Can social media tell us which drug is better?
Assessment of Web-Based Consumer Reviews as a Resource for Drug PerformanceJ Med Internet Res 2015;17(8):e211
Can we use online reviews?
Easy to understand & access
Large numbers– 6% have shared drug
experiences online– Millions of health experiences
online
Limited Access to Drug Comparisons
Publications1. Funded by drug companies2. Shown to be biased3. Hard to critique based on the way it’s written
FDA Drug Trials4. Studies are funded by drug
companies themselves5. Biased self-reporting
An online WebMD Drug Review
Compare drugs that treat the same condition– Controls for the heterogeneous populations– Assume similar populations being treated
Agreeing with the LiteratureCondition: Joint damage causing pain
Nabumetone 2.6
Meloxicam 3.1
Rofecoxib
4.6
“The overall 6-month effectiveness rates <…>59.8% for nabumetone, 67.6% for meloxicam.”Clin Drug Investig. 2004;24(2):89-101
“Median time to a good or excellent PGART was significantly shorter with rofecoxib (52 hours) than nabumetone (100 hours, P = 0.001)”
J Clin Rheumatol. 2006 Feb;12(1):17-25
427 drug pairs with significant and substantially different ratingsFirst Drug
(online rating)Second Drug (online rating)
Deduced online trend
Amlodipine (2.5) Felodipine (3.2) Amlodipine < Felodipine Amlodipine (2.5) Telmisartan (3.1) Amlodipine < Telmisartan
Search scientific literature
Search terms: Condition, Drug A vs. Drug Be.g. Hypertension, Amlodipine vs. Felodipine
See whether literature agrees with online trend
Online ratings supported 62-68% when rely on literature evidence
0.5 0.750000000000002 10
102030405060708090
100
62 (48/77)
64 (28/44)
68 (15/22)
* 71.4 (55/77)* 75 (33/44)* 81.8 (18/22)
Scientific LiteratureScientific Literature+FDA Labels
Difference between drug ratings
% v
alid
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with
scie
ntific
su
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Where is there more support for online ratings?
FDA label carries warnings
FDA Warnings
Amiodarone had the LOWEST online ratings. Many complain about side effects.
Amiodarone#Reviews/total
#reviewsComplaints
13.9% (23/166) “kill, died, death, dead”
But the FDA does not recommend amiodarone to treat atrial fibrillation.
Scientific Publication says “Amiodarone is effective compared to flecainide” Arch Intern Med. 1995 Sep 25;155(17):1885-91
Online data supported 71-82% when FDA labels added as support
0.5 0.750000000000002 10
102030405060708090
100
*62 (48/77)
*64 (28/44)
68 (15/22)
* 71 (55/77)
* 75 (33/44)
*82 (18/22)
Scientific LiteratureScientific Literature+FDA Labels
Difference between drug ratings
% v
alid
ated
with
scie
ntific
su
ppor
t
*significant
Validating Results
• 71% of online comparisons agree with literature and FDA labels
• 82% for comparisons with at least 1 point rating difference
Reviewer biases and insights
Reviewers give higher ratings to:
– Addictive drugs– Alternative treatments
Addictive Drugs Rate Higher
Condition: Muscle spasmCarisoprodol and cyclobenzaprine not significantly different
Clin Ther. 2004 Sep;26(9):1355-67.Drug Rating % reviews with the word
“addict”Carisoprodol 4.35 9.2
cyclobenzaprine 3.33 0
It's a great medication, but can easily become dangerously addicting.
so far this has been the best medication to help give me almost complete relief. Just be careful using it, it is addictive.
Alternative Choice of Treatment(the road less travelled)
Second-line treatments rate higher.
Is it truly a better drug?
Or a preselected population who are happy to have found this drug because standard therapy did not work?
Example: Underactive Thyroid
Thyroxine (synthetic thyroid hormone)“official” approved drugOnline rating 2.22
Natural thyroid extractOnline rating 3.92
When the Generic is Better than the Brand-Name
• Pro-Air brand rated 2 stars lower than generic• “Green”, environmentally-friendly design, cost more $
Online reviewers complained about “inhaler”Generic had a counter with number of doses remaining, Pro-Air did not
Pro-Air later released new design
Conclusion
• Online drug reviews are useful, with caveatsReviewers give higher ratings to– Addictive drugs– Alternative treatments
• Gain new insights like bad inhaler design