, Issue 11, pp 1105–1115 | Cite as

Post-Approval Safety Issues with Innovative Drugs: A European Cohort Study

  • Peter G. M. Mol
  • Arna H. Arnardottir
  • Domenico Motola
  • Patrick J. Vrijlandt
  • Ruben G. Duijnhoven
  • Flora M. Haaijer-Ruskamp
  • Pieter A. de Graeff
  • Petra Denig
  • Sabine M. J. M. Straus
Original Research Article



At time of approval, knowledge of the full benefit risk of any drug is limited, in particular with regards to safety. Post-approval surveillance of potential drug safety concerns is recognized as an important task of regulatory agencies. For innovative, often first-in-class drugs, safety knowledge at time of approval is often even less extensive and these may require tighter scrutiny post approval.


We evaluated whether more post-approval serious safety issues were identified for drugs with a higher level of innovation.


A cohort study was performed that included all new active substances approved under the European Centralized Procedure and for which serious safety issues were identified post-approval from 1 January 1999 to 1 January 2012. Serious safety issues were defined as issues requiring a Direct Healthcare Professional Communication to alert individual healthcare professionals of a new serious safety issue, or a safety-related drug withdrawal. Data were retrieved from publicly available websites of the Dutch Medicines Evaluation Board and the European Medicines Agency. The level of innovation was scored using a validated algorithm, grading drugs as important (A), moderate (B) or modest (C) innovations or as pharmacological or technological (pharm/tech) innovations. The data were analyzed using appropriate descriptive statistics and Kaplan–Meier analysis, with a Mantel–Cox log-rank test, and Cox-regression models correcting for follow-up duration, to identify a possible trend in serious safety issues with an increasing level of innovation.


In Europe, 279 new drugs were approved between 1999 and 2011. Fifty-nine (21 %) were graded as important, 63 (23 %) moderate, or 34 (12 %) modest innovations and 123 (44 %) as non-innovative (pharm/tech), while 15 (25 %), 13 (21 %), 8 (24 %) and 17 (14 %) had post-approval safety issues, respectively (p = 0.06, linear-by-linear test). Five drugs were withdrawn from the market. The Kaplan–Meier-derived probability for having a first serious safety issue was statistically significant, log-rank (Mantel–Cox) p = 0.036. In the final adjusted Cox proportional hazard model there was no statistically significant difference in occurrence of a first serious safety issue for important, moderate and modest innovations versus non-innovative drugs; hazard ratios 1.76 (95 % CI 0.82–3.77), 1.61 (95 % CI 0.76–3.41)], and 1.25 (95 % CI 0.51–3.06), respectively.


A higher level of innovation was not clearly related to an increased risk of serious safety issues identified after approval.


Safety Issue Orphan Drug Rimonabant Valdecoxib Dofetilide 



This study was performed in part supported by an unconditional grant in the context of the Escher project (T6-202), a project of the Dutch Top Institute Pharma. The funder did not have any role in the design or execution of the study. The authors who are employed by the MEB (Pieter de Graeff, Sabine Straus, Patrick Vrijlandt, Ruben Duijnhoven and Peter Mol), state that the opinions in this paper are their own, and do not necessarily reflect those of the MEB.

Conflict of interest

Peter G.M. Mol, Arna H. Arnardottir, Domenico Motola, Patrick J. Vrijlandt, Ruben G. Duijnhoven, Flora M. Haaijer-Ruskamp, Pieter A. de Graeff, Petra Denig and Sabine M.J.M. Straus report no conflicts of interest that are directly relevant to the content of this study.

Supplementary material

40264_2013_94_MOESM1_ESM.docx (23 kb)
Supplementary material 1 (DOCX 22 kb)


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Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Peter G. M. Mol
    • 1
    • 2
  • Arna H. Arnardottir
    • 1
  • Domenico Motola
    • 3
  • Patrick J. Vrijlandt
    • 2
  • Ruben G. Duijnhoven
    • 2
    • 4
  • Flora M. Haaijer-Ruskamp
    • 1
  • Pieter A. de Graeff
    • 1
    • 2
  • Petra Denig
    • 1
  • Sabine M. J. M. Straus
    • 2
    • 5
  1. 1.Department of Clinical PharmacologyUniversity Medical Center Groningen, University of Groningen, FB20GroningenThe Netherlands
  2. 2.Dutch Medicines Evaluation Board (CBG-MEB)UtrechtThe Netherlands
  3. 3.Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
  4. 4.Division of Pharmacoepidemiology and Clinical PharmacologyUtrecht Institute for Pharmaceutical SciencesUtrechtThe Netherlands
  5. 5.Department of Medical InformaticsErasmus Medical CenterRotterdamThe Netherlands

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