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The impact of legislation on drug substances used off-label in paediatric wards—a nationwide study

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

This nationwide study is aimed at describing to what extent the European Paediatric Regulation has met therapeutic needs in children.

Methods

Data for each drug substance in defined daily doses (DDD) were extracted from the national Danish data base. We evaluated if drug substances were used off-label and whether they had a paediatric investigation plan (PIP). This study did not include drug prescriptions for individual paediatric patients; thus, it was not possible to make use of all off-label categories previously used. Additionally, paediatric standard assortments (SA) were compared to the European survey on paediatric medicinal products.

Results

Thirteen percent of the 100 most used drug substances were determined as being used off-label, four of which had a PIP and one had a full waiver. Only one of the three drug substances used off-label most often, accounting for 85 % of such use, had a PIP. Neonates were included in one-third of PIPs and adolescents in 15. Nineteen out of 21 PIPs had a waiver and 14 PIPs were deferred. In line with the European survey, carbapenems, corticosteroids and proton pump inhibitors were frequent found in SAs.

Conclusion

PIPs only cover a small proportion of the drugs found to be used off-label in this study. Despite waivers granted, drug substances were used nonetheless. Unmet regulatory needs are still considerable in some therapeutic areas in neonates as well as in children.

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Acknowledgments

We thank pharmacist Henrik Thomsen for his efforts collecting data and for his extensive help and knowledge. We also thank the pharmacists who helped gather the standard assortments.

We thank Dr Paul Raymond, who has kindly revised the English language.

Conflict of interest

An abstract addressing the same results has been accepted to the EACPT congress 2013.

Author information

Authors and Affiliations

  1. Department of Clinical Pharmacology, Bispebjerg Hospital, 2400, Copenhagen, Denmark

    Sissel Haslund-Krog, Hanne Rolighed Christensen & Helle Holst

  2. Pediatric and Adolescent Medicine, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark

    René Mathiasen

Authors
  1. Sissel Haslund-Krog
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  2. René Mathiasen
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  3. Hanne Rolighed Christensen
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  4. Helle Holst
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Correspondence to Helle Holst.

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Haslund-Krog, S., Mathiasen, R., Christensen, H.R. et al. The impact of legislation on drug substances used off-label in paediatric wards—a nationwide study. Eur J Clin Pharmacol 70, 445–452 (2014). https://doi.org/10.1007/s00228-013-1626-1

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  • DOI: https://doi.org/10.1007/s00228-013-1626-1

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