Inácio Pedro, Cavaco Afonso, Airaksinen Marja
Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.
iMed.ULisboa Research Institute for Medicines and Pharmaceutical Sciences, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal.
Br J Clin Pharmacol. 2017 Feb;83(2):227-246. doi: 10.1111/bcp.13098. Epub 2016 Oct 12.
Current trends in pharmacovigilance systems are veering towards patient involvement in spontaneous reporting of adverse drug reactions (ADRs). The aim of the current systematic review was to identify what is known and what remains unknown with respect to patient reporting to pharmacovigilance systems.
A systematic literature search was conducted in PubMed, CINAHL, Journals@Ovid and the Cochrane Library. Studies were included if they contained: (i) reviews about patient reporting; (ii) evaluation of patient reports to national or supranational pharmacovigilance authorities; (iii) a comparison between patient and healthcare professional (HCP) reports submitted to pharmacovigilance authorities; and (iv) surveys of patient experiences, opinions and awareness about reporting ADRs. The methodological quality of the studies was assessed according to principles of Grading of Recommendations, Assessment, Development and Evaluations (GRADE).
A total of thirty four studies were included. Five of the studies were reviews (two of which systematic reviews), fourteen retrospective observational studies, nine surveys and six applied mixed research methods. Patient reporting has the advantages of bringing novel information about ADRs. It provides a more detailed description of ADRs, and reports about different drugs and system organ classes when compared with HCP reporting. In addition, patients describe the severity and impact of ADRs on daily life, complementing information derived from HCPs. Patient reporting is relatively rare in most countries.
Patient reporting adds new information, and perspective about ADRs in a way otherwise unavailable. This can contribute to better decision-making processes in regulatory activities. The present review identified gaps in knowledge that should be addressed to improve our understanding of the full potential and drawbacks of patient reporting.
药物警戒系统当前的趋势正朝着让患者参与药物不良反应(ADR)自发报告的方向发展。本系统评价的目的是确定关于患者向药物警戒系统报告的已知信息和未知信息。
在PubMed、CINAHL、Ovid期刊数据库和Cochrane图书馆进行了系统的文献检索。纳入的研究需包含:(i)关于患者报告的综述;(ii)对向国家或超国家药物警戒机构提交的患者报告的评估;(iii)提交给药物警戒机构的患者报告与医疗保健专业人员(HCP)报告之间的比较;以及(iv)对患者关于报告ADR的经历、意见和意识的调查。根据推荐分级、评估、制定和评价(GRADE)原则评估研究的方法学质量。
共纳入34项研究。其中5项为综述(2项为系统综述),14项为回顾性观察研究,9项为调查,6项采用了混合研究方法。患者报告具有带来ADR新信息的优势。与HCP报告相比,它能提供更详细的ADR描述,以及关于不同药物和系统器官类别的报告。此外,患者会描述ADR的严重程度及其对日常生活的影响,对HCP提供的信息起到补充作用。在大多数国家,患者报告相对较少。
患者报告以其他方式无法实现的途径增加了关于ADR的新信息和视角。这有助于在监管活动中做出更好的决策过程。本综述确定了知识空白,应加以解决以增进我们对患者报告的全部潜力和缺点的理解。