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A review of methods used in assessing non-serious adverse drug events in observational studies among type 2 diabetes mellitus patients.

Hakobyan L, Haaijer-Ruskamp FM, de Zeeuw D, Dobre D, Denig P - Health Qual Life Outcomes (2011)

Bottom Line: The patient population was restricted to a lower risk population in 19% of the studies.Less than one third of the studies exceeded pre-approval regulatory requirements for sample size and duration of follow-up.Patient-reported outcomes and combinations of methods are underutilized.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Clinical Pharmacology, University Medical Center Groningen, University of Groningen, The Netherlands.

ABSTRACT
Clinical drug trials are often conducted in selective patient populations, with relatively small numbers of patients, and a short duration of follow-up. Observational studies are therefore important for collecting additional information on adverse drug events (ADEs). Currently, there is no guidance regarding the methodology for measuring ADEs in such studies. Our aim was to evaluate whether the methodology used to assess non-serious ADEs in observational studies is adequate for detecting these ADEs, and for addressing limitations from clinical trials in patients with type 2 diabetes mellitus. We systematically searched MEDLINE and EMBASE for observational studies reporting non-serious ADEs (1999-2008). Methods to assess ADEs were classified as: 1) medical record review; 2) surveillance by health care professionals (HCP); 3) patient survey; 4) administrative data; 5) laboratory/clinical values; 6) not specified. We compared the range of ADEs identified, number and selection of patients included, and duration of follow-up. Out of 10,125 publications, 68 studies met our inclusion criteria. The most common methods were based on laboratory/clinical values (n = 25) and medical record review (n = 18). Solicited surveillance by HCP (n = 17) revealed the largest diversity of ADEs. Patient surveys (n = 15) focused mostly on hypoglycaemia and gastrointestinal ADEs, laboratory values based studies on hepatic and metabolic ADEs, and administrative database studies (n = 5) on cardiovascular ADEs. Four studies presented ADEs that were identified with the use of more than one method. The patient population was restricted to a lower risk population in 19% of the studies. Less than one third of the studies exceeded pre-approval regulatory requirements for sample size and duration of follow-up. We conclude that the current assessment of ADEs is hampered by the choice of methods. Many observational studies rely on methods that are inadequate for identifying all possible ADEs. Patient-reported outcomes and combinations of methods are underutilized. Furthermore, while observational studies often include unselective patient populations, many do not adequately address other limitations of pre-approval trials. This implies that these studies will not provide sufficient information about ADEs to clinicians and patients. Better protocols are needed on how to assess adverse drug events not only in clinical trials but also in observational studies.

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Sample size included in studies using different assessment methods.
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Figure 2: Sample size included in studies using different assessment methods.

Mentions: Studies using patient survey methods, medical record review, or laboratory data often included less than 300 patients (Figure 2). A sample size of equal or more than 1500 was achieved by all studies using administrative databases, and in many studies using solicited surveillance by HCP. Overall, the follow-up period did not exceed one year in 77% of the cohort studies. Longer follow-up periods were mostly seen in studies using administrative data or laboratory/clinical values. Evaluation of sample size and follow-up jointly showed that all 3 cohort studies using administrative data exceeded the requirements of the guidelines for pre-approval safety assessment, whereas this was the case in less than a quarter of the studies using any of the other specified methods (Table 3).


A review of methods used in assessing non-serious adverse drug events in observational studies among type 2 diabetes mellitus patients.

Hakobyan L, Haaijer-Ruskamp FM, de Zeeuw D, Dobre D, Denig P - Health Qual Life Outcomes (2011)

Sample size included in studies using different assessment methods.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3198877&req=5

Figure 2: Sample size included in studies using different assessment methods.
Mentions: Studies using patient survey methods, medical record review, or laboratory data often included less than 300 patients (Figure 2). A sample size of equal or more than 1500 was achieved by all studies using administrative databases, and in many studies using solicited surveillance by HCP. Overall, the follow-up period did not exceed one year in 77% of the cohort studies. Longer follow-up periods were mostly seen in studies using administrative data or laboratory/clinical values. Evaluation of sample size and follow-up jointly showed that all 3 cohort studies using administrative data exceeded the requirements of the guidelines for pre-approval safety assessment, whereas this was the case in less than a quarter of the studies using any of the other specified methods (Table 3).

Bottom Line: The patient population was restricted to a lower risk population in 19% of the studies.Less than one third of the studies exceeded pre-approval regulatory requirements for sample size and duration of follow-up.Patient-reported outcomes and combinations of methods are underutilized.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Clinical Pharmacology, University Medical Center Groningen, University of Groningen, The Netherlands.

ABSTRACT
Clinical drug trials are often conducted in selective patient populations, with relatively small numbers of patients, and a short duration of follow-up. Observational studies are therefore important for collecting additional information on adverse drug events (ADEs). Currently, there is no guidance regarding the methodology for measuring ADEs in such studies. Our aim was to evaluate whether the methodology used to assess non-serious ADEs in observational studies is adequate for detecting these ADEs, and for addressing limitations from clinical trials in patients with type 2 diabetes mellitus. We systematically searched MEDLINE and EMBASE for observational studies reporting non-serious ADEs (1999-2008). Methods to assess ADEs were classified as: 1) medical record review; 2) surveillance by health care professionals (HCP); 3) patient survey; 4) administrative data; 5) laboratory/clinical values; 6) not specified. We compared the range of ADEs identified, number and selection of patients included, and duration of follow-up. Out of 10,125 publications, 68 studies met our inclusion criteria. The most common methods were based on laboratory/clinical values (n = 25) and medical record review (n = 18). Solicited surveillance by HCP (n = 17) revealed the largest diversity of ADEs. Patient surveys (n = 15) focused mostly on hypoglycaemia and gastrointestinal ADEs, laboratory values based studies on hepatic and metabolic ADEs, and administrative database studies (n = 5) on cardiovascular ADEs. Four studies presented ADEs that were identified with the use of more than one method. The patient population was restricted to a lower risk population in 19% of the studies. Less than one third of the studies exceeded pre-approval regulatory requirements for sample size and duration of follow-up. We conclude that the current assessment of ADEs is hampered by the choice of methods. Many observational studies rely on methods that are inadequate for identifying all possible ADEs. Patient-reported outcomes and combinations of methods are underutilized. Furthermore, while observational studies often include unselective patient populations, many do not adequately address other limitations of pre-approval trials. This implies that these studies will not provide sufficient information about ADEs to clinicians and patients. Better protocols are needed on how to assess adverse drug events not only in clinical trials but also in observational studies.

Show MeSH
Related in: MedlinePlus