6533b826fe1ef96bd1284d64

RESEARCH PRODUCT

Intérêt des méthodes alternatives dans l’évaluation du médicament dans les populations particulières

subject

description

Well conducted randomized clinical trial is considered gold standard in drug safety and efficacy evaluation. Drug development can be challenging in rare diseases, or in ethically sensitive populations (pregnant women, children, patient with cognitive defect), because of low number of subjects. The low rate of observed events at a sample scale in this population can lead to a biased evaluation of drugs compared to the general population. The aim of this work was to address alternative methods for drug evaluation in particular populations, especially pharmaco-epidemiology on populational database of the SNDS (Système National des Données de Santé). We first evaluate the safety of anti-TNFα in French pregnant women with a diagnosis of Inflammatory Bowel Disease (IBD), and in their children during their first year of life, using the SNDS database. Anti-TNFα use was associated with an increased risk of overall maternal complications during pregnancy, whatever the duration of treatment. There was no increased risk in children up to 1 year of age. In this same cohort, we then studies the security of recommended vaccines during the first year of life in children exposed in utero to antiTNF, and born to mothers with IBD. No adverse event related to tuberculosis or measles was observed. Those results demonstrate the value of alternative methods as useful tools for drug evaluation, and can strengthen the quality of clinical recommendations, in populations where clinical trial cannot be considered.