药物警戒与药物流行病学中的因果关联:关于奥斯汀·布拉德福德·希尔标准应用的思考
Causal association in pharmacovigilance and pharmacoepidemiology: thoughts on the application of the Austin Bradford-Hill criteria.
作者信息
Shakir Saad A W, Layton Deborah
机构信息
Drug Safety Research Unit, Bursledon Hall, Southampton, United Kingdom.
出版信息
Drug Saf. 2002;25(6):467-71. doi: 10.2165/00002018-200225060-00012.
The methods used for the evaluation of drug safety signals (including major signals leading to withdrawal of products from the market) are inconsistent and sometimes of poor quality. While the assessment of the safety of medicines needs to consider specific issues such as drug interactions and variation in compliance, the general principles, which are used to study environmental hazards, can be applied for this purpose. The criteria proposed by Sir Austin Bradford-Hill more than 35 years ago for attributing disease causation to environmental factors have been used widely in epidemiology, are applicable to pharmacovigilance and pharmacoepidemiology. The Austin Bradford-Hill criteria include strength, consistency, specificity, temporality, biological gradient, plausibility, coherence, experimental evidence and analogy. The paper reviews each of these criteria with emphasis on pharmacovigilance and pharmacoepidemiology and with some examples. The application of the Austin Bradford-Hill criteria to the evaluation of causal association in pharmacovigilance and pharmacoepidemiology is very useful. However, it requires understanding of the limitations of the data, such as, under-reporting, poor quality of information from third parties and misclassification. Further work is required to develop strategies to handle these limitations.
用于评估药物安全信号(包括导致产品退市的主要信号)的方法并不一致,而且有时质量较差。虽然药品安全性评估需要考虑药物相互作用和依从性差异等特定问题,但用于研究环境危害的一般原则可用于此目的。35多年前奥斯汀·布拉德福德·希尔爵士提出的将疾病病因归因于环境因素的标准在流行病学中得到了广泛应用,适用于药物警戒和药物流行病学。奥斯汀·布拉德福德·希尔标准包括强度、一致性、特异性、时间性、生物学梯度、合理性、连贯性、实验证据和类推法。本文回顾了这些标准中的每一项,重点是药物警戒和药物流行病学,并列举了一些例子。奥斯汀·布拉德福德·希尔标准在药物警戒和药物流行病学因果关联评估中的应用非常有用。然而,这需要了解数据的局限性,如报告不足、第三方信息质量差和错误分类。需要进一步开展工作来制定应对这些局限性的策略。