title: Adverse drug reactions - examples of detection of rare events using databases.
abstract: It is recognised that randomised controlled trials are not feasible for capturing rare adverse events. There is an increasing trend towards observational research methodologies using large population-based health databases. These databases offer more scope for adequate sample sizes, allowing for comprehensive patient characterisation and assessment of the associated factors. While direct causality cannot be established and confounders cannot be ignored, databases present an opportunity to explore and quantify rare events. The use of databases for the detection of rare adverse events in the following conditions, sudden death associated with attention deficit hyperactivity disorder (ADHD) treatment, retinal detachment associated with the use of fluoroquinolones and toxic epidermal necrolysis associated with drug exposure, are discussed as examples. In general, rare adverse events tend to have immediate and important clinical implications and may be life-threatening. An understanding of the causative factors is therefore important, in addition to the research methodologies and database platforms that enable the undertaking of the research.
authors: Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
authors: Esther W
authors: EW
authors: Chan
authors: Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
authors: Kirin Q L
authors: KQ
authors: Liu
authors: Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
authors: Celine S L
authors: CS
authors: Chui
authors: Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
authors: Chor-Wing
authors: CW
authors: Sing
authors: Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
authors: Lisa Y L
authors: LY
authors: Wong
authors: Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
authors: Ian C K
authors: IC
authors: Wong
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000401:mortality*; D016208:Databases, Factual; D003645:Death, Sudden / Q000453:epidemiology*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology* / Q000401:mortality; D024841:Fluoroquinolones / Q000009:adverse effects*; D006801:Humans; D012163:Retinal Detachment / Q000139:chemically induced / Q000453:epidemiology*; D013262:Stevens-Johnson Syndrome / Q000453:epidemiology*
chemical_list: D024841:Fluoroquinolones
keywords: adverse drug reactions; attention deficit hyperactivity disorder; database; retinal detachment; sudden death; toxic epidermal necrolysis (TEN)