PASS studies in secondary care (SCEM)
One of our key capabilities is undertaking Post-authorisation Safety Studies (PASS) in the hospital setting. These studies follow our Specialist Cohort Event Monitoring (SCEM) methodology, which we created to address the need to provide safety studies in secondary care, specifically for patients who receive initial or all drug treatment in hospitals or hospital outpatient clinics.
Our ability to conduct hospital-based PASS studies and access a network of prescribers in secondary or specialist care is almost unique in the fields of pharmacovigilance and pharmacoepidemiology.
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For these hospital PASS studies, event data is gathered from medical records of consented patients by hospital prescribers or care teams. A team of DSRU regional study facilitators works with the NIHR CRN (National Institute for Health Research Clinical Research Network) and other networks across the UK to identify secondary or specialist care prescribers in the relevant speciality.
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Our SCEM methodology for studies in secondary care is explained in this short video:
Our SCEM methodology complements the already well-established technique of Modified Prescription Event Monitoring (M-PEM), which we have used to conduct PASS on many medicines prescribed in primary care. SCEM methodology is described in detail in this publication. By conducting studies in specialist care using SCEM methodology, safety data is collected on patients who may be more complex in terms of underlying disease, co-morbidities and concomitant medications than in the general disease population. We can also monitor prescribing that is transferred from hospital to primary care by obtaining outcome data from both the specialist and the general practitioner.
Hospital patients are identified through a network of specialists and are enrolled into the study only after the clinical decision to prescribe the study drug has been made by the clinician.
Using secondary care medical records, data is collected at treatment initiation and post initiation (the length of the observation period depends on the research question).
In SCEM studies, data on individual patients’ general health, medical history, exposure and outcomes on exposure are captured. SCEM methodology is naturalistic in nature, reflecting clinical practice, is non-interventional, and allows for broad inclusion criteria. SCEM studies can also allow collection of comparative cohorts.
The SCEM study process is shown below:
The DSRU is already conducting SCEM studies across a range of therapeutic areas. Further information on the current active SCEM studies can be found here.
ROSE Study: Rivaroxaban Observational Safety Evaluation Study
This PASS study monitored the short term (first 3 months) safety and utilisation of rivaroxaban (Xarelto®) prescribed for medical conditions requiring anticoagulation by specialists in secondary care in England and Wales. Further details are available here.
ROSE ACS Study: Rivaroxaban Observational Safety Evaluation Study post-Acute Coronary Syndrome Study
This PASS study monitored the short term (first 3 months) safety and utilisation of rivaroxaban (Xarelto®) when prescribed with antiplatelet therapy or dual antiplatelet therapy for the secondary prevention of atherothrombotic events in adults after acute coronary syndrome (ACS). Further details are available here.
OBSERVA Study: Observational Safety Evaluation of Asenapine
This PASS study monitored the safety and utilisation of the atypical antipsychotic, asenapine (Sycrest®), in the mental health care setting in England and Wales. Further details are available here.
OASIS Study: Observational Assessment of Safety in Seroquel SCEM study
The OASIS study was conducted as part of the risk management plan for the product Seroquel XL prescribed for schizophrenia and mania associated with bipolar disorder. It was designed to examine the short-term (up to 12 weeks) safety and use of quetiapine fumarate in the prolonged-release formulation (Seroquel XL™), along with a comparator group started on the immediate-release formulation, quetiapine IR. The DSRU worked in collaboration with the Mental Health Research Network (MHRN) to recruit patients newly initiated on treatment with quetiapine XL within the mental health care trust setting. Data from the OASIS study will be published shortly.