Student 1 Verification: ADHD (drugs)

[callahantiff]

Student (GitHub Username): @deringtonc Verification Number: 1

Verification Assignments: ADHD

• Phenotype Definition
• Spreadsheet

[deringtonc]

@callahantiff just checking that this row is supposed to have "N/A" in the "standard_code" column? https://docs.google.com/spreadsheets/d/1Va7cin600gumAUxQ-MT6InADK87iIwpqR0Qmca22dCc/edit#gid=0&range=26:26

[deringtonc]

@callahantiff @trinklek Some of these indicate an NDC for a product that is an exact match to the string, but the product is no longer produced by the manufacturer today (therefore is not clinically relevant). In this instance, would we consider this "Exactly Matches Definition String + Clinically Relevant" or "Exactly Matches Definition String + NOT Clinically Relevant"? If we decide to go with the latter, it'll add a significant amount of time for me and Amanda to look up every single NDC to see if it's still being produced, and manufacturers discontinue NDCs all the time to re-produce the product under a different NDC, so we might be limiting the generalizability of our work to future projects. I suggest using "Exactly Matches Definition String + Clinically Relevant", but I just wanted to triple check with you two!

https://docs.google.com/spreadsheets/d/1Va7cin600gumAUxQ-MT6InADK87iIwpqR0Qmca22dCc/edit#gid=0&range=96:96

[callahantiff]

@callahantiff just checking that this row is supposed to have "N/A" in the "standard_code" column? https://docs.google.com/spreadsheets/d/1Va7cin600gumAUxQ-MT6InADK87iIwpqR0Qmca22dCc/edit#gid=0&range=26:26

@deringtonc, thanks for pointing that out. I thought I had caught all of those. If you find any others like that let me know! 😄

[callahantiff]

@callahantiff @trinklek Some of these indicate an NDC for a product that is an exact match to the string, but the product is no longer produced by the manufacturer today (therefore is not clinically relevant). In this instance, would we consider this "Exactly Matches Definition String + Clinically Relevant" or "Exactly Matches Definition String + NOT Clinically Relevant"? If we decide to go with the latter, it'll add a significant amount of time for me and Amanda to look up every single NDC to see if it's still being produced, and manufacturers discontinue NDCs all the time to re-produce the product under a different NDC, so we might be limiting the generalizability of our work to future projects. I suggest using "Exactly Matches Definition String + Clinically Relevant", but I just wanted to triple check with you two!

https://docs.google.com/spreadsheets/d/1Va7cin600gumAUxQ-MT6InADK87iIwpqR0Qmca22dCc/edit#gid=0&range=96:96

@deringtonc, great question. Let's see what @trinklek thinks and discuss further from there.

[trinklek]

@callahantiff @trinklek Some of these indicate an NDC for a product that is an exact match to the string, but the product is no longer produced by the manufacturer today (therefore is not clinically relevant). In this instance, would we consider this "Exactly Matches Definition String + Clinically Relevant" or "Exactly Matches Definition String + NOT Clinically Relevant"? If we decide to go with the latter, it'll add a significant amount of time for me and Amanda to look up every single NDC to see if it's still being produced, and manufacturers discontinue NDCs all the time to re-produce the product under a different NDC, so we might be limiting the generalizability of our work to future projects. I suggest using "Exactly Matches Definition String + Clinically Relevant", but I just wanted to triple check with you two! https://docs.google.com/spreadsheets/d/1Va7cin600gumAUxQ-MT6InADK87iIwpqR0Qmca22dCc/edit#gid=0&range=96:96

@deringtonc, great question. Let's see what @trinklek thinks and discuss further from there.

@callahantiff @deringtonc Tiffany, I am hoping to chat with you about this one. Katie and I chatted briefly already. I think we need to discuss the label of "not clinically relevant" for drugs that are no longer available.

[deringtonc]

@callahantiff I know we are comparing the source string to the source name, but is it an issue when we see a row where the source name and the standard name do not match? https://docs.google.com/spreadsheets/d/1Va7cin600gumAUxQ-MT6InADK87iIwpqR0Qmca22dCc/edit#gid=0&range=742:742

[trinklek]

@callahantiff @trinklek Some of these indicate an NDC for a product that is an exact match to the string, but the product is no longer produced by the manufacturer today (therefore is not clinically relevant). In this instance, would we consider this "Exactly Matches Definition String + Clinically Relevant" or "Exactly Matches Definition String + NOT Clinically Relevant"? If we decide to go with the latter, it'll add a significant amount of time for me and Amanda to look up every single NDC to see if it's still being produced, and manufacturers discontinue NDCs all the time to re-produce the product under a different NDC, so we might be limiting the generalizability of our work to future projects. I suggest using "Exactly Matches Definition String + Clinically Relevant", but I just wanted to triple check with you two! https://docs.google.com/spreadsheets/d/1Va7cin600gumAUxQ-MT6InADK87iIwpqR0Qmca22dCc/edit#gid=0&range=96:96

@deringtonc Tiffany and I discussed via phone. Focus on comparing column B and D without consideration of NDC or current availability of the drug in column D. We decided that as long as the drug was once available in the US it is "clinically relevant" - this is a change in classification different than we originally discussed. In the instance of amphetamine in column B and dextroamphetamine 1mg/ml solution in column D - we would still include that as "clinically relevant" even without checking its availability in the US, because we know the drug of dextroamphetamine is available in the US even if the 1mg/ml is not.

[deringtonc]

@trinklek can you provide a domain expert opinion as to whether bupropion should be considered "clinically relevant" or "NOT clinically relevant" for treatment of ADHD? https://docs.google.com/spreadsheets/d/1Va7cin600gumAUxQ-MT6InADK87iIwpqR0Qmca22dCc/edit#gid=0&range=228:228

I did find a cochrane review and some other literature supporting its use given action on norepi and dopamine similar to stimulants. https://www.cochrane.org/CD009504/BEHAV_bupropion-attention-deficit-hyperactivity-disorder-adhd-adults

[deringtonc]

@trinklek can you provide a domain expert opinion as to whether bupropion should be considered "clinically relevant" or "NOT clinically relevant" for treatment of ADHD? https://docs.google.com/spreadsheets/d/1Va7cin600gumAUxQ-MT6InADK87iIwpqR0Qmca22dCc/edit#gid=0&range=228:228

I did find a cochrane review and some other literature supporting its use given action on norepi and dopamine similar to stimulants. https://www.cochrane.org/CD009504/BEHAV_bupropion-attention-deficit-hyperactivity-disorder-adhd-adults

@trinklek Same with paroxetine? https://docs.google.com/spreadsheets/d/1Va7cin600gumAUxQ-MT6InADK87iIwpqR0Qmca22dCc/edit#gid=0&range=2081:2081

Evidence I could find: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518387/

[trinklek]

@trinklek can you provide a domain expert opinion as to whether bupropion should be considered "clinically relevant" or "NOT clinically relevant" for treatment of ADHD? https://docs.google.com/spreadsheets/d/1Va7cin600gumAUxQ-MT6InADK87iIwpqR0Qmca22dCc/edit#gid=0&range=228:228 I did find a cochrane review and some other literature supporting its use given action on norepi and dopamine similar to stimulants. https://www.cochrane.org/CD009504/BEHAV_bupropion-attention-deficit-hyperactivity-disorder-adhd-adults

@trinklek Same with paroxetine? https://docs.google.com/spreadsheets/d/1Va7cin600gumAUxQ-MT6InADK87iIwpqR0Qmca22dCc/edit#gid=0&range=2081:2081 Evidence I could find: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518387/

@deringtonc I agree with including bupropion . Although certainly not common or first line, it is used and has some evidence to support it as monotherapy. I don't think paroxetine should be included in the phenotype given there is no evidence to support its efficacy as monotherapy and the evidence when used in combination with dextroamphetamine is not strong. In defining the phenotype, I think paroxetine should only be included if used in combination with another mainstream/first-line stimulant.

In summary - bupropion is clinically relevant and paroxetine is not clinically relevant

[deringtonc]

@callahantiff I found some more "N/A"s in column F starting here https://docs.google.com/spreadsheets/d/1Va7cin600gumAUxQ-MT6InADK87iIwpqR0Qmca22dCc/edit#gid=0&range=2660:2660

Also on other rows through row 2671.

[callahantiff]

@deringtonc

@callahantiff I know we are comparing the source string to the source name, but is it an issue when we see a row where the source name and the standard name do not match? https://docs.google.com/spreadsheets/d/1Va7cin600gumAUxQ-MT6InADK87iIwpqR0Qmca22dCc/edit#gid=0&range=742:742

This type of variation is totally normal and expected given the way that OMOP does vocabulary mapping. Always great to check though (thank you 😄)

[callahantiff]

@callahantiff I found some more "N/A"s in column F starting here https://docs.google.com/spreadsheets/d/1Va7cin600gumAUxQ-MT6InADK87iIwpqR0Qmca22dCc/edit#gid=0&range=2660:2660

Also on other rows through row 2671.

@deringtonc - Thanks for the heads up and sorry about that! I have fixed ADHD and will have the remaining phenotypes updated shortly.

[deringtonc]

@callahantiff another good example for why this work is needed: https://docs.google.com/spreadsheets/d/1Va7cin600gumAUxQ-MT6InADK87iIwpqR0Qmca22dCc/edit#gid=0&range=2751:2751

[deringtonc]

@callahantiff I noticed that, usually, if a generic name is in column B, there will be another entry in column B elsewhere in the list for the Brand name.

I don't see that the brand products for guanfacine (Tenex(R) or Intuniv(R)) are present in this list. Is this something that we need to address? This is a medication that is commonly prescribed for children with ADHD and would have been available only as a brand product until a few years ago.

https://docs.google.com/spreadsheets/d/1Va7cin600gumAUxQ-MT6InADK87iIwpqR0Qmca22dCc/edit#gid=0&range=13558:13558

[callahantiff]

@deringtonc - good find! I think these types of things are great to note, but at least for this first round, we won’t directly address them. 😀

On Jun 12, 2019, at 22:28, deringtonc notifications@github.com wrote:

@callahantiff I noticed that, usually, if a generic name is in column B, there will be another entry in column B elsewhere in the list for the Brand name.

I don't see that the brand products for guanfacine (Tenex(R) or Intuniv(R)) are present in this list. Is this something that we need to address? This is a medication that is commonly prescribed for children with ADHD and would have been available only as a brand product until a few years ago.

https://docs.google.com/spreadsheets/d/1Va7cin600gumAUxQ-MT6InADK87iIwpqR0Qmca22dCc/edit#gid=0&range=13558:13558

— You are receiving this because you were mentioned. Reply to this email directly, view it on GitHub, or mute the thread.

[trinklek]

@deringtonc - good find! I think these types of things are great to note, but at least for this first round, we won’t directly address them. 😀

…

I concur with both of you - good to note, but will reserve for later! We found this with other ADHD meds too - going back to our initial conversation RE: the enantiomers of amphetamine. Just writing this note so it isn't forgotten.

[deringtonc]

@callahantiff I think there might be a coding issue with the source_string "tran%q". I think that we are trying to find entries under the branded name Tran-Q, which is a brand for hydroxyzine (based on what I could find here). Correct me if I'm wrong, but the "%" stands in as a wildcard not just for symbols like the "-", but it stands in as a wildcard for spaces, words, or strings of words. So for this source_string, we're getting lots of source_names that are neither a match nor clinically relevant because of the use of the "%".

Example: https://docs.google.com/spreadsheets/d/1Va7cin600gumAUxQ-MT6InADK87iIwpqR0Qmca22dCc/edit#gid=0&range=30955:30955

24 HR Nicotine 0.875 MG/HR Tran sdermal Patch [Nicoderm C- Q ]

Do you still want me to move forward with categorizing these? Or do we want to try to fix the code?

[callahantiff]

@callahantiff I think there might be a coding issue with the source_string "tran%q". I think that we are trying to find entries under the branded name Tran-Q, which is a brand for hydroxyzine (based on what I could find here). Correct me if I'm wrong, but the "%" stands in as a wildcard not just for symbols like the "-", but it stands in as a wildcard for spaces, words, or strings of words. So for this source_string, we're getting lots of source_names that are neither a match nor clinically relevant because of the use of the "%".

Example: https://docs.google.com/spreadsheets/d/1Va7cin600gumAUxQ-MT6InADK87iIwpqR0Qmca22dCc/edit#gid=0&range=30955:30955

24 HR Nicotine 0.875 MG/HR Tran sdermal Patch [Nicoderm C- Q ]

Do you still want me to move forward with categorizing these? Or do we want to try to fix the code?

@deringtonc - The wildcard character is used on purpose to model a naïve approach and as a result, there should be a fair number of false positives. In other words, the code is working as I intended it to. Fine to keep going on these. :smile

[deringtonc]

@callahantiff I think there might be a coding issue with the source_string "tran%q". I think that we are trying to find entries under the branded name Tran-Q, which is a brand for hydroxyzine (based on what I could find here). Correct me if I'm wrong, but the "%" stands in as a wildcard not just for symbols like the "-", but it stands in as a wildcard for spaces, words, or strings of words. So for this source_string, we're getting lots of source_names that are neither a match nor clinically relevant because of the use of the "%". Example: https://docs.google.com/spreadsheets/d/1Va7cin600gumAUxQ-MT6InADK87iIwpqR0Qmca22dCc/edit#gid=0&range=30955:30955 24 HR Nicotine 0.875 MG/HR Tran sdermal Patch [Nicoderm C- Q ] Do you still want me to move forward with categorizing these? Or do we want to try to fix the code?

@deringtonc - The wildcard character is used on purpose to model a naïve approach and as a result, there should be a fair number of false positives. In other words, the code is working as I intended it to. Fine to keep going on these. :smile

Got it! In that case, it is very worth noting that none of the entries were actually for hydroxyzine. 😆

[deringtonc]

Completed on 6/13/2019

Opened Issue #95 to consider adding venlafaxine to phenotype definition. Also read comments above to consider other things to include in phenotype definition (missing generics/brands or other drugs in a class)