Adverse drug reactions meta-analysis

Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients a meta-analysis of prospective studies. JAMA. 1998 Apr 15 279(15) 1200-5. 

Lazarou, J., et al., "Incidence of Adverse Drug Reactions in Hospitalized Patients, A Meta-Analysis Of Prospective Studies," JAMA, 279,1200-1205 (1998). 

Meanwhile, these chemicals—like chemical agents encountered at work or in hobbies or as pollutants in air, water, soil, or food—can also cause harm. Sometimes the known mechanisms of action permit us to predict the nature of toxicity to be expected. A meta-analysis of prospective studies from U.S. hospitals indicates that 6.7% of in-patients have serious adverse drug reactions 0.3% have fatal reactions (Lazarou et al., 1998). In fact, estimates of 40,000 to 100,000 deaths per year attributed to errors in medical care, primarily due to adverse reactions to pharmaceuticals, make this phenomenon a major cause of death in the United States (Meyer, 2000). A tremendous... 

Beijer HJ and de Blaey CJ (2002) Hospitalisations caused by adverse drug reactions (ADR) a meta-analysis of observational studies. Pharm World Sci 24(2) 46-54... 

Horne R and Weinman J (1999) Patients beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 47(6) 555-567 Kannisto V, Lauritsen J, Thatcher AR et al. (1994) Reductions in mortality at advanced age several decades of evidence from 27 countries. Population and development review 20(4) 793-810 Lazarou J, Pomeranz BH, Corey PN (1998) Incidence of adverse drug reactions in hospitalized patients a meta- analysis of prospective studies. JAMA 279(15) 1200-1205 LeSage J (1991) Polypharmacy in geriatric patients. Nurs Clin North Am 26(2) 273-290 Pitkala KH, Strandberg TE, Tilvis RS (2001) Is it possible to reduce polypharmacy in the elderly ... 

Jason Lazarou, Bruce H. Pomeranz, and Paul N. Corey, Incidence of Adverse Drug Reactions in Hospitalized Patients A Meta-Analysis of Prospective Studies. JAMA 279, no. 15, April 15, 1998, pp. 1,200-1,205. Also available online. URL http //jama.ama-assn.Org/cgi/content/abstract/279/15/1200. Downloaded April 15, 2009. 

Machado M, Iskedjian M, Ruiz I, et al. Remission, dropouts, and adverse drug reaction rates in major depressive disorder a meta-analysis of head-to-head trials. Curr Med Res Opin 2006 22(9) 1825-37. 

Limited retrospective data suggest that nonadherence is associated with increased health services use and adverse drug reactions. A meta-analysis of studies published by Sullivan and associates that included patients of aU ages determined that the rate of hospital admissions owing to nonadherence was 5.5%. A study by Col and coworkers evaluated 315 consecutive elderly patients admitted to a hospital and determined that 11.4% of admissions resulted from nonadherence. Gurwitz and colleagues found that 21 % of preventable ADRs in elderly outpatients were due to errors in patient adherence. 

Adverse drug reactions (ADR) are far more commonplace than one would think. It is estimated that ADRs represent the fourth leading cause of death in the United States and Canada behind heart disease, cancer, and stroke. Further, it is estimated that ADRs are the sixth leading cause of death worldwide. Recent meta-analysis of prospective ADR studies estimates that over 180,000 Americans will die from ADRs and over one million will be injured from ADRs in 2008. Although these data are controversial and the actual incidence of ADRs is impossible to assess, there is no doubt that ADRs have a significant impact on both... 

Some of the methodological problems related to limited sample sizes and inadequate power can of course be overcome by techniques of systematic review and meta-analysis. In the era of evidence-based medicine, these techniques are used to help us arrive at more precise and less biased estimates of risk. Examples of the use of meta-analysis in studying adverse drug reactions are shown in Figures 1 and 2 [4,5]. 

In September 2001, however, a news item in the British Medical Journal reported that further analyses confirmed the increase in rates of myocardial infarction and questioned whether this was an adverse reaction affecting the whole class of COX 2 drugs. The debate continued for the next 3 years with the main emphasis remaining on GI toxicity. A PEM study that included more than 15 000 patients made no mention of cardiovascular adverse events. However, a second paper compared rofecoxib and meloxicam with respect to thromboembolic events which showed that both, to a variable extent were associated with cardiovascular, cerebrovascular and peripheral venous pathology. A meta-analysis published recently in The Lancet suggests that Merck, the licence holder... 

---