safetyriskБезопасность и риск фармакотерапииSafety and Risk of Pharmacotherapy2312-78212619-1164Federal State Budgetary Institution ‘Scientific Centre for Expert Evaluation of Medicinal Products’ of the Ministry of Health of the Russian Federation (FSBI ‘SCEEMP’)10.30895/2312-7821-2022-10-3-283-292safetyrisk-281Research ArticleБЕЗОПАСНОСТЬ ФАРМАКОТЕРАПИИ ПРИ COVID-19SAFETY OF COVID-19 PHARMACOTHERAPYПодходы к оценке безопасности лекарственных средств во время пандемии COVID-19 на примере азитромицинаApproaches to Assessing the Safety of Medicines during the COVID-19 Pandemic Using the Example of Azithromycinhttps://orcid.org/0000-0001-7704-9900ГомонЮ. М.GomonYu. M.

Гомон Юлия Михайловна, доктор медицинских наук

ул. Льва Толстого, д. 6–8, Санкт-Петербург, 197022, Российская Федерация,

Северный пр-т, д. 1, Санкт-Петербург, 194354, Российская Федерация

Yulia M. Gomon, Dr. Sci. (Med.).

6–8 Lev Tolstoy St., St. Petersburg 197022, Russian Federation

1 Severny Ave, St. Petersburg 194354, Russian Federation

gomonmd@yandex.ruhttps://orcid.org/0000-0001-6284-7133КасимоваА. Р.KasimovaA. R.

Касимова Алина Рашидовна, кандидат медицинских наук

ул. Льва Толстого, д. 6–8, Санкт-Петербург, 197022, Российская Федерация,

ул. Академика Байкова, д. 8, Санкт-Петербург, 195427, Российская Федерация

Alina R. Kasimova, Cand. Sci. (Med.)

6–8 Lev Tolstoy St., St. Petersburg 197022, Russian Federation,

8 Academician Baykov St., St. Petersburg 195427, Russian Federation

kasi-alina@yandex.ruhttps://orcid.org/0000-0002-1919-2909КолбинА. С.KolbinA. S.

Колбин Алексей Сергеевич, доктор медицинских наук, профессор

ул. Льва Толстого, д. 6–8, Санкт-Петербург, 197022, Российская Федерация,

Университетская наб., д. 7–9, Санкт-Петербург, 199034, Российская Федерация

Alexey S. Kolbin, Dr. Sci. (Med.), Professor

6–8 Lev Tolstoy St., St. Petersburg 197022, Russian Federation,

7–9, Universitetskaya Emb., St. Petersburg 199034, Russian Federation

alex.kolbin1971@gmail.comhttps://orcid.org/0000-0002-1838-9961СтрижелецкийВ. В.StrizheletskyV. V.

Стрижелецкий Валерий Викторович, доктор медицинских наук, профессор

Северный пр-т, д. 1, Санкт-Петербург, 194354, Российская Федерация,

Университетская наб., д. 7–9, Санкт-Петербург, 199034, Российская Федерация

Valery V. Strizheletsky, Dr. Sci. (Med.), Professor

1 Severny Ave, St. Petersburg 194354, Russian Federation,

7–9, Universitetskaya Emb., St. Petersburg 199034, Russian Federation

b4@zdrav.spb.ruhttps://orcid.org/0000-0003-3040-4009ИвановИ. Г.IvanovI. G.

Иванов Игорь Григорьевич

Северный пр-т, д. 1, Санкт-Петербург, 194354, Российская Федерация,

Университетская наб., д. 7–9, Санкт-Петербург, 199034, Российская Федерация

Igor G. Ivanov

1 Severny Ave, St. Petersburg 194354, Russian Federation,

7–9, Universitetskaya Emb., St. Petersburg 199034, Russian Federation

b4@zdrav.spb.ruhttps://orcid.org/0000-0002-1915-2237МазуренкоС. O.MazurenkoS. O.

Мазуренко Сергей Oлегович, доктор медицинских наук, профессор

Северный пр-т, д. 1, Санкт-Петербург, 194354, Российская Федерация

Университетская наб., д. 7–9, Санкт-Петербург, 199034, Российская Федерация

Sergey O. Mazurenko, Dr. Sci. (Med.), Professor

1 Severny Ave, St. Petersburg 194354, Russian Federation

7–9, Universitetskaya Emb., St. Petersburg 199034, Russian Federation

b4@zdrav.spb.ruФедеральное государственное бюджетное учреждение высшего образования «Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова» Министерства здравоохранения Российской Федерации; Государственное бюджетное учреждение здравоохранения «Больница Святого Великомученика Георгия»РоссияAcademician I.P. Pavlov First St. Petersburg State Medical University; St. George City HospitalRussian FederationФедеральное государственное бюджетное учреждение высшего образования «Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова» Министерства здравоохранения Российской Федерации; Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр травматологии и ортопедии им. Р.Р. Вредена» Министерства здравоохранения Российской ФедерацииРоссияAcademician I.P. Pavlov First St. Petersburg State Medical University; R.R. Vreden National Medical Research Centre of Traumatology and OrthopaedicsRussian FederationФедеральное государственное бюджетное учреждение высшего образования «Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова» Министерства здравоохранения Российской Федерации; Федеральное государственное бюджетное образовательное учреждение высшего образования «Санкт-Петербургский государственный университет»РоссияAcademician I.P. Pavlov First St. Petersburg State Medical University; St. Petersburg State UniversityRussian FederationГосударственное бюджетное учреждение здравоохранения «Больница Святого Великомученика Георгия»; Федеральное государственное бюджетное образовательное учреждение высшего образования «Санкт-Петербургский государственный университет»РоссияSt. George City Hospital; St. Petersburg State UniversityRussian Federation202205102022103283292Copyright © Гомон Ю.М., Касимова А.Р., Колбин А.С., Стрижелецкий В.В., Иванов И.Г., Мазуренко С.O., 20222022Гомон Ю.М., Касимова А.Р., Колбин А.С., Стрижелецкий В.В., Иванов И.Г., Мазуренко С.O.Gomon Y.M., Kasimova A.R., Kolbin A.S., Strizheletsky V.V., Ivanov I.G., Mazurenko S.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.risksafety.ru/jour/article/view/281

Большинство лекарственных средств для терапии новой коронавирусной инфекции COVID-19 используется вне зарегистрированных показаний к применению либо на основании процедуры ускоренной регистрации, что требует особого внимания к оценке безопасности этих препаратов.Цель работы: обзор методологических подходов к сбору данных о безопасности лекарственных средств на примере применения азитромицина в режимах терапии COVID-19.Материалы и методы: в базах данных PubMed® (MEDLINE), Scopus, eLIBRARY, Киберленинка проведен поиск публикаций о применении азитромицина в комплексной терапии при COVID-19 в 2020–2021 гг. Поисковый запрос составляли из названия лекарственного средства или группового названия лекарственных средств и терминов, описывающих нежелательные реакции (НР) при лечении.Результаты: в анализ включены 7 публикаций результатов исследований, охватывающих опыт применения азитромицина в комплексной терапии COVID-19 более чем у 4000 пациентов. Выявлено, что у пациентов при терапии COVID-19 с использованием азитромицина наиболее часто (до 30% случаев назначения азитромицина) развивались нарушения со стороны сердечно-сосудистой системы. Информацию о НР в 3 включенных в анализ исследованиях получали методом спонтанных сообщений и путем активной регистрации на основании анализа данных лабораторных и инструментальных исследований при проведении клинических исследований, в 3 исследованиях — только методом спонтанных сообщений, в одном исследовании — путем анализа информации в базе данных НР.Выводы: в настоящее время метод спонтанных сообщений является основным для сбора информации о НР при применении лекарственных средств. Перспективным направлением совершенствования существующих подходов к сбору данных о безопасности лекарственных средств является получение сведений об индивидуальном опыте применения непосредственно от пациентов, в том числе анализ публикаций в социальных сетях.

Most of the medicines used to treat the novel coronavirus infection (COVID-19) are either approved under an accelerated procedure or not approved for the indication. Consequently, their safety requires special attention.The aim of the study was to review methodological approaches to collecting data on the safety of medicines, using COVID-19 treatment regimens involving azithromycin as a case study.Materials and methods: PubMed® (MEDLINE), Scopus, eLIBRARY, and Cyberleninka databases were searched for publications on azithromycin as part of combination therapy for COVID-19 in 2020–2021. Search queries included names of the medicinal product or its pharmacotherapeutic group and words describing adverse drug reactions (ADRs) during treatment.Results: the analysis included 7 publications presenting the results of studies covering the use of azithromycin as part of COVID-19 combination therapy in more than 4000 patients. Most commonly, the patients receiving COVID-19 therapy including azithromycin developed cardiovascular ADRs (up to 30% of azithromycin prescription cases). In 3 of the analysed publications, safety information was collected through spontaneous reporting and active identification based on the findings of laboratory and instrumental investigations performed during the clinical studies; in other 3, only spontaneous reports were used; and in the last one, ADR database information was studied.Conclusion: currently, information on ADRs associated with the use of medicines is mainly gathered via spontaneous reporting. Direct sourcing of information on personal experiences with a certain product from patients, among other means through social media analysis, opens a promising direction towards the improvement of existing approaches to collecting safety data.

фармаконадзорнежелательные реакцииспонтанные сообщенияазитромицинновая коронавирусная инфекцияCOVID-19база данныхсоциальные сетисообщество пациентовpharmacovigilanceadverse drug reactionsspontaneous reportsazithromycinnovel coronavirus infectionCOVID-19databasesocial networkspatient communityРабота выполнена без спонсорской поддержки.The study was performed without external funding.ReferencesМурашко МА, Пархоменко ДВ, Асецкая ИЛ, Косенко ВВ, Поливанов ВА, Глаголев СВ. Роль и практика фармаконадзора в российском здравоохранении. Вестник Росздравнадзора. 2014;(3):54–61.Murashko MA, Parkhomenko DV, Asetskaya IL, Kosenko VV, Polivanov VA, Glagolev SV. The role and practice of pharmacovigilance in the Russian healthcare. Vestnik Roszdravnadzora = Bulletin of Roszdravnadzor. 2014;(3):54–61 (In Russ.)Metlay JP, Waterer GW. Treatment of community-acquired pneumonia during the Coronavirus Disease 2019 (COVID-19) pandemic. Ann Intern Med. 2020;173(4):M20–2189. https://doi.org/10.7326/m20-2189Metlay JP, Waterer GW. Treatment of community-acquired pneumonia during the Coronavirus Disease 2019 (COVID-19) pandemic. Ann Intern Med. 2020;173(4):M20–2189. https://doi.org/10.7326/m20-2189Du Y, Tu L, Zhu P, Mu M, Wang R, Yang P, et al. Clinical features of 85 fatal cases of COVID-19 from Wuhan: a retrospective observational study. Am J Respir Crit Care Med. 2020;201(11):1372–9. https://doi.org/10.1164/rccm.202003-0543ocDu Y, Tu L, Zhu P, Mu M, Wang R, Yang P, et al. Clinical features of 85 fatal cases of COVID-19 from Wuhan: a retrospective observational study. Am J Respir Crit Care Med. 2020;201(11):1372–9. https://doi.org/10.1164/rccm.202003-0543ocZhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–62. https://doi.org/10.1016/S0140-6736(20)30566-3Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–62. https://doi.org/10.1016/S0140-6736(20)30566-3Kanoh S, Rubin BK. Mechanisms of action and clinical application of macrolides as immunomodulatory medications. Clin Microbiol Rev. 2010;23(3):590–615. https://doi.org/10.1128/cmr.00078-09Kanoh S, Rubin BK. Mechanisms of action and clinical application of macrolides as immunomodulatory medications. Clin Microbiol Rev. 2010;23(3):590–615. https://doi.org/10.1128/cmr.00078-09Cramer CL, Patterson A, Alchakaki A, Soubani AO. Immunomodulatory indications of azithromycin in respiratory disease: a concise review for the clinician. Postgrad Med. 2017;129(5):493–9. https://doi.org/10.1080/00325481.2017.1285677Cramer CL, Patterson A, Alchakaki A, Soubani AO. Immunomodulatory indications of azithromycin in respiratory disease: a concise review for the clinician. Postgrad Med. 2017;129(5):493–9. https://doi.org/10.1080/00325481.2017.1285677Parnham MJ, Haber VE, Giamarellos-Bourboulis EJ, Perletti G, Verleden GM, Vos R. Azithromycin: mechanisms of action and their relevance for clinical applications. Pharmacol Ther. 2014;143(2):225–45. https://doi.org/10.1016/j.pharmthera.2014.03.003Parnham MJ, Haber VE, Giamarellos-Bourboulis EJ, Perletti G, Verleden GM, Vos R. Azithromycin: mechanisms of action and their relevance for clinical applications. Pharmacol Ther. 2014;143(2):225–45. https://doi.org/10.1016/j.pharmthera.2014.03.003Bosseboeuf E, Aubry M, Nhan T, de Pina JJ, Rolain JM, Raoult D, et al. Azithromycin inhibits the replication of Zika virus. J Antivir Antiretrovir. 2018;10(1):6–11. http://dx.doi.org/10.4172/1948-5964.1000173Bosseboeuf E, Aubry M, Nhan T, de Pina JJ, Rolain JM, Raoult D, et al. Azithromycin inhibits the replication of Zika virus. J Antivir Antiretrovir. 2018;10(1):6–11. http://dx.doi.org/10.4172/1948-5964.1000173Retallack H, Di Lullo E, Arias C, Knopp KA, Laurie MT, Sandoval-Espinosa C, et al. Zika virus cell tropism in the developing human brain and inhibition by azithromycin. Proc Natl Acad Sci USA. 2016;113(50):14408–13. https://doi.org/10.1073/pnas.1618029113Retallack H, Di Lullo E, Arias C, Knopp KA, Laurie MT, Sandoval-Espinosa C, et al. Zika virus cell tropism in the developing human brain and inhibition by azithromycin. Proc Natl Acad Sci USA. 2016;113(50):14408–13. https://doi.org/10.1073/pnas.1618029113Madrid PB, Panchal RG, Warren TK, Shurtleff AC, Endsley AN, Green CE, et al. Evaluation of Ebola virus inhibitors for drug repurposing. ACS Infect Dis. 2015;1(7):317–26. https://doi.org/10.1021/acsinfecdis.5b00030Madrid PB, Panchal RG, Warren TK, Shurtleff AC, Endsley AN, Green CE, et al. Evaluation of Ebola virus inhibitors for drug repurposing. ACS Infect Dis. 2015;1(7):317–26. https://doi.org/10.1021/acsinfecdis.5b00030Gielen V, Johnston SL, Edwards MR. Azithromycin induces anti-viral responses in bronchial epithelial cells. Eur Respir J. 2010;36(3):646–54. https://doi.org/10.1183/09031936.00095809Gielen V, Johnston SL, Edwards MR. Azithromycin induces anti-viral responses in bronchial epithelial cells. Eur Respir J. 2010;36(3):646–54. https://doi.org/10.1183/09031936.00095809Tschida SJ, Guay DRP, Straka RJ, Hoey LL, Johanning R, Vance-Bryan K. QT(c)-interval prolongation associated with slow intravenous erythromycin lactobionate infusions in critically ill patients: a prospective evaluation and review of the literature. Pharmacotherapy. 1996;16(4):663–74. PMID: 8840374Tschida SJ, Guay DRP, Straka RJ, Hoey LL, Johanning R, Vance-Bryan K. QT(c)-interval prolongation associated with slow intravenous erythromycin lactobionate infusions in critically ill patients: a prospective evaluation and review of the literature. Pharmacotherapy. 1996;16(4):663–74. PMID: 8840374De Ponti F, Poluzzi E, Montanaro N. QT-interval prolongation by non-cardiac drugs: lessons to be learned from recent experience. Eur J Clin Pharmacol. 2000;56(1):1–18. https://doi.org/10.1007/s002280050714De Ponti F, Poluzzi E, Montanaro N. QT-interval prolongation by non-cardiac drugs: lessons to be learned from recent experience. Eur J Clin Pharmacol. 2000;56(1):1–18. https://doi.org/10.1007/s002280050714Shaffer D, Singer S, Korvick J, Honig P. Concomitant risk factors in reports of torsades de pointes associated with macrolide use: review of the United States Food and Drug Administration Adverse Event Reporting System. Clin Infect Dis. 2002;35(2):197–200. https://doi.org/10.1086/340861Shaffer D, Singer S, Korvick J, Honig P. Concomitant risk factors in reports of torsades de pointes associated with macrolide use: review of the United States Food and Drug Administration Adverse Event Reporting System. Clin Infect Dis. 2002;35(2):197–200. https://doi.org/10.1086/340861Abbas HM, Al-Jumaili AA, Nassir KF, Al-Obaidy MW, Al Jubouri AM, Dakhil BD, et al. Assessment of COVID-19 treatment containing both hydroxychloroquine and azithromycin: a natural clinical trial. Int J Clin Pract. 2021;75(4):e13856. https://doi.org/10.1111/ijcp.13856Abbas HM, Al-Jumaili AA, Nassir KF, Al-Obaidy MW, Al Jubouri AM, Dakhil BD, et al. Assessment of COVID-19 treatment containing both hydroxychloroquine and azithromycin: a natural clinical trial. Int J Clin Pract. 2021;75(4):e13856. https://doi.org/10.1111/ijcp.13856Cavalcanti AB, Zampieri FG, Rosa RG, Azevedo LCP, Veiga VC, Avezum A, et al. Hydroxychloroquine with or without azithromycin in mild-to-moderate COVID-19. N Engl J Med. 2020;383(21):2041–52. https://doi.org/10.1056/nejmoa2019014Cavalcanti AB, Zampieri FG, Rosa RG, Azevedo LCP, Veiga VC, Avezum A, et al. Hydroxychloroquine with or without azithromycin in mild-to-moderate COVID-19. N Engl J Med. 2020;383(21):2041–52. https://doi.org/10.1056/nejmoa2019014Furtado RHM, Berwanger O, Fonseca HA, Correa TD, Ferraz LR, Lapa MG, et al. Azithromycin in addition to standard of care versus standard of care alone in the treatment of patients admitted to the hospital with severe COVID‐19 in Brazil (COALITION II): a randomised clinical trial. Lancet. 2020;396(10256):959–67. https://doi.org/10.1016/s0140-6736(20)31862-6Furtado RHM, Berwanger O, Fonseca HA, Correa TD, Ferraz LR, Lapa MG, et al. Azithromycin in addition to standard of care versus standard of care alone in the treatment of patients admitted to the hospital with severe COVID‐19 in Brazil (COALITION II): a randomised clinical trial. Lancet. 2020;396(10256):959–67. https://doi.org/10.1016/s0140-6736(20)31862-6Mercuro NJ, Yen CF, Shim DJ, Maher TR, McCoy CM, Zimetbaum PJ, Gold HS. Risk of QT interval prolongation associated with use of hydroxychloroquine with or without concomitant azithromycin among hospitalized patients testing positive for coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020;5(9):1036–41. https://doi.org/10.1001/jamacardio.2020.1834Mercuro NJ, Yen CF, Shim DJ, Maher TR, McCoy CM, Zimetbaum PJ, Gold HS. Risk of QT interval prolongation associated with use of hydroxychloroquine with or without concomitant azithromycin among hospitalized patients testing positive for coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020;5(9):1036–41. https://doi.org/10.1001/jamacardio.2020.1834RECOVERY Collaborative Group, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, et al. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med. 2021;384(8):693–704. https://doi.org/10.1056/NEJMoa2021436RECOVERY Collaborative Group, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, et al. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med. 2021;384(8):693–704. https://doi.org/10.1056/NEJMoa2021436Sekhavati E, Jafari F, SeyedAlinaghi S, Jamalimoghadamsiahkali S, Sadr S, Tabarestani M, et al. Safety and effectiveness of azithromycin in patients with COVID-19: an open-label randomised trial. Int J Antimicrob Agents. 2020;56(4):106143. https://doi.org/10.1016/j.ijantimicag.2020.106143Sekhavati E, Jafari F, SeyedAlinaghi S, Jamalimoghadamsiahkali S, Sadr S, Tabarestani M, et al. Safety and effectiveness of azithromycin in patients with COVID-19: an open-label randomised trial. Int J Antimicrob Agents. 2020;56(4):106143. https://doi.org/10.1016/j.ijantimicag.2020.106143Omrani AS, Pathan SA, Thomas SA, Harris TRE, Coyle PV, Thomas CE, et al. Randomized double-blinded placebo-controlled trial of hydroxychloroquine with or without azithromycin for virologic cure of non-severe Covid-19. EClinicalMedicine. 2020;29:100645. https://doi.org/10.1016/j.eclinm.2020.100645Omrani AS, Pathan SA, Thomas SA, Harris TRE, Coyle PV, Thomas CE, et al. Randomized double-blinded placebo-controlled trial of hydroxychloroquine with or without azithromycin for virologic cure of non-severe Covid-19. EClinicalMedicine. 2020;29:100645. https://doi.org/10.1016/j.eclinm.2020.100645Колбин АС, Зырянов СК, Белоусов ДЮ, Логиновская ОА, ред. Фармаконадзор. М.: Буки Веди: ОКИ; 2022.Kolbin AS, Zyryanov SK, Belousov DYu, Loginovskaya OA, eds. Pharmacovigilance. Moscow: Buki-Vedi: OKI; 2022 (In Russ.)Charan J, Dutta S, Kaur R, Bhardwaj P, Sharma P, Ambwani S, et al. Tocilizumab in COVID-19: a study of adverse drug events reported in the WHO database. Expert Opin Drug Saf. 2021;20(9):1125–36. https://doi.org/10.1080/14740338.2021.1946513Charan J, Dutta S, Kaur R, Bhardwaj P, Sharma P, Ambwani S, et al. Tocilizumab in COVID-19: a study of adverse drug events reported in the WHO database. Expert Opin Drug Saf. 2021;20(9):1125–36. https://doi.org/10.1080/14740338.2021.1946513Sultana J, Cutroneo PM, Crisafulli S, Puglisi G, Caramori G, Trifirò G. Azithromycin in COVID-19 patients: pharmacological mechanism, clinical evidence and prescribing guidelines. Drug Saf. 2020;43(8):691–8. https://doi.org/10.1007/s40264-020-00976-7Sultana J, Cutroneo PM, Crisafulli S, Puglisi G, Caramori G, Trifirò G. Azithromycin in COVID-19 patients: pharmacological mechanism, clinical evidence and prescribing guidelines. Drug Saf. 2020;43(8):691–8. https://doi.org/10.1007/s40264-020-00976-7Kamel AM, Monem MSA, Sharaf NA, Magdy N, Farid SF. Efficacy and safety of azithromycin in Covid-19 patients: a systematic review and meta-analysis of randomized clinical trials. Rev Med Virol. 2022;32(1):e2258. https://doi.org/10.1002/rmv.2258Kamel AM, Monem MSA, Sharaf NA, Magdy N, Farid SF. Efficacy and safety of azithromycin in Covid-19 patients: a systematic review and meta-analysis of randomized clinical trials. Rev Med Virol. 2022;32(1):e2258. https://doi.org/10.1002/rmv.2258Platt R, Brown JS, Robb M, McClellan M, Ball R, Nguyen MD, Sherman RE. The FDA Sentinel Initiative – an evolving national resource. N Engl J Med. 2018;379(22),2091–3. https://doi.org/10.1056/nejmp1809643Platt R, Brown JS, Robb M, McClellan M, Ball R, Nguyen MD, Sherman RE. The FDA Sentinel Initiative – an evolving national resource. N Engl J Med. 2018;379(22),2091–3. https://doi.org/10.1056/nejmp1809643Weissenbacher D, Sarker A, Klein A, O’Connor K, Magge A, Gonzalez-Hernandez G. Deep neural networks ensemble for detecting medication mentions in tweets. J Am Med Inform Assoc. 2019;26(12):1618–26. https://doi.org/10.48550/arXiv.1904.05308Weissenbacher D, Sarker A, Klein A, O’Connor K, Magge A, Gonzalez-Hernandez G. Deep neural networks ensemble for detecting medication mentions in tweets. J Am Med Inform Assoc. 2019;26(12):1618–26. https://doi.org/10.48550/arXiv.1904.05308Klein AZ, Sarker A, Weissenbacher D, Gonzalez-Hernandez G. Towards scaling Twitter for digital epidemiology of birth defects. NPJ Digit Med. 2019;(2):96. https://doi.org/10.1038/s41746-019-0170-5Klein AZ, Sarker A, Weissenbacher D, Gonzalez-Hernandez G. Towards scaling Twitter for digital epidemiology of birth defects. NPJ Digit Med. 2019;(2):96. https://doi.org/10.1038/s41746-019-0170-5

The authors declare that there are no conflicts of interest present.