Paediatric Pharmacovigilance: Use of Pharmacovigilance Data Mining Algorithms for Signal Detection in a Safety Dataset of a Paediatric Clinical Study Conducted in Seven African Countries

Background: Pharmacovigilance programmes monitor and help ensuring the safe use of medicines which is critical to the
success of public health programmes. The commonest method used for discovering previously unknown safety risks is
spontaneous notifications. In this study we examine the use of data mining algorithms to identify signals from adverse
events reported in a phase IIIb/IV clinical trial evaluating the efficacy and safety of several Artemisinin-based combination
therapies (ACTs) for treatment of uncomplicated malaria in African children.

Methods: We used paediatric safety data from a multi-site, multi-country clinical study conducted in seven African countries
(Burkina Faso, Gabon, Nigeria, Rwanda, Uganda, Zambia, and Mozambique). Each site compared three out of four ACTs,
namely amodiaquine-artesunate (ASAQ), dihydroartemisinin-piperaquine (DHAPQ), artemether-lumefantrine (AL) or
chlorproguanil/dapsone and artesunate (CD+A). We examine two pharmacovigilance signal detection methods, namely
proportional reporting ratio and Bayesian Confidence Propagation Neural Network on the clinical safety dataset.

Results: Among the 4,116 children (6–59 months old) enrolled and followed up for 28 days post treatment, a total of 6,238
adverse events were reported resulting into 346 drug-event combinations. Nine signals were generated both by
proportional reporting ratio and Bayesian Confidence Propagation Neural Network. A review of the manufacturer package
leaflets, an online Multi-Drug Symptom/Interaction Checker (DoubleCheckMD) and further by therapeutic area experts
reduced the number of signals to five. The ranking of some drug-adverse reaction pairs on the basis of their signal index
differed between the two methods.

Conclusions: Our two data mining methods were equally able to generate suspected signals using the pooled safety data from a phase IIIb/IV clinical trial. This analysis demonstrated the possibility of utilising clinical studies safety data for key pharmacovigilance activities like signal detection and evaluation. This approach can be applied to complement the spontaneous reporting systems which are limited by under reporting.

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Authors: Dan K. Kajungu, Annette Erhart, Ambrose Otau Talisuna, Quique Bassat, Corine Karema, Carolyn Nabasumba, Michael Nambozi, Halidou Tinto, Peter Kremsner, Martin Meremikwu, Umberto D’Alessandro, Niko Speybroeck

Journal:  Public Library of Science (PLoS)  

Keyword(s): Malaria, Child health