William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, United Kingdom.
Pharmacovigilance and Epidemiology Department, European Medicines Agency, Amsterdam, Netherlands.
Drug Saf. 2019 Nov;42(11):1343-1351. doi: 10.1007/s40264-019-00848-9.
Patient registries, 'organised systems that use observational methods to collect uniform data on a population defined by a particular disease, condition, or exposure, and that is followed over time', are potentially valuable sources of data for supporting regulatory decision-making, especially for products to treat rare diseases. Nevertheless, patient registries are greatly underused in regulatory assessments. Reasons include heterogeneity in registry design and in the data collected, even across registries for the same disease, as well as unreliable data quality and data sharing impediments. The Patient Registries Initiative was established by the European Medicines Agency in 2015 to support registries in collecting data suitable to contribute to regulatory assessments, especially post-authorisation safety and effectiveness studies.
We conducted a qualitative synthesis of the published observations and recommendations from an initiative-led multi-stakeholder consultation and four disease-specific patient registry workshops. We identified the primary factors facilitating the use of registry data in regulatory assessments. We generated proposals on operational measures needed from stakeholders including registry holders, patients, healthcare professionals, regulators, marketing authorisation applicants and holders, and health technology assessment bodies for implementing these.
Ten factors were identified as facilitating registry use for supporting regulatory assessments of medicinal products. Proposals on operational measures needed for implementation were categorised according to three themes: (1) nature of the data collected and registry quality assurance processes; (2) registry governance, informed consent, data protection and sharing; and (3) stakeholder communication and planning of benefit-risk assessments.
These are the first explicit proposals, from a regulatory perspective, on operational methods for increasing the use of patient registries in medicines regulation. They apply to registry holders, patients, regulators, marketing authorisation holders/applicants and healthcare stakeholders broadly, and their implementation would greatly facilitate the use of these valuable data sources in regulatory decision-making.
患者登记处是“使用观察方法收集特定疾病、病症或暴露人群的统一数据,并随着时间的推移进行随访的有组织系统”,对于支持监管决策具有潜在价值,尤其是对于治疗罕见病的产品。然而,患者登记处在监管评估中并未得到充分利用。原因包括登记处设计和收集的数据存在异质性,即使是针对同一疾病的登记处也是如此,还包括数据质量不可靠以及数据共享障碍。欧洲药品管理局于 2015 年成立了患者登记处倡议,以支持登记处收集适合用于监管评估的数据,尤其是在授权后安全性和有效性研究方面。
我们对一项由倡议主导的多方利益相关者磋商以及四项特定疾病患者登记处研讨会的已发表意见和建议进行了定性综合分析。我们确定了促进将登记处数据用于监管评估的主要因素。我们生成了关于利益相关者(包括登记处持有者、患者、医疗保健专业人员、监管机构、上市许可申请人和持有者以及卫生技术评估机构)需要采取的操作措施的提案,以实施这些措施。
确定了 10 个有利于将登记处用于支持药品监管评估的因素。关于实施所需操作措施的提案根据三个主题进行了分类:(1)收集的数据的性质和登记处质量保证流程;(2)登记处治理、知情同意、数据保护和共享;(3)利益相关者沟通和风险效益评估规划。
这些是从监管角度出发,关于增加患者登记处在药品监管中使用的操作性方法的首批明确建议。它们适用于登记处持有者、患者、监管机构、上市许可持有者/申请人和医疗保健利益相关者广泛使用,其实施将极大地促进这些有价值数据源在监管决策中的使用。