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Contents

Оглавление

Thank You

Introductions

Contributors

Notice

Chapter 1The Theory and Definitions of Drug Safety — Pharmacovigilance

The Theory

Adverse Event (AE) — ICH

Adverse Event (AE) — EMA

Adverse Event/Experience (AE) — FDA

Adverse Reaction (AR)

Serious Adverse Event and Serious Adverse Reaction (SAE/SAR)

Non-serious Adverse Event and Non-serious Adverse Reaction (NSAE/NSAR)

Suspected Adverse (Drug) Reaction (SAR/SADR) — FDA

Serious, Unexpected, Suspected Adverse Reaction (SUSAR)

Serious, Expected, Suspected Adverse Reaction

Unexpected Adverse Event — FDA

Unexpected Adverse Reaction — EMA

Unlisted Adverse Reaction — EMA

Expected (Listed versus Labeled)

The Practice

Chapter 2Clinical Trials, Clinical Research Organizations, Phases I–IV, and Investigator-Initiated Trials

Introduction

Phase I

Phase II

Phase III

Phase IV

Late Phase Studies

Investigator-Initiated Research

Other Study-Related Issues

Frequently Asked Questions

Chapter 3Spontaneous Post-marketing Adverse Events

Introduction

United States Regulations

European Union Requirements

Other Regions

Process Issues

Frequently Asked Questions

Chapter 4The Theory of Drug Safety — Pharmacovigilance

A Brief History of the FDA

Regulations, Laws, and Guidances

The United States Regulations and Guidances

The European Union Legislation (including Directives and Regulations), and Guidance

Frequently Asked Questions

Chapter 5The Mathematics of Adverse Events and a Brief Note on Pharmacoepidemiology

Introduction

Case Report or Individual Case Safety Report

Aggregate Reports

Reporting Rates versus Risk

Why We Can’t Calculate Good Rates

Quantitative Signal Detection Methods

Other Data Mining Methods

Chapter 6Epidemiology and Pharmacoepidemiology: What Are They?

What Are Their Limitations and Advantages?

Introduction

Randomized Controlled Trial

Adaptive Clinical Trials

Cohort Study

Case-Control Study

Nested Case-Control Study

Confidence Intervals

Frequently Asked Questions

Chapter 7Regulations, Directives, Guidance, Laws and Consensus Documents

United States

European Union

Consensus Documents

The Practice

Over-the-Counter Drugs

United States

European Union

Staying Up to Date

Scientific/Medical Literature

Meetings and Conferences

The Internet

Chapter 8The United States Food and Drug Administration

Introduction

Center for Drug Evaluation and Research

The Safety Reporting Portal

Risk Management

MedWatch

Safety Databases

Other Useful FDA Web Pages

Center for Biologics Evaluation and Research

Center for Devices and Radiologic Health

Over-the-Counter Products

Drug Safety Oversight Board

Prescription Drug User Fee Act

Prescription Drug User Fee Act: Five-Year Plan

Food and Drug Administration Act (FDAAA) of 2007

21st Century Cures Act

FDA Reauthorization Act of 2017

The Sentinel System and ARIA

What is Expected from Drug Companies by the FDA?

What is Expected from Consumers and Healthcare Professionals by the FDA?

FDA Publications and Updates

Drug Safety Inspections

Frequently Asked Questions

Chapter 9The European Medicines Agency

Introduction

Registration Procedures in the EU

European Medicines Agency

Organization and Structure

Risk Management

EudraVigilance — The EU Safety Database

What Is Not in the Scope of EMA?

The Pharmacovigilance Risk Assessment Committee

Post-marketing PV EU Regulation

Volume 10 Clinical Trial PV

The EMA Website

European Network of Centers for Pharmacoepidemiology and Pharmacovigilance

Newsletters and RSS Feeds

Comments

Agence Nationale de Sécurité des Médicaments et Produits de santé

Missions

Scope

Organization

Frequently Asked Questions

Chapter 10The EU Qualified Person for Pharmacovigilance

Introduction

Practicalities

Frequent QPPV Inspection Findings by the EMA

Frequently Asked Questions

Chapter 11The Uppsala Monitoring Centre

WHO Programme for International Drug Monitoring

Key Functions of UMC

Chapter 12Council for International Organizations of Medical Sciences

Introduction

CIOMS I (1990): International Reporting of Adverse Drug Reactions

CIOMS II (1992): International Reporting of Periodic Drug-Safety Update Summaries

CIOMS III (1995 and 1998/1999): Guidelines for Preparing Core Clinical Safety Information on Drugs (1995), Including New Proposals for Investigator’s Brochures (1998/1999)

CIOMS IV (1998): Benefit–Risk Balance for Marketed Drugs: Evaluating Safety Signals

CIOMS V (2001): Current Challenges in Pharmacovigilance: Pragmatic Approaches

CIOMS VI (2005): Management of Safety Information from Clinical Trials

Regulatory Reporting and Communications of Safety Information from Clinical Trials

CIOMS VII (2006): Development Safety Update Report (DSUR)

CIOMS VIII (2010): Signal Detection (Points to Consider in Application of Signal Detection in Pharmacovigilance)

CIOMS/WHO Working Group on Vaccine Pharmacovigilance (2012): Definitions and Applications of Terms for Vaccine Pharmacovigilance

CIOMS IX (2014): Practical Approaches to Risk Minimization for Medicinal Products

CIOMS X (2016): Evidence Synthesis and Meta-analysis

CIOMS SMQs (2016): Development and Rational Use of Standardized MedDRA Queries: Retrieving Adverse Drug Reactions with MedDRA — Second Edition

CIOMS (2017): Guide to Active Vaccine Safety Surveillance

Chapter 13Where Data Reside

Introduction

FDA Adverse Event Reporting System

FAERS Public Dashboard

FAERS Quarterly Data Files

Redacted ICSRs

Clinical Trial Data

The Uppsala Monitoring Centre

VigiBase

EMA EudraVigilance Database

Motherisk

Health Canada

MHRA

Teratology Data

General Practice Research Database and Clinical Practice Research Datalink

Other Registries and Databases

Chapter 14Information Technology, Databases, and Computers

Introduction

Required Safety Database Functionality

Data Entry

Workflow

Administration

Vendor Support and Information Technology Issues

Validation

Labeling Functions

Reporting Functions

Data Export and Import

Pharmacovigilance Functions

Database Support

Data Entry

Data Transmission (E2B)

E2B(R3)

Safety Databases

Database Migration

Health Level 7

Clinical Data Interchange Consortium

Systematized Nomenclature of Medicine Clinical Terms

Frequently Asked Question

Chapter 15Adverse Events with New Chemical Entities, Generics, Excipients, Placebos, and Counterfeits

Introduction

Generics

Excipients

Placebo

Other Manufacturers’ Drugs’ AEs

Placebo and Breaking the Blind in Clinical Trials

Picking up AEs Due to Excipients

Generics

Adverse Events with Counterfeit, Impure, and Other Non-standard Products

Online Pharmacies

Authors’ Comments for PV Personnel

Frequently Asked Questions

Chapter 16Children, Elderly, and Other Special (Vulnerable) Groups

Theory

Children

In the United States

In the European Union

The Elderly

FDA and the ICH E7 Guideline

FDA Guidance and Geriatric Rule

EMA

Other Special Groups

Women

African Americans

Chapter 17Pregnancy and Lactation

Introduction

Situation in the United States

Pregnancy

Lactation

Females and Males of Reproductive Potential

FDA Guidance on Pregnancy Registries — 2002

Good Epidemiologic Practices

Regulatory Reporting Requirements

Situation in the European Union

Lactation

AEs in Pregnant Partners of Males Taking a Drug

Other Resources

perinatology.com

Motherisk

Teratology Registries and Organizations

Frequently Asked Questions

Chapter 18Acute and Chronic (Late Occurring) Adverse Events, Adverse Events That Disappear (Bendectin) and Diethylstilbesterol

Introduction

Bendectin®: A False Alert

Market Removal

Return to the Market in Canada and Europe

Adriamycin®

Gene Therapy

Anti-retroviral Drugs

Diethylstilbestrol (DES)

Delayed Onset of Malignancy (Long Latency)

Actions Taken

Future for Long-Latency AEs

Frequently Asked Question

Chapter 19Drug Interactions

Introduction

Cytochrome P450

Drug–Food, Drug–Alcohol, Drug–Disease and Other Interactions

Frequency

Communication

Chapter 20Product Quality Issues

Introduction

Counterfeiting

Frequently Asked Question

Chapter 21AE Volume, Quality, Good Documentation Procedures, and Medical Records

Introduction

Archiving

Record Retention Times

Good Documentation Practices

Chapter 22Seriousness, Expectedness, and Causality

Seriousness

Expectedness

Relatedness (Causality)

Methodology

Global Introspection

Algorithms

Comment

Health Authority Guidance and Requirements

United States FDA

European Union

CIOMS I Assessment of Causality

Uppsala Monitoring Centre (WHO)

Judgment of Cases When Received Versus at the Time of Periodic Reporting and Signaling

Summary and Comments

Chapter 23Coding of Adverse Events and Drug Names

Introduction

AR/AE Coding

MedDRA

Regulatory Status

MedDRA in Practice

Standardized MedDRA Queries (SMQs)

Training

Systematized Nomenclature of Medicine — Clinical Terms

AE Severity Coding

Drug Names and Drug Dictionaries

Multiple Names and Name Changes

WHODrug Global

EudraVigilance Medicinal Product Dictionary

Future

Frequently Asked Question

Chapter 24Expedited and Aggregate Reporting in Clinical Trials

Expedited Reporting

Clinical Trial Reporting

United States Requirements for Expedited IND Reports

Expedited IND Reports (Alert Reports, 7-Day and 15-Day IND Reports)

IND Annual Reports

Other Clinical Trial (IND) Reporting Issues

European Union Requirements

Expedited Reporting in Clinical Trials

Development Safety Update Reports

When to Start Collecting Serious AEs in Trials

Canadian Requirements

Elsewhere

Bottom Line

Chapter 25Post-marketing Spontaneous ICSR/SAE Reporting

General Principles

Post-marketing ICSRs versus Clinical Trial ICSRs

Sources of AEs

Literature and Publications

Other Sources of Reports

Follow-Up

Notes on United States Requirements for Post-marketing NDA Reporting of SAEs

MedWatch to Manufacturer Program

Reports from the FDA via the Freedom of Information Act

Instructions on Filling Out the MedWatch Form

European Union Regulations

General Comments

Frequently Asked Questions

Chapter 26Periodic Adverse Drug Experience Reports, and Periodic Safety Update Reports/Periodic Benefit Risk Evaluation Reports

Introduction

NDA Periodic Reports

PSURs to the FDA

Post-marketing Periodic Reports

Section 1: Narrative Summary and Analysis

Section 2: Narrative Discussion of Actions Taken

Section 3: Index Line Listing

Section 4: ICSRs

Other Reports

Periodic Safety Update Reports

PSUR in ICH E2C(R2) Format: The Periodic Benefit–Risk Evaluation Report

Frequently Asked Question

Chapter 27Signals and Signaling in the Context of Risk Management

The Signal — Definition

Signal Sources and Generation

Increased Frequency

Data Mining

Other Sources of Signal Data

Putting It All Together

Organizational Team

Signal Workup

Prioritize

Arrange and Review

The Workup

The Conclusions and Next Steps

The Safety Committee

Computerized Tools for Signal Detection and Workup

Key Documents on Signaling and Good PV Practices

FDA Guidance on Good Pharmacovigilance Practices of 3/2005

Investigating a Signal

Interpreting a Signal

EU GVP Module IX — Signal Management (2012: Revision 1, Delivered Nov 2017)

Frequently Asked Questions

Chapter 28Risk: What Is It? Risk Management and Assessment, Risk Evaluation and Mitigation Strategies, and Risk Management Plans

Introduction

Why Risk Management?

The US FDA

The Proposed REMS

The Approved REMS

Roles of Key REMS Participants

Comments

Shared System REMS

REMS Template

Comments

European Union RMPs

When is an RMP Needed?

EU RMP Content

Part I: Product(s) Overview (GVP V. B.4)

Part II: Safety Specification (GVP V.B.5)

Part III: PV Plan, Including Post-authorization Safety Studies (GVP V.B.6 RMP part III)

Part IV: Plans for Post-authorization Efficacy Studies (GVP V.B.7 RMP part IV)

Part V: Risk Minimization Measures (Including Evaluation of the Effectiveness of Risk Minimization Activities) (GVP V.B.8 RMP part V)

Part VI: Summary of the RMP (GVP V.B.9 RMP part VI)

General Remarks on the EU RMP

Practicalities, Co-ordination, and Other Comments

Risk Management within Pharma Companies

Comments and Suggestions

Chapter 29Data Monitoring Committees and Investigational Review Boards/Ethics Committees

Data Monitoring Committees

Investigational Review Boards/Ethics Committees

Frequently Asked Questions

Chapter 30Pharmaceutical Companies

Introduction

Big and Somewhat Big Pharma

Mid-sized and Small Pharma

Contract/Clinical Research Organizations

Mergers, Acquisitions, and Bankruptcies

Chapter 31Organization of a Typical Drug Safety Department

Introduction

Management

Qualified (Responsible) Person for Pharmacovigilance

Triage Unit

Case Assessment and Prioritization

Data Entry Unit

Case Processing Unit

Medical Case Review

Transmission Unit

PV Regulatory Intelligence

Regulatory Unit

Legal Unit

Signaling, Pharmacovigilance, Pharmacoepidemiology, Medical Information or Medical Affairs Unit

Aggregate Report Preparation

Labeling Review and Update for Safety

Archive/File Room

Information Technology/Informatics Liaison

Quality Documents Creation and Maintenance

Training

Quality Assurance/Control

Safety (AE) Exchange Agreement Function: Creation and Maintenance

Literature Review

Data Dictionary Maintenance

Coding Unit

Planning and Project Management/Operations

Risk Management

Liaison to External Organizations/Drug Safety Intelligence

PV Worker Education, Skills, and Profile

Education

Skills

Profile

Frequently Asked Question

Chapter 32How an Individual Case Safety Report (ICSR) is Handled from Start to Finish

Introduction

AE Sources and Arrival in the Safety Department

Triage

Database Entry

Quality Review

Follow-Up

Medical Review

Case Closure

Case Distribution and Transmission

Tracking

Investigator Notification

15 Calendar Days and Day 0 versus Day 1

Chapter 33PV Quality System

Introduction

Chapter 34Training

Introduction

Organizational Structure and Site Information

Computer, Forms, Electronic, and Print Resources

What is Pharmacovigilance?

Corporate and Drug Safety SOPs, Working Documents, Guidelines, and Manuals

Medical Dictionary for Regulatory Activities (MedDRA®) and Other Dictionaries

Safety Database

Workflow

Partner and CRO Interactions

Signaling and Pharmacovigilance

Academic Training

Other External Training

Chapter 35Audits and Inspections

The Basics

Scope of the Audit

How an Inspection Flows

Findings

Penalties

Common Inspection Findings

The Response to the Inspection or Audit

The Corrective Action Preventive Action Plan (CAPA)

FDA Safety Inspections

Comments on EMA and MHRA Inspections

Quality Systems and Inspection Preparation in Companies

Key Documents

Summary and Comments

Chapter 36Pharmacovigilance System Master File

Introduction

Pharmacovigilance System Master File (Guideline on Good

Pharmacovigilance Practice Module II)

Comment

Chapter 37Ethical Issues and Conflicts of Interest

Introduction

Dynamics in Play in Regard to Drug Safety and Companies

Data Safety Management Boards and Ethics Committees/Institutional Review Boards

Safety Assessment Committee

Dynamics in Play in Regard to Drug Safety and Health Agencies

Dynamics in Play in Regard to Drug Safety and Academic and Non-academic Healthcare Facilities

Dynamics in Play in Regard to Drug Safety and Consumer Groups, Disease Groups, and the Internet (Blogs, Websites, Social Media, etc.)

Dynamics in Play in Regard to Drug Safety and Lawyers/Litigation

Codes of Conduct

Comments and Summary

Chapter 38The Safety Department’s Role in Clinical Research, CROs, Marketing and Sales, Labeling, Regulatory, Quality, Due Diligence, Legal Issues, Toxicology, Epidemiology, Medical Information and Manufacturing

Clinical Research

CROs

Marketing and Sales

The Labeling Department

The Legal Department

Regulatory Affairs Department

The Quality and Compliance Department

New Business Due Diligence

Toxicology and Pharmacology

Signaling and Epidemiology Groups

The Medical Information/Medical Affairs Department

Manufacturing (Product Quality Complaints)

Chapter 39Drug Labeling

Investigator Brochure

Company Core Safety Information

United States Safety Labeling for Marketed Products

European Union Safety Labeling for Marketed Products

Other Countries

Comments about Labeling Content

OTC Labeling in the United States

Labeling Update Process

Comments

Frequently Asked Questions

Chapter 40Universities and Academic Medical Centers

The Bayh–Dole Act in the United States

Clinical Research Units/Academic Study Units

Translational Medicine

Drug Safety Training in Academia

North America

Europe

Academic Consultation

Bad Behavior

The Sunshine Act

Chapter 41Vaccinovigilance

Differences between Vaccinovigilance and Pharmacovigilance

Causality versus Attribution

Temporal Association

Drugs are Metabolized; Vaccines are Processed

Incidence and Prevalence of Adverse Event Symptoms

Vaccine Efficacy

United States Initiative: The Vaccine Adverse Events Reporting System

GACVS and the European Commission

Vaccine Adverse Event Reporting

European Union System

Sources of Additional Information

Chapter 42Business Partners and Exchange of Safety Data

Introduction

Why a Written Safety Exchange Agreement is Needed

Telling the Safety Department about a New Contract or Arrangement

The Generic, Boilerplate, or Template Agreement

Developing a Safety Agreement with the Safety Department

Pharmacovigilance Agreement Database

Safety Agreement Contents

Regulatory Status

Regulatory Responsibilities

Regulatory Documents

Health Authority Queries and Requests

Regulatory Submissions

Investigator and Investigational Review Board/Ethics Committee Notifications: Blinding and Unblinding, Data Monitoring Committees (DMCs/DMSBs/DMSCs), Data Safety Boards

Safety Databases

Definitions

Data and Mechanisms of Data Exchange

Signaling, Safety Reviews, and Risk Management

Audits

Other Issues

Soft Points

Comments

Drug Due Diligence

Chapter 43Data Privacy and Security

Introduction

United States Health Insurance Portability and Accountability Act (HIPAA)

The European Union and the Privacy Regulation & Directive

EU-US Privacy Shield

Frequently Asked Question

Chapter 44The Roles and Interactions of Companies, Governments, Non-governmental Organizations, and Others in the World of Pharmacovigilance

Introduction

Pharmaceutical Companies

Governments

Media

NGOs and Lobbies

Industry Organizations

Litigation, Lawyers, and Legalities

Other Groups

Organizations for Drug Safety Personnel

Conclusion and Comments

Frequently Asked Question

Chapter 45Real-World Issues: Case Studies

Fialuridine

Fen–Phen

Nomifensine

TGN-1412/TAB08

Chapter 46Medical Marijuana and Pharmacovigilance

Overview and Pharmacology

US Federal Regulatory Situation

US State Regulatory Situation

Efficacy

Safety

Canada

Europe

Comments

Bottom Line

Chapter 47International Council for Harmonisation (ICH)

E1: The Extent of Population Exposure to Assess Clinical Safety for Drugs Intended for Long-Term Treatment of Non-Life Threatening Conditions

E2A: Clinical Safety Data Management: Definitions and Standards for Expedited Reporting

Definitions

Managing Blinded Cases

Other Issues

E2B: Clinical Safety Data Management: Data Elements for Transmission of Individual Case Safety Reports

The E2B(R2) and M2 Documents

The E2B(R3) and ISO/HL7 Documents

E2C(R2) Periodic Benefit-Risk Evaluation Report and E2C(R2) Q&As

E2C(R2) Periodic Benefit-Risk Evaluation Report (PBRER)

E2D: Post-Approval Safety Data Management: Definitions and Standards for Expedited Reporting

Definitions

Sources of Individual Case Safety Reports

Standards for Expedited Reporting

Good Case Management Practices

E2E: Pharmacovigilance Planning

Background and Scope

The Sections of a Pharmacovigilance Plan

Pharmacovigilance Plan

E2F: Development Safety Update Report

E19: Optimisation of Safety Data Collection

M1: MedDRA® Terminology (Medical Dictionary for Regulatory Activities)

Abbreviations

Index

Cobert's Manual Of Drug Safety And Pharmacovigilance (Third Edition)

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