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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Pharmacol. | doi: 10.3389/fphar.2019.01031

Evaluation of information in Summaries of Product Characteristics (SmPCs) on the use of a medicine in patients with hepatic impairment

 Rianne A. Weersink1, 2*,  Lotte Timmermans1, 3,  Margje H. Monster-Simons4, 5, Peter G. Mol4, 5, Herold J. Metselaar6,  Sander D. Borgsteede2, 6 and  Katja Taxis1
  • 1University of Groningen, Netherlands
  • 2Health Base, Netherlands
  • 3KU Leuven, Belgium
  • 4Medicines Evaluation Board, Netherlands
  • 5University Medical Center Groningen, Netherlands
  • 6Erasmus Medical Center, Netherlands

Background: In 2005, the European Medicines Agency (EMA) released guidance on pharmacokinetic studies in patients with hepatic impairment. This guidance describes the design of these studies and what information should be presented in the Summary of Product Characteristics (SmPC). We aim to evaluate the availability and clinical applicability of information on medicine use in patients with hepatic impairment in SmPCs and registrational dossiers of recently approved medicines.
Methods: We reviewed SmPC information on use in patients with hepatic impairment of 51 new medicines authorized between 2015 and 2017. Per medicine, we assessed the availability of nine information items derived from the EMA guidance; i.e., type of hepatic disease studied, stratification by severity of hepatic impairment, influence of hepatic impairment on the pharmacokinetics, safety advice in mild, moderate and severe hepatic impairment and dosing recommendation in mild, moderate and severe hepatic impairment. If unavailable, the European Public Assessment Report (EPAR) and study report were consulted consecutively. Of available items, clinical applicability was assessed by labelling information as “clear” or “ambiguous”.
Results: Of 51 medicines, 15 had no pharmacokinetic study in patients with hepatic impairment described in their SmPC. The other 36 SmPCs contained on average 7 of the 9 information items (range 4-9). One SmPC contained all 9 items and after consulting the study reports 11 SmPCs were complete. The item “type of hepatic disease studied” was available in one SmPC, though could be retrieved in 21 study reports. Regarding clinical applicability, there was no medicine with all information items available and clearly formulated in the SmPC. A total of 12 medicines (33%) contained only clearly formulated information, while 24 (67%) contained at least one ambiguously formulated information item (range 0-4). Items often ambiguously formulated were: “definition of mild, moderate and severe hepatic impairment” (15 ambiguous SmPCs) and “safety advice in severe hepatic impairment” (17 ambiguous SmPCs).
Conclusion: While SmPCs contain a large part of information requested by the EMA, clinical applicability seems low as it is often unclear to which specific type of hepatic disease patient the advice applies. This can negatively influence the practical use by healthcare professionals.

Keywords: SmPC (Summary of Product Characteristics), Hepatic impairment, Medicines information, EMA guideline, Prescribing information

Received: 13 May 2019; Accepted: 12 Aug 2019.

Copyright: © 2019 Weersink, Timmermans, Monster-Simons, Mol, Metselaar, Borgsteede and Taxis. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mx. Rianne A. Weersink, University of Groningen, Groningen, Netherlands, r.a.weersink@rug.nl