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In March 2020, World Health Organization recognized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emergence as a public health emergency of international concern. One of the major preventative measures developed against coronavirus disease 2019 (COVID-19) was vaccines. To monitor their use and safety of vaccines from the first utilization in humans during clinical development phases to implementation for the general population, an enhanced national pharmacovigilance system was enabled by the French National Agency for Medicines and Health Products Safety in collaboration with the 30 Regional Pharmacovigilance Centres. Here, we review the significant outcomes from a 2-year collaboration experience between the French National Agency for Medicines and Health Products Safety, the 30 Regional Pharmacovigilance Centres, disease-related experts and the pharmacovigilance and risk assessment committee at the European medicine agency. In France, until January 2023, over 155 million doses of COVID-19 vaccines were administrated, and 190,000 adverse events following immunizations (25% classified as serious) were analysed. Altogether 53 potential safety signals were reported to the Pharmacovigilance and Risk Assessment Committee at the European Medicine Agency by the French National Agency for Medicines and Health Products Safety: 13 were confirmed, 24 are still under investigation and 16 were not confirmed. The enhanced national PV system contributed actively better to define the safety profile of the newly developed vaccines, and the French National Agency for Medicines and Health Products Safety continues to monitor the benefit and risks of the COVID-19 vaccines.

To study determinants associated with GPs’ compliance with benzodiazepine discontinuation guidelines through a case-vignette of a patient with multimorbidity treated with long-term lorazepam for insomnia.

In this special issue, we present the main highlights of the first weeks of pharmacovigilance monitoring of coronavirus disease 2019 (COVID-19) vaccines in this unprecedented situation in France: the deployment of a vaccination during an epidemic period with the aim of vaccinating the entire population and the intense pharmacovigilance and surveillance of these vaccines still under conditional marketing authorizations. In this unprecedented situation, the cross approach and interaction between the French pharmacovigilance network and French National Agency for the Safety of Medicines and Health Products (ANSM) has been optimized to provide a real-time safety related to COVID-19 vaccines. Every week, pair of regional pharmacovigilance centers gathered safety data from the French pharmacovigilance network, to acutely expertise all the adverse drug reactions (ADRs) reported with each COVID-19 vaccine within a direct circuit with ANSM. Results of this expertise are presented and discussed with ANSM in order to raise safety signals and take appropriate measures if necessary. These reports are then published online. At the 25th of March 2021, more than 9 815 000 doses were injected and 20,265 ADRs were reported, mostly non-serious (76%). Several potential or confirmed signals were raised at the european level for those vaccines and others ADRs are under special attentions. This underlines the adaptiveness of the French pharmacovigilance system to both the identification of new patient profiles experiencing ADRs and the evolution of the vaccine strategy. Such an efficiency is necessary to manage a careful and acute surveillance of these new COVID-19 vaccines for and to face the pandemic at the same time.

To provide a tool for drug misuse or potential misuse monitoring by using a healthcare insurance database.

In the field of diabetes, pharmacoepidemiologic (PE) studies are numerous and represent an essential tool to assess the real life effects of diabetes drugs. However, the specificity of the study of drugs used in diabetes, characterized by a high frequency of switches, interruptions and add-on, must be kept in mind by pharmacoepidemiologists in order to perform well-conducted studies and avoid several biases. In this article, the authors discussed the specific interest of PE studies in the field of diabetes, provide a brief overview of biases that can affect those studies, and suggest pragmatic solutions for more correct results and appropriate interpretation.

Two severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccines, tozinameran/BNT162b2 (Comirnaty®, Pfizer-BioNTech) and elasomeran/mRNA-1273 (Spikevax®, Moderna), were approved by the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) at the end of 2020, less than a year after the start of the coronavirus disease 2019 (COVID-19) pandemic. In France, the health authorities have requested an intensive vaccination campaign, accompanied by a reinforced and active pharmacovigilance surveillance. This surveillance and analysis of real-life data, based on spontaneous reports received by the French Network of Regional PharmacoVigilance Centers (RFCRPV), has enabled to identify numerous pharmacovigilance signals. Some of them, such as myocarditis and heavy menstrual bleeding, have been confirmed as adverse effects of these vaccines.

Post-mRNA coronavirus diseases 2019 (COVID-19) vaccines myocarditis emerged as a rare adverse effect, particularly in adolescents and young adults, and was labeled as such for both vaccines in the summer of 2021. This study aims to summarize the timeline and process of signal detection, substantiation, and quantification of myocarditis cases related to mRNA vaccines in France.

In 2018, the “Ateliers de Giens” (Giens Workshops) devoted a workshop to artificial intelligence (AI) and led its experts to confirm the potential contribution and theoretical benefit of AI in clinical research, pharmacovigilance, and in improving the efficiency of care. The 2022 workshop is a continuation of this reflection on AI and intelligent automation (IA) by focusing on its contribution to pharmacovigilance and the applications and tasks could be optimized to preserve and strengthen medical and pharmacological expertise in pharmacovigilance. The evolution of pharmacovigilance work is characterized by many tasks with low added value, a growing volume of pharmacovigilance reporting of suspected side effects, and a scarcity of medical staff with expertise in clinical pharmacology and pharmacovigilance and human resources to support this growing need. Together, these parameters contribute to an embolization of the pharmacovigilance system at risk of missing its primary mission: to identify and characterize a risk or even a health alert on a drug. The participants of the workshop (representatives of the Regional Pharmacovigilance Centres (CRPV), the French National Agency for Safety of Medicinal Products (ANSM), patients, the pharmaceutical industry, or start-ups working in the development of AI in the field of medicine) shared their experiences, their pilot projects and their expectations on the expected potential, theoretical or proven, AI and IA. This work has made it possible to identify the needs and challenges that AI or IA represent, in the current or future modes of organization of pharmacovigilance activities. This approach led to the development of a SWOT matrix (strengths, weaknesses, opportunities, threats), a basis for reflection to identify critical points and consider four main recommendations: (1) preserve and develop business expertise in pharmacovigilance (including research and development in methods) with the integration of new technologies; (2) improve the quality of pharmacovigilance reports; (3) adapt technical and regulatory means; (4) implement a development strategy for AI and IA tools at the service of expertise.

Les Ateliers de Giens avaient consacré en 2018 une table ronde à l’intelligence artificielle (IA) et conduit ses experts à confirmer l’apport potentiel et le bénéfice théorique que représente l’IA en recherche clinique et en matière d’amélioration de l’efficience de soins. La table ronde de 2022 s’inscrit dans la continuité de cette réflexion sur l’IA et l’automatisation intelligente (AI) en la ciblant sur son apport en pharmacovigilance et les applications et tâches qu’elles pourraient optimiser afin de préserver et de renforcer l’expertise médicale et pharmacologique en pharmacovigilance. En effet, l’évolution du travail en pharmacovigilance est caractérisée par de nombreuses tâches à faible valeur ajoutée, une volumétrie croissante des déclarations de pharmacovigilance, la rareté des personnels médicaux ayant une expertise en pharmacologique clinique et en pharmacovigilance et des ressources humaines qui ne sont pas et ne seront pas en adéquation avec l’évolution constatée. Tous ces paramètres concourent à une embolisation du système de pharmacovigilance avec le risque de passer à côté de sa mission première qui est d’identifier et de caractériser un risque, voire une alerte sanitaire, sur un médicament. Les participants de la table ronde (représentants des centres régionaux de pharmacovigilance (CRPV), de l’Agence nationale de sécurité du médicament et des produits de santé (ANSM), des patients, de l’industrie du médicament ou encore de start-upstravaillant dans le développement de l’IA dans le domaine du médicament) ont partagé leurs expériences, leurs projets pilotes et leurs attentes sur les potentialités attendues, théoriques ou avérées, de l’IA et l’AI. Ce travail a permis de dégager les besoins et les enjeux réels que représentent, ou pas, l’IA ou l’AI dans les modes d’organisation actuelles ou futures de la pharmacovigilance. Cette démarche a permis l’élaboration d’une matrice SWOT (forces, faiblesses, opportunités, menaces), socle de réflexion pour identifier des points critiques et envisager quatre principales recommandations : (1) préserver et développer l’expertise métier en pharmacovigilance (incluant la partie recherche et développement en méthodes) avec l’intégration de nouvelles technologies ; (2) améliorer la qualité des déclarations en pharmacovigilance ; (3) adapter les moyens techniques et réglementaires ; (4) implémenter une stratégie de développements des outils AI et IA au service de l’expertise.

Le dextropropoxyphène (DXP) était l’antalgique opioïde faible le plus prescrit jusqu’à son retrait en 2011. L’objectif de cette étude est de décrire les délivrances d’antalgiques chez les utilisateurs chroniques de DXP au moment du retrait et pendant 18 mois suivant le retrait du DXP.