Incidence of and Risk Factors for Repeat Adverse Drug Events: A Systematic Review

Area of Science:

• Pharmacovigilance
• Clinical Pharmacology
• Drug Safety Research

Background:

• Adverse drug events (ADEs) cause significant harm, with many emergency department visits stemming from repeat events after re-exposure to a causative medication.
• Understanding the risks and risk factors associated with repeat ADEs is essential for informing clinical decision-making and preventing patient harm.

Purpose of the Study:

• To systematically review the literature on repeat adverse drug events (ADEs) over a 20-year period.
• To identify risk factors and outcomes associated with repeat ADEs.
• To quantify the incidence of repeat ADEs through meta-analysis where possible.

Main Methods:

• A systematic literature review was conducted using MEDLINE, Embase, and Scopus.
• Data on risk factors (age, sex, drug type, re-exposure type) and ADE outcomes were extracted.
• Meta-analysis was performed for studies with comparable data on drug class, re-exposure type, ADE outcome, and follow-up period.

Main Results:

• 55 articles were included from 13,452 screened articles, focusing on re-exposure to the same drug (44 studies).
• Antineoplastics, anticoagulants, and antibiotics were the most studied drug classes.
• A meta-analysis of anticoagulant re-exposure showed a 10% rebleeding rate within 90 days; repeat ADE risk varied significantly by drug class.

Conclusions:

• Repeat ADEs are an understudied area with significant clinical implications.
• Variability in repeat ADE risk across drug classes necessitates further research.
• Pooled incidence data can aid shared decision-making regarding medication re-exposure for underlying conditions.