Use of case reports and the Adverse Event Reporting System in systematic reviews: overcoming barriers to assess the link between Crohn's disease medications and hepatosplenic T-cell lymphoma

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dc.contributor.authorSelvaraj, Saranya A.
dc.contributor.authorChairez, Elizabeth
dc.contributor.authorWilson, Lisa M.
dc.contributor.authorLazarev, Mark
dc.contributor.authorBass, Eric B.
dc.contributor.authorHutfless, Susan
dc.date.accessioned2015-02-25T20:17:58Z
dc.date.available2015-02-25T20:17:58Z
dc.date.issued2013-07-05
dc.descriptionPMCID: PMC3710465en_US
dc.description.abstractBACKGROUND: To identify demographic and clinical characteristics associated with cases of hepatosplenic T-cell lymphoma (HSTCL) in patients with Crohn's disease, and to assess strength of evidence for a causal relationship between medications and HSTCL in Crohn's disease. METHODS: We identified cases of HSTCL in Crohn's disease in studies included in a comparative effectiveness review of Crohn's disease medications, through a separate search of PubMed and Embase for published case reports, and from the Food and Drug Administration (FDA) Adverse Event Reporting System (AERS). We used three causality assessment tools to evaluate the relationship between medication exposure and HSTCL. RESULTS: We found 37 unique cases of HSTCL in patients with Crohn's disease. Six cases were unique to the published literature and nine were unique to AERS. Cases were typically young (<40 years of age) and male (86%). The most commonly reported medications were anti-metabolites (97%) and anti-tumor necrosis factor alpha (anti-TNFa) medications (76%). Dose and duration of therapy were not consistently reported. Use of aminosalicylates and corticosteroids were rarely reported, despite the high prevalence of these medications in routine treatment. Using the causality assessment tools, it could only be determined that anti-metabolite and anti-TNFa therapies were possible causes of HSTCL in Crohn's disease based on the data contained in the case reports. CONCLUSION: Systematic reviews that incorporate case reports of rare lethal events should search both published literature and AERS, but consideration should be given to the limitations of case reports. In this study, establishing a causative effect other than 'possible' between anti-metabolite or anti-TNFa therapies and HSTCL was not feasible because case reports lacked data required by the causality assessments, and because of the limited applicability of causality assessment tools for rare irreversible events. We recommend minimum reporting requirements for case reports to improve causality assessment and routine reporting of rare life-threatening events, including their absence, in clinical trials to help clinicians determine whether rare adverse events are causally related to a medication.en_US
dc.description.sponsorshipJH Libraries Open Access Funden_US
dc.identifier.citationdoi: 10.1186/2046-4053-2-53en_US
dc.identifier.issn2046-4053
dc.identifier.urihttp://jhir.library.jhu.edu/handle/1774.2/37330
dc.language.isoen_USen_US
dc.publisherBioMed Centralen_US
dc.relation.ispartofseriesSystematic Reviews;v. 2 p.53
dc.subjectTumor Necrosis Factor-alphaen_US
dc.subjectSplenic Neoplasmsen_US
dc.subjectLymphoma, T-Cellen_US
dc.subjectLiver Neoplasmsen_US
dc.subjectGastrointestinal Agentsen_US
dc.subjectCrohn Diseaseen_US
dc.subjectAntimetabolitesen_US
dc.titleUse of case reports and the Adverse Event Reporting System in systematic reviews: overcoming barriers to assess the link between Crohn's disease medications and hepatosplenic T-cell lymphomaen_US
dc.typeArticleen_US
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