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Expert Opinion on Drug Safety
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Expert Opinion on Drug Safety
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Expert Opinion on Drug Safety
Article . 2021
License: CC BY NC ND
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Comprehensive evaluation of post-approval regulatory actions during the drug lifecycle – a focus on benefits and risks

Authors: Lourens T. Bloem; Mariana Karomi; Jarno Hoekman; Menno E. van der Elst; Hubert G.M. Leufkens; Olaf H. Klungel; Aukje K. Mantel-Teeuwisse;

Comprehensive evaluation of post-approval regulatory actions during the drug lifecycle – a focus on benefits and risks

Abstract

Background: Prior studies investigated regulatory actions that reflected a negative impact on drug risks. We aimed to evaluate occurrence of regulatory actions that reflected a negative or positive impact on benefits or risks, as well as relations between them. Research design and methods: We followed EMA-approved innovative drugs from approval (2009���2010) until July 2020 or withdrawal to identify regulatory actions. We assessed these for impact on benefits or risks and relations between actions. Additionally, we scrutinized drug lifecycles for time-variant characteristics that may contribute to specific patterns of regulatory actions. Results: We identified 14 letters and 361 label updates for 40 drugs. Of the label updates, 85 (24%) reflected a positive impact, mostly concerning indications, and 276 (76%) a negative impact, mostly adverse drug reactions. Many updates (54%) occurred simultaneously with other updates, also if these reflected a different impact. Furthermore, levels of patient exposure, innovativeness, needs for regulatory learning and unexpected risks may contribute to patterns of regulatory actions. Conclusions: Almost a quarter of regulatory actions reflected a positive impact on benefits and risks. Also, simultaneous learning about benefits and risks suggests an important role for drug development in risk characterization. These findings may impact regulatory analyses and decision-making.

Keywords

Time Factors, Drug-Related Side Effects and Adverse Reactions, Drug Approval/legislation & jurisprudence, Drug-Related Side Effects and Adverse Reactions/epidemiology, Cohort Studies, Government Agencies, European Medicines Agency, drug lifecycle, Humans, Pharmacology (medical), European Union, Drug Approval, Drug Labeling, Retrospective Studies, clinical trials, benefit-risk, Drug regulation, pharmacovigilance, Drug Labeling/legislation & jurisprudence, adverse effects, Drug and Narcotic Control, regulatory data, Drug and Narcotic Control/legislation & jurisprudence

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    selected citations
    These citations are derived from selected sources.
    This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    4
    popularity
    This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
    Top 10%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    Average
    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
    Average
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
4
Top 10%
Average
Average
Green
hybrid