浅谈药物流行病学和药品评价的发展与国际现状

药物流行病学是把流行病学的方法、知识和推理应用到临床药理学中,并以此为基础对特定人群或特定药品的使用情况、有效性及安全性进行集中研究,在对药品进行研究和评价的过程中起着十分重要的作用.同时,药物流行病学与药品评价的应用研究已经贯穿于药品的整个研发、使用、甚至流通等诸多领域,直接为制定相关治疗指导原则、国家药品政策提供依据.本文从药物流行病学的历史和发展、药物流行病学常用的研究方法、药物流行病学和药品评价在药品审批和管理过程中的应用以及非政府组织对药物流行病学和药品评价研究的推动等方面入手,着重分析了药物流行病学和药品评价的国际现状.     

Challenges in conducting post-authorisation safety studies (PASS): A vaccine manufacturer's view

Post-authorisation safety studies (PASS) of vaccines assess or quantify the risk of adverse events following immunisation that were not identified or could not be estimated pre-licensure. The aim of this perspective paper is to describe the authors’ experience in the design and conduct of twelve PASS that contributed to the evaluation of the benefit-risk of vaccines in real-world settings. We describe challenges and learnings from selected PASS of rotavirus, malaria, influenza, human papillomavirus and measles-mumps-rubella-varicella vaccines that assessed or identified potential or theoretical risks, which may lead to changes to risk management plans and/or to label updates. Study settings include the use of large healthcare databases and de novo data collection. PASS methodology is influenced by the background incidence of the outcome of interest, vaccine uptake, availability and quality of data sources, identification of the at-risk population and of suitable comparators, availability of validated case definitions, and the frequent need for case ascertainment in large databases. Challenges include the requirement for valid exposure and outcome data, identification of, and access to, adequate data sources, and mitigating limitations including bias and confounding. Assessing feasibility is becoming a key step to confirm that study objectives can be met in a timely manner. PASS provide critical information for regulators, public health agencies, vaccine manufacturers and ultimately, individuals. Collaborative approaches and synergistic efforts between vaccine manufacturers and key stakeholders, such as regulatory and public health agencies, are needed to facilitate access to data, and to drive optimal study design and implementation, with the aim of generating robust evidence.     

Pharmacoepidemiology and thalidomide embryopathy surveillance in Brazil

IntroductionThalidomide causes congenital defects in children, such as limb reduction defects. Currently, it is used for a few indications; in Brazil, where leprosy is endemic, thalidomide is used for the treatment of erythema nodosum leprosum, and recent cases of thalidomide embryopathy have been reported.MethodsWe analyzed the frequency of births with phenotypes consistent with thalidomide embryopathy (TEP) and correlated this with the distribution of thalidomide and the prevalence of leprosy between 2005 and 2010 in Brazil.ResultsA total of 5,889,210 thalidomide tablets were distributed; the prevalence of limb reduction defects was 1.60 (CI95%: 1.54–1.66) and TEP was 0.11 (CI95%: 0.10–0.13) per 10,000 births. Poisson regression showed an increase in cases of TEP and limb reduction defects per 100,000 tablets dispensed. Clusters and geographical isolates were identified in several regions.ConclusionsThere is a correlation between thalidomide and TEP showing that thalidomide embryopathy should be monitored in countries where this medication is available.