Metropolitan Autonomous University-Xochimilco, Division of Biological and Health Sciences, Department of Biological Systems, Mexico City, Mexico.
Drug Saf. 2012 Oct 1;35(10):837-44. doi: 10.1007/BF03261979.
BACKGROUND: The Mexican National Centre of Pharmacovigilance (CNFV) receives suspected adverse drug reaction (ADR) reports from the pharmaceutical industry, Federal States Centre of Pharmacovigilance (CEFV) and Healthcare Institution Centres of Pharmacovigilance (CIFV). The completeness of these suspected ADR reports is particularly important for the proper evaluation of drug safety. OBJECTIVE: The aim of the study was to evaluate the completeness of the information reported in a representative sample of suspected ADR reports submitted to the CNFV during 2007 and 2008, to evaluate the completeness of the suspected ADR reports submitted to the CNFV from different sources during these 2 years and to identify the therapeutic subgroups with the highest number of suspected ADR reports during the study years. METHODS: A cross-sectional period-prevalence study was conducted at the CNFV. Only reports of suspected ADRs submitted by the CEFV, pharmaceutical industry and CIFV during 2007 and 2008 were included in the present study (reports related to vaccines were excluded). The sample sizes to be used for each year were determined using the formula for population rate at 95% significance level. The samples for each year were randomly selected from the reports related to synthetic drugs submitted that year. The suspected ADR reports were classified according to the standing Mexican Official Norm (Norma Oficial Mexicana [NOM]) guidelines, which were used to divide the reports into four categories (0, 1, 2 and 3) based on their completeness. The seriousness of the suspected ADRs reported was also evaluated; a suspected ADR was classified as 'non-serious' when signs and symptoms are likely to be tolerated, 'moderate' when ADR is not life threatening and needs pharmacological treatment, 'serious' when ADR is life threatening and leads to hospitalization and 'fatal' when ADR contributes directly or indirectly to the patient's death. RESULTS: A total sample size of 370 and 371 suspected ADR reports from 2007 and 2008, respectively, were examined. Our analysis revealed that the pharmaceutical industry sent the highest number of suspected ADR reports for both years (58% and 63%, respectively). Results of the information completeness analysis by using the NOM categories showed that, in both study years, among the total suspected ADR reports about 32% (119) and 40% (148), respectively, were categorized as grade 0 (information insufficient to generate risk signals). Analyses of the seriousness of all suspected ADR reports revealed that 2% of reports were classified as fatal each year, whereas 6% and 5% were classified as serious and 25% and 29% were classified as moderate in 2007 and 2008, respectively. The therapeutic subgroups, according to the Anatomical Therapeutic Chemical classification, with the highest frequencies of suspected ADR reports in both study years were sex hormones and modulators of the genital system, antibacterial for systemic use, antiepileptics and psychoanaleptics, and antihypertensives. CONCLUSIONS: The completeness of the information provided in the suspected ADR reports submitted during the sample study years was incomplete and, in general, did not fulfil the requirements established by the NOM guidelines. Among the pharmaceutical industry, CEFV and CIFV, the suspected ADR reports were mainly provided by the pharmaceutical industry. It is necessary to improve the pharmacovigilance system in Mexico to achieve a high level of completeness of suspected ADR reports that totally fulfil the standing regulations.
背景:墨西哥国家药物警戒中心(CNFV)接收来自制药行业、联邦州药物警戒中心(CEFV)和医疗机构药物警戒中心(CIFV)的疑似药物不良反应(ADR)报告。这些疑似 ADR 报告的完整性对于药物安全性的正确评估尤为重要。
目的:本研究旨在评估 2007 年和 2008 年向 CNFV 提交的代表性疑似 ADR 报告的信息完整性,评估这两年来自不同来源的疑似 ADR 报告的完整性,并确定研究年份中疑似 ADR 报告数量最多的治疗亚组。
方法:在 CNFV 进行了一项横断面现况研究。仅包括 2007 年和 2008 年 CEFV、制药行业和 CIFV 提交的疑似 ADR 报告(不包括与疫苗相关的报告)。使用 95%置信水平的人群率公式确定每年要使用的样本量。每年的样本均从当年提交的合成药物相关报告中随机抽取。疑似 ADR 报告按照墨西哥官方标准(Norma Oficial Mexicana [NOM])指南进行分类,该指南用于根据其完整性将报告分为四个类别(0、1、2 和 3)。还评估了疑似 ADR 的严重程度;当症状和体征可能被耐受时,疑似 ADR 被归类为“非严重”;当 ADR 无生命威胁但需要药物治疗时,被归类为“中度”;当 ADR 有生命威胁并导致住院时,被归类为“严重”;当 ADR 直接或间接导致患者死亡时,被归类为“致命”。
结果:分别对 2007 年和 2008 年的 370 份和 371 份疑似 ADR 报告进行了检查。我们的分析表明,制药行业在这两年都提交了最多的疑似 ADR 报告(分别为 58%和 63%)。使用 NOM 类别进行信息完整性分析的结果表明,在这两年的所有疑似 ADR 报告中,分别有 32%(119 份)和 40%(148 份)被归类为 0 级(信息不足以产生风险信号)。对所有疑似 ADR 报告严重程度的分析显示,每年有 2%的报告被归类为致命,而 6%和 5%的报告被归类为严重,25%和 29%的报告被归类为中度,分别在 2007 年和 2008 年。根据解剖治疗化学分类,在这两年中疑似 ADR 报告频率最高的治疗亚组是性激素和生殖系统调节剂、全身用抗菌药、抗癫痫药和精神兴奋药、以及抗高血压药。
结论:样本研究年份提交的疑似 ADR 报告中提供的信息完整性不完整,总体上未满足 NOM 指南规定的要求。在制药行业、CEFV 和 CIFV 中,疑似 ADR 报告主要由制药行业提供。有必要改善墨西哥的药物警戒系统,以实现疑似 ADR 报告的高度完整性,使其完全符合现行法规。
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