Types, frequencies, and burden of nonspecific adverse events of drugs: analysis of randomized placebo-controlled clinical trials.
OBJECTIVE
Scarce studies analyzing adverse event (AE) data from randomized placebo-controlled clinical trials (RPCCTs) of selected illnesses suggested that a substantial proportion of collected AEs are unrelated to the drug taken. This study analyzed the nonspecific AEs occurring with active-drug exposure in RPCCTs for a large range of medical conditions.


METHODS
Randomized placebo-controlled clinical trials published in five prominent medical journals during 2006-2012 were searched. Only trials that evaluated orally or parenterally administered active drugs versus placebo in a head-to-head setting were selected. For AEs reported from ≥10 RPCCTs, Pearson's correlation coefficients (r) were calculated to determine the relationship between AE rates in placebo and active-drug recipients. Random-effects meta-analyses were used to compute proportions of nonspecific AEs, which were truncated at a maximum of 100%, in active-drug recipients.


RESULTS
We included 231 trials addressing various medical domains or healthy participants. For the 88 analyzed AE variables, AE rates for placebo and active-drug recipients were in general strongly correlated (r > 0.50) or very strongly correlated (r > 0.80). The pooled proportions of nonspecific AEs for the active-drug recipients were 96.8% (95%CI: 95.5-98.1) for any AEs, 100% (97.9-100) for serious AEs, and 77.7% (72.7-83.2) for drug-related AEs. Results were similar for individual medical domains and healthy participants. The pooled proportion of nonspecificity of 82 system organ class and individual AE types ranged from 38% to 100%.


CONCLUSIONS
The large proportion of nonspecific AEs reported in active-drug recipients of RPCCTs, including serious and drug-related AEs, highlights the limitations of clinical trial data to determine the tolerability of drugs. Copyright © 2017 John Wiley & Sons, Ltd.
Department of Internal Medicine, Hospital Saint-Louis, University Paris Diderot, Paris, France.|ECSTRA Team, Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center UMR 1153, Inserm, Paris, France.
Alfred
A
Mahr
Department of Internal Medicine, Hospital Saint-Louis, University Paris Diderot, Paris, France.
Clara
C
Golmard
Pharmacy Department, Hospital Saint-Louis, University Paris Diderot, Paris, France.
Emilie
E
Pham
Department of Internal Medicine, Hospital Saint-Louis, University Paris Diderot, Paris, France.
Laura
L
Iordache
Pharmacy Department, Hospital Saint-Louis, University Paris Diderot, Paris, France.
Laure
L
Deville
Pharmacy Department, Hospital Saint-Louis, University Paris Diderot, Paris, France.
Pierre
P
Faure
D064420:Drug-Related Side Effects and Adverse Reactions / Q000145:classification*; D006801:Humans; D010919:Placebos / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic
D010919:Placebos
adverse drug reaction; adverse events; nocebo; pharmacoepidemiology; placebo; randomized controlled trial