Un niveau élevé de protection de la santé humaine est assuré dans la définition et la mise en oeuvre de toutes les politiques et actions de l’Union européenne. L’une des politiques les plus importantes, conformément aux enjeux de santé et au développement économique, est celle des médicaments. Leur sécurité est garantie par un cadre juridique donné par une législation pharmaceutique d’envergure présidant à l’octroi de l’autorisation de mise sur le marché et au suivi post-autorisation. Ce cadre juridique est supporté par un dispositif institutionnel d’exception, caractérisé par une interaction étroite entre l’Agence européenne des médicaments, la Commission européenne et les autorités nationales compétentes. Il a récemment été réformé à travers la nouvelle législation de pharmacovigilance. Le concept de sécurité sanitaire est ainsi devenu le principe directeur de la gestion du risque pharmaceutique. Toutefois, lorsque le risque inhérent à tout produit pharmaceutique se manifeste, le dommage médicamenteux se produit ainsi que la demande de réparation. Face à la nécessité d’indemniser les victimes de tels accidents, les réponses nationales des systèmes juridiques français et italien, par les biais de la responsabilité civile de droit commun et de la responsabilité du fait des produits défectueux issue de la directive 85/374/CEE, se révèlent inefficaces, car peu respectueuses de la spécificité du médicament. Ce constat conduit à plaider en faveur d’une dissociation entre responsabilité et indemnisation, en garantissant cette dernière à travers la création d’un fonds d’indemnisation général pour les dommages médicamenteux à participation mixte public-privé. Cette solution garantit une socialisation des risques justifiée par le caractère social du risque thérapeutique. Cela constitue le contrepoids aux dangers inhérents aux innovations de la science, tout en faisant profiter les malades des bénéfices thérapeutiques de demain. En prônant une approche holistique de la politique du médicament, la proposition de ce fonds constitue un instrument d’une politique de santé publique qui ne voit dans l’indemnisation des risques médicamenteux qu’un complément et un prolongement de la garantie de sécurité à la base de la législation pharmaceutique européenne. / The definition and implementation of the European Union’s policies and activities guarantee a very high level of human health protection. One of its most important policies, in accordance with the relative health and economic development issues, is that on medicinal products. Drug safety is guaranteed by a legal framework, constructed on the pharmaceutical legislation laying down rules and procedures for obtaining marketing authorisation and for post authorisation monitoring. This legal framework is supported by a special institutional system,which in particular ensures close interaction between the European Medicines Agency, the European Commission and the national competent authorities. This legal framework has recently been revised as a result of the new pharmacovigilance legislation. As such, health safety has become a key directive in managing pharmaceutical risk. Yet, whenever a risk relating directly to a particular pharmaceutical product becomes apparent, medical damages and compensation claims arise. The response of the national French and Italian legal systems to the application for compensation of the victims of such accidents, by way of the ordinary rules of civil liability and the liability for defective products as defined in Council Directive85/374/EEC, has proven ineffective: they fail to take into account the specific nature ofpharmaceutical products. Based on this observation, there is a sound case for separating liability from compensation: the latter can be guaranteed by setting up a general compensationfund for medical damages, with both public and private sector participation. This solutionwould guarantee a socialisation of risks that is justified by the social nature of therapeutic risk. It would provide a counterbalance to the dangers inherent in scientific innovation, whilst simultaneously allowing patients to benefit from future therapeutic developments. By advocating a holistic approach to drug policy, this proposed compensation fund would act as apublic health policy instrument, in the context of which compensation for medical risks would only be considered an addition to, and extension of, the security guarantee that constitutes the cornerstone of the European pharmaceutical legislation.

Background: In paediatrics, the limited documentation to guide medication, the lack of suitable dosage forms, and the continuous development in childhood present a scenario where safety of medication is a particular challenge. Aim: To explore reported adverse drug reactions (ADRs) and the challenges in prescribing and administering medicines in paediatrics, in order to identify and suggest areas needing international surveillance within medication safety and improvement in the clinical setting. Methods: Four exploratory studies were conducted. Worldwide reporting of suspected ADRs (individual case safety reports, ICSR) with ages 0-17 years were examined overall. Twenty published case reports and ICSRs for adolescents, who developed a rare and incompletely documented ADR (rhabdomyolysis) during antipsychotic medicine use, were analysed in-depth. Prescribed doses of anti-inflammatory medicines were studied in a UK electronic health record database. Transcribed focus group interviews with 20 registered nurses from four paediatric wards in Sweden were analysed for factors that may promote or hinder safe medication practices. Descriptive statistics, multiple regression, and content analyses were used. Results: Although, skin reactions and anti-infective medicines were most frequently reported, and more reported in paediatric patients than in adults, medication errors and adverse reactions related to psychostimulant medicines were reported with increased frequency during 2005 to February 2010. The in-depth case analysis emphasised the need for increased vigilance following changes in patients’ medicine regimens, and indicated that ICSRs could contribute with clinically valuable information. Prescribed dose variations were associated with type of dosage form. Tablets and capsules were prescribed with a higher dose than liquid dosage forms. Six themes emerged from the interviews: preparation and administration was complex; medication errors caused considerable psychological burden; support from nurse colleagues was highly valued; unfamiliar medication was challenging; clear dose instructions were important; nurses handling medications needed to be accorded higher priority. Conclusions: Age-specific screening of ICSRs and the use of ICSRs to enhance knowledge of ADRs and medication errors need to be developed. Access to age-appropriate dosage forms is important when prescribing medicines to children. To improve medication safety practices in paediatric care, interdisciplinary collaborations across hospitals on national or even global levels are needed.

Le Réseau National de Vigilance et de Prévention des Pathologies Professionnelles (RNV3P) enregistre au sein d'une base nationale un résumé structuré de chaque consultation réalisée au sein des centres de consultations de pathologies professionnelles. L'objectif est de proposer et tester des méthodes avec lesquelles le RNV3P pourrait être en mesure de renforcer sa capacité de détection précoce de " pathologies professionnelles potentiellement émergentes ", définies comme étant des associations " pathologie x exposition professionnelle ", non préalablement identifiées, et qui semblent justifier d'une exploration complémentaire de part les données internes du RNV3P. Ce travail débute par une analyse des méthodes de surveillance et de détection d'évènements émergents utilisés au sein d'autres vigilances sanitaires (Partie 1). Sept méthodes de Data Mining utilisées en pharmacovigilance pour explorer les bases de notifications spontanées d'effets indésirables médicamenteux suspectés, ont été identifiées, testées et comparées. Finalement, la méthode globale retenue s'appuie sur la détection de signaux avec la méthode " Proportional Reporting Ratio " (PRR), puis leur investigation secondaire à partir de données internes mais aussi externes à la base (Partie 2). Une 2e méthode de mise en évidence d'évènements de santé émergents valorisant directement l'expertise clinique, point fort du réseau, a été formalisée (Partie 3). Enfin, les forces et limites du RNV3P ont été identifiées pour chacune des étapes entre la survenue d'un phénomène de santé émergent en santé-travail, jusqu'à sa prise en charge en termes de prévention, afin de proposer des pistes d'amélioration.

Ce travail de thèse porte sur l'estimation paramétrique du maximum de vraisemblance pour des données de survie tronquées à droite, lorsque les délais de troncature sont considérés déterministes. Il a été motivé par le problème de la modélisation des délais de survenue des effets indésirables médicamenteux à partir des bases de données de pharmacovigilance, constituées des cas notifiés. Les distributions exponentielle, de Weibull et log-logistique ont été explorées.Parfois le caractère tronqué à droite des données est ignoré et un estimateur naïf est utilisé à la place de l'estimateur pertinent. Une première étude de simulations a montré que, bien que ces deux estimateurs - naïf et basé sur la troncature à droite - puissent être positivement biaisés, le biais de l'estimateur basé sur la troncature est bien moindre que celui de l'estimateur naïf et il en va de même pour l'erreur quadratique moyenne. De plus, le biais et l'erreur quadratique moyenne de l'estimateur basé sur la troncature à droite diminuent nettement avec l'augmentation de la taille d'échantillon, ce qui n'est pas le cas de l'estimateur naïf. Les propriétés asymptotiques de l'estimateur paramétrique du maximum de vraisemblance ont été étudiées. Sous certaines conditions, suffisantes, cet estimateur est consistant et asymptotiquement normal. La matrice de covariance asymptotique a été détaillée. Quand le délai de survenue est modélisé par la loi exponentielle, une condition d'existence de l'estimation du maximum de vraisemblance, assurant ces conditions suffisantes, a été obtenue. Pour les deux autres lois, une condition d'existence de l'estimation du maximum de vraisemblance a été conjecturée.A partir des propriétés asymptotiques de cet estimateur paramétrique, les intervalles de confiance de type Wald et de la vraisemblance profilée ont été calculés. Une seconde étude de simulations a montré que la couverture des intervalles de confiance de type Wald pouvait être bien moindre que le niveau attendu en raison du biais de l'estimateur du paramètre de la distribution, d'un écart à la normalité et d'un biais de l'estimateur de la variance asymptotique. Dans ces cas-là, la couverture des intervalles de la vraisemblance profilée est meilleure.Quelques procédures d'adéquation adaptées aux données tronquées à droite ont été présentées. On distingue des procédures graphiques et des tests d'adéquation. Ces procédures permettent de vérifier l'adéquation des données aux différents modèles envisagés.Enfin, un jeu de données réelles constitué de 64 cas de lymphomes consécutifs à un traitement anti TNF-α issus de la base de pharmacovigilance française a été analysé, illustrant ainsi l'intérêt des méthodes développées. Bien que ces travaux aient été menés dans le cadre de la pharmacovigilance, les développements théoriques et les résultats des simulations peuvent être utilisés pour toute analyse rétrospective réalisée à partir d'un registre de cas, où les données sur un délai de survenue sont aussi tronquées à droite.

Background: There is a widespread and increasing use of psychoactive prescription drugs, such as opioid analgesics, anxiolytics, hypnotics and anti-epileptics, but their use is associated with a risk of drug use disorder, misuse and abuse. Today, these are globally recognized and emerging public health concerns. Aim: The aim of this thesis is to estimate the prevalence of psychoactive prescription drug (PPD) use disorders, misuse and abuse, and to investigate the association with some potential risk factors. Methods: A study using register data from forensic cause of death investigations investigated and described cases of fatal unintentional intoxication with tramadol (Study I). Based on register data on spontaneously reported adverse drug reactions (ADRs) reported cases of tramadol dependence were investigated and summarised (Study II). In a study in suspected drug-impaired drivers with a toxicology analysis confirming the intake of one out of five pre-specified PPDs, the prevalence of non-prescribed use was assessed and associated factors were investigated (Study III). From a cohort of patients initiating prescribed treatment with pregabalin, using data on prescription fills, a study investigated longitudinal utilisation patterns during five years with regards to use of the drug above the maximum approved daily dose (MAD), and factors associated with the utilisation patterns (Study IV). Results: In the first study, 17 cases of unintentional intoxications were identified, of which more concerned men, the median age was 44 years and the majority used multiple psychoactive substances (alcohol, illicit drugs and prescription drugs). The second study identified 104 spontaneously reported cases of tramadol dependence, in which more concerned women, the median age was 45 years, and a third reported a history of substance abuse and 40% of past psychoactive medication use. In the third study, more than half of the individuals suspected of drug-impaired driving used the drug without a recent prescription. Non prescribed use was most frequent in users of benzodiazepines and tramadol, and was more likely in younger individuals and in multiple-substance users. In the last paper five longitudinal utilisation patterns were found in pregabalin users, with two patterns associated with a particularly high risk of doses above the maximum approved dosing recommendation. This pattern of use was associated with male sex, younger age, non-urban residency and a recent prescribed treatment with an antiepileptic or opioid analgesic drug. Conclusions: This thesis shows that psychoactive prescription drug use disorders, misuse and abuse occur and may have serious and even fatal consequences. The prevalence varies between different drugs and populations. Abuse and misuse seem to be more common in young people. Fatal intoxications and misuse of prescribed drugs may be more common in men, while drug use disorders following prescribed treatment may be more common in women and non-prescribed use equally distributed between women and men. Individuals with a history of mental illness, substance use disorder or abuse, or of past use of psychoactive medications are likely important risk groups. In summary, the findings suggest a potential for improvements in the utilisation of psychoactive prescription drugs. The results may be useful in the planning of clinical and regulatory preventive interventions to promote the rational, individualised and safe use of such drugs.

To increase medicine safety, researchers use adverse event reports to assess causal relationships between drugs and suspected adverse reactions. VigiBase, the world's largest database of such reports, collects data from numerous sources, introducing the risk of several records referring to the same case. These duplicates negatively affect the quality of data and its analysis. Thus, efforts should be made to detect and clean them automatically.  Today, VigiBase holds more than 3.8 million COVID-19 vaccine adverse event reports, making deduplication a challenging problem for existing solutions employed in VigiBase. This thesis project explores methods for this task, explicitly focusing on records with a COVID-19 vaccine. We implement Jaccard similarity, TF-IDF, and BERT to leverage the abundance of information contained in the free-text narratives of the reports. Mean-pooling is applied to create sentence embeddings from word embeddings produced by a pre-trained SapBERT model fine-tuned to maximise the cosine similarity between narratives of duplicate reports. Narrative similarity is quantified by the cosine similarity between sentence embeddings.  We apply a Gradient Boosted Decision Tree (GBDT) model for classifying report pairs as duplicates or non-duplicates. For a more calibrated model, logistic regression fine-tunes the leaf values of the GBDT. In addition, the model successfully implements a ruleset to find reports whose narratives mention a unique identifier of its duplicate. The best performing model achieves 73.3% recall and zero false positives on a controlled testing dataset for an F1-score of 84.6%, vastly outperforming VigiBase’s previously implemented model's F1-score of 60.1%. Further, when manually annotated by three reviewers, it reached an average 87% precision when fully deduplicating 11756 reports amongst records relating to hearing disorders.

This project aims to support pharmacovigilance, the science and activities relating to drug-safety and prevention of adverse drug reactions (ADRs). We focus on a specific ADR called QT prolongation, a serious reaction affecting the heartbeat. Our main goal is to group medicinal ingredients that might cause QT prolongation. This grouping can be used in safety analysis and for exclusion lists in clinical studies. It should preferably be ranked according to level of suspected correlation. We wished to create an automated and standardised process. Drug safety-related reports describing patients' experienced ADRs and what medicinal products they have taken are collected in a database called VigiBase, that we have used as source for ingredient extraction. The ADRs are described in free-texts and coded using an international standardised terminology. This helps us to process the data and filter ingredients included in a report that describes QT prolongation. To broaden our project scope to include uncoded data, we extended the process to use free-text verbatims describing the ADR as input. By processing and filtering the free-text data and training a classification model for natural language processing released by Google on VigiBase data, we were able to predict if a free-text verbatim is describing QT prolongation. The classification resulted in an F1-score of 98%. For the ingredients extracted from VigiBase, we wanted to validate if there is a known connection to QT prolongation. The VigiBase occurrences is a parameter to consider, but it might be misleading since a report can include several drugs, and a drug can include several ingredients, making it hard to validate the cause. For validation, we used product labels connected to each ingredient of interest. We used a tool to download, scan and code product labels in order to see which ones mention QT prolongation. To rank our final list of ingredients according to level of suspected QT prolongation correlation, we used a multinomial logistic regression model. As training data, we used a data subset manually labeled by pharmacists. Used on unlabeled validation data, the model accuracy was 68%. Analyzing the training data showed that it was not easily separated linearly explaining the limited classification performance. The final ranked list of ingredients suspected to cause QT prolongation consists of 1086 ingredients.

The aim of the diploma thesis is to describe and basically analyze representative databases and digital libraries that focus on pharmaceutical disciplines. The introductory chapter is concerned with related terminology, while the following chapters refer to significant subjects and principles in the field of pharmaceutical industry, and also to important classification systems and retrieval languages that can be found in some of the described resources. The fifth chapter focuses on pharmaceutical information resources which are offered by some of the world's leading database service companies. The sixth chapter contains a description and a basic analysis of 10 representative electronic resources for pharmaceutical disciplines. The empirical section of this diploma thesis consists of three major parts. One of them is a subject coverage analysis of bibliographic databases MEDLINE and EMBASE from the viewpoint of pharmaceutical information. Secondly, it contains a presentation of an indicative survey that is related to using electronic information resources by a commercial and a nonprofit subject. The last chapter deals with information brokering that is presented on example of the Medistyl company. Keywords Pharmaceutical industry, pharmacy, pharmacovigilance, factographic databases, bibliographic...

Structured Product Labels (SPLs), the package inserts that accompany drugs governed by the Food and Drugs Administration (FDA), hold information about Adverse Drug Reactions (ADRs) that exists associated with drugs post-market. This information is valuable for actors working in the field of pharmacovigilance aiming to improve the safety of drugs. One such actor is Uppsala Monitoring Centre (UMC), a non-profit conducting pharmacovigilance research. In order to access the valuable information of the package inserts, UMC have constructed an SPL mining pipeline in order to mine SPLs for ADRs. This project aims to investigate new approaches to the solution to the Scan problem, the part of the pipeline responsible for extracting mentions of ADRs. The Scan problem is solved by approaching the problem as a Named Entity Recognition task, a subtask of Natural Language Processing. By using the transformer-based deep learning model BERT, with domain-specific pre-training, an F1-score of 0.8220 was achieved. Furthermore, the chosen model was used in an iteration of Active Learning in order to efficiently extend the available data pool with the most informative examples. Active Learning improved the F1-score to 0.8337. However, the Active Learning was benchmarked against a data set extended with random examples, showing similar improved scores, therefore this application of Active Learning could not be determined to be effective in this project.

Natural health products (NHPs) are attractive due to the public’s perception that they are natural and safe but there is wide variety of risks associated with these products. Post-market surveillance is the key to control hazards produced from NHPs. A set of activities are involved in post-market surveillance designed to assure the safety, efficacy and quality of products after being launched into the market. Although post-market surveillance is an efficient tool to preserve the safety of users from adverse reactions of NHPs but there are various challenges associated with performing post-market surveillance specifically for NHPs. This research project is focused on defining a framework for performing post-market surveillance for NHPs and on identifying best practices in its application. An international comparative analysis was undertaken to formulate best practices by reviewing existing frameworks for post-market surveillance of NHPs in Australia, Germany, New Zealand, United Kingdom and United States. Evidence-based best practices are compared with the Canadian post-market surveillance framework to identify key gaps in the Canadian system. Recommendations are provided for bridging each gap, and making the Canadian NHPs surveillance system, strong according to the international standards of best practices.