Challenge–dechallenge–rechallenge (CDR) is a medical testing protocol in which a medicine or drug is administered, withdrawn, then re-administered, while being monitored for adverse effects at each stage. The protocol is used when statistical testing is inappropriate due to an idiosyncratic reaction by a specific individual, or a lack of sufficient test subjects and unit of analysis is the individual. During the dechallenge (withdrawal) phase, the medication is allowed to wash out of the system in order to determine what effect the medication is having on an individual.
CDR is one means of establishing the validity and benefits of medication in treating specific conditions[1] as well as any adverse drug reactions. The Food and Drug Administration of the United States lists positive dechallenge reactions (an adverse event which disappears on withdrawal of the medication) as well as negative (an adverse event which continues after withdrawal), as well as positive rechallenge (symptoms re-occurring on re-administration) and negative rechallenge (failure of a symptom to re-occur after re-administration).[2] It is one of the standard means of assessing adverse drug reactions in France.[3]
Peter Breggin asserted that there was an association between fluoxetine (Prozac) use and suicidal thoughts. While his research group were investigating the effectiveness and side effects of the medication, Breggin noticed that only certain individuals responded to the medication with increased thoughts of suicide, and used the challenge–dechallenge–rechallenge protocol in an effort to verify the link. Given the low occurrence rate of suicidality, statistical testing was considered inappropriate.[4] Other researchers have similarly suggested that the CDR is useful for researching the adverse effect of suicidality while taking fluoxetine, and Eli Lilly adopted the protocol rather than randomized controlled trials when testing for increased risk of suicide.[5] In addition to suicidality, akathisia is a reaction to medication which is suggested as amenable to a CDR protocol.[6][7]
Clinical trials using a CDR protocol are also reported for clinicians attempting to assess the effects of a medication on patients.[8][9]
^Begaud B (1984). "Standardized assessment of adverse drug reactions: the method used in France. Special workshop—clinical". Drug Inf J. 18 (3–4): 275–81. doi:10.1177/009286158401800314. PMID 10268556. S2CID 42797865.
^Breggin, Ginger Ross; Breggin, Peter Roger (1995). Talking back to Prozac: what doctors won't tell you about today's most controversial drug. New York: St. Martin's Paperbacks. ISBN978-0-312-95606-6.
^Maris, RWM (2002-10-04). . Philadelphia, Pennsylvania. Archived from the original on November 20, 2008. Retrieved 2008-03-15.
^Healy D, Whitaker C (2003). "Antidepressants and suicide: risk-benefit conundrums". J Psychiatry Neurosci. 28 (5): 331–7. PMC193979. PMID 14517576.
^Healy D (2003). "Lines of evidence on the risks of suicide with selective serotonin reuptake inhibitors". Psychother Psychosom. 72 (2): 71–9. doi:10.1159/000068691. PMID 12601224. S2CID 1583644.
^Rothschild AJ, Locke CA (1991). "Reexposure to fluoxetine after serious suicide attempts by three patients: the role of akathisia". J Clin Psychiatry. 52 (12): 491–3. PMID 1752848.
^Banu AB, Alias Balamurugan SA, Thirumalaikolundusubramanian P (2014). "Detection of dechallenge in spontaneous reporting systems: A comparison of Bayes methods". Indian J Pharmacol. 46 (3): 277–80. doi:10.4103/0253-7613.132157. PMC4071703. PMID 24987173.
April 13, 2024
challenge, dechallenge, rechallenge, medical, testing, protocol, which, medicine, drug, administered, withdrawn, then, administered, while, being, monitored, adverse, effects, each, stage, protocol, used, when, statistical, testing, inappropriate, idiosyncrati. Challenge dechallenge rechallenge CDR is a medical testing protocol in which a medicine or drug is administered withdrawn then re administered while being monitored for adverse effects at each stage The protocol is used when statistical testing is inappropriate due to an idiosyncratic reaction by a specific individual or a lack of sufficient test subjects and unit of analysis is the individual During the dechallenge withdrawal phase the medication is allowed to wash out of the system in order to determine what effect the medication is having on an individual Challenge dechallenge rechallengePurposemonitor adverse effects for drug medication Contents 1 Use in drug testing 2 Fluoxetine and suicide 3 See also 4 ReferencesUse in drug testing editCDR is one means of establishing the validity and benefits of medication in treating specific conditions 1 as well as any adverse drug reactions The Food and Drug Administration of the United States lists positive dechallenge reactions an adverse event which disappears on withdrawal of the medication as well as negative an adverse event which continues after withdrawal as well as positive rechallenge symptoms re occurring on re administration and negative rechallenge failure of a symptom to re occur after re administration 2 It is one of the standard means of assessing adverse drug reactions in France 3 Fluoxetine and suicide editMain article Fluoxetine Peter Breggin asserted that there was an association between fluoxetine Prozac use and suicidal thoughts While his research group were investigating the effectiveness and side effects of the medication Breggin noticed that only certain individuals responded to the medication with increased thoughts of suicide and used the challenge dechallenge rechallenge protocol in an effort to verify the link Given the low occurrence rate of suicidality statistical testing was considered inappropriate 4 Other researchers have similarly suggested that the CDR is useful for researching the adverse effect of suicidality while taking fluoxetine and Eli Lilly adopted the protocol rather than randomized controlled trials when testing for increased risk of suicide 5 In addition to suicidality akathisia is a reaction to medication which is suggested as amenable to a CDR protocol 6 7 Clinical trials using a CDR protocol are also reported for clinicians attempting to assess the effects of a medication on patients 8 9 See also editCDR computerized assessment system Self experimentation in medicine Single subject designReferences edit Spitzer WO 1986 Importance of valid measurements of benefit and risk Med Toxicol 1 Suppl 1 74 8 PMID 3821430 Guideline for Adverse Experience Reporting for Licensed Biological Products Definitions Food and Drug Administration Archived from the original on 2007 10 07 Retrieved 2008 03 15 Begaud B 1984 Standardized assessment of adverse drug reactions the method used in France Special workshop clinical Drug Inf J 18 3 4 275 81 doi 10 1177 009286158401800314 PMID 10268556 S2CID 42797865 Breggin Ginger Ross Breggin Peter Roger 1995 Talking back to Prozac what doctors won t tell you about today s most controversial drug New York St Martin s Paperbacks ISBN 978 0 312 95606 6 Maris RWM 2002 10 04 Suicide and Neuropsychiatric Adverse Effects of SSRI Medications Methodological Issues Philadelphia Pennsylvania Archived from the original on November 20 2008 Retrieved 2008 03 15 Healy D Whitaker C 2003 Antidepressants and suicide risk benefit conundrums J Psychiatry Neurosci 28 5 331 7 PMC 193979 PMID 14517576 Healy D 2003 Lines of evidence on the risks of suicide with selective serotonin reuptake inhibitors Psychother Psychosom 72 2 71 9 doi 10 1159 000068691 PMID 12601224 S2CID 1583644 Rothschild AJ Locke CA 1991 Reexposure to fluoxetine after serious suicide attempts by three patients the role of akathisia J Clin Psychiatry 52 12 491 3 PMID 1752848 Banu AB Alias Balamurugan SA Thirumalaikolundusubramanian P 2014 Detection of dechallenge in spontaneous reporting systems A comparison of Bayes methods Indian J Pharmacol 46 3 277 80 doi 10 4103 0253 7613 132157 PMC 4071703 PMID 24987173 Retrieved from https en wikipedia org w index php title Challenge dechallenge rechallenge amp oldid 1186394666, wikipedia, wiki, book, books, library,
