How To Create A Pediatric Health Care Database In The European Union
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- Mary McDonald
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1 GRiP Global Research in Paediatrics Pediatric Pharmacoepidemiology Platform Miriam Sturkenboom, Erasmus University Jan Bonhoeffer, Brighton Collaboration Foundation On behalf of the GRiP Network of Excellence
2 ENCePP DB sites with pediatric data Enpr-EMA The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/ ) under grant agreement n
3 Objectives WP 2 To develop an integrated electronic infrastructure for pediatric (pharmaco)epidemiological research This infrastructure will exploit and link existing healthcare databases around the world to assess the occurrence of diseases in children, plus the use and effects of drugs (including vaccines) on a large scale. Methodologies for harmonization, data exchange across national boundaries (including ethical and governance issues), data mining and comparative safety and effectiveness studies will be developed and tested The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/ ) under grant agreement n
4 What is the current status regarding evidence on effects of drugs in pediatrics? Many complaints about lack of data in pediatrics Many studies showing the off-label use of drugs in children Several pediatric regulations/initiatives to boost trials in children in the beginning of 2000 (FDA/EMA/WHO) Pediatric drug safety still often the cause for regulatory action (in for 28 medicines or drug classes safety warnings (Clavenna A et al. Archives of disease in childhood. Sep 2009;94(9): ) Postmarketing data need to be utilized, as many children are exposed very day and this information should be utilized. No single database has enough power to study serious safety issues in children. E.g. EU-ADR: 4.8 million children/adolescents across 7 databases in 4 countries, 25 Million PY Total 2,170 drugs prescribed / dispensed Anaphylactic shock (3/100,000): only for 8 drugs power to demonstrate RR>4 UGIB (10/100,000) only for 39 drugs power to demonstrate RR> 4 The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/ ) under grant agreement n
5 WP 2 Vision relevant to ENCePP TO BUILD a SUSTAINABLE & TESTED GLOBAL PLATFORM TO IMPROVE INFORMATION ON THE USE & EFFECTS OF DRUGS IN CHILDREN
6 Key Products WP 2 1) A technical operational research infrastructure for collaborative data sharing / analysis accessible around the world 2) A catalogue of databases with contact and meta-data on pediatric patients that can be approached for collaborative pharmacoepidemiological studies 3) Description of ethical and governance issues related to secondary use of health care data across the world 4) Description of paediatric spontaneous reports in WHO- VIGIBASE, EUDRAVIGILANCE, AERS and VAERS 5) Catalogue of disease codes for different pediatric events to be extracted in SRS and EHR databases The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/ ) under grant agreement n
7 Key Products WP 2 6) Reference set of positive and negative controls for signal detection to be used (vaccines/drugs) 7) Tested methods for Signal detection in pediatrics (SRS/EHR) and a comparison between databases and methods, together with EMA, PROTECT & OMOP 8) Templates and global proof of concept studies on drug/vaccine use, disease incidence, drug safety and effectiveness 9) Pediatric pharmacoepidemiology courses (e-learning) The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/ ) under grant agreement n
8 Some outputs.. so far
9 Platform for data-sharing (Octopus) Functional platform in ARITMO, SAFEGUARD, GRIP Shared aggregated data within firewalls Remote access to work together and analyse and rotate coordinator ship The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/ ) under grant agreement n
10 Description of available spontaneous reports (EUDRAVIGILANCE being analysed) Vigibase AERS VAERS Overall [1968-Feb2010] [ ] [ ] Age group N [%] N [%] N [%] N [%] 0-27 days 6,142 [2.3] 4,717 [4.4] - 10,859 [2.0] 28 days - 23 months 38,205 [14.2] 16,096 [15.2] 80,760 [46.2] 135,061 [24.6] 2-11 years 124,321 [46.4] 47,248 [44.5] 68,726 [39.3] 240,295 [43.8] years 99,477 [37.1] 38,061 [35.9] 25,463 [14.6] 163,001 [29.7] Total 268,145 [100.0] 106,122 [100.0] 174,949 [100.0] 549,216 [100.0] The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/ ) under grant agreement n
11 Catalogue of databases to identify pediatric data globally Databases are contacted and requested to fill out an online survey The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/ ) under grant agreement n
12 Results of the survey N. of responders= 46 (35% of 130 DB contacted) only 20 from EU Do you agree to be involved in the GRiP project? 11% 4% 22% yes (29) no (5) no answer (2) not completed or not displayed (10) 63% FDA will make SENTINEL available as well for studies The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/ ) under grant agreement n
13 DBs in EU participating ENCEPP sites 1 GB 21 ES 17 IT 16 FR 15 DE 12 NL 9 PT 7 DK 6 CH 5 FI 4 BE 3 SE 3 GR 2 IE 2 AT 1 NO 1 RO 1 SK 1 The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/ ) under grant agreement n
14 Invitation to ENCePP sites Participate in GRiP What to do? 1) Complete the survey if you have access to population-based data on drug/vaccine use / outcomes comprising children 2) Participate in proof of concept studies What do you get? 1) Get access to the OCTOPUS platform to initiate & perform studies 2) Publish together & boost the field of pediatrics 3) Find your partners for collaborative studies in pediatrics around the world The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/ ) under grant agreement n
15 First proof of concept study proposal for collaboration Use & quality of prescribing of antibiotics in children globally ARPEC project (Mike Sharland): large differences in annual prevalence of use The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/ ) under grant agreement n
16 How to participate? Indicate your interest Requirements: Access to prescription database & population database Creation of two standardized input files locally population: identifier, start follow-up, end follow-up, date of birth, sex Prescriptions: identifier, date, ATC code, duration Run JAVA or SAS script locally and share output table on RRE (in excel) Get token for RRE access Analyse/discuss /publish together with your colleagues The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/ ) under grant agreement n
17 What is being shared on RRE? ATC7 AgeRange Year Month PersonDays PersonDays_ PersonDays_BExposedI ExposedInNewUsePrescript Prevalence (p Incidence (pe Mean duration J01CR02 age J01CR02 age J01CR02 age J01CR02 age J01CR02 age J01CR02 age J01CR02 age J01CR02 age J01CR02 age J01CR02 age G02CB03 age The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/ ) under grant agreement n
18 Summary GRiP will provide a platform to work together ENCePP sites not yet well represented, whereas large USA sites will participate Opportunity to start working together (proof of concept) on a very relevant topic The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/ ) under grant agreement n
19 Participants WP 2 Major contributors EMC (Miriam Sturkenboom) BF (Jan Bonhoeffer) AOPD (Carlo Giaquinto) CVBFTEDDY (A. Ceci) BIOEF (Adolf Valls-i-Soler) WHO (Krisanta Weereasuriya) FDA P-95 Minor contributors NICHD-NIH (S Hirschfeld) EMA (Agnes Saint Raymond) ULIV-MCRN (M. Turner) INSERM (E. Jacqz-Aigrain) NCCHD (Hidefumi Nakamura) SGUL (M. Sharland) AMC (M. Offringa) SoP (I Wong) HUS (K Hoppu) 19
20 Interested? The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/ ) under grant agreement n
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