29 30 Overall, the general lack of analysis and validated data on counterfeit Avastin incidents selleck catalog raises key concerns. Primarily, though the FDA sent notices directly to clinics suspected of purchasing counterfeit Avastin, patients that may have been directly adversely impacted were not notified with the exception of a public service announcement posted on the FDA website providing general safety information.3 5 Additionally, legal prosecutions of clinics that received warning notices uncovered that they knowingly purchased
counterfeit Avastin and continued its use even after nurse employees raised serious safety concerns, bringing into question the effectiveness of notices focused on clinical sites.31 Finally, lack of data limits efforts to estimate the true scope and impact of counterfeit Avastin cases (eg, the number of patients potentially impacted), including possible differences in the population and safety characteristics between warning notices
in waves 1 and 2 that we have attempted to identify in this study. Collectively, these limitations hamper efforts to develop prevention strategies for counterfeit medicine incidents that may occur in the future. Finally, the inadequacy of existing surveillance mechanisms and their associated data collection may in part relate to a lack of engagement with healthcare professionals (HCPs) on the issue. Though counterfeit versions of Avastin were easily detectable (ie, had foreign language markings on packaging/identified incorrect manufacturer), surveillance and reporting by HCPs was largely absent. A model that has the potential to proactively respond to the penetration of counterfeit Avastin could be one that encourages or requires the participation of HCPs in active surveillance for counterfeit and unapproved medications.
Central to this type of model is education to HCPs on the patient safety and associated legal risks to the practitioner of sourcing and administering counterfeit medications, information on how to avoid such risks and providing better information on specific populations/areas of the country at-risk. If HCPs had greater awareness regarding sourcing risks and better information to adequately detect counterfeit versions, they may have acted as important data sources Carfilzomib for prevention, surveillance and reporting. Such reporting is currently possible and indeed required in the FDA Adverse Event Reporting System (FAERS), but would likely be enhanced through education, collaborations, and partnerships on drug safety and surveillance strategies for counterfeit medicines.32 33 Limitations Our study relied on the use of data available from the FDA that identifies US clinical practices that are suspected as being at risk for purchase or use of counterfeit Avastin. However, this data may be incomplete.