meddra safety data analysis and smqs...–more than one term selected increases counts –diagnosis...

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MedDRA: Safety Data Analysis

and SMQs

MedDRA was developed under the auspices of the

International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH). The activities of the MedDRA Maintenance and Support Services Organization (MSSO) are overseen by an ICH MedDRA Management Committee, which is composed of the ICH parties, the Medicines and Healthcare products Regulatory Agency (MHRA) of the UK, Health Canada, and the WHO (as Observer).

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Disclaimer and

Copyright Notice

• This presentation is protected by copyright and may, with the exception of the MedDRA and ICH logos, be used, reproduced, incorporated into other works, adapted, modified, translated or distributed under a public license provided that ICH's copyright in the presentation is acknowledged at all times. In case of any adaption, modification or translation of the presentation, reasonable steps must be taken to clearly label, demarcate or otherwise identify that changes were made to or based on the original presentation. Any impression that the adaption, modification or translation of the original presentation is endorsed or sponsored by the ICH must be avoided.

• The presentation is provided "as is" without warranty of any kind. In no event shall the ICH or the authors of the original presentation be liable for any claim, damages or other liability arising from the use of the presentation.

• The above-mentioned permissions do not apply to content supplied by third parties. Therefore, for documents where the copyright vests in a third party, permission for reproduction must be obtained from this copyright holder.

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Course Overview

• In this course, we will cover:

– MedDRA overview

– MedDRA Data Retrieval and Presentation: Points to Consider document

– Developing queries using MedDRA

– Examples and hands-on exercises

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Course Overview (cont)

• In this course, we will cover (cont):– SMQ background and definition – SMQs development status– SMQ data characteristics– SMQ testing, production maintenance, and

versioning– Analysis of a data set using SMQs– SMQ applications– Customized searches

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MedDRA Overview

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MedDRA Definition

MedDRA is a clinically-validated international medical terminology used by regulatory authorities and the regulated biopharmaceutical industry. The terminology is used through the entire regulatory process, from pre-marketing to post-marketing, and for data entry, retrieval, evaluation, and presentation.

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Where MedDRA is Used

Individual Case Safety Reports and Safety Summaries

Clinical Study Reports

Investigators’ Brochures

Core Company Safety Information

Marketing Applications

Publications

Prescribing Information

Advertising

Regulatory Authority and Industry Databases

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MedDRA Users Profile

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• As of January 2020

– Over 6,200 Subscribing organizations (MSSO+JMO)

– 125 Countries

• Graph shows types of subscribing organizations

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MedDRA Users Profile by

Region

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Country CountUnited States 1689

Japan 827

China 443

United Kingdom 335

Germany 331

France 243

Italy 202

Spain 159

Republic of Korea 146

Canada 132

Netherlands 104

Australia 102

Sweden 101

India 98

Switzerland 97

Chinese Taipei 76

Poland 69

Egypt 68

Belgium 64

Greece 58

Russian Federation 58

Denmark 55

Israel 52

Portugal 50

Austria 45

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MedDRA Data Sharing

• Subscription grants access to MedDRA for one year

• Subscriber cannot grant any sublicense, publish or otherwise distribute MedDRA to a third party

• Data may be freely exchanged between current MedDRA subscribers

– Sponsor-sponsor, sponsor-CRO, vendor-user, etc.

– Use Self-Service Application to check organization’s subscription status

• Sharing MedDRA with a non-subscribing organization is a violation of the MedDRA license

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MedDRA Data Sharing

(cont)• For details, see the Statement on MedDRA Data Sharing

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Scope of MedDRA

Medical conditionsIndications

Investigations (tests, results)Medical and surgical proceduresMedical, social, family history

Medication errorsProduct quality issuesDevice-related issuesProduct use issues

Pharmacogenetic termsToxicologic issues

Standardized queries

Not a drug dictionary

Not an equipment, device,diagnostic product dictionary

Clinical trial study design terms

Patient demographicterms

Frequency qualifiers

Numerical values forresults

Severity descriptors

IN

OUT

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MedDRA Structure

System Organ Class (SOC) (27)

High Level Group Term (HLGT) (337)

High Level Term (HLT) (1,738)

Preferred Term (PT) (24,313)

Lowest Level Term (LLT) (81,885)

MedDRA Version 23.0Update April 2020000404 14

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Main Page Screenshot

• <Screenshot>

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Codes and Languages

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System Organ Classes

• Blood and lymphatic system disorders

• Cardiac disorders

• Congenital, familial and genetic disorders

• Ear and labyrinth disorders

• Endocrine disorders

• Eye disorders

• Gastrointestinal disorders

• General disorders and administration site conditions

• Hepatobiliary disorders

• Immune system disorders

• Infections and infestations

• Injury, poisoning and procedural complications

• Investigations

• Metabolism and nutrition disorders

• Musculoskeletal and connective tissue disorders

• Neoplasms benign, malignant and unspecified (incl cysts and polyps)

• Nervous system disorders

• Pregnancy, puerperium and perinatal conditions

• Product issues

• Psychiatric disorders

• Renal and urinary disorders

• Reproductive system and breast disorders

• Respiratory, thoracic and mediastinal disorders

• Skin and subcutaneous tissue disorders

• Social circumstances

• Surgical and medical procedures

• Vascular disorders

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A Multi-Axial Terminology

• Multi-axial = the representation of a medical concept in multiple SOCs

– Allows grouping by different classifications

– Allows retrieval and presentation via different data sets

• All PTs assigned a primary SOC– Determines which SOC will represent a PT during

cumulative data outputs

– Prevents “double counting”

– Supports standardized data presentation

– Pre-defined allocations should not be changed by users

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SOC = Respiratory, thoracic andmediastinal disorders(Secondary SOC)

HLGT = Respiratory tract infections

HLT = Viral upper respiratorytract infections

HLT = Influenza viral infections

HLGT = Viral infectious disorders

SOC = Infections and infestations

(Primary SOC)

PT = Influenza


(cont)

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Rules for Primary SOC

Allocation

• PTs represented in only one SOC are automatically assigned that SOC as primary

• PTs for diseases, signs and symptoms are assigned to prime manifestation site SOC

• Congenital and hereditary anomalies terms have SOC Congenital, familial and genetic disorders as Primary SOC

• Neoplasms terms have SOC Neoplasms benign, malignant and unspecified (incl cysts and polyps) as Primary SOC – Exception: Cysts and polyps have prime manifestation

site SOC as Primary SOC

• Infections and infestations terms have SOC Infections and infestations as Primary SOC

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Primary SOC Priority

If a PT links to more than one of the exceptions, the following priority will be used to determine primary SOC:1st: Congenital, familial and genetic disorders2nd: Neoplasms benign, malignant and

unspecified (incl cysts and polyps)3rd: Infections and infestations

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(cont)

PTs in the following SOCs only appear in that particular SOC and not in others, i.e., they are not multi-axial

• Investigations

• Surgical and medical procedures

• Social circumstances

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MSSO’s MedDRA

Browsers• MedDRA Desktop Browser (MDB)

– Download MDB and release files from MedDRA website

• MedDRA Web-Based Browser (WBB)– https://tools.meddra.org/wbb/

• Mobile MedDRA Browser (MMB)– https://mmb.meddra.org

• Features– Each require MedDRA ID and password

– View/search MedDRA and SMQs

– Support for all MedDRA languages

– Language specific interface

– Ability to export search results and Research Bin to local file system (MDB and WBB only)

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MDB and WBB Special

Features

• Preview upcoming (supplemental) changes in next release*

• View primary and secondary link information

• Upload terms to run against SMQs

• Advanced search options (e.g., NOT, OR)

*Supplemental view not available on MDB

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https://tools.meddra.org/wbb/

https://mmb.meddra.org/

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Browser Demonstration SOC View

MedDRA Data Retrieval and Presentation: Points to Consider

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ICH M1 Points to Consider

Working Group (PtC WG)• Regulators and industry

from EU, US, and Japan

• Health Canada, Canada

• MFDS, Republic of

Korea

• ANVISA, Brazil

• NMPA, China

• MSSO

• JMO

• WHO (Observer)

November 2017, Geneva, Switzerland

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PtC Documents

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PtC Category PtC Document Purpose Languages Release Cycle

Term Selection MedDRA Term

Selection: Points to

Consider

Promote accurate and

consistent coding with

MedDRA

English, Japanese, and other

selected languages

Updated annually

with the March

release of MedDRA

(starting with

MedDRA Version

23.0)

MedDRA Term

Selection: Points to

Consider

Condensed Version

Shorter version focusing on

general coding principles to

promote accurate and

consistent use of MedDRA

worldwide

All MedDRA languages

(except English, Japanese,

and other languages with an

available translation of the

full MTS:PTC document)

Update as needed

Data Retrieval

and

Presentation

MedDRA Data

Retrieval and

Presentation: Points

to Consider

Demonstrate how data

retrieval options impact the

accuracy and consistency

of data output

English, Japanese, and other

selected languages

Updated annually

with the March

release of MedDRA

(starting with

MedDRA Version

23.0)

MedDRA Data

Retrieval and

Presentation: Points

to Consider

Condensed Version

Shorter version focusing on

general retrieval and

analysis principles to

promote accurate and

consistent use of MedDRA

worldwide

All MedDRA languages

(except English, Japanese,

and other languages with an

available translation of the

full DRP:PTC document)

Update as needed

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PtC Documents (cont)

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PtC Category PtC Document Purpose Languages Release Cycle

General MedDRA Points to

Consider

Companion

Document

More detailed information,

examples, and guidance on

specific topics of regulatory

importance. Intended as a

“living” document with

frequent updates based on

users’ needs. First edition

covers data quality and

medication errors. New

section on product quality is

being drafted.

English and

Japanese

Updated as needed

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• Provides data retrieval

and presentation options

for industry or regulatory

purposes

• Most effective when used

in conjunction with

MedDRA Term Selection:

PTC document

• Recommended to be

used as basis for

individual organization’s

own data retrieval

conventions

MedDRA Data Retrieval and

Presentation: Points to Consider

(DRP:PTC)

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MedDRA Data Retrieval and

Presentation: PTC (cont)

• Developed by a working group of the ICH Management Committee

• Updated annually in step with the March release of MedDRA (starting with MedDRA Version 23.0)

• Available on MedDRA and JMO websites–English, Japanese, and other selected languages

–Word (“clean” and “redlined”), PDF, HTML formats

– “Redlined” document identifies changes made from previous to current release of document

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Data Retrieval PTC

Points Addressed

• General Principles– Quality of Source Data– Documentation of Data Retrieval and Presentation

Practices– Do Not Alter MedDRA – Organisation-Specific Data Characteristics – Characteristics of MedDRA that Impact Data

Retrieval and Analysis– MedDRA Versioning

• General Queries and Retrieval• Standardised MedDRA Queries• Customised Searches

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Quality of Source Data

• High quality data output is dependent on maintaining quality of original information reported by using consistent and appropriate term selection (Refer to MedDRA Term Selection: Points to Consider document)

• Method of conversion of data into MedDRA might impact retrieval and presentation - legacy data conversion using verbatims or coded terms

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Documentation of Data Retrieval and Presentation Practices

• Organisation-specific guidelines– Consistent with Points to Consider documents

– Coding conventions

– Data retrieval and output strategies (including SMQs)

– Quality assurance procedures

– MedDRA version used for search

– Search strategy methods

– Version update processes

– Processes for customised MedDRA queries

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Organisation-Specific

Data Characteristics

• Database structure (storage and use of hierarchy)

• Data storage (level of term, synonym/reported term)

• Data conversion (if applicable)

• Coding practices over time

• Limitations/restrictions (inability to view secondary SOCs)

• Term selection principles– More than one term selected increases counts– Diagnosis term only selected reduces counts

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Do Not Alter MedDRA

• MedDRA is a standardized terminology with a pre-defined term hierarchy

• Users must not make ad hoc structural alterations, including changing the primary SOC allocation

• If terms are incorrectly placed, submit a change request to the MSSO

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Impact of MedDRA’s

Characteristics

– Grouping Terms

• HLGTs and HLTs provide clinically relevant groupings

– HLGT Cardiac arrhythmias• HLT Cardiac conduction disorders

• HLT Rate and rhythm disorders NEC

• HLT Supraventricular arrhythmias

• HLT Ventricular arrhythmias and cardiac arrest

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Impact of MedDRA’s

Characteristics

– Grouping Terms (cont)

• Caution - ensure all terms are relevant to output– HLT Vascular tests NEC (incl blood pressure)

• PT Blood pressure decreased• PT Blood pressure increased

• Caution - related PTs in different locations in SOC– HLT Bullous conditions

• PT Stevens-Johnson syndrome

– HLT Exfoliative conditions• PT Dermatitis exfoliative

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Which Level? –

SOC Investigations Adverse Event (MedDRA v23.0) 25 mg MyDrug

(N=44)

Placebo

(N=15)

SOC Investigations 13 (29.5%) 2 (13.3%)

PT Aspartate aminotransferase increased 6 0

PT Alanine aminotransferase increased 5 0

PT Gamma-glutamyltransferase increased 4 0

PT Blood creatine phosphokinase increased 2 1

PT Blood alkaline phosphatase increased 2 0

PT Blood glucose increased 1 1

PT Blood lactate dehydrogenase increased 2 0

PT Lipase increased 2 0

PT White blood cell count decreased 2 0

PT Amylase increased 1 0

PT Faecal fat increased 0 1

Patients may have more than one event reported000404 39

Which Level? –

SOC Investigations (cont)

Adverse Event (MedDRA v23.0) 25 mg MyDrug

(N=44)

Placebo

(N=15)


PT Blood pressure increased 1 0

PT Blood urea increased 1 0

PT Occult blood positive 1 0

PT Liver function test abnormal 1 0

PT Monocyte count decreased 1 0

PT Protein urine present 1 0

Patients may have more than one event reported

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Which Level? –

SOC Investigations (cont)Adverse Event (MedDRA v23.0) 25 mg MyDrug

(N=44)

Placebo

(N=15)


HLT Liver function analyses 16 0

HLT Tissue enzyme analyses NEC 4 0

HLT Digestive enzymes 3 0

HLT White blood cell analyses 3 0

HLT Skeletal and cardiac muscle analyses 2 1

HLT Carbohydrate tolerance analyses (incl

diabetes)

1 1

HLT Faecal analyses NEC 1 1

HLT Vascular tests NEC (incl blood pressure) 1 0

HLT Renal function analyses 1 0

HLT Urinalysis NEC 1 0


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Multi-Axiality

• Primary SOC allocation rules affect the way data are distributed across the terminology

• Impact on frequencies of medical condition of interest should be considered

• Example: for hepatic abnormality search in SOC Hepatobiliary disorders, SOC Investigations(laboratory test terms), SOC Surgical and medical procedures (e.g., PT Liver transplant)

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Multi-Axiality (cont)

• Main presentation is by Primary SOC

• Secondary SOCs used for alternate views and presentation of data

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Primary SOC Analysis –

SOC Infections and

infestationsAdverse Event (MedDRA v23.0) 25 mg MyDrug

(N=44)

Placebo

(N=15)

SOC Infections and infestations 14 (31.8%) 4 (26.7%)

PT Upper respiratory tract infection 5 2

PT Sinusitis 3 0

PT Urinary tract infection 2 1

PT Ear infection 2 0

PT Viral infection 2 0

PT Bronchitis 1 0

PT Influenza 1 0

PT Localised infection 0 1

PT Lower respiratory tract infection 1 0

PT Pneumonia 1 0

PT Tooth abscess 1 0

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Secondary SOC Analysis –

SOC Infections and

infestations


(N=44)

Placebo

(N=15)

SOC Respiratory, thoracic and mediastinal

disorders

PT Upper respiratory tract infection 5 2

PT Sinusitis 3 0

PT Bronchitis 1 0

PT Influenza 1 0

PT Lower respiratory tract infection 1 0

PT Pneumonia 1 0

SOC Infections and infestations

PT Viral infection 2 0

PT Localised infection 0 1


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Secondary SOC Analysis –

SOC Infections and

infestations (cont)


(N=44)

Placebo

(N=15)

SOC Renal and urinary disorders

PT Urinary tract infection 2 1

SOC Ear and labyrinth disorders

PT Ear infection 2 0

SOC Gastrointestinal disorders

PT Tooth abscess 1 0


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MedDRA Versioning

• MedDRA is updated twice a year– 1 March X.0 release (all levels)

– 1 September X.1 release (LLT and PT levels only)

• Version used in data retrieval and presentation should be documented

• Resources:– “What’s New” document– Version report– MedDRA Version Analysis Tool (MVAT)

• Terms used for queries should be in same version as data being queried

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MedDRA Versioning (cont):

Effect of PT Demotion

MedDRA Version 22.1 Number of Events at PT Level

Fractured ischium (PT) 15

Pelvic fracture 5

MedDRA Version 23.0 Number of Events at PT Level

Fractured ischium (no longer a PT) 0

Pelvic fracture 20

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MedDRA Versioning (cont):

Effect of Primary SOC

Change

MedDRA Version 22.1 Number of Events

SOC Psychiatric disorders

PT Vascular cognitive impairment

20

MedDRA Version 23.0 Number of Events

SOC Psychiatric disorders 0

SOC Nervous system disorders

PT Vascular cognitive impairment

20

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MedDRA Version Analysis

Tool (MVAT)

• Web-based (https://tools.meddra.org/mvat)

• Free to all users

• Features

–Version Report Generator (produces exportable report comparing any two versions)

–Data Impact Report (identifies changes to a specific set of MedDRA terms or codes uploaded to MVAT)

–Search Term Change (identifies changes to a single MedDRA term or code)

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MedDRA Version Analysis

Tool (MVAT) (cont)

• User interface and report output available in all MedDRA languages

• Ability to run reports on supplemental changes

• Option to run reports on secondary SOC changes

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Exercise

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How Many Cases of

Autoimmune Diseases?

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Adverse Event (MedDRA v23.0) No. of cases

SOC Blood and lymphatic system disorders

PT Anaemia 5

PT Autoimmune neutropenia 5

PT Evans syndrome 1

PT Platelet anisocytosis 1

PT Platelet toxicity 2

SOC Cardiac disorders

PT Autoimmune myocarditis 4

PT Myocardial infarction 1

PT Myocarditis 2

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How Many Cases of

Autoimmune Diseases? (cont)

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SOC Endocrine disorders

PT Polyglandular autoimmune syndrome type I 2

PT Thyroid disorder 1

SOC Eye disorders

PT Birdshot chorioretinopathy 2

PT Autoimmune uveitis 3

SOC Hepatobiliary disorders

PT Primary biliary cholangitis 3

PT Hepatitis toxic 1

PT Hepatocellular injury 1

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How Many Cases of

Autoimmune Diseases? (cont)

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SOC Immune system disorders

PT Autoimmune disorder 4

SOC Musculoskeletal and connective tissue disorders

PT Arthritis 1

PT Muscular weakness 2

PT Polymyalgia rheumatica 1

PT Rheumatoid arthritis 3

SOC Skin and subcutaneous tissue disorders

PT Alopecia 1

PT Skin haemorrhage 1

PT Vitiligo 2

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Secondary SOC Analysis

Example

• In my dataset, which terms are autoimmune disorders?

56Input

Primary SOC

Blood and lymphatic system disorders

Cardiac disorders

Endocrine disorders

Eye disorders

Hepatobiliary disorders

Immune system disorders

Musculoskeletal and connective tissue disorders

Skin and subcutaneoustissue disorders

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Secondary SOC

Information• My system only shows

the primary SOC hierarchy. How do I view secondary SOC links for a set of terms?

• Option 1: Export search results

– Example: search for “headache”

– Export with primary and secondary SOC hierarchies (default setting)

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Optional Secondary SOC hierarchy

Secondary SOC

Information (cont)

• Option 2: Use the Research Bin

–Add terms to Research Bin

–Export with primary and secondary SOC hierarchies

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Optional Secondary SOC hierarchy

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Secondary SOC

Information (cont)

• Option 3: Hierarchy Analysis feature

– Upload terms in spreadsheet

– Export with primary and secondary SOC hierarchies

– No need for programming

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Hierarchy Analysis feature

Secondary SOC Analysis

Example (cont)

• Output sorted by HLGT – there are 11 autoimmune disorders

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Row ID Term Code LevelHLT HLGT SOC Primary

SOC

1 Anaemia 10002034 PT Anaemias NEC Anaemias nonhaemolytic and marrow depressionBlood and lymphatic system disorders Y

7 Myocardial infarction 10028596 PT Coronary necrosis and vascular insufficiencyArteriosclerosis, stenosis, vascular insufficiency and necrosisVascular disorders N

2 Autoimmune neutropenia 10055128 PT Blood autoimmune disorders Autoimmune disorders Immune system disorders N

3 Evans syndrome 10053873 PT Blood autoimmune disorders Autoimmune disorders Immune system disorders N

6 Autoimmune myocarditis 10064539 PT Autoimmune disorders NEC Autoimmune disorders Immune system disorders N

9 Polyglandular autoimmune syndrome type I10036072 PT Endocrine autoimmune disorders Autoimmune disorders Immune system disorders N

11 Birdshot chorioretinopathy 10072959 PT Autoimmune disorders NEC Autoimmune disorders Immune system disorders N

12 Autoimmune uveitis 10075690 PT Autoimmune disorders NEC Autoimmune disorders Immune system disorders N

13 Primary biliary cholangitis 10080429 PT Hepatic autoimmune disorders Autoimmune disorders Immune system disorders N

16 Autoimmune disorder 10061664 PT Autoimmune disorders NEC Autoimmune disorders Immune system disorders Y

19 Polymyalgia rheumatica 10036099 PT Muscular autoimmune disorders Autoimmune disorders Immune system disorders N

20 Rheumatoid arthritis 10039073 PT Rheumatoid arthritis and associated conditionsAutoimmune disorders Immune system disorders N

23 Vitiligo 10047642 PT Skin autoimmune disorders NEC Autoimmune disorders Immune system disorders N

19 Polymyalgia rheumatica 10036099 PT Connective tissue disorders NEC Connective tissue disorders (excl congenital)Musculoskeletal and connective tissue disordersY

7 Myocardial infarction 10028596 PT Ischaemic coronary artery disordersCoronary artery disorders Cardiac disorders Y

9 Polyglandular autoimmune syndrome type I10036072 PT Polyglandular endocrine disordersEndocrine and glandular disorders NECEndocrine disorders Y

5 Platelet toxicity 10059440 PT Poisoning and toxicity Exposures, chemical injuries and poisoningInjury, poisoning and procedural complicationsN

14 Hepatitis toxic 10019795 PT Poisoning and toxicity Exposures, chemical injuries and poisoningInjury, poisoning and procedural complicationsN

3 Evans syndrome 10053873 PT Anaemias haemolytic immune Haemolyses and related conditionsBlood and lymphatic system disorders Y

13 Primary biliary cholangitis 10080429 PT Hepatic fibrosis and cirrhosis Hepatic and hepatobiliary disordersHepatobiliary disorders Y

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Secondary SOC Analysis and

Use of a Grouping Term

61


SOC Immune system disorders

HLGT Autoimmune disorders 30

PT Autoimmune disorder 4

PT Autoimmune myocarditis 4

PT Autoimmune neutropenia 5

PT Primary biliary cholangitis 3

PT Birdshot chorioretinopathy 2

PT Evans syndrome 1

PT Polyglandular autoimmune syndrome type I 2

PT Polymyalgia rheumatica 1

PT Rheumatoid arthritis 3

PT Autoimmune uveitis 3

PT Vitiligo 2

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General Queries and

Retrieval

• Document search strategy

• Highlight overall distribution of ADRs/AEs

• Identify areas for in-depth analysis (focused searches)

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Overview by Primary SOC

• Use Internationally Agreed Order of SOCs when applicable, e.g., the EU SPC guideline

– See MedDRA Introductory Guide, ASCII files

• Consider use of HLTs and HLGTs

• Line listings, tables, graphs

• Benefits - Broad overview, PTs displayed only once

• Limitations - Incomplete groupings due to SOC allocation rules, lengthy output

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Primary SOC Graphical

Display Example

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Primary SOC Output

Listing Example

SOC Nervous system disorders 8

HLGT Mental impairment disorders

HLT Mental impairment (excl dementia and memory loss)

PT Disturbance in attention 1

HLGT Movement disorders (incl Parkinsonism)

HLT Dyskinesias and movement disorders NEC

PT Psychomotor hyperactivity 2

HLT Tremor (excl congenital)

PT Tremor 3

HLGT Neurological disorders NEC

HLT Disturbances in consciousness NEC

PT Somnolence 1

HLT Neurological signs and symptoms NEC

PT Dizziness 1

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Focused Searches

Useful when further investigating concepts of interest

• Secondary SOC assignments

– Programming required if database does not allow automated output by secondary SOC

– Benefits - more comprehensive view of medically related events

– Limitations - display by primary and secondary SOC could lead to double counting

• Grouping terms (HLGT/HLT)

• SMQ

• Customized search

– Modified SMQ

– Ad hoc query000404 66

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Secondary SOC Output

Listing Example

000404 67Example as of MedDRA Version 23.0

Developing Queries Using

MedDRA

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What is a Query?

Query

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Query Strategy Tips

• Define the condition

• Develop inclusion/exclusion criteria

• Good browser is key component

• Search “non multi-axial” and “other/support” SOCs

• Search a term’s “neighbors”, including secondary locations

• Use grouping terms where applicable

• Avoid using LLTs (Exception: species information at LLT level in SOC Infections and infestations)

• Store for future use

• Review for impact of new MedDRA versions

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Example and Hands-on

Exercises

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Example

Cardiac Arrhythmias

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Example –

Cardiac Arrhythmias

• Obvious starting point – HLGT Cardiac arrhythmias (“Top-down” search)

• Also use “Arrhythmia” terms as starting point of “Bottom-up” search

• What about non-multi-axial SOCs?

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Example –

Cardiac Arrhythmias (cont)

• SOC Investigations– PTs subordinate to HLT ECG investigations and

HLT Heart rate and pulse investigations should be reviewed• Example: PT Heart rate irregular

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Example –


• SOC Surgical and medical proceduresImportant to review:

– PTs subordinate to HLT Cardiac device therapeutic procedures*

• Example: PT Implantable defibrillator insertion

– PTs subordinate to HLT Cardiac therapeutic procedures NEC*

• Example: PT Cardioversion

*Note: Pacemaker and other cardiac therapeutic procedure terms were not included in SMQ Cardiac arrhythmias

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Example –


• Because arrhythmias may produce various signs and symptoms, you may wish to review PTs subordinate to the following HLTs:

– HLT Disturbances in consciousness NEC

– HLT Neurological signs and symptoms NEC

– HLT Cardiac disorders NEC

– HLT Cardiac signs and symptoms NEC

– HLT Dyspnoeas

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Example –


• Lastly…

– PTs subordinate to HLT Death and sudden death(under SOC General disorders and administration site conditions) should be reviewed

• Example: PT Cardiac death

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Cardiac Arrhythmias –

Identifying CasesPatient ID

Patient Events (PTs)MedDRA v23.0

Primary SOC Case of interest?

01 NauseaVomiting

Unlikely

02 Sudden death General disorders and administration site conditions Potential case. Needs review.

03 Electrocardiogram abnormalDyspnoeaCardio-respiratory arrest

InvestigationsRespiratory, thoracic and mediastinal disordersCardiac disorders

Potential case. Needs review.

04 Breast cancerPostmenopause

Unlikely

05 SyncopePalpitations

Nervous system disordersCardiac disorders


06 Pacemaker generated arrhythmia

General disorders and administration site conditions Potential case. Needs review.

07 Atrial fibrillationCardioversion

Cardiac disordersSurgical and medical procedures


08 Long QT syndrome congenital Congenital, familial and genetic disorders Potential case. Needs review.

09 Cerebrovascular accidentProstate cancer

Unlikely

10 Cardiac assistance device user Social circumstances Potential case. Needs review

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Query Development

Exercises

Alcoholic liver disease FallsHypoglycemia ObesityDepression Prostate cancerOsteonecrosis ParkinsonismAbuse liability Hearing loss

• Before starting– Develop a definition of the condition

– Develop inclusion/exclusion criteria (etiologies and risk factors are typically excluded)

• Note the main SOCs, HLGTs and HLTs used in your query, as well as examples of specific PTs

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Developing Queries –

Lessons Learned

• MedDRA is a potentially powerful tool for data retrieval, BUT it requires:– Solid medical knowledge

– Solid MedDRA knowledge

• Size and complexity of MedDRA overcome lack of specificity of other terminologies, but may require a more “creative” approach to data retrieval

• WELL WORTH THE EFFORT to develop, share, and store in-house queries

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Standardised MedDRA Queries

(SMQs)

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Standardised MedDRA

Queries (SMQs)

• Groupings of terms from one or more

MedDRA SOCs related to medical condition or

area of interest

• Terms relate to signs/symptoms, diagnoses,

syndromes, physical findings, laboratory and

other test data, etc.

• Intended to aid in case identification

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SMQ Benefits and

Limitations

• Benefits– Application across multiple therapeutic areas

– Validated reusable search logic

– Standardized communication of safety information

– Consistent data retrieval

– Maintenance by MSSO/JMO

• Limitations– Do not cover all medical topics or safety issues

– Will evolve and undergo further refinement even though they have been tested during development

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SMQs in Production -

Examples• As of Version 23.0, a total of 106 level 1 SMQs in production

• Agranulocytosis

• Anaphylactic reaction

• Central nervous system vascular disorders

• Convulsions

• Depression and suicide/self-injury

• Hepatic disorders

• Hypersensitivity

• Ischaemic heart disease

• Lack of efficacy/effect

• Medication errors

• Osteonecrosis

• Peripheral neuropathy

• Pregnancy and neonatal topics

• Pseudomembranous colitis

• Rhabdomyolysis/myopathy

• Severe cutaneous adverse

reactions

• Systemic lupus erythematosus

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SMQ Data Characteristics

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SMQ Data Characteristics

• MedDRA term inclusion

• Broad/narrow

• Algorithms

• Hierarchy

• SMQ status/term status within an SMQ

• SMQ files and documents

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MedDRA Term Inclusion

• SMQs are constructed at MedDRA PT level

• LLTs that are subordinate to an included PT are also included

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Narrow and Broad

Searches

• “Narrow” scope – specificity (cases highly likely to be condition of interest)

• “Broad” scope – sensitivity (all possible cases)

• “Broad search” = All broad + all narrow terms

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Narrow vs. Broad Example

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SMQ Lactic acidosis

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Narrow Terms

Blood lactic acid increased

HyperlactacidaemiaLactic acidosis

Broad Terms

Acid base balance abnormal

Acidosis

Anion gap abnormal

Anion gap increased

Blood alkalinisation therapy

Blood bicarbonate abnormal

Blood bicarbonate decreased

Blood gases abnormal

Blood lactic acid abnormal

Blood pH abnormal

Blood pH decreased

Carbon dioxide combining power abnormal

Carbon dioxide combining power decreasedComa acidotic

Kussmaul respiration

Metabolic acidosis

PCO2 abnormal

PCO2 decreased

Urine lactic acid increased

Algorithmic SMQs

• Some SMQs are designed to utilize algorithms

• Better case identification among broad search terms may result if cases are selected by a defined combination of selected terms

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Algorithmic SMQ

Example• Anaphylactic reaction (SMQ):

– A case with any of the following PTs:• Anaphylactic reaction• Anaphylactic shock• Anaphylactic transfusion reaction• Anaphylactoid reaction• Anaphylactoid shock• Circulatory collapse• Dialysis membrane reaction• Kounis syndrome• Procedural shock• Shock• Shock symptom• Type I hypersensitivity

(Narrow search terms = Category A)

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Algorithmic SMQ

Example (cont)

• Case = A (Narrow terms)

• Or Term from Category B and term from Category C

• Or Term from either Category B or Category C plus Term from Category D

Category B –Upper airway/Respiratory

Category C –Angioedema/

Urticaria, etc.

Category D –Cardiovascular/Hypotension

Acute respiratory failure

Allergic oedema Blood pressure decreased

Asthma Angioedema Blood pressure diastolic decreased

Bronchial oedema Erythema Blood pressure systolic decreased

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Hierarchical SMQs

• Some SMQs may develop as set of queries related to one another in a hierarchical relationship

• Not related to MedDRA standard hierarchy

• One or more subordinate SMQs combined to create a superordinate, more inclusive SMQ

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Hierarchical SMQ

Example

Haematopoietic cytopenias

Haematopoietic cytopenias affecting more than one type

of blood cell

Haematopoietic erythropenia

Haematopoietic leukopenia

Haematopoietic thrombocytopenia

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SMQ Status/Term Status

• Each SMQ has a status (Active/Inactive)

• Similar in concept to MedDRA currency

• Terms assigned to an SMQ also have a status flag– Once a term is added to an SMQ, it will always

be included in the SMQ but the status may be inactive

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SMQ Files and

Documents

• MedDRA distributed files unchanged by inclusion of SMQ files

• SMQ Introductory Guide

– Recommended reading for optimal use of SMQs

– Details of individual SMQs

– Notes for implementation and/or expectation of results

• Production SMQ Spreadsheet

– SMQs and included terms, SMQ summary

• SMQ changes: “What’s New” document, Version Report, MVAT

• Original CIOMS Working Group documentation

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SMQ Testing, Production Maintenance, and Versioning

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SMQ Development

Summary

• Pre-release testing

– Typically, at least one company and one regulator database

– Cases retrieved reviewed for relevance

– Fine-tuning of SMQ may require several iterations

• Production phase: continue to be updated through the MSSO maintenance process

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SMQ Versioning

• It is recommended that organizations use the SMQs with data coded with the same version of MedDRA

– Match the MedDRA version of the SMQ with the MedDRA version of the coded data

– Mismatches of SMQ and MedDRA coded data could produce unexpected results

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SMQ Versioning (cont)

• Example of PT added to SMQs in MedDRA Version 23.0:

– PT Hormone receptor positive breast cancer in SMQ Breast malignant tumours

• Using version 22.1 SMQs which do not contain these PTs would fail to identify cases coded to these terms in a database using MedDRA Version 23.0

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Browser Demonstration SMQ

View

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How to “Run” SMQs

• IT perspective of SMQs = stored queries

• Code at LLT level; most organizations store coded data as LLTs

• SMQ ASCII files include PTs and LLTs

• Load SMQs into a query tool; run query against coded MedDRA terms in safety or clinical trial database for “Hits”

• Use SMQ options, if applicable– Narrow/broad search

– Algorithms

– Hierarchy

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How to “Run” SMQs

(cont)

Query

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Standardised MedDRA

Query (SMQ) Analysis

• In my dataset, which cases are “hits” for SMQs (potential cases of interest)?

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SMQ Analysis (cont)

• SMQ Analysis feature

• Apply SMQs to user’s MedDRA-coded data

– Narrow/broad

– Hierarchical

– Algorithmic (separate search option to apply algorithm)

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SMQ Analysis tool

Standardised MedDRA

Query (SMQ) Analysis

• Run broad search on all SMQs

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SMQ Analysis (cont)

• Results of broad search on all SMQs

– Includes narrow search

– Includes hierarchical SMQs

– Algorithmic SMQ analysis not shown

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SMQ Analysis (cont)

• Results of algorithmic SMQ analysis

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SMQ Applications

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SMQ Applications

• Clinical trials

– Where safety profile is not fully established, use multiple SMQs on routine basis as screening tool

– Selected SMQs to evaluate previously identified issue (pre-clinical data or class effect)

• Post-marketing

– Selected SMQs to retrieve cases for suspected or known safety issue

– Signal detection (multiple SMQs employed)

– Single case alerts

– Periodic reporting (aggregate cases for safety and other issues, e.g., lack of efficacy)

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EMA: Signal Detection

Analysis• ICSR coding at LLT level, analysis at PT level (medical

concept):It may be important to conduct analysis at higher level of hierarchy:

SOC, HLGT, HLT

• When doing so, impact of axial and non multi-axial SOCs needs to be taken into account: relevant PTs in more than 1 SOC

It may be important to conduct analysis at SMQ level to maximise likelihood that all terms related to a specific medical condition of interest are identified

• Challenge: strike the correct balanceToo narrowly focused search (specificity): exclude events of

potential relevance

Too broad search (sensitivity): difficult to identify a trend or signal that

may require further analysis (incl. case review)

111Acknowledgement: Dr. Aniello Santoro, EMA

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Use of SMQs at FDA –

Reviewing Prescribing

Information• Proposed Prescribing Information:

• Warnings & Precautions:

– Dizziness/Somnolence

– Withdrawal of Antiepileptic Drugs

– Suicidal Behavior and Ideation (class labeling)

• Final Prescribing Information

• Boxed Warning:

– Serious Psychiatric and Behavioral Reactions

• Warnings & Precautions:

– Falls

– Dizziness & somnolence

– Withdrawal of Antiepileptic Drugs

– Suicidal Behavior and Ideation (class labeling)

SMQ (Narrow Search) RR

(1) Hostility/aggression 4.4

(2) Vestibular disorders 4.258

(1) Hearing and vestibular disorders 4.088

(1) Hyponatraemia/SIADH 3.832

(2) Hearing impairment 3.832

(1) Dyslipidaemia * 2.555

(1) Biliary disorders 2.135

(2) Functional, inflammatory and gallstone

related biliary disorders 2.135

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Customized Searches

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Customized Searches –

Modified SMQs

• Do not modify SMQ unless there is a compelling reason – makes it non-standard

• “Modified MedDRA query based on an SMQ”– To be used to refer to an SMQ that has been

modified– All modifications must be documented– Version updates and maintenance are responsibility

of organization that created it– SMQ Lack of efficacy/effect often modified based on

particular product

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Modified MedDRA Queries

Based on SMQs - Examples

• Additional PTs needed

– For possible safety signal of dementia, user added PT Disturbance in attention to existing SMQ Dementia

• Excluding PTs

– Antipsychotic (with known association with hypotension and fainting) being evaluated for QT prolongation

– User excluded PT Syncope from SMQ Torsade de pointes/QT prolongation to prevent “noise” in retrieval

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Modified MedDRA Queries

Based on SMQs –

Examples (cont)

• Changing scope of SMQ term– Product being investigated for hyperglycaemia and

diabetes mellitus; specific (narrow) search result is required

– Include PT Increased insulin requirement (normally a broad search term) with the narrow search terms in Hyperglycaemia/new onset diabetes mellitus (SMQ)

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Customized Searches –

Ad Hoc Queries

• Need medical knowledge

• Need knowledge of structure and characteristics of MedDRA and of your data

• Refer to the MedDRA Data Retrieval and Presentation: Points to Consider document for query construction tips

• Save query for future use; maintenance needed for MedDRA version changes

• Consider submitting ad hoc query to MSSO via change request for possible development as an SMQ

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Exercise

• SMQ Lack of efficacy/effect often needs to be modified based on the particular characteristics of a product

• Consider how you would create a Modified MedDRA Query based on SMQ Lack of efficacy/effect for:

– An inhaled bronchodilator indicated for use in asthma

– A contraceptive

• Remember to document changes!

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Course Summary

• In this course, we:– Reviewed MedDRA’s scope, structure, and

characteristics

– Reviewed key sections of the MedDRA Data Retrieval and Presentation: Points to Consider document

– Reviewed key points for developing queries using MedDRA

– Worked on MedDRA query exercises

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Course Summary (cont)

• In this course, we:– Reviewed SMQ background and definition– Reviewed the development status of SMQs– Discussed SMQ data characteristics– Discussed SMQ testing, production maintenance,

and versioning– Analyzed a data set using SMQs– Reviewed SMQ applications– Discussed customized searches

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MSSO Contacts

• Website–www.meddra.org

• Email–[email protected]

• Frequently Asked Questions–www.meddra.org/faq

• MedDRA Browsers–https://www.meddra.org/meddra-desktop-browsers

(Desktop Browser)

–https://tools.meddra.org/wbb/ (Web-Based Browser)

– https://mmb.meddra.org (Mobile Browser)

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MSSO Contacts (cont)

• Self-Service Application

–https://www.meddra.org/meddra-self-service-application

• Training Schedule

–https://www.meddra.org/training/schedule

• Change Request Submission

–https://www.meddra.org/how-to-use/change-requests

• MedDRA Support Documentation

–https://www.meddra.org/how-to-use/support-documentation

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http://www.meddra.org/

mailto:[email protected]

http://www.meddra.org/faq



https://mmb.meddra.org/

https://www.meddra.org/meddra-self-service-application

https://www.meddra.org/training/schedule

https://www.meddra.org/how-to-use/change-requests

https://www.meddra.org/how-to-use/support-documentation