Effects of coding dictionary on signal generation: a consideration of use of MedDRA compared with WHO-ART

To support signal generation a terminology should facilitate recognition of medical conditions by using terms which represent unique concepts, providing appropriate, homogeneous grouping of related terms. It should allow intuitive or mathematical identification of adverse events reaching a threshold frequency or with disproportionate incidence, permit identification of important events which are commonly drug-related, and support recognition of new syndromes. It is probable that the Medical Dictionary for Regulatory Activities (MedDRA) preferred terms (PTs) or high level terms (HLTs) will be used to represent adverse events for the purposes of signal generation. A comparison with 315 WHO Adverse Reaction Terminology (WHO-ART) PTs showed that for about 72% of WHO-ART PTs, there were one or two corresponding MedDRA PTs. However, there were instances where there were many MedDRA PTs corresponding to single WHO-ART PTs. In many cases, MedDRA HLTs grouped large numbers of PTs and sometimes there could be problems when a single HLT comprises PTs which represent very different medical concepts, or conditions which differ greatly in their clinical importance. Further studies are needed to compare the way in which identical data sets coded with MedDRA and with other terminologies actually function in generating and exploring signals using the same methods of detection and evaluation.