Evaluation of two Japanese regulatory actions using medical information databases

A 'Dear Doctor' letter to restrict oseltamivir use in teenagers, and label change caution against co-administration of omeprazole with clopidogrel

T. Hanatani, K. Sai, M. Tohkin, K. Segawa, Y. Antoku, Naoki Nakashima, H. Yokoi, K. Ohe, M. Kimura, K. Hori, J. Kawakami, Y. Saito

Research output: Contribution to journalArticle

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Abstract

What is known and objective The implementation of appropriate epidemiological methodology using medical information databases (MIDs) to evaluate the effects of regulatory actions has been highly anticipated. To assess scientific methods for active pharmacovigilance using MIDs, we conducted a quantitative assessment of the impact of two regulatory actions by the Japanese government: (i) restriction of use of oseltamivir in teenagers in March 2007 and (ii) caution against the co-administration of omeprazole (OPZ) with clopidogrel (CPG) in April 2010. Methods Data were obtained from four hub hospitals in Japan. We measured the seasonal proportion of patients prescribed oseltamivir to those prescribed neuraminidase inhibitors for the 2002/2003 to 2010/2011 seasons. The monthly proportion of patients co-administered OPZ and CPG (OPZ+CPG) to those prescribed CPG was measured from May 2009 to April 2011. We evaluated the changes observed with implementation of the regulatory actions. To estimate the impact of the actions, we conducted segmented regression analysis using interrupted time series data. The impact was assessed by two parameter estimates of the regression model: the change in level for short-term effects and change in trend for long-term effects. Results and discussion The use of oseltamivir in the target 10-19 years age group showed a significant and large decline (63·16%) immediately after the intervention (P = 0·0008). No change was observed in OPZ+CPG, although there was a relative inhibitory trend for OPZ+CPG compared with co-administration of lansoprazole or rabeprazole with CPG as the control group. When restricted to new users of CPG, the stratified results were consistent with the overall results. What is new and conclusion The current analysis demonstrates the effectiveness of two regulatory actions. The results of the current study indicate that MID research can contribute to assessing and improving pharmacovigilance activities. Impacts of two regulatory actions on drug safety in Japan were evaluated using hospital medical information databases (MIDs). The segmented regression analysis using interrupted time series data revealed the effectiveness of these actions. The current study supports the benefit of MID research for improving pharmacovigilance.

Original languageEnglish
Pages (from-to)361-367
Number of pages7
JournalJournal of Clinical Pharmacy and Therapeutics
Volume39
Issue number4
DOIs
Publication statusPublished - Jan 1 2014

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clopidogrel
Oseltamivir
Omeprazole
Databases
Pharmacovigilance
Japan
Rabeprazole
Regression Analysis
Lansoprazole
Neuraminidase
Research

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Pharmacology (medical)

Cite this

Evaluation of two Japanese regulatory actions using medical information databases : A 'Dear Doctor' letter to restrict oseltamivir use in teenagers, and label change caution against co-administration of omeprazole with clopidogrel. / Hanatani, T.; Sai, K.; Tohkin, M.; Segawa, K.; Antoku, Y.; Nakashima, Naoki; Yokoi, H.; Ohe, K.; Kimura, M.; Hori, K.; Kawakami, J.; Saito, Y.

In: Journal of Clinical Pharmacy and Therapeutics, Vol. 39, No. 4, 01.01.2014, p. 361-367.

Research output: Contribution to journalArticle

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abstract = "What is known and objective The implementation of appropriate epidemiological methodology using medical information databases (MIDs) to evaluate the effects of regulatory actions has been highly anticipated. To assess scientific methods for active pharmacovigilance using MIDs, we conducted a quantitative assessment of the impact of two regulatory actions by the Japanese government: (i) restriction of use of oseltamivir in teenagers in March 2007 and (ii) caution against the co-administration of omeprazole (OPZ) with clopidogrel (CPG) in April 2010. Methods Data were obtained from four hub hospitals in Japan. We measured the seasonal proportion of patients prescribed oseltamivir to those prescribed neuraminidase inhibitors for the 2002/2003 to 2010/2011 seasons. The monthly proportion of patients co-administered OPZ and CPG (OPZ+CPG) to those prescribed CPG was measured from May 2009 to April 2011. We evaluated the changes observed with implementation of the regulatory actions. To estimate the impact of the actions, we conducted segmented regression analysis using interrupted time series data. The impact was assessed by two parameter estimates of the regression model: the change in level for short-term effects and change in trend for long-term effects. Results and discussion The use of oseltamivir in the target 10-19 years age group showed a significant and large decline (63·16{\%}) immediately after the intervention (P = 0·0008). No change was observed in OPZ+CPG, although there was a relative inhibitory trend for OPZ+CPG compared with co-administration of lansoprazole or rabeprazole with CPG as the control group. When restricted to new users of CPG, the stratified results were consistent with the overall results. What is new and conclusion The current analysis demonstrates the effectiveness of two regulatory actions. The results of the current study indicate that MID research can contribute to assessing and improving pharmacovigilance activities. Impacts of two regulatory actions on drug safety in Japan were evaluated using hospital medical information databases (MIDs). The segmented regression analysis using interrupted time series data revealed the effectiveness of these actions. The current study supports the benefit of MID research for improving pharmacovigilance.",
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