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Postmarketing Research

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Essentials of Clinical Research

Abstract

In the past, postmarketing research, postmarketing surveillance and pharmacovigilance were synonymous with phase IV studies because the main activities of the regulatory agency (e.g. FDA) were focused on the monitoring of adverse drug events and inspections of drug manufacturing facilities and products. (1) However, the fact that not all FDA mandated (classical phase IV trials) research consists of randomized controlled trials (RCTs), and not all postmarketing activities are limited to safety issues (pharmacovigilance), these terms require clarification. This chapter attempts to clarify the confusing terminology; and, to discuss many of the postmarketing research designs-both their place in clinical research as well as their limitations.

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References

  1. Hartzema A. Pharmacoepidemiology. Vol 41. 3rd ed. Cincinnati, OH: Harvey Whitney Books Company; 1998.

    Google Scholar 

  2. Gough S. Post-marketing surveillance: a UK/European perspective. Curr Med Res Opin. Apr 2005; 21(4):565–570.

    Article  Google Scholar 

  3. Olsson J, Terris D, Elg M, Lundberg J, Lindblad S. The one-person randomized controlled trial. Qual Manag Health Care. Oct–Dec 2005; 14(4):206–216.

    PubMed  Google Scholar 

  4. Bugeja G, Kumar A, Banerjee AK. Exclusion of elderly people from clinical research: a descriptive study of published reports. BMJ. Oct 25, 1997; 315(7115):1059.

    PubMed  CAS  Google Scholar 

  5. Corrigan OP. A risky business: the detection of adverse drug reactions in clinical trials and post-marketing exercises. Soc Sci Med. Aug 2002; 55(3):497–507.

    Article  PubMed  Google Scholar 

  6. Gurwitz JH, Col NF, Avorn J. The exclusion of the elderly and women from clinical trials in acute myocardial infarction. JAMA. Sept 16, 1992; 268(11):1417–1422.

    Article  PubMed  CAS  Google Scholar 

  7. Simon SD. Is the randomized clinical trial the gold standard of research? J Androl. Nov–Dec 2001; 22(6):938–943.

    PubMed  CAS  Google Scholar 

  8. Glasser SP, Salas M, Delzell E. Importance and challenges of studying marketed drugs: what is a phase IV study? Common clinical research designs, registries, and self-reporting systems. J Clin Pharmacol. Sept 2007; 47(9):1074–1086.

    Article  PubMed  Google Scholar 

  9. Farahani P, Levine M, Gaebel K, Thabane L. Clinical data gap between phase III clinical trials (pre-marketing) and phase IV (post-marketing) studies: evaluation of etanercept in rheumatoid arthritis. Can J Clin Pharmacol. Fall 2005; 12(3):e254–263.

    Google Scholar 

  10. Gex-Fabry M, Balant-Gorgia AE, Balant LP. Therapeutic drug monitoring databases for postmarketing surveillance of drug-drug interactions. Drug Saf. 2001; 24(13):947–959.

    Article  PubMed  CAS  Google Scholar 

  11. Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA. Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. Jama. Jan 16, 2002; 287(3):337–344.

    Article  PubMed  Google Scholar 

  12. Vijan S, Kent DM, Hayward RA. Are randomized controlled trials sufficient evidence to guide clinical practice in type II (non-insulin-dependent) diabetes mellitus? Diabetologia. Jan 2000; 43(1):125–130.

    Article  PubMed  CAS  Google Scholar 

  13. Castle WM, Lewis JA. Postmarketing surveillance of adverse drug reactions. Br Med J (Clin Res Ed). May 12, 1984; 288(6428):1458–1459.

    Article  CAS  Google Scholar 

  14. Hayward RA, Kent DM, Vijan S, Hofer TP. Reporting clinical trial results to inform providers, payers, and consumers. Health Aff (Millwood). Nov–Dec 2005; 24(6):1571–1581.

    Article  Google Scholar 

  15. Edwards C, Blowers DA, Pover GM. Fosinopril national survey: a post-marketing surveillance study of fosinopril (Staril) in general practice in the UK. Int J Clin Pract. Sept 1997; 51(6):394–398.

    PubMed  CAS  Google Scholar 

  16. Fallowfield JM, Blenkinsopp J, Raza A, Fowkes AG, Higgins TJ, Bridgman KM. Post-marketing surveillance of lisinopril in general practice in the UK. Br J Clin Pract. Nov–Dec 1993; 47(6):296–304.

    PubMed  CAS  Google Scholar 

  17. Marsh BT, Atkins MJ, Talbot DJ, Fairey IT. A post-marketing acceptability study in 11, 685 patients of the efficacy of timolol/bendrofluazide in the management of hypertension in general practice. J Int Med Res. Mar–Apr 1987; 15(2):106–114.

    PubMed  CAS  Google Scholar 

  18. Riley J, Wilton LV, Shakir SA. A post-marketing observational study to assess the safety of mibefradil in the community in England. Int J Clin Pharmacol Ther. June 2002; 40(6):241–248.

    PubMed  CAS  Google Scholar 

  19. Schmidt J, Kraul H. Clinical experience with spirapril in human hypertension. J Cardiovasc Pharmacol. Aug 1999; 34 Suppl 1:S25–30.

    Article  Google Scholar 

  20. Ueng KC, Chen ZC, Yeh PS, et al. Nifedipine OROS in Chinese patients with hypertension–results of a post-marketing surveillance study in Taiwan. Blood Press Suppl. July 2005; 1:32–38.

    Google Scholar 

  21. Tognoni G, Alli C, Avanzini F, et al. Randomised clinical trials in general practice: lessons from a failure. BMJ. Oct 19, 1991; 303(6808):969–971.

    Article  PubMed  CAS  Google Scholar 

  22. Ben-Menachem E. Data from regulatory studies: what do they tell? What don’t they tell? Acta Neurol Scand Suppl. 2005; 181:21–25.

    Article  PubMed  CAS  Google Scholar 

  23. Lesko SM, Mitchell AA. The safety of acetaminophen and ibuprofen among children younger than two years old. Pediatrics. Oct 1999; 104(4):e39.

    Article  Google Scholar 

  24. Jackson L, Ting A, McKay S, Galea P, Skeoch C. A randomised controlled trial of morphine versus phenobarbitone for neonatal abstinence syndrome. Arch Dis Child Fetal Neonatal Ed. July 2004; 89(4):F300–304.

    Article  Google Scholar 

  25. Fischer G, Ortner R, Rohrmeister K, et al. Methadone versus buprenorphine in pregnant addicts: a double-blind, double-dummy comparison study. Addiction. Feb 2006; 101(2):275–281.

    Article  PubMed  Google Scholar 

  26. Vocci F, Ling W. Medications development: successes and challenges. Pharmacol Ther. Oct 2005; 108(1):94–108.

    Article  PubMed  CAS  Google Scholar 

  27. Jones HE, Suess P, Jasinski DR, Johnson RE. Transferring methadone-stabilized pregnant patients to buprenorphine using an immediate release morphine transition: an open-label exploratory study. Am J Addict. Jan–Feb 2006; 15(1):61–70.

    Article  PubMed  Google Scholar 

  28. Lurie P. FDA Report Highlights Poor Enforcement of Post-Marketing Follow-up. http://www.citizen.org/pressroom/release.cfm?ID=2147. Accessed October 12, 2006.

  29. Yusuf S, Mehta SR, Xie C, et al. Effects of reviparin, a low-molecular-weight heparin, on mortality, reinfarction, and strokes in patients with acute myocardial infarction presenting with ST-segment elevation. JAMA. Jan 26, 2005; 293(4):427–435.

    Article  PubMed  CAS  Google Scholar 

  30. Smith DH, Neutel JM, Lacourciere Y, Kempthorne-Rawson J. Prospective, randomized, open-label, blinded-endpoint (PROBE) designed trials yield the same results as double-blind, placebo-controlled trials with respect to ABPM measurements. J Hypertens. July 2003; 21(7):1291–1298.

    Article  PubMed  CAS  Google Scholar 

  31. Cross J, Lee H, Westelinck A, Nelson J, Grudzinskas C, Peck C. Postmarketing drug dosage changes of 499 FDA-approved new molecular entities, 1980–1999. Pharmacoepidemiol Drug Saf. Sept 2002; 11(6):439–446.

    Article  PubMed  Google Scholar 

  32. FDA news Drug Daily Bulletin. Oct 2006; 3(207).

    Google Scholar 

  33. Bombardier C, Laine L, Reicin A, et al. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. VIGOR Study Group. N Engl J Med. Nov 23, 2000; 343(21):1520–1528, 1522 p following 1528.

    Article  PubMed  CAS  Google Scholar 

  34. Mukherjee D, Nissen SE, Topol EJ. Risk of cardiovascular events associated with selective COX-2 inhibitors. JAMA. Aug 22–29, 2001; 286(8):954–959.

    Article  PubMed  CAS  Google Scholar 

  35. Juni P, Nartey L, Reichenbach S, Sterchi R, Dieppe PA, Egger M. Risk of cardiovascular events and rofecoxib: cumulative meta-analysis. Lancet. Dec 4–10, 2004; 364(9450):2021–2029.

    Article  PubMed  CAS  Google Scholar 

  36. Bresalier RS, Sandler RS, Quan H, et al. Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. N Engl J Med. Mar 17, 2005; 352(11): 1092–1102.

    Article  PubMed  CAS  Google Scholar 

  37. Merck & Co I. http://www.vioxx.com/vioxx/documents/english/vioxx_press_release.pdf. Accessed October 4.

  38. Abenhaim L. Lessons from the withdrawal of rofecoxib: France has policy for overall assessment of public health impact of new drugs. BMJ. Dec 4, 2004; 329(7478):1342.

    Article  PubMed  Google Scholar 

  39. FDA. MedWatch: Voluntary Reporting by Health Professionals. http://www.fda.gov/medwatch/report/hcp.htm. Accessed October 12, 2006.

  40. Grootheest van A, Graafe e L, Jong van den Berg de L. Consumer reporting: a new step in pharmacovigilance? An overview. Drug Safety. 2003; 26:211–217.

    Article  Google Scholar 

  41. Improving ADR reporting. Lancet. Nov 9, 2002; 360(9344):1435.

    Article  Google Scholar 

  42. Zwillich T. How Vioxx is changing US drug regulation. Lancet. Nov 19, 2005; 366(9499):1763–1764.

    Article  PubMed  Google Scholar 

  43. Taylor R, Bethell H, Brodie D. Clinical trial versus the real world: the example of cardiac rehabilitation. Br J Cardiol. 2007; 14:175–178.

    Google Scholar 

  44. Tappenden P, Chilcott J, Ward S, Eggington S, Hind D, Hummel S. Methodological issues in the economic analysis of cancer treatments. Eur J Cancer. Nov 2006; 42(17):2867–2875.

    Article  PubMed  Google Scholar 

  45. Chilcott J, Brennan A, Booth A, Karnon J, Tappenden P. The role of modelling in prioritising and planning clinical trials. Health Technol Assess. 2003; 7(23):iii, 1–125.

    Google Scholar 

  46. Ramsdell JW, Braunstein SN, Stephens JM, Bell CF, Botteman MF, Devine ST. Economic model of first-line drug strategies to achieve recommended glycaemic control in newly diagnosed type 2 diabetes mellitus. Pharmacoeconomics. 2003; 21(11):819–837.

    Article  PubMed  CAS  Google Scholar 

  47. Briggs A, Gray A. The distribution of health care costs and their statistical analysis for economic evaluation. J Health Serv Res Policy. Oct 1998; 3(4):233–245.

    PubMed  CAS  Google Scholar 

  48. Leiter LA, Ceriello A, Davidson JA, et al. Postprandial glucose regulation: New data andnew implications. Clin Ther. 2005; 27 Suppl 2:S42–56.

    Article  Google Scholar 

  49. Plosker GL, Figgitt DP. Repaglinide: a pharmacoeconomic review of its use in type 2 diabetes mellitus. Pharmacoeconomics. 2004; 22(6):389–411.

    Article  PubMed  Google Scholar 

  50. Heeley E, Riley J, Layton D, Wilton LV, Shakir SA. Prescription-event monitoring and reporting of adverse drug reactions. Lancet. Dec 1, 2001; 358(9296):1872–1873.

    Article  PubMed  CAS  Google Scholar 

  51. Lassila R, Rothschild C, De Moerloose P, Richards M, Perez R, Gajek H. Recommendations for postmarketing surveillance studies in haemophilia and other bleeding disorders. Haemophilia. July 2005; 11(4):353–359.

    Article  PubMed  CAS  Google Scholar 

  52. Institute of Medicine of the National Academies. The Future of Drug Safety. http://www.nap.edu/books/0303103045/html/1.html. Accessed April 3, 2007.

  53. Public Health Newswire. Drug’s Black Box Warning Violations in Outpatient Settings Putting Patients at Risk. http://www.medicalnewstoday.com/medicalnews.php?newsid=37735. Accessed April 3, 2007.

  54. DeVane CL, Grasela TH, Jr., Antal EJ, Miller RL. Evaluation of population pharmacokinetics in therapeutic trials. IV. Application to postmarketing surveillance. Clin Pharmacol Ther. May 1993; 53(5):521–528.

    PubMed  CAS  Google Scholar 

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Glasser, S.P., Delzell, E., Salas, M. (2008). Postmarketing Research. In: Glasser, S.P. (eds) Essentials of Clinical Research. Springer, Dordrecht. https://doi.org/10.1007/978-1-4020-8486-7_5

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  • DOI: https://doi.org/10.1007/978-1-4020-8486-7_5

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