An analysis of international strategies for monitoring and preventability described in medicinal product information: a study protocol

IntroductionProduct information is intended to be a reference for healthcare professionals to verify instructions for monitoring and preventability of adverse drug reactions (ADRs), among other things. International comparisons of these documents, using the Systematic Information for Monitoring (SIM) method, have highlighted discrepancies in the instructions for monitoring, but there has been no comparison of preventability instructions. ObjectivesTo quantify and compare, across different countries, the completeness of instructions for monitoring and preventability provided to healthcare professionals in medicinal product information. MethodsWe shall retrieve information included with medicinal products that have been involved in signals communicated by regulators, in 2014-2019 and based on clinical assessments of reports of ADRs, from the websites of 35 regulatory agencies. We shall evaluate the completeness of instructions for monitoring using a modified version of the SIM method; a score of 67% will qualify a monitoring instruction as sufficiently complete. To evaluate the completeness of instructions for preventability, we have derived a framework from the Dose-responsiveness-Temporality-Susceptibility (DoTS) classification of ADRs and related implications, comprising domains and items/implications. We shall iteratively develop a threshold to define the sufficiency of completeness of instructions based on data distribution across DoTS domains. We shall present descriptive statistics by country for each item of the framework and by total scores, using tables, or figures where necessary. OutcomesOur target audience is regulators, and the results should highlight gaps in the level of information available to healthcare professionals. This study may also provide some insights into how suspicions of causality that arise from clinical assessments of reports of ADRs translate into actionable recommendations in clinical practice.