Abstract
Current FDA and pharmaceutical industry drug safety efforts rely on statistical review of large databases populated with voluntary reports of sADRs. These data are limited by low rates of complete reporting and high rates of underreporting. Improved post-marketing drug surveillance efforts are needed to improve patient safety. The RADAR project is an academic pharmacovigilance program that focuses on small numbers of thoroughly researched cases of sADRs. In the last decade, RADAR has utilized the resources of a comprehensive cancer center and a global network of collaborators to evaluate and disseminate information on sADRs, many of which are related to hematology. Between 1998 and 2007, RADAR investigated and reported 16 hematology-associated sADRs. RADAR disseminated information on over half of the sADRs within 2 years of FDA approval, compared to half of all new sADRs documented in the Physician’s Desk Reference within 7 years of FDA approval. RADAR’s novel pharmacovigilance methods identified previously undetected sADRs based on small numbers of completely described reports. The RADAR project’s experience shows that private sector programs that utilize small yet comprehensive datasets can significantly contribute to pharmacovigilance networks in hematology. As the FDA develops public-private networks to evaluate safety concerns associated with new drugs, focused independent efforts can assume increasing importance to address unmet needs.
Drug (FDA approval) . | sADR (# of reports) . | Clinical Setting (yr) . | Data Source . | Time to detection (yrs) . | FDA/Company alert . |
---|---|---|---|---|---|
PEG-rHuMGDF(unapproved) | ITP (13) | Healthy volunteers (2001) | Phase I trials | Preclinical detection | NA |
PEG-rHuMGDF(unapproved) | Lymphomas (3) | Healthy volunteers (2003) | Case reports | Preclinical detection | NA |
Ticlopidine (1991) | TTP (13) | CVA pts (1998) | Case reports | <1 | DHP letter; boxed warning |
Gemtuzumab (2000) | VOD (50) | Leukemia or AML (2000) | Phase II trials | <1 | Boxed warning |
Lenalidomide (2005) | VTE (75) | Multiple myeloma (2005) | Phase III trial | <1 | Boxed warning |
Enoxaparin (1993) | Hemorrhage (5) | PTCA (2003) | Case reports | 1 | NA |
Clopidogrel (1997) | TTP (39) | CAD pts (1998) | Case reports | 1 | Company warning |
Thalidomide (1998) | VTE (91) | Multiple myeloma (2002) | Phase II trials | 1 | Black box warning |
Nevirapine (1996) | Stevens-Johnson syndrome (3) | Healthcare workers (2002) | Case series | 2 | Boxed warning |
Nevirapine (1996) | Hepatotoxicity (5) | Healthcare workers (2002) | Case series | 2 | Boxed warning; DHP letter |
EPO (1993) | PRCA (9) | ESRD (2000) | Referral hematologist | 5 | Boxed warning; DHP letter |
EPO (1993) | Loss of efficacy (2) | Counterfeit drug (2000) | Case reports | 7 | NA |
EPO(1993)/ Darb (2001) | VTE (52) | Cancer (2004) | Phase III trial | 10(EPO)/3 (Darb) | FDA alert; DHP letter; boxed warning |
EPO (1993)/ Darb(2001) | Death (NA) | Cancer (2006) | Clinical trials | 10(EPO)/3 (Darb) | FDA alert; DHP letter; boxed warning |
G-CSF (1991) | AML/MDS (16) | Breast Ca (2007) | SEER-Medicare | 12 | NA |
Piperacillin (1981) | Neutropenia (1) | Infection (2006) | Case reports | 25 | Precaution |
Drug (FDA approval) . | sADR (# of reports) . | Clinical Setting (yr) . | Data Source . | Time to detection (yrs) . | FDA/Company alert . |
---|---|---|---|---|---|
PEG-rHuMGDF(unapproved) | ITP (13) | Healthy volunteers (2001) | Phase I trials | Preclinical detection | NA |
PEG-rHuMGDF(unapproved) | Lymphomas (3) | Healthy volunteers (2003) | Case reports | Preclinical detection | NA |
Ticlopidine (1991) | TTP (13) | CVA pts (1998) | Case reports | <1 | DHP letter; boxed warning |
Gemtuzumab (2000) | VOD (50) | Leukemia or AML (2000) | Phase II trials | <1 | Boxed warning |
Lenalidomide (2005) | VTE (75) | Multiple myeloma (2005) | Phase III trial | <1 | Boxed warning |
Enoxaparin (1993) | Hemorrhage (5) | PTCA (2003) | Case reports | 1 | NA |
Clopidogrel (1997) | TTP (39) | CAD pts (1998) | Case reports | 1 | Company warning |
Thalidomide (1998) | VTE (91) | Multiple myeloma (2002) | Phase II trials | 1 | Black box warning |
Nevirapine (1996) | Stevens-Johnson syndrome (3) | Healthcare workers (2002) | Case series | 2 | Boxed warning |
Nevirapine (1996) | Hepatotoxicity (5) | Healthcare workers (2002) | Case series | 2 | Boxed warning; DHP letter |
EPO (1993) | PRCA (9) | ESRD (2000) | Referral hematologist | 5 | Boxed warning; DHP letter |
EPO (1993) | Loss of efficacy (2) | Counterfeit drug (2000) | Case reports | 7 | NA |
EPO(1993)/ Darb (2001) | VTE (52) | Cancer (2004) | Phase III trial | 10(EPO)/3 (Darb) | FDA alert; DHP letter; boxed warning |
EPO (1993)/ Darb(2001) | Death (NA) | Cancer (2006) | Clinical trials | 10(EPO)/3 (Darb) | FDA alert; DHP letter; boxed warning |
G-CSF (1991) | AML/MDS (16) | Breast Ca (2007) | SEER-Medicare | 12 | NA |
Piperacillin (1981) | Neutropenia (1) | Infection (2006) | Case reports | 25 | Precaution |
Author notes
Disclosure: No relevant conflicts of interest to declare.
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