Adverse event defined

The safety and tolerability of once-daily oral metrifonate has been evaluated in patients with probable mild to moderate Alzheimer s disease in a randomized, doubleblind, placebo-controlled, parallel-group study (9). Metrifonate was given to 29 patients as a loading dose (2.5 mg/kg) for 2 weeks, followed by maintenance dose (1 mg/kg) for 4 weeks 10 patients received placebo. The proportion of patients who had at least one adverse event was comparable in the two groups metrifonate 76%, placebo 80%. Selected adverse events, defined as those for which the incidence in the metrifonate and placebo group differed by at least 10%, were diarrhea, nausea, leg cramps, and accidental injury. The adverse events were predominantly mild and transient. Those who took metrifonate had a significantly lower heart rate. Metrifonate had no clinically important effect on laboratory tests, such as liver function tests, and did not affect exercise tolerance or pulmonary function. 

Concomitant or prior medications may be used in either safety or efficacy analyses. The presence of specific medications may be used as covariates for inferential analyses. Also, medications are often summarized to show that the therapies under study come from medically comparable populations. Medications may be used to determine protocol compliance and to help define a protocol-compliant study population. Concomitant medications may be examined to determine whether they interact with study therapy or whether they can explain the presence of certain adverse events. From a CDISC perspective, prior medications would be considered a finding while concomitant medications would be considered an intervention. 

In the FDA s Guidance for Industry E6 Good Clinical Practice Consolidated Guidance, an adverse event is defined as follows ... 

In guidance document ICH E3, Structure and Content of Clinical Study Reports, the FDA defines treatment-emergent signs and symptoms (TESS) as events not seen at baseline and events that worsened even if present at baseline. As simple as that may sound, it can sometimes be quite difficult to program. The important data variables that come into play are dosing record dates and times, adverse event start and stop times, and adverse event severity. All of these data variables need to be completed accurately for TESS to be calculated properly. 

Just as there is an adverse event form, there is usually a serious adverse event (SAE) form. Note here that serious as defined by the FDA is different from severe on the adverse event form. A patient can have a severe headache that may not be considered serious. The ICH guideline (also in ICH E3) entitled Clinical Safety Data Management Definitions and Standards for Expedited Reporting defines serious adverse events as follows ... 

Time is a critical measure for clinical trial analysis. Time is captured in clinical trial databases in a study day variable. Study day can be defined as the number of days from therapeutic intervention to any given time point or event. By defining study day, you create a common metric for measuring time across a population of patients in a clinical trial. There can be a study day calculation for any time point of interest. Adverse event start, study termination, and clinical endpoint event date all make good choices for study day calculations. The study day calculation is performed with one of the two following approaches. 

Imagine you have a data set of adverse event data and a data set of concomitant medications, and you want to know if a concomitant medication was given to a patient during the time of the adverse event. The following program defines the two data sets and joins them with PROC SQL so that you get all medications taken during any specific... 

O This DATA NULL step defines three macro variables, nl, n2, and n3, that are used in the column headings for Placebo, Active and Overall therapy groups as well as for denominators to be used for percentage calculations. Note that the variable representing all patients who received therapy serves as the denominator, as any of them could possibly have had an adverse event. 

An adverse drug event (ADE) can be defined as An injury related to the use of a drug, although the causality of this relationship may not be proven (Leape 1995). Medications are the most frequent cause of adverse event. In a review it was reported that ADEs are common in most clinical settings included adult inpatients (reported incidences of 6.5%), adult outpatients (27.4%), and a paediatric inpatients (2.3%) (Morimoto et al. 2004). No data on the elderly was reported but it is probably even higher than in adult settings. 

Synonyms of adverse reactions generally include adverse medical effects, untoward effects, side effects, adverse drug experiences, and adverse drug reactions. Specific distinctions among some of these terms may be defined operationally. For example, the term adverse reaction is used to denote those signs and symptoms at least possibly related to a medicine, whereas the term adverse experience is used to include nonmedicine-related medical problems in a trial such as those emanating from trauma or concurrent illness. Distinctions among side effects, adverse events, and adverse reactions are illustrated in the definitions of the two former terms. 

An adverse event or experience (as in the preceding section) is defined as any undesirable experience occurring to a subject whether or not considered related to the investigational product(s). Sponsors will have their own set of definitions and SOPs governing reporting of adverse events. The following account is generally applicable to most situations. 

NDA requires manufacturers to submit product-labeling language, which describes the proper use, benefits, and risks of the product in question. FDA may also require, as a condition of approval of an NDA or BLA application, that postmarketing studies be conducted to monitor and confirm the safety and efficacy of a product as it is used more widely in clinical practice. In addition, all sponsors or manufacturers are required to monitor and report adverse effects, defined as health effects that may or may not be related to the drug in question. For vaccines, adverse events that occur after immunization must be reported to the Vaccine Adverse Event Reporting System. 

Because of the problems that resulted from self-regulation, another law, the Dietary Supplement and Non-Prescription Drug Consumer Protection Act, was approved in 2006. This law requires manufacturers, packers, or distributors of supplements to submit reports of serious adverse events to the FDA. Serious adverse events are defined as death, a life-threatening event, hospitalization, a persistent or significant disability or incapacity, congenital anomaly or birth defect, or an adverse event that requires medical or surgical intervention to prevent such outcomes based on reasonable medical judgment. If this requirement were enforced, and consumers cooperated, these reports would make it possible to identify trends in adverse effects and would help to alert the public to safety issues. 

Why would genotyping tests be ordered and when The intended use of the test is usually to reduce adverse events by more precise dosing in at risk genotypes defined by the tests. Possible scenarios include a priori testing followed by tailored initial dosing in patients at-risk, e.g., patients with heart disease who need a... 

---