1. WHO Program for International Drug Monitoring:
Global Pharmacovigilance of Biological products
Dr Malin Fladvad, Head of Production
Uppsala Monitoring Centre
WHO Collaborating Centre for International Drug Monitoring
Latin America Conference on Biotherapeutic Medicines Experience:
Sharing Experiences and Best Practices
Nov 19-20, 2013, Lima, Peru
2. UMC’s vision and main tasks
Improve worldwide patient safety and
welfare by reducing the risk of
medicines
Collect and analyse
individual case safety
reports (ICSRs)
worldwide
Communicate
potential
patient safety issues
Actively support and
provide training in
Pharmacovigilance
Develop the science
and practice of
Pharmacovigilance
Malin Fladvad, Uppsala Monitoring Centre
4. VigiBaseTM quality aspects
A combination of quantative and qualitative measures
Quantity of ICSRs
Up-to-date ICSRs
Quality of ICSRs
Each report
is valuable!
Structured
Complete
Correct
Malin Fladvad, Uppsala Monitoring Centre
5. The UMC signal detection process
National Centre
Pharma Company
VigiBaseTM
’Follow-up’
or ’Not signal’
Triage
Literature check
Potential signals
Malin Fladvad, Uppsala Monitoring Centre
Clinical assessment:
Review Panel
(or UMC)
6. Improved adverse drug interaction
signal detection
• Inclusion of clinical information and
pharmacological characteristics give clear
performance improvement over previous
methods
Identification of previously unknown risks.
Malin Fladvad, Uppsala Monitoring Centre
10. WHO Drug Dictionaries
• A source of international drug (trade) names
260 000 product namnes
2 million entries
Malin Fladvad, Uppsala Monitoring Centre
12. The WHO Drug Dictionaries holds
standardised medicinal information
• Trade name
• Active ingredient(s)
• Ma Holder
• Form
• Strength
• Country of sales
• ATC
Malin Fladvad, Uppsala Monitoring Centre
13. The WHO Drug Dictionaries
CRT
Japan
WHO
DD DRL
WHO
DDE+
HD
Malin Fladvad, Uppsala Monitoring Centre
WHO
DDE
DDC
SDGs
14. Product types in the WHO Drug
Dictionaries
– Conventional drugs (Arinate, Cetamol)
– Biologicals (monoclonal antibodies,
biosimilars, blood products, vaccines etc)
– Herbal products
– Chemotherapy regimens
– Radiopharmaceutical diagnostics
– Generic products
– Substance and substance synonyms
Malin Fladvad, Uppsala Monitoring Centre
15. Coding using the WHO Drug
Dictionaries
Mabthera
Rituxan
Kikuzubam
Rituximab
Reditux
Tidecron
Malin Fladvad, Uppsala Monitoring Centre
16. The added value of WHO Drug
Dictionaries
Reditux
Rituxan
Mabthera
Kikuzubam
Rituximab
Malin Fladvad, Uppsala Monitoring Centre
Tidecron
17. WHO Drug Dictionary structure
using current WHO Policy (INN)
Reference
product
Biosimilar
Reference
product
Biosimilar
Active
substance,
Malin Fladvad, Uppsala Monitoring Centre
18. Some Biosimilars have the same
nonproprietary name as reference
product
No discrimination between Reference
product and Biosimilar when only drug
substance is reported
– Signal analysis
– Coding concomittant medication in clinical
trials.
Reference
Biosimilar
product
Reference
product
Biosimilar
Active
substance,
Malin Fladvad, Uppsala Monitoring Centre
19. ICSR Reports on biotherapeutics
in VigibaseTM
Drug group
Number of ICSR
Biotherapeutics
1 531 822
All
8 480 965
Malin Fladvad, Uppsala Monitoring Centre
20. ICSR per year reported on
biotherapeutics with biosimilars in
VigibaseTM
60000
50000
40000
30000
20000
10000
0
Malin Fladvad, Uppsala Monitoring Centre
Rituximab
Etanercept
Somatropin
Filgrastim
Infliximab
21. ICSR per regional area reported on
biotherapeutics with biosimilars in
VigibaseTM
250000
200000
Rituximab
Etanercept
Somatropin
Filgrastim
Infliximab
150000
100000
50000
0
Africa
Malin Fladvad, Uppsala Monitoring Centre
Latin
America
North
America
Asia
Europe
Oceania
22. Product classification
Timeline
Innovation 1
Later innovation Loss of exclusivity Further innovation
Reference
product
NonReferenced
product
Biosimilar
Malin Fladvad, Uppsala Monitoring Centre
Patent
protected
product
23. ICSR reported on biotherapeutics
with biosimilars in VigibaseTM
100%
80%
Biosimilar
60%
Non-Ref product
Ref product
40%
Active substance
20%
0%
Rituximab
Malin Fladvad, Uppsala Monitoring Centre
Etanercept Somatropin
Filgrastim
Infliximab
24. ICSR reported on biotherapeutics
with biosimilars in VigibaseTM
60000
50000
40000
30000
20000
10000
0
Malin Fladvad, Uppsala Monitoring Centre
Drug substance
Trade name
Rituximab
Etanercept
Somatropin
Filgrastim
Infliximab
25. Reasons for underreporting
•
•
•
•
•
•
•
•
•
•
Lack of information
Lack of understanding
Lack of time
Lack of routines
ADR already known
Uncertain causality
Failure to recognize ADR
Patient confidentiality concern
Fear of legal liability
Forgetfulness
Malin Fladvad, Uppsala Monitoring Centre
26. Thank you for your attention!
malin.fladvad@who-umc.org
Malin Fladvad, Uppsala Monitoring Centre