title: Safety monitoring of drugs receiving pediatric marketing exclusivity.
abstract: OBJECTIVE
  The Food and Drug Administration Modernization Act provided for an additional 6-month period of marketing exclusivity to companies that perform pediatric drug trials in response to a Food and Drug Administration-issued written request. Because many safety concerns cannot be detected until after the introduction of a product to a larger and more diverse market, the Best Pharmaceuticals for Children Act required the Food and Drug Administration to report to the Pediatric Advisory Committee on adverse events occurring during the 1-year period after granting pediatric exclusivity. We sought to describe the Pediatric Advisory Committee's recommendations made in response to safety reviews informed by data from the Food and Drug Administration Adverse Event Reporting System in 67 drugs granted exclusivity.
  
  
  METHODS
  Pediatric Advisory Committee meetings and data presented by the Food and Drug Administration for all drugs were reviewed from June 2003 through April 2007. We divided the drugs into 2 groups: those that were returned to routine adverse event monitoring and those that had specific Pediatric Advisory Committee recommendations.
  
  
  RESULTS
  Forty-four (65.7%) drugs were returned to routine monitoring for adverse events. The Pediatric Advisory Committee, sometimes working with other advisory committees, recommended label changes for 12 (17.9%) drugs, continued monitoring for 10 (14.9%), production of MedGuides for 9 (13.4%), and an update on label changes resulting from discussions with the sponsor for 1 (1.5%) drug. Some drugs had >1 action. Several of the adverse events revealed during this process were rare and life-threatening.
  
  
  CONCLUSIONS
  Safety monitoring during the early postmarketing period is crucial to detect rare, serious, or pediatric-specific adverse events. Fortunately, the majority of drugs given exclusivity had no adverse events of a frequency or severity that prevented a return to routine adverse event monitoring.
authors.affiliation: MHS, Duke University Medical Center, Box 3179, Durham, NC 27710, USA. brian.smith@duke.edu
authors.forename: P Brian
authors.initials: PB
authors.lastname: Smith
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Benjamin
authors.forename: M Dianne
authors.initials: MD
authors.lastname: Murphy
authors.forename: Rosemary
authors.initials: R
authors.lastname: Johann-Liang
authors.forename: Solomon
authors.initials: S
authors.lastname: Iyasu
authors.forename: Barbara
authors.initials: B
authors.lastname: Gould
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Li
authors.forename: William
authors.initials: W
authors.lastname: Rodriguez