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In the Real-World, Kids Use Medications and Devices
1MIE Resources, Baltimore, MD, USA. tlasky@mie-epi.com.
Insights
Real-world evidence (RWE) can address the lack of data for pediatric medications and devices. Unique challenges in pediatric RWE include data access and linkage, but addressing these ensures benefits for children.
Area of Science:
- Pediatric pharmacology
- Real-world evidence research
- Clinical trial methodology
Background:
- Limited evidence exists for pediatric medication and device use due to historical exclusion from clinical trials.
- Real-world evidence (RWE), encompassing diverse data sources, offers a potential solution to bridge this evidence gap.
- Previous challenges in pediatric research stemmed from difficulties in conducting trials with vulnerable populations.
Discussion:
- While RWE principles for adults largely apply to children, unique considerations are critical.
- Specific challenges include identifying suitable pediatric databases, accessing essential variables (birth date, weight, gestational age), and linking to parental/school records.
- Linkage to parental records is vital for prenatal exposure and family history data.
- School record linkage is crucial for assessing outcomes like academic progress and school absenteeism.
Key Insights:
- Pediatric RWE necessitates specialized approaches to overcome data limitations.
- Ensuring adequate representation of pediatric age subgroups within databases is paramount.
- Integrating diverse data sources, including health, parental, and educational records, is essential for comprehensive analysis.
Outlook:
- Developing robust RWE methodologies tailored for children is crucial for advancing pediatric healthcare.
- Addressing unique pediatric data challenges will enhance the utility of RWE for regulatory and clinical decision-making.
- Future efforts in RWE development must prioritize the specific needs of pediatric populations to ensure equitable evidence generation.
Abstract:
In the real world, we lack evidence guiding the use of medications and devices in children. This lack of evidence arose out of the challenges of conducting clinical trials in children and other vulnerable populations and the historical decision (reversed in recent decades) to exclude children from clinical trials. The recent focus on the potential of real-world evidence (RWE) to guide approval and use of new treatments may provide a much-needed solution. A broad definition of RWE includes prospective observational data and data from electronic health records and claims, as well as other sources. For the most part, it is reasonable to expect that considerations around the use of RWE in adult populations will apply to its use in children. However, a number of issues around the use of RWE are unique to studying children. These fall into at least four categories: (1) identification of databases with adequate numbers of children in the age sub-groups of interest, (2) access to critical variables such as birth date, birth weight, and gestational age, (3) linkage to parental records for information about pre-natal exposures, family history, and socio-economic status, and (4) linkage to school records for information about outcomes such as missed school days, academic progress, and behavioral issues. Addressing the needs of children in developing methodologies for use of RWE ensures that ongoing efforts will benefit children as well as other sectors of the population.
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