Skip to main content

Advertisement

Log in

Pharmacoepidemiology in Safety Evaluations of Newly Approved Medications

  • Drug Safety
  • Published:
Drug information journal : DIJ / Drug Information Association Aims and scope Submit manuscript

Abstract

In the recent extension of the Prescription Drug User Fee Act, the risk management programs that are to be funded by additional user fees combine ascertainment of risks in the initial postapproval phase with activities to confront these risks. Better recognition of risks, a prerequisite for success in managing risks, will require strategies to supplement the present system of spontaneous event reporting. This overview considers the merits of pharmacoepidemiology studies in examining gaps in drug safety resulting from the inherent limitations of clinical trials. After drugs become widely used following regulatory approval, many health outcomes potentially related to drug exposures can be studied in large health insurance claims databases using pharmacoepidemiology designs tailored to this venue. We clarify types of safety investigations particularly suited to examination in a large claims database, as well as the benefits and caveats of expanding postapproval follow-up through Prescription Drug User Fee Act funding.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. US General Accounting Office. Food and Drug Administration: Effect of User Fees on Drug Approval Times, Withdrawals, and Other Agency Activities. Report to the Chairman. Committee on Health, Education. Labor, and Pensions, US Senate. GAO-02-958. http://www.gao.org.

  2. Strom B. What is pharmacoepidemiology? In: Strom BL, ed. Pharmacoepidemiology. Third edition. New York, NY: John Wiley & Sons. Ltd; 2000:3–16.

    Chapter  Google Scholar 

  3. US Food and Drug Administration. Managing the Risks from Medical Product Use: Creating a Risk Management Framework. Report to the FDA Commissioner from the Task Force on Risk Management. May 1999. http://www.fda.gov/medwatch/articles.htm. Accessed Oct 14, 2002.

  4. Glasser DB, Dieck GS. A view from industry. In: Strom BL, ed. Pharmacoepidemiology. Third edition. New York, NY: John Wiley & Sons, Ltd; 2000:91–108.

    Chapter  Google Scholar 

  5. Benayoun S, Ernst P, Suissa S. The impact of combined inhaled bronchodilator therapy in the treatment of COPD. Chest 2001;119:85–92.

    Article  CAS  Google Scholar 

  6. Suissa S, Ernst P. Inhaled corticosteroids: Impact on asthma morbidity and mortality. J Allergy Clin lmmunol. 2001;107:937–944.

    Article  CAS  Google Scholar 

  7. Downs JR, Clearfield M, Wets S, Whitney E, Shapiro DR, Beere PA, et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas coronary atheroschlerosis prevention study. JAMA. 1998;279:1615–1622.

    Article  CAS  Google Scholar 

  8. Pradhan AD, Manson JE, Rossouw JE, Siscovick DS, Mouton CP. Inflamatory biomarkers, hormone replacement therapy, and incident coronary heart disease: prospective analysis from the Women’s Health Initiative observational study. JAMA. 2002;288(8):980–987.

    Article  CAS  Google Scholar 

  9. ICD-9-CM. International Classification of Diseases 9th Revision Clinical Modification. Sixth Edition. Professional for Hospitals Volumes 1,2,3. Hart AC, Hopkins CA, eds. Salt Lake City, UT: Ingenix, Inc.; 2002.

    Google Scholar 

  10. US Food and Drug Administration. Center for Drug Evaluation and Research. Postmarketing surveillance and epidemiology: Human drugs (Chap 13). September 30, 1999. http://www.fda.gov/cder/aers/chapter53.htm. Accessed Oct 14, 2002.

  11. Kennedy DL, Goldman SA, Lillie RB. Spontaneous reporting in the United States. In: Strom BL, ed. Pharmacoepidemiology. Third edition. New York, NY: John Wiley & Sons, Ltd; 2000: 151–174.

    Google Scholar 

  12. Wood AJ. Thrombotic thrombocytopenic purpura and clopidogrel: a need for new approaches to drug safety. N Engl J Med. 2000;342:1824–1826.

    Article  CAS  Google Scholar 

  13. Lasser KE, Allen PD, Woolhandler SJ, Himmelstein DU, Wolfe SM, Bor DH. Timing of new black box warnings and withdrawals for prescription medications. JAMA. 2002;287:2215–2220.

    Article  Google Scholar 

  14. Garbe E, Suissa S, Le Lorier J. Association of inhaled corticosterioid use with cataract extraction in elderly patients. JAMA. 1998;280:539–543.

    Article  CAS  Google Scholar 

  15. Joseph KS, Blais L, Ernst P, Suissa S. Increased morbidity and mortality related asthma among asthmatic patients who use major tranquillisers. Br Med J. 1996;312:79–82.

    Article  CAS  Google Scholar 

  16. Kelsey JL, Whittemore AS, Evans AS, Thompson WD. Methods in Observational Epidemiology. Second edition. New York, NY: Oxford University Press; 1996.

    Google Scholar 

  17. Kirking DM, Ammann MA, Harrington GA. Comparison of medical records and prescription claims files in documenting prescription medication therapy. J Pharmacoepidemiol. 1996;5:3–15.

    Article  Google Scholar 

  18. Strom BL, Carson JL, Halpern AC, Schinnar R, Snyder ES, Shaw M, Tilson HH, Joseph M, Dai WS, Chen D, et al. A population-based study of Stevens-Johnson syndrome. Incidence and antecedent drug exposures. Arch Dermatol. 1991;127:831–838.

    Article  CAS  Google Scholar 

  19. West SL, Strom BL, Poole C. Validity of pharmacoepidemiology drug and diagnosis data. In: Strom BL, ed. Pharmacoepidemiology. Third edition. New York, NY: John Wiley & Sons, Ltd, 2000:661–706.

    Chapter  Google Scholar 

  20. Kronick R, Gilmer T, Dreyfus T, Lee L. Improving health-based payment for Medicaid beneficiaries: CDPS. Health Care Financ Rev. 2000;21:29–64.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Taylor Jr DH, Fillenbaum GG, Ezell ME. The accuracy of medicare claims data in identifying Alzheimer’s disease. J Clin Epidemiol. 2002;55:929–937.

    Article  Google Scholar 

  22. Markowitz JS, Pashko S, Gutterman EM Linde-Zwirble WT, Newbold III R. Death rates among patients hospitalized with community-acquired pneumonia: A reexamination with data from three states. Am J Pub Health. 1996;86:1152–1154.

    Article  CAS  Google Scholar 

  23. Hemmelgarn B, Suissa S, Huang A, Bolvin J, Pinard G. Benzodiazepine use and the risk of motor vehicle crash in the elderly. JAMA. 1997;278:27–31.

    Article  CAS  Google Scholar 

  24. Meadows M. Why drugs get pulled off the market. FDA Consumer Magazine. Jan-Feb2002. http://www.fda.gov/fdac/features/2002/102_drug.html. Accessed Oct 14, 2002.

  25. Steinman MA, Gonzales R, Under JA, Landefeld CS. Changing use of antibiotics in community-based outpatient practice, 1991–1999. Ann Int Med. 2003;138:525–533.

    Article  Google Scholar 

  26. Suissa A. Novel approaches to pharmacoepidemiology study design and statistical analysis. In: Strom BL, ed. Pharmacoepidemiology. Third edition. New York, NY: John Wiley & Sons, Ltd; 2000:785–807.

    Chapter  Google Scholar 

  27. Gutterman EM, Markowitz JS, Lewis B, Fillit H. Cost of Alzheimer’s disease and other dementia in Managed-Medicare. J Am Geriatr Soc. 1999; 47:1065–1071.

    Article  CAS  Google Scholar 

  28. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987;40:373–382.

    Article  CAS  Google Scholar 

  29. Deyo RA, Cherkin DC, Ciol, MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–619.

    Article  CAS  Google Scholar 

  30. Engel S. The new FDA. R& D Directions. 2002;8(5):42–44.

    Google Scholar 

  31. Wolfe S, Peck B, Clemente E Comments on: the Prescription Drug User Fee Act (PDUFA). Public Citizen Health Research Group and Congress Watch. Docket No. 01N-0450. http://www.citizen.org/publications/release.cfm?ID=7145. Accessed Sept 25, 2002.

  32. Strom B, When should one perform pharmacoepidemiology studies? In: Strom BL, ed. Pharmacoepidemiology. Third edition. New York, NY: John Wiley & Sons, Ltd; 2000:63–72.

    Chapter  Google Scholar 

  33. Friedberg M, Saffran B, Stinson TJ, Nelson W, Bennett CL. Evaluation of conflict of interest in economic analyses of new drugs used in oncology. JAMA. 1999;282:1453–1457.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Elane M. Gutterman PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gutterman, E.M. Pharmacoepidemiology in Safety Evaluations of Newly Approved Medications. Ther Innov Regul Sci 38, 61–67 (2004). https://doi.org/10.1177/009286150403800109

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1177/009286150403800109

Key Words

Navigation