Agreement of Label Information of Antihistamine, Anti-allergy Medications in Pregnancy among Korea, the USA, the UK, and Japan

임신부에서 항히스타민제와 알레르기용약의 국가별 안전정보 일치도 분석 : 한국, 미국, 영국, 일본 허가사항을 중심으로

  • Park, Mi-Ju (Korea Institute of Drug Safety and Risk Management) ;
  • Shin, Ju-Young (Korea Institute of Drug Safety and Risk Management) ;
  • Kim, Hong-Ah (Korea Institute of Drug Safety and Risk Management) ;
  • Park, Hyo-Ju (Korea Institute of Drug Safety and Risk Management) ;
  • Kim, Mi-Hee (Korea Institute of Drug Safety and Risk Management) ;
  • Shin, Sun-Mi (Korea Institute of Drug Safety and Risk Management) ;
  • Park, Byung-Joo (Korea Institute of Drug Safety and Risk Management)
  • Received : 2013.09.10
  • Accepted : 2013.12.18
  • Published : 2013.12.31

Abstract

Background: Antihistamine and anti-allergy medications are widely used during pregnancy. Reading label information is one of the easiest ways to get safety information. But there are content gaps among countries. Objective: To compare the risk level and the recommendation level of antihistamine/anti-allergy drug's label information in pregnant women among Korea, the USA, the UK, and Japan. Method: Study drugs of antihistamine/anti-allergy medications were selected according to Korea drug classification codes. Based on the label information of selected product, risk level was classified into 5 categories as follows: 'Definite', 'Probable', 'Possible', and 'Unlikely', 'Unclassified' according to the level of evidence. Recommendation level was classified into 4 categories as follows: 'Contraindicated', 'Cautious', 'Compatible', and 'Unclassified'. Frequency and proportion were presented according to the each category. To estimate agreement of each category among 4 countries, percent agreement and kappa (k) coefficient were calculated. Results: Total 13 drug ingredients were selected for antihistamine/anti-allergy medications. In risk level, Korea (46%) and Japan (69%) were mostly classified in the category of 'Unclassified', but 'Unlikely' category was more frequent in the UK (62%) and the USA (46%). In recommendation level, the proportion of 'Contraindicated' was highest in Korea (46%) compared to other countries. In contrast, the category of 'Cautious' was 77%-85% in the USA, the UK, and Japan. The percent agreement for risk level was highest in the USA-UK (54%). The recommendation level of Korea-USA showed lowest agreement for percent agreement (46%) and kappa coefficient (k=0.02). Conclusion: We confirmed the differences among safety information provided by four different countries. 'Contraindicated' was more likely in Korea compared with other countries.

Keywords

References

  1. Kim MJ, Kim SB, Jang JH, et al. Information book about proper use of medicines for pregnant women for expert. Seoul: Korea Food & Drug Administration, 2010.
  2. Andrade SE, Gurwitz JH, Davis RL, et al. Prescription drug use in pregnancy. Am J Obstet Gynecol 2004; 191: 398-407. https://doi.org/10.1016/j.ajog.2004.04.025
  3. Rubin JD, Ferencz C, Loffredo C. Use of prescription and non-prescription drugs in pregnancy. J Clin Epidemiol 1993; 46: 581-9. https://doi.org/10.1016/0895-4356(93)90132-K
  4. Jung HY, Yu BK, Jo YJ, et al. Drug utilization monitoring for pregnancy, In; Lee GS. Drug utilization monitoring for fragil population, specific impaired patients, contraindicated drug combinations, age-limited drugs and drugs with narrow therapeutic index. Korea Food & Drug Administration, 2007: 399-497.
  5. Reggi V, Balocco-Mattavelli R, Bonati M, et al. Prescribing information in 26 countries: a comparative study. Eur J Clin Pharmacol 2003; 59: 263-70. https://doi.org/10.1007/s00228-003-0607-1
  6. Shimazawa R, Ikeda M. Safety information in drug labeling: a comparison of the USA, the UK, and Japan. Pharmacoepidemiol Drug Saf 2013; 22: 306-18. https://doi.org/10.1002/pds.3408
  7. WHO-ATC. available at http://www.whocc.no/atc_ddd_index/. accessed on April 12, 2013.
  8. KIMS. available at http://www.kimsonline.co.kr/001_Detail/effectrefclasslist.aspx. accessed on April 12, 2013.
  9. EZdrug. available at http://ezdrug.kfda.go.kr/index.jsp.accessed on April 12, 2013.
  10. Malinowski HJ, Westelinck A, Sato J, et al. Same drug, different dosing: differences in dosing for drugs approved in the United States, Europe, and Japan. J Clin Pharmacol 2008; 48: 900-8. https://doi.org/10.1177/0091270008319794
  11. Arnold F, Kusama M, Ono S. Exploring differences in drug doses between Japan and western countries. J Clin Pharm Ther 2010; 87: 714-20. https://doi.org/10.1038/clpt.2010.31
  12. Drugs@FDA. available at http://www.fda.gov/Drugs/default.htm accessed on May 22, 2013.
  13. Dailymed. available at http://dailymed.nlm.nih.gov/dailymed/about.cfm. accessed on May 22, 2013.
  14. EMC. available at http://www.medicines.org.uk/emc/. accessed on May 22, 2013.
  15. PMDA. available at http://www.info.pmda.go.jp/.accessed on May 22, 2013.
  16. Weblio. available at http://ejje.weblio.jp/. accessed on May 22, 2013.
  17. Sackett DL, Straus SE, Richardson WS, et al. Evidencebased medicine: how to practice and teach EBM, 2nd edition. Edinburgh: Churchill Livingstone, 2000.
  18. Widnes SKF, Schjott J. Advice on drug safety in pregnancy. Drug Safety 2008; 31: 799-806. https://doi.org/10.2165/00002018-200831090-00008
  19. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977: 159-74.
  20. Seto A, Einarson T, Koren G. Pregnancy outcome following first trimester exposure to antihistamines: meta-analysis. Am J Perinatol 1997; 14: 119-24. https://doi.org/10.1055/s-2007-994110
  21. ACOG (American College of Obstetrics and Gynecology) practice bulletin: nausea and vomiting of pregnancy. Obstet Gynecol 2004; 103: 803-15. https://doi.org/10.1097/00006250-200404000-00045
  22. Kim KO. Nausea and vomiting in pregnancy. Korean J Med 2012;82:525-31. https://doi.org/10.3904/kjm.2012.82.5.525
  23. Keles N. Treatment of allergic rhinitis during pregnancy. Am J Rhinol 2004; 18: 23-8.
  24. ACOG (American College of Obstetrics and Gynecology) practice bulletin: asthma in pregnancy. Obstet Gynecol 2008; 111: 457-64. https://doi.org/10.1097/AOG.0b013e3181665ff4
  25. Tan KS, Thomson NC. Asthma in pregnancy. Am J Med 2000; 109: 727-33. https://doi.org/10.1016/S0002-9343(00)00615-X
  26. Lee YS, Lee JS, Lee SH. Analysis of drug interaction information. Kor J Clin Pharm 2009; 19: 1-17.
  27. Bergk V, Haefeli WE, Gasse C, et al. Information deficits in the summary of product characteristics preclude an optimal management of drug interactions: a comparison with evidence from the literature. Eur J Clin Pharmacol 2005; 61: 327-35. https://doi.org/10.1007/s00228-005-0943-4
  28. Drug approval regulation of Ministry of Food and Drug Safety. updated April 5, 2013. available at http://www.mfds.go.kr/index.do?mid=1013&pageNo=1&seq= 7247&cmd=v.
  29. Warnings and precautions, contraindications, and boxed Warning sections of labeling for human prescription drug and biological products - content and format. updated October 11, 2011. available at http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ucm065010.htm.
  30. Werler MM, Mitchell AA, Hernandez-Diaz S, et al. Use of over-the-counter medications during pregnancy. Am J Obstet Gynecol 2005; 193 :771-7. https://doi.org/10.1016/j.ajog.2005.02.100