Conducting protocol-based assessments in the Mini-Sentinel pilot - PowerPoint PPT Presentation

Conducting protocol-based assessments in the Mini-Sentinel pilot Process & Lessons learned Darren Toh, ScD Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute On behalf of the Mini-Sentinel angioedema workgroup January 31, 2013 1

Mini-Sentinel angioedema workgroup Name Affiliation Role Marsha Reichman OSE/CDER/FDA Co-Lead Monika Houstoun OSE/CDER/FDA Co-Lead Sean Hennessy University of Pennsylvania Co-Lead Darren Toh Harvard Pilgrim Health Care Institute Co-Lead Xiao Ding OTS/CDER/FDA Member Adrian Hernandez Duke University School of Medicine Member Mark Levenson OTS/CDER/FDA Member Lingling Li Harvard Pilgrim Health Care Institute Member Carolyn McCloskey OSE/CDER/FDA Member Azadeh Shoaibi OMP/CDERFDA Member Mary Ross Southworth OND/CDER/FDA Member Eileen Wu OSE/CDER/FDA Member Gwen Zornberg OSE/CDER/FDA Member 2

Overarching goals of the project  To assess selected drug-event associations • Drugs targeting renin-angiotensin-aldosterone system & angioedema  To build general strategies for safety assessments of medical products on the market for >2 years  NOT designed to provide definitive evidence of a causal relation 3

Mini-Sentinel partner organizations Institute for Health, Health Care Policy & Aging Research 4

Process to conducting a MS protocol-based assessment FDA identifies topic Operations Center issues a workgroup opportunity Workgroup develops a protocol, invites public comment via MS website. Final version posted. Workgroup implements the protocol Workgroup prepares final report & posts it on website 5

Mini-Sentinel distributed analysis Mini-Sentinel Operations Center 1 Workgroup creates and submits query (a 6 1 computer program) Mini-Sentinel Secure Network Portal 2 Data partners retrieve Data Partner 1 the query Review & Review & Return Run Query Results 3 Data partners review 5 3 2 and run query against 4 Enrollment Demographics their local data Utilization Pharmacy Etc 4 Data partners review results Data Partner N 5 Data partners return Review & Review & Return results via secure Run Query Results network 3 4 Enrollment Demographics 6 Results are aggregated Utilization and returned Pharmacy Etc 6

Cohort creation Total population in Mini- Sentinel as July 2011 ~99,000,000 Applying eligibility criteria (age, medical history, etc) ACEIs ARBs Aliskiren 1,845,138 467,313 4,867 7

Cohort creation Total population in Mini- Sentinel as July 2011 ~99,000,000 Applying eligibility criteria (age, medical history, etc) ACEIs ARBs Aliskiren ß-blockers 1,845,138 467,313 4,867 1,592,278 8

Statistical analysis  Propensity score approach • Condensing information from a large number of variables into a non-identifiable measure  Case-centered approach and meta-analysis • Needing only aggregated data to complete the analysis 9

Timeline Draft final report Analysis complete 1 st workplan sent Protocol finalized Kick-off meeting Mar 11 Aug 11 Sep 11 Jan 12 Feb 12 Total time from start to completion: ~11 months 10

Results 8.0 Mini-Sentinel Literature Adjusted relative risk 4.0 2.0 1.0 ACEIs ARBs Aliskiren 0.5 * Beta-blockers as the common reference group Toh et al, Arch Intern Med 2012;172:1582-1589 11

Results 8.0 Mini-Sentinel Literature Adjusted relative risk 4.0 2.0 1.0 ACEIs ARBs Aliskiren 0.5 * Beta-blockers as the common reference group Toh et al, Arch Intern Med 2012;172:1582-1589 12

Results 8.0 Mini-Sentinel Literature Adjusted relative risk 4.0 2.0 1.0 ACEIs ARBs Aliskiren 0.5 * Beta-blockers as the common reference group Toh et al, Arch Intern Med 2012;172:1582-1589 13

More results can be found here  Report: http://www.mini- sentinel.org/work_products/Assessments/Mini- Sentinel_Angioedema-and-RAAS_Final-Report.pdf  Manuscript: http://archinte.jamanetwork.com/article.aspx?articleid=139 1058#qundefined  Presentation: http://www.brookings.edu/events/2012/10/16-medical- product-assessment-webinar 14

Summary of overarching goal #1  Largest assessment on this topic to date  Replicated known ACEIs–angioedema association • With much more precise risk estimates  Provided new information on angioedema risk for • Aliskiren (caveat: based on 7 exposed cases) • ARBs 15

Summary of overarching goal #2  Developed a time and cost efficient process to perform medical product safety assessments within a large distributed data system  Developed analytic strategies to perform robust statistical analysis without sharing identifiable information 16

Thank you 17