Search strategies to identify reports on “off-label” drug use in EMBASE

BMC Medical Research Methodology

Harald Herkner¹  Markus Müller²  Bita Mesgarpour¹ 

[1] Department of Emergency Medicine, Medical University Vienna, General Hospital, Währinger Gürtel 18-20, Vienna, 1090, Austria;Department of Clinical Pharmacology, Medical University Vienna, General Hospital, Währinger Gürtel 18-20, Vienna, 1090, Austria

关键词: Sensitivity;    MEDLINE;    EMBASE;    Information retrieval;    Off-label use;   

Others  :  1126346
DOI  :  10.1186/1471-2288-12-190

 received in 2012-07-05, accepted in 2012-12-19,  发布年份 2012

【 摘 要 】

Background

Medications are frequently prescribed outside their regulatory approval (off-label) by physicians particularly where appropriate therapies are not available. However, the risk/benefit ratio of drugs in off-label use needs to be critically appraised because it may differ from approved on-label usage. Therefore, an extensive exploration of current evidence on clinical data is well-advised. The objective of this study was to develop a search strategy that facilitates detection of the off-label drug use documents in EMBASE via OvidSP.

Methods

We constructed two sets of gold standards from relevant records to off-label drug use by a sensitive search of MEDLINE and EMBASE. Search queries, including search words and strings, were conceived based on definition of off-label use of medications as well as text analysis of 500 randomly selected relevant documents. The selected terms were searched in EMBASE (from 1988 to 2011) and their retrieval performance was compared with the gold standards. We developed a sensitivity-maximizing, and a sensitivity- and precision-maximizing search strategy.

Results

From 4067 records relevant to off-label drug use in our full gold standard set, 3846 records were retrievable from EMBASE. “off label*.af.” was the most sensitive single term (overall sensitivity 77.5%, sensitivity within EMBASE 81.9%, precision 88.1%). The highest sensitive search strategy was achieved by combining 36 search queries with overall sensitivity of 94.0% and precision of 69.5%. An optimal sensitive and precise search strategy was yielded precision 87.4% at the expense of decreasing overall sensitivity to 89.4%.

Conclusion

We developed highly sensitive search strategies to enhance the retrieval of studies on off-label drug use in OvidSP EMBASE.

【 授权许可】

   
2012 Mesgarpour et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Alexander GC, Gallagher SA, Mascola A, Moloney RM, Stafford RS: Increasing off-label use of antipsychotic medications in the United States, 1995-2008. Pharmacoepidemiol Drug Saf 2011, 20:177-184.
• [2]de Souza JA: Advances in drug development: off-label drug utilization in oncology. Clin Adv Hematol Oncol 2011, 9:473-475.
• [3]Lat I, Micek S, Janzen J, Cohen H, Olsen K, Haas C: Off-label medication use in adult critical care patients. J Crit Care 2011, 26:89-94.
• [4]Lee E, Teschemaker AR, Johann-Liang R, Bazemore G, Yoon M, Shim KS, Daniel M, Pittman J, Wutoh AK: Off-label prescribing patterns of antidepressants in children and adolescents. Pharmacoepidemiol Drug Saf 2012, 21:137-144.
• [5]Logan AC, Yank V, Stafford RS: Off-label use of recombinant factor VIIa in U.S. hospitals: analysis of hospital records. Ann Intern Med 2011, 154:516-522.
• [6]Ajuwon GA: Use of the Internet for health information by physicians for patient care in a teaching hospital in Ibadan, Nigeria. Biomed Digit Libr 2006, 3:12. BioMed Central Full Text
• [7]Sahapong S, Manmart L, Ayuvat D, Potisat S: Information use behavior of clinicians in evidence-based medicine process in Thailand. J Med Assoc Thai 2009, 92:435-441.
• [8]Briggs K, Crowlesmith I: EMBASE—The excerpta medica database: Quick and comprehensive drug information. Publish Res Q 1995, 11:51-60.
• [9]University of York, NHS centre for reviews and dissemination: Finding studies for systematic reviews: a resource list for researchers. Centre for Reviews and Dissemination, University of York, York; 2010.
• [10]Wong SS, Wilczynski NL, Haynes RB: Comparison of top-performing search strategies for detecting clinically sound treatment studies and systematic reviews in MEDLINE and EMBASE. J Med Libr Assoc 2006, 94:451-455.
• [11]Bahaadinbeigy K, Yogesan K, Wootton R: MEDLINE versus EMBASE and CINAHL for telemedicine searches. Telemed J E Health 2010, 16:916-919.
• [12]Kelly L, St Pierre-Hansen N: So many databases, such little clarity: Searching the literature for the topic aboriginal. Can Fam Physician 2008, 54:1572-1573.
• [13]Sampson M, Barrowman NJ, Moher D, Klassen TP, Pham B, Platt R, St John PD, Viola R, Raina P: Should meta-analysts search Embase in addition to Medline? J Clin Epidemiol 2003, 56:943-955.
• [14]Wilkins T, Gillies RA, Davies K: EMBASE versus MEDLINE for family medicine searches: can MEDLINE searches find the forest or a tree? Can Fam Physician 2005, 51:848-849.
• [15]Sampson M, McGowan J, Lefebvre C, Moher D, Grimshaw J: PRESS: peer review of electronic search strategies. Canadian Agency for Drugs and Technologies in Health, Ottawa; 2008.
• [16]Mesgarpour B, Müller M, Herkner H: Search strategies- identified reports on “off-label” drug use in MEDLINE. J Clin Epidemiol 2012, 65:827-834.
• [17]Gaudio PA: Ranibizumab for uveitic macular edema: why? Am J Ophthalmol 2009, 148:179-180.
• [18]Acharya NR, Hong KC, Lee SM: Ranibizumab for refractory uveitis-related macular edema. Am J Ophthalmol 2009, 148:303-309. e302
• [19]Caron C: Practice tips. Inserting the levonorgestrel intrauterine system: off-label use. Can Fam Physician 2007, 53:643-644.
• [20]Daskalaki I, Spain CV, Long SS, Watson B: Implementation of rotavirus immunization in Philadelphia, Pennsylvania: high levels of vaccine ineligibility and off-label use. Pediatrics 2008, 122:e33-e38.
• [21]Konda C, Rao AG: Colchicine in dermatology. Indian J Dermatol Venereol Leprol 2010, 76:201-205.
• [22]de Jong J, van den Berg PB, Visser ST, de Vries TW, de Jong-van den Berg LT: Antibiotic usage, dosage and course length in children between 0 and 4 years. Pharmacoepidemiol Drug Saf 2009, 18:S213-S214.
• [23]de Jong J, van den Berg PB, Visser ST, de Vries TW, de Jong-van den Berg LT: Antibiotic usage, dosage and course length in children between 0 and 4 years. Acta Paediatr 2009, 98:1142-1148.
• [24]Matar HE, Almerie MQ, Adams CE, Essali A: Publications indexed in Medline and Embase originating from the Syrian Arab Republic: a survey. East Mediterr Health J 2009, 15:648-652.
• [25]Excerpta Medica Database (EMBASE): Release fact sheet (summer 2009). Elsevier B.V, The Netherlands; 2009. Available from http://www.embase.com/info/UserFiles/Aug1ReleaseFactSheet_0.pdf webcite
• [26]Chalumeau M, Treluyer JM, Salanave B, Assathiany R, Cheron G, Crocheton N, Rougeron C, Mares M, Breart G, Pons G: Off label and unlicensed drug use among French office based paediatricians. Arch Dis Child 2000, 83:502-505.
• [27]Mukattash T, Hawwa AF, Trew K, McElnay JC: Healthcare professional experiences and attitudes on unlicensed/off-label paediatric prescribing and paediatric clinical trials. Eur J Clin Pharmacol 2011, 67:449-461.
• [28]Glanville J, Kaunelis D, Mensinkai S: How well do search filters perform in identifying economic evaluations in MEDLINE and EMBASE. Int J Technol Assess Health Care 2009, 25:522-529.
• [29]Deacon P, Smith JB, Tow S: Using metadata to create navigation paths in the HealthInsite Internet gateway. Health Info Libr J 2001, 18:20-29.
• [30]Jenuwine ES, Floyd JA: Comparison of medical subject headings and text-word searches in MEDLINE to retrieve studies on sleep in healthy individuals. J Med Libr Assoc 2004, 92:349-353.
• [31]Lefebvre C, Manheimer E, Glanville J: Chapter 6: Searching for studies. In Cochrane handbook for systematic reviews of interventions version 5.1.0 (Updated march 2011) Edited by Higgins JPT, Green S. 2011. Available from http://www.cochrane-handbook.org webcite
• [32]Wilczynski NL, McKibbon KA, Haynes RB: Search filter precision can be improved by NOTing out irrelevant content. AMIA Annu Symp Proc 2011, 2011:1506-1513.