A systematic, concept‐based method of developing the exposure measure for drug safety and effectiveness studies

• Published in: Pharmacoepidemiology and drug safety Vol. 31; no. 1; pp. 13 - 21
• Main Authors: Kuramoto, Lisa K., Sobolev, Boris G., Rosner, Jan, Brasher, Penelope M. A., Azoulay, Laurent, Cragg, Jacquelyn J.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Inc 01.01.2022; Wiley Subscription Services, Inc
• Subjects: drug evaluation; drug utilization; Effectiveness studies; Humans; Hyperplasia; Male; Movement disorders; Neurodegenerative diseases; Parkinson disease; Parkinson's disease; Pharmaceutical Preparations; Pharmacoepidemiology; Pharmacovigilance; Product safety; Prostate; Prostatic Hyperplasia; Research Design; Safety; Statistical analysis; Tamsulosin; Parkinson disease; drug utilization; drug evaluation; pharmacoepidemiology
• ISSN: 1053-8569; 1099-1557; 1099-1557
• DOI: 10.1002/pds.5372

Purpose In drug safety and effectiveness studies based on secondary data, the choice of an appropriate exposure measure for a given outcome can be challenging. Different measures of exposure can yield different estimates of treatment effect and safety. There is a knowledge gap with respect to developing and refining measures of drug exposure, to ensure that the exposure measure addresses the study question and is suitable for statistical analysis. Methods We present a transparent, step‐by‐step approach to the development of drug exposure measures involving secondary data. This approach would be of interest to students and investigators with initial training in pharmacoepidemiology. We illustrate the approach using a study about Parkinson's disease. Results We described the exposure specifications according to the study question. Next, we refined the exposure measure by linking it to knowledge about four major concepts in drug safety and effectiveness studies: drug use patterns, duration, timing, and dose. We then used this knowledge to guide the ultimate choice of exposure measure: time‐varying, cumulative 6‐month exposure to tamsulosin (a drug used to treat prostate hyperplasia). Conclusions The proposed approach links exposure specifications to four major concepts in drug safety and effectiveness studies. Formulating subject‐matter knowledge about these major concepts provides an avenue to develop the rationale and specifications for the exposure measure.