Incidence of and Risk Factors for Repeat Adverse Drug Events: A Systematic Review.
Chris Niosco, Christina Lam, Terri Ser et al.
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In 30 seconds
This systematic review and meta-analysis examined the incidence of and risk factors for repeat adverse drug events (ADEs), defined as harm occurring after medication re-exposure. The authors screened 13,452 articles and included 55 studies, most of which assessed re-exposure to the same drug. Repeat ADE proportions varied widely, from <1 to 88%. Only anticoagulant re-exposure studies could be pooled: 10% (95% confidence interval: 4%-19%) rebled within 90 days. Inconsistent reporting across studies prevented quantification of risk factors.
Key findings
- Across studies, repeat ADE proportions ranged from <1 to 88%.
- After re-exposure to anticoagulants, 10% (95% confidence interval: 4%-19%) rebled within 90 days.
- Of 55 included studies, 44 examined re-exposure to the same drug, while 5 examined exposure to new drugs.
- Inconsistent reporting prevented the authors from quantifying risk factors for repeat ADEs.
Why it matters
Repeat ADEs can occur when a medication is restarted after previously causing harm, yet the review found that their risks differ across drug classes and clinical contexts. The pooled anticoagulant estimate offers one quantified example, while the broad variation and limited ability to assess risk factors underscore how little comparable evidence is available to support decisions about re-exposure.
What to keep in mind
Inconsistent reporting limited risk-factor analysis, and meta-analysis was possible only for anticoagulant re-exposure; estimates across other drug classes could not be pooled.