Drug Safety最新文献

Introduction: Medicinal product information documents (PIDs) detail clinical characteristics and instructions for monitoring, preventing, and mitigating adverse drug reactions (ADRs). They vary across countries, but there have been no recent international comparisons. We have therefore quantified and compared the completeness of the information given in drug labelling from different countries.

Methods: From the websites of 35 regulatory agencies, we retrieved the PIDs of medicinal products that were involved in signals communicated by regulators in 2014-2019. We developed a data extraction framework based on the Dose-relatedness, Time course, Susceptibility (DoTS) clinical classification of ADRs and used its implications for prevention and mitigation to score the completeness of related instructions in PIDs. To extract and classify monitoring instructions, we used a modified Systematic Instructions for Monitoring (SIM) method. PIDs had sufficiently complete instructions for prevention when the DoTS score was ≥ 5/12, and sufficiently complete monitoring instructions when the SIM score was ≥ 3/6. We used proportions of PIDs having a score ≥ 1 to determine the relative availability of clinical characteristics or instructions in a country, compared with all other countries. We quantified their pairwise disagreements using Jaccard's distance and identified clusters with similar patterns of completeness using agglomerative hierarchical clustering.

Results: PIDs were available on the websites of 18 of 35 regulatory agencies. They concerned 364 distinct medicinal products, which were involved in 627 signals. Across all countries, the instructions for prevention or mitigation met sufficient completeness for a median of 30% of PIDs (IQR 28-33%), while instructions for monitoring were sufficiently complete for a median of 22% (IQR 19-25%). The information given by the European Union (EU) and Canada had the highest relative availability of clinical characteristics and prevention or mitigation instructions, with a proportion of 0.86. Canadian and EU PIDs also had the highest relative availability of monitoring instructions, with proportions of 0.79 and 0.70. Two clusters of countries showed low disagreements: Malaysia and Singapore; Australia and New Zealand.

Conclusions: This study suggests that PIDs often do not contain complete instructions for prevention, mitigation, and monitoring of ADRs. Extending existing regulatory cooperation globally would enable regulators to access clinical characteristics and instructions from different regions.

Pharmacovigilance in Latin America has witnessed notable progress in recent years, marked by advancements in regulatory frameworks, regional cooperation, and increased academic involvement. However, heterogeneity among countries, uneven institutional development, and limited resources still hinder its full impact on public health. In this context, the Latin American Chapter of the International Society of Pharmacovigilance (ISoP LATAM) has played a key role in organizing two regional symposia: Cartagena, Colombia (2023), and Merida, Mexico (2025). Through multidisciplinary roundtables and open forums, ISoP LATAM has brought together regulators, academia, healthcare professionals, researchers, patient organizations, and industry representatives to promote dialogue, identify opportunities, and propose measures to improve pharmacovigilance in the region. Discussion included regulatory harmonization and convergence, the adoption of international standards for risk management and safety reporting, and the integration of artificial intelligence and real-world evidence into pharmacovigilance systems. Participants emphasized the importance of addressing medication errors through a Human Factors/Ergonomics approach, strengthening the monitoring and regulation of biosimilars, and creating differentiated frameworks for recognizing therapeutic failures. The expansion of pharmaceutical care and the systematic inclusion of pharmacovigilance education across the health sciences' curriculum were highlighted as priorities. The reflections from these symposia emphasize the crucial role of ISoP LATAM in providing a platform for open and multidisciplinary discussions. Shifting the focus from solely regulatory topics to a broader public health perspective and expanding the agenda to include emerging fields such as pharmacogenomics, ecopharmacovigilance, and patient engagement-while ensuring fair access to technological innovations-will be vital for enhancing drug safety in Latin America.

Many high-stakes artificial intelligence (AI) applications target low-prevalence events, where apparent accuracy can conceal limited real-world value. Relevant AI models range from expert-defined rules and traditional machine learning to generative large language models (LLMs) constrained for classification. As the effort and expertise required to develop modern AI decrease, there is a risk that organizations devote too little time to understanding their limitations and sources of error. We outline key dimensions for critical appraisal of AI in rare-event recognition, including problem framing and test set design, prevalence-aware statistical evaluation, robustness assessment, and integration into human workflows. In addition, we propose an approach to structured case-level examination (SCLE), to complement statistical performance evaluation, and a set of considerations to guide procurement or development of AI models for rare-event recognition. We instantiate the framework in pharmacovigilance, drawing on three studies: rule-based retrieval of pregnancy-related reports, duplicate detection combining machine learning with probabilistic record linkage, and automated redaction of person names using an LLM. We highlight pitfalls specific to the rare-event setting including optimism from unrealistic class balance and lack of difficult positive controls in test sets-and show how cost-sensitive targets align model performance with operational value. While grounded in pharmacovigilance practice, the principles generalize to domains where positives are scarce, and error costs may be asymmetric.

Background: Mpox is a re-emerging zoonotic infection caused by an Orthopoxvirus closely related to smallpox. The 2022-23 global outbreak prompted rapid use of vaccinia-based vaccines, historically developed for smallpox and those of the latest generation used for mpox prevention. Assessing their safety and effectiveness in pregnant persons and children is critical to guide policies protecting populations at an elevated risk of severe illness.

Objective: This study assessed the safety and effectiveness of mpox and historical smallpox vaccines, administered during pregnancy and childhood.

Methods: We conducted a living systematic review and meta-analysis (PROSPERO CRD42024591322/CRD42024586205) following Cochrane, World Health Organization, and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) standards. We searched biweekly across major databases, trial registries, preprints, and gray literature (inception to September 2025) for studies evaluating the safety and effectiveness of vaccinia-based smallpox vaccines, including historical (first- and second-generation) and modern (third-generation) vaccines, in maternal and pediatric populations. Reviewers independently conducted study selection, data extraction, and risk-of-bias assessment. Meta-analyses employed random-effects models, and results are presented through an interactive dashboard and a living platform.

Results: We included 27 clinical studies (1949-2025), involving 1,406,771 children/adolescents (eight studies) and 11,482 pregnant persons (19 studies). Most maternal data came from first-generation vaccines (Lister, Finnish, Dryvax, APSV). These vaccines were not associated with an increased risk of spontaneous abortion (risk ratio [RR] 1.02, 95% confidence interval [CI] 0.70-1.48), stillbirth (RR 1.02, 95% CI 0.70-1.48), or preterm birth (RR 1.08, 95% CI 0.78-1.50), but were linked to a higher risk of congenital anomalies (RR 1.25, 95% CI 1.01-1.54). Fifty-two fetal vaccinia cases were reported globally up to 1978, with none since. Evidence on second- (ACAM2000) and third-generation (MVA-BN) non-replicating vaccines remains limited. In children, serious adverse events were rare, and MVA-BN caused only mild self-limiting reactions. No study assessed vaccine effectiveness in pregnant persons, while limited pediatric data suggested possible protection after post-exposure prophylaxis.

Conclusions: Vaccinia-based vaccines appear generally safe in pregnancy and children. However, evidence on the safety and effectiveness of third-generation mpox vaccines is still scarce. High-quality prospective studies and strengthened pharmacovigilance are urgently needed to inform policy and clinical decision making.

Antibody-drug conjugates (ADCs) have emerged as an important therapeutic class in oncology, offering targeted delivery of potent cytotoxic agents to cancer cells, thereby reducing systemic toxicity. However, the potential for cardiac toxicity, particularly QT interval prolongation, remains a critical safety concern during ADC development and clinical use. We review the mechanisms underlying ADC-induced QT prolongation, including payload-related direct ion channel interactions and indirect effects mediated by systemic exposure. By systematically examining clinical and preclinical data across ADC classes, including auristatins, maytansinoids, topoisomerase inhibitors, and DNA alkylators, we highlight the risk evaluation of 14 US Food and Drug Administration-approved ADCs, along with their regulatory review outcomes and labeling recommendations. Most approved ADCs appear to have a low corrected QT prolongation risk at therapeutic doses; clear signals are largely confined to inotuzumab and gemtuzumab ozogamicin, whereas auristatin-, maytansinoid-, and topoisomerase-1-based ADCs have shown minimal or no corrected QT changes. Regulatory approaches to ADC QT assessment are flexible and largely driven by payload novelty: novel payloads generally require comprehensive non-clinical testing and early dedicated QT studies, whereas established payloads can often rely on prior safety data, permitting extrapolation without new QT studies and use of pooled clinical data plus concentration-QT analyses when exposure and the linker-payload structure align with historical experience. Finally, we outline a practical framework for integrating translational and regulatory considerations for evaluating QT interval prolongation risk into the development of ADCs for patients with cancer, aiming to enhance cardiac safety for patients and improve the design of preclinical and clinical studies.

Despite the widespread use of medications during pregnancy, ethical and methodological barriers to clinical trials make observational studies necessary for evaluating medication safety in this population. Observational studies are prone to biases that often limit their validity due to the lack of randomization; integrating genetic information through discordant sibling designs, polygenic scores, and Mendelian randomization can address several confounding issues. However, application of these three approaches in perinatal pharmacoepidemiology has been limited. Complementing traditional designs with these genetically informed research designs can tackle common biases and strengthen causal inference. This paper focuses on applying genetically informed research designs to child outcomes in perinatal pharmacoepidemiology by reviewing various methods, discussing their strengths and limitations, and examining their application to date, as well as considerations for implementing them in future research. Such considerations include the availability of genetic data, the complexity of integrating genetic data with existing epidemiological data, and selection of appropriate genetic instruments for analyses. Incorporating causal inference in perinatal pharmacoepidemiology can ultimately contribute to enhancing safe medication use during pregnancy.

Background: Adverse drug reactions (ADRs) are a key contributor to unplanned hospitalisations, particularly in patients with polypharmacy. Traditional detection methods, such as expert reviews or diagnostic coding, are limited in scalability and sensitivity.

Objective: This study introduces and evaluates a novel scalable method, implied ADR-admissions, that links drug exposures to adverse events using administrative data to improve the detection of plausible drug-related hospitalisations.

Methods: A retrospective cohort study was conducted using linked health data from 123,662 individuals aged ≥ 40 years with polypharmacy in two Scottish health boards. Implied ADR-admissions were defined as emergency hospitalisations with one of 15 adverse events plausibly linked to drug exposure (based on a structured consensus process) within the prior 90 days. Incidence was compared with three existing approaches: adverse event-admissions (regardless of drug exposure), explicit ADR-admissions (explicitly coded as ADRs) and preventable ADR-admissions (with prior medication error). Multivariate logistic regression was used to identify predictors of implied ADR-admissions.

Results: Over 1 year, 2.6% experienced an implied ADR-admission, compared with 5.7% with adverse event-admissions, and 0.4% with explicit ADR-admissions. For gastrointestinal bleeding, the implied ADR-admission incidence was 20 times higher than the preventable ADR-admission incidence. Key predictors for implied ADR-admissions included prior hypokalaemia-related hospitalisation and use of potentially inappropriate medications.

Conclusions: The implied ADR-admission approach has improved specificity relative to broad adverse event definitions while enhancing sensitivity beyond methods that rely solely on explicit ADR codes or pre-specified medication errors. It offers a scalable automated tool for pharmacovigilance, though further validation is needed prior to routine use in medication safety monitoring.