1 US Investigator Meeting DIAS-4, Chicago, July 2011 Pharmacovigilance & Adverse Event Reporting Meredin Stoltenberg MD, PhD, DMSC Medical Safety Advisor Global Pharmacovigilance HQ
Mar 26, 2015
1 US Investigator Meeting DIAS-4, Chicago, July 2011
Pharmacovigilance &Adverse Event Reporting
Meredin Stoltenberg MD, PhD, DMSC
Medical Safety AdvisorGlobal Pharmacovigilance HQ
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Agenda
Context What will you get from this session? Safety and Pharmacovigilance at Lundbeck Working in partnership
Getting it ‘right first time’ Definitions of Adverse Events and Serious Adverse Events Ensuring correct diagnosis From diagnosis to coding Identifying causality Using the study reporting tools
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Voting pads
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Context
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Your patients, our reputation
Why we are here: A new medicine that may help doctors and patients So far, so good, but this is still ‘something new’ Our first duty: the safety of trial participants You are our eyes and ears What we do will affect how this medicine benefits patients
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60 minutes, to safeguard study participants
What you will get from this presentation:
How we will work togetherHow to save time and avoidreworkHow to reportHow to use the reporting toolsOpportunity to ask questions
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Interactive question
How many safety/ pharmacovigilance presentations have you been to?
1. This is my first
2. A few
3. A lot
4. Far more than you can imagine
5. I could probably give this presentation myself
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Please give us yourundivided attention
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Pharmacovigilance: The science of safety
Understanding and preventing adverse events by:Monitoring and reporting the use of the drugDetecting and assessing any adverse effectsAssessing frequency, riskfactors, levels of riskAssessing risk versus benefit
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Working together
First point: the patient comes first Partners in an investigative process Simplicity, accuracy and ‘right first
time’ Unclear or incomplete data will be
followed up Every report is followed up
appropriately
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Getting it‘right first time’
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Adverse events
What is an Adverse Event? Untoward, or out of place, medical event during the clinical trial Patients included when they sign the consent form Events before first administration ARE included Does not need to be caused by the drug Unchanged pre-existing conditions are not AEs
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Interactive question
Which of the events shown should you report as an Adverse Event or Serious Adverse Event?
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Interactive question
1. All 3 events should be reported
2. Only event number 3 should be reported
3. Events number 2 & 3 should be reported
Which of the events shown should you report as an Adverse Event or Serious Adverse Event?
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Laboratory abnormalities can also indicate an Adverse EventIf the investigator believes they are clinically significantIf they lead to a change or discontinuation of treatmentIf they fulfil a seriousness criteriaIf they indicate a potential safety risk to the patient
Other things to note
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Other things to note
Overdose At minimum, should be reported as an AE, stating whether intentional
or accidental If intentional, please add the reason Any symptoms resulting from the overdose should also be declared as
AEs Medication errors, drug abuse, drug interactions, quality issues with the
drug Medical or surgical procedures
The reason for the procedure should be reported as an AE
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Other things to note
Pregnancy Should be reported as an AE within 24
hours using the ‘Pregnancy’ form and entered as an ‘AE’ in the eCRF
Any untoward event, such as spontaneous abortion, congenital anomaly or foetal death should be reported as a Serious Adverse Event
Report the outcome to Lundbeck, even if study has ended
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What is a serious adverse event?
Death Life-threatening Results in persistent or permanent
disability or incapacity Results in birth defect/
congenital anomaly Requires
hospitalisation Medically important
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Serious adverse events
All SAEs should be reported immediately, then tracked and updated until there is an outcome:
“Recovered”
“Recovered with sequelae”
“Died”
“Did not recover”(for chronic conditions)
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Interactive question
Which of the following are serious adverse events?
1. Patient died after being stabbed with a knife
2. Patient broke leg and was admitted to hospital
3. Patient suffered anaphylactic shock
4. Patient gave birth to a healthy baby
5. Patient admitted for scheduled surgery to remove gall bladder
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Interactive question
Press one of the following options
Events 1,2,3 are SAEs Events 1,2,3,5 are SAEs Events 2,3 are SAEs All 5 events are SAEs
Which of the following are serious adverse events?
1. Patient died after being stabbed with a knife
2. Patient broke leg and was admitted to hospital
3. Patient suffered anaphylactic shock
4. Patient gave birth to a healthy baby
5. Patient admitted for scheduled surgery to remove gall bladder
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Reporting AEs and SAEs
Reports should include:Symptoms and/or diagnosisTheir intensityCause (if known)Causality assessmentAction takenOutcome
Be specific about cause and sequence: “Patient took an extra tablet because he forgot the previous dose”Patient presented with an arm fracture after falling over due to dizziness”
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Symptoms and diagnosis
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Symptoms and diagnosis
Ensure that cumulative symptoms are reported correctly:Together, chest pain, dyspnoea, diaphoresis and ECG changes can indicate a myocardial infarctionThe symptoms should be reported as AEs or SAEs as they occur but should be connected when the link becomes clear
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Coding and why we do it
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Causality
Is the AE or SAE linked to the study drug? Probably: There is a reasonable time relationship between the AE/SAE and
drug administration, or the AE/SAE recurs when the drug is taken again. Is unlikely to be caused by disease or other drugs.
Possibly: There is a suggested time relationship between the AE/SAE and drug administration, however, it could also be caused by disease or other drugs.
Not related: There is no time relationship between the AE/SAE and drug administration, or AE/SAE is caused by disease or other drugs.
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Interactive question
How many different CRF systems have you been trained in over the years?
1. None
2. 1-3
3. 4 or 5
4. 6-10
5. More than 10
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Recording using the eCRF
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Recording using the eCRF
Our goals: Simple to use Necessary, but not excessive, data Clear purpose and subsequent outcomes
Your goals: Devote adequate time CRF completion as a priority task Consistent and, where appropriate, report diagnosis instead of signs and
symptoms
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Sample entry: reporting a sequence of linked AEs
If possible combine signs and symptoms into a single diagnosis
Ensure the initially reported AEs (symptoms) are inactivated
Note whether the adverse event is serious
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Sample entry: reporting an AE
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Sample entry: reporting an AE
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Sample entry: reporting an AE
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Sample entry: reporting an AE
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Sample entry: reporting a sequence of linked AEs
If possible combine signs and symptoms into a single diagnosis
Ensure the initially reported AEs (symptoms) are inactivated
Note whether the adverse event is serious
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Sample entry: reporting a sequence of linked AEs
If possible combine signs and symptoms into a single diagnosis
Ensure the initially reported AEs (symptoms) are inactivated
Note whether the adverse event is serious
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Sample entry: reporting a sequence of linked AEs
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Sample entry: reporting a sequence of linked AEs
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Sample entry: narrative reports
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Sample entry: narrative reports
Narrative reports can be pasted into a free text field Give detail about the events leading to the AE Describe investigations and treatments Ensure the outcome is included
A good example:
On 12 October the patient was shovelling snow. The path was slippery and he fell and hit his head. He had not ingested alcohol and was not dizzy. He was hospitalised to be investigated (CT scan) and monitored for neurological injury. None was found and, on 14 October he was discharged with only a mild headache.
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Sample entry: reporting a sequence of linked AEs
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Sample entry: reporting a sequence of linked AEs
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Back-up procedure
If it is not possible to use the eCRF, record SAEs on emergency worksheets
If necessary, continue to use these for follow-up assessments and reports
Send them to the contact details shown at the end
Update the eCRF at the earliest opportunity
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Summary
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Summary
You are our eyes and ears -- we, and the study participants, are in your hands
Familiarise yourselves with the definitions of AEs and SAEs
Familiarise yourselves with the reporting tools
Getting it right, first time, will prevent follow-up contact and save you time
There is a support network to help answer any queries
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Interactive question
Has this session been:
1. Unnecessary
2. Necessary but nothing new
3. Useful
4. Useful and engaging
5. So good, I’d like to sit through it again right now
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For further information
All information in this presentation is summarised in the study protocol:
Section 9, pages 46 to 51 Ask your CRA or international/regional study manager Ask your Safety Advisor: [email protected]
Contact Details: For reporting, always use the eCRF Backup options: Fax US: 866 832 0540 ( Fax DK: +45 36 30 99 67) or email
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Data Monitoring Committee(DMC)
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DMC
The Data Monitoring Committee (DMC) is an independent expert advisory group
Combined DMC for 12402A (DIAS-3) study and 12649A (DIAS-4)
Purpose and functions: Monitoring the safety of patients Conduct a predefined interim futility analysis when
half of the patients have been evaluated in either one of the studies.
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DMC
Members:3 external experts Chairman Deputy Chairman Third member
MeetingsThroughout the studies when a predefined number of patients have been enrolled and followed up for 90 days. First meeting: Feb 2010, 50 patients Second Meeting: 09 Feb 2011, 150 patients Thereafter for 250, 400, 550 and 700 patients
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DMC members
Prof. Kennedy R. Lees, MDDMC Chair and Stroke SpecialistDepartment of Medicine Western InfirmaryGlasgow, UK
Dr Lawrence R. Wechsler, MDDeputy DMC Chair and Stroke SpecialistUniversity of Pittsburgh, Stroke InstitutePittsburgh, USA
Dr Michael Eliasziw, PhDDMC member and Biostatistics SpecialistDavLar BiostatsCalgary, Canada
Lundbeck personnel involved: Meredin Stoltenberg MD, PhD, DMScDMC secretaryH. Lundbeck A/S, Denmark
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