Slide1 l.jpg
This presentation is the property of its rightful owner.
Sponsored Links
1 / 47

FDA/CVM/OSC/DS Adverse Drug Experience (ADE) Reporting System PowerPoint PPT Presentation


  • 412 Views
  • Uploaded on
  • Presentation posted in: General

FDA/CVM/OSC/DS Adverse Drug Experience (ADE) Reporting System. Division Director: Dr. Lynn Post Team Leaders: Dr. John Baker, ADE Coordinator Dr. Dorothy McAdams Beth Anne Grove. History of ADE Program at CVM.

Download Presentation

FDA/CVM/OSC/DS Adverse Drug Experience (ADE) Reporting System

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Slide1 l.jpg

FDA/CVM/OSC/DS

Adverse Drug Experience (ADE) Reporting System

Division Director:

Dr. Lynn Post

Team Leaders:

Dr. John Baker, ADE Coordinator

Dr. Dorothy McAdams

Beth Anne Grove


History of ade program at cvm l.jpg

History of ADE Program at CVM

  • Initially ADE reports were reviewed by Veterinary Medical Officers when they had time

  • 1998 – Pilot program started to have dedicated ADE reviewers; 4 reviewers were hired

  • Expanded in 2001(3 reviewers) and 2008(3 reviewers)


Number of ade reports l.jpg

Number of ADE Reports


Slide4 l.jpg

Safety Reviewers:

Margarita Brown, DVM, MS (Coordinator)

Priscilla Batten, DVMLee Anne Palmer, VMD

Tina Burgess, DVMAme Walesby, DVM, MS, DACVS

Sandi Ehnen, VMDLinda Walter-Grimm, DVM

Jeanne Herring, VMD, ACLAM

Roderick Hudson, DVM

Teresa Koogler, DVM


Reviewers experience l.jpg

Reviewers experience

  • 9/10 have between 8-30 years practice experience and hold current clinical licenses

  • 2/10 have large animal practice experience

  • 8/10 have companion animal and/or exotic experience

  • 7/10 still practice in local practices up to 20-hrs/week

  • 3/10 are current or previous practice owners

  • 1/10 has lab animal experience


Other ade team members l.jpg

Other ADE team members:

Linda Kim-Jung, PharmD

Renee Shibukawa-Kent, VMD, MPH, DACVPM

Susan Bright, DVM

Developing Positions:

Liaison for pet food adverse events: Lee Anne Palmer

Liaison for international adverse events: Margarita Brown


Adverse drug experience ade l.jpg

Adverse Drug Experience(ADE)

AnAdverse Drug Experience is any adverse reaction that occurs following the use of a drug product. ADEs can be mild (itching, sneezing) to severe (death). ADEs include complaints of ineffectiveness, product defects and human safety associated with the handling of animal drugs products.


Slide8 l.jpg

Veterinary Drug

ADE Evaluation Scoring System

Amended Human System: 6-Part Components of ADE Scoring System (Modified Kramer Algorithm)

  • Previous Experience (-1, 0, +1)

  • Alternative Etiologic Candidate (-1, 0, +2)

  • Timing (-2, 0, +1)

  • Overdose (0, +1)

  • Dechallenge (-1, 0, +1)

  • Rechallenge (–1, 0, +1)


Slide9 l.jpg

Interpretation of Range

  • -9= not applicable to label instructions

  • -8, -7= not enough information; no conclusion

  • -6 to -1= remotely drug related

  • 0-2= possibly related to the drug

  • 3-5= probably related to the drug

  • 6= definitely drug related


Ineffectiveness scoring l.jpg

Ineffectiveness Scoring

-9 Ineffectiveness – Not Applicable (claim for ineffect for condition not on label)

-1 Ineffectiveness – Remotely drug related

0-1 Ineffectiveness – Possibly drug related

Ineffectiveness – Probably drug related

6 Ineffectiveness – Definitely drug related


Drug problems and interactions evaluated by cvm l.jpg

Drug problems and interactions evaluated by CVM

  • Baytril – Blindness in cats

  • Etogesic – Keratoconjunctivitis sicca

  • Moxidectin – Overdoses from failure of syringe-locking device

  • Comfortis – interaction with ivermectin

  • NSAID’s – liver disease, perforations, aggression, vets failure to follow label precautions


Importance of knowing the label l.jpg

Importance of knowing the label

  • Side effects and interactions – preapproval testing is limited

  • Precautions – which animals should not get the drug; follow up testing that should be done

  • Post-approval experience section

  • Client information sheet or consent


Purpose of ade reporting l.jpg

Purpose of ADE Reporting

Data Collection: 1: Veterinary Adverse Drug Experiences (ADEs)

2: Suspected Product Failures (Ineffectiveness)

3: Product Defects

4: Human exposures

Pre-testing by the manufacturer and review of the data by the government does not guarantee absolute safety and effectiveness of approved veterinary drugs due to the inherent limitations imposed by testing the product on a limited population of animals. Anyone with information to report is encouraged to contact the manufacturer of the suspect product.


New drugs less than 3 yrs of marketing l.jpg

New drugs (less than 3 yrs of marketing):

Reporting of ADE’s is very important for new drugs:

Since pre-approval data is limited, once new drugs are used in thousands of animals – new side effects can show up


Reporting an ade l.jpg

Reporting an ADE

1. a. Drug Company’s 800 #

b. FDA: 888-FDA-VETS


Slide16 l.jpg

FORM 1932: Submitted by Sponsor


Helpful information l.jpg

Helpful Information

  • Physical exam by veterinarian

  • Medical history

  • Diagnostic evaluation

  • Veterinarian’s opinion

  • Follow Up information


Reporting an ade18 l.jpg

Reporting an ADE

1. a. Drug Company’s 800 #

b. FDA: 888-FDA-VETS

2. By Computer: www.fda.gov/cvm

download form 1932A


Slide19 l.jpg

Form 1932A:

Mailed From The

Consumer


Slide20 l.jpg

ADEs

  • Most of ADEs reported come from the manufacturer on FDA Form 1932

  • Reports from owners and veterinarians on FDA Form 1932a account for less than 1% of reported ADEs


Reporting a non drug adverse event l.jpg

Reporting a non-drug adverse event

3. Vaccine Reaction: USDA 800-752-6255

4. Pesticide Reaction: EPA 800-858-7378


Cvm does not l.jpg

CVM does not:

  • Regulate the practice of veterinary medicine

  • Report or judge off-label use

  • Advise on how to treat

    animals with reactions


Use of data l.jpg

Use of Data:

Evaluate Trends and relative frequencies of clinical signs and lack of efficacy.

Initiate label revisions, formulation changes, product packaging alterations or further clinical studies for investigation

In rare circumstances this information may lead to removal of the drug from the market.

Monitor off label uses of products including wildlife and human user safety issues.


Communication of our information l.jpg

Communication of our information

  • JAVMA Articles

  • Freedom of Information (FOIA) requests

  • Dear Doctor letters

  • Client information sheets

  • Informed consent

  • Cumulative ADE summaries webpage

  • Post approval label changes

  • Outreach


Dear doctor letter l.jpg

Dear Doctor Letter

  • After a label is revised to include new safety information, the drug company generally will send a letter to all practitioners describing the label changes and other important prescribing information.

    http://www.fda.gov/AnimalVeterinary/SafetyHealth/ ProductSafetyInformation/ucm055433.htm


Client information sheet required for nsaid s l.jpg

Client Information Sheet (required for NSAID’s)

  • Similar to the Patient Prescribing Information (PPI), which is commonly distributed with human pharmacy prescriptions.

  • Written in “consumer-friendly” language and provides information about the benefits and side effects associated with the use of the prescribed drug in easily understandable Q & A format.

  • Supplements the information provided in the Package Insert; some Client Information Sheets are printed on the reverse side of the Package Insert.


Informed consent l.jpg

Informed Consent

  • Remember to discuss possible side effects with the client before you dispense the drugs. Consider pre-administration blood work especially with long term administrations.

  • Supply the associated Client Information Sheets when dispensing drugs to the client.

  • Computer programs are now available that print out information sheets for other drugs similar to ones we get at a pharmacy.


Foi freedom of information act l.jpg

FOI (Freedom of Information Act)

Reviewed ADE summaries are available to the public at the FDA website.

http://www.fda.gov/AnimalVeterinary/SafetyHealth/ProductSafetyInformation/ucm055394.htm

THIS SITE IS UPDATED MONTHLY


Slide30 l.jpg

AMOXICILLIN

ORAL, CAT

Number of Animals Evaluated

90

Sign

HYPERESTHESIA

HYPERPNEA

HYPERSALIVATION

HYPOTHERMIA

HYPOTHERMIA, BODY

ICTERUS

INEFFECT, ANTIBIOTIC


Post approval ade section for labels l.jpg

Post-approval ADE section for labels:

  • After a drug has been on the market for 1 to 2 years, the primary reviewer does an analysis of the information to see if there are signs that need to be added to the Adverse Reaction section.

  • It is good to regularly review the labels for drugs to see if there have been any changes.


The future for adverse drug event reviewing l.jpg

The Future For Adverse Drug Event Reviewing


Current workflow l.jpg

Current Workflow

  • ADE report received

  • Triaged for review

  • Newly approved drugs (prior to 1 year anniversary) within 1 week (prior to 3 years) within 1 month

  • Hot topics as presented

  • ADE report entered into current database for review

  • Summary report updated monthly on CVM website


Slide34 l.jpg

Owner/Vet/Drug company reports case

Medwatch Plus

Portal

Call FDA if no

Web-access

Web-access

Voluntary/

Mandatory

Gateway

Report coded, triaged, and sent to appropriate Center

CDER

CFSAN

CBER

ORA/

OCM

CDRH

CVM


New reporting form l.jpg

New Reporting Form

  • Electronic format

    • Also available as paper until submission requirements change at Agency level

      Compatible with VICH reporting form

      Accompanying Guidance helps explain how to fill out the form


Electronic submissions l.jpg

Electronic Submissions

  • Automatic population of the database

  • Workflow management

  • Identification of emerging problems

  • More efficient data mining capabilities, even if the report has not yet been reviewed


Slide37 l.jpg

VICH International Cooperation on Harmonization of Technical Requirements for Registration of Veterinary Products

  • International harmonization of reporting adverse events

    • USA, EU, Japan

      • Canada, Australia

    • standardize definitions

    • standardize data elements

    • standardize dictionaries

    • electronic submission


References l.jpg

References

  • Hampshire VA, Doddy FM, Post LO, et al., Adverse drug event reports at the United States Food and Drug Administration Center for Veterinary Medicine. J Am Vet Med Assoc., 2004 Jan 15; 224(2):177.


References39 l.jpg

References

Bataller N, Keller WC., Monitoring adverse reactions to veterinary drugs. Pharmacovigilance. Vet Clin North Am Food Anim Pract. 1999 Mar;15(1):13-30, vii-viii.


References40 l.jpg

References

  • Keller WC, Bataller N, Oeller DS, Processing and evaluation of adverse drug experience reports at the Food and Drug Administration Center for Veterinary Medicine. J Am Vet Med Assoc. 1998 Jul 15;213(2):208-11.Am Vet Med Assoc. 1998 Jul 15;213(2):208-11.


Ade algorithm l.jpg

ADE algorithm

(if time allows)


Slide42 l.jpg

Previous Experience

  • For a score of +1

  • The clinical manifestation is generally recognized to occur in this species at the dosage received (from label adverse warnings; or appearing in the STARS updated database more than 10% of the time or in published veterinary literature.

  • For a score of 0

  • The clinical manifestation is not generally recognized to occur in this species at the dosage received but has been previously reported in veterinary and/or human medicine or:

  • The drug has limited accumulated clinical experience (time and/or quantity marketed)

  • For a score of –1

  • The clinical manifestation is previously unreported and the drug has substantial accumulated clinical experience (time and/or quantity marketed)


Slide43 l.jpg

Alternative Etiologic Candidate

  • For a Score of +2

  • There is no good candidate or no change in a candidate which can explain the clinical manifestation, exclusive of drug administration

  • For a score of 0

  • An alternative candidate(s) exists, but not a good one(s) which can well explain the clinical manifestation or:

  • The clinical manifestation commonly occurs spontaneously in this type of patient and situation, usually in the absence of any recognizable alternative candidate(s)

  • For a score of –1

  • There is a good candidate or a change in a candidate which can well explain the clinical manifestation, exclusive of drug administration. (usually identified by a DDX in the comments section of the final report)


Slide44 l.jpg

Timing of Events

  • For a score of +1

  • Timing was consistent and as expected for this type of clinical manifestation to this drug

  • For a score of 0

  • Do not know what timing to expect

  • For a score of –2

  • The timing was inconsistent for this type of clinical manifestation to this drug


Slide45 l.jpg

Evidence of Overdose

  • For a score of +1

  • The clinical manifestation is clearly a dose-related type of manifestation , and there is unequivocal evidence that the amount of drug received was an overdose for this animal

  • For a score of 0

  • The clinical manifestation is not a dose-related type of manifestation or there is no evidence of an overdose.


Slide46 l.jpg

Dechallenge

  • For a Score of +1

  • The clinical manifestation disappeared after discontinuation of the suspect drug or administration of a specific antidote

  • For a Score of 0

  • Dechallenge difficult, impossible, or inappropriate to assess

  • A non-specific agent or maneuver (non-antidotal) was administered that was directed against the clinical manifestations and that usually produces the degree and rate of improvement observed in this case

  • The clinical manifestation is characteristically transient and episodic, and there is no established pattern of the episodes regardless of what occurs after discontinuing the drug

  • The clinical manifestation is known to be dose-related and the clinical manifestation did not diminish or disappear after the dosage was reduced

    For a score of –1

  • The clinical manifestation did not diminish or disappear after discontinuation of suspect drug

  • The clinical manifestation improved without Dechallenge and the improvement cannot be attributed to the development of tolerance


Slide47 l.jpg

Rechallenge

  • For a score of +1

  • The clinical manifestation unequivocally recurred or exacerbated after Rechallenge

  • For a score of 0

  • There was no Rechallenge attempted

  • The clinical manifestation failed to recur or exacerbate on Rechallenge, but the dosage or duration of drug administration on Rechallenge was substantially less than that suspected of causing the original clinical manifestation

  • Recurrence or exacerbation of the clinical manifestation was impossible to assess because it was progressing or was at a level of severity that any further increase would be difficult to appreciate

  • For a score of –1

  • The clinical manifestation failed to recur or exacerbate on Rechallenge


  • Login