PSUR Instructions - Final
PSUR Instructions - Final
PSUR Instructions - Final
Introduction
that have benefited from the MRP or the DCP in accordance with Directive
2001/82/EC;
that have been subject to referrals considered under Articles 36, 37 and 38 of
Directive 2001/82/EC,
General Principles
2.1
MAHs must include in the PSURs of all VMPs, details of all adverse events arising in
the EEA and in a third country.
The main focus of the PSUR should be the presentation, analysis and evaluation of new
or changing safety data received during the period covered by the PSUR, providing a
basis for conclusion whether further investigations or changes in the SPC will be
necessary.
For this purpose the PSUR should include information on the following types of adverse
event reports/case histories received during the period of review:
All adverse events in animals and in human beings, sent spontaneously to the
MAH and occurring in the EEA and in a third country, including information
from literature.
2.2
For products authorised through the MRP or DCP, the PSUR submission schedule
should be agreed on and be the same for all involved NCAs.
The PSUR cycle should be based on the EU Birth Date (EBD, date of the first
marketing authorisation within the European Union) of a VMP or its International Birth
Date (IBD, date of the first marketing authorisation for the product granted to the MAH
in any country in the world), or the EU HBD (EU Harmonised Birth Date for VMPs
included in the work sharing initiative on PSUR assessments, provided it is not against
National Legislation).
Once a VMP is authorised in the EU, even if it is not marketed, the MAH is required to
submit PSURs at 6-monthly intervals, until initial placing of the VMP on the market.
When launch dates are planned, this information should be reflected in the forthcoming
PSUR.
The PSUR covering this period during which the product is launched is considered the
last of the six-month PSURs to be submitted before 'initial placing on the EEA market'.
After this initial placing of the product on the EEA market, the MAH should submit at
least four PSURs covering 6 months each, in order to ensure that two full years of
experience with the product on the EEA market are covered through provision of 6monthly PSURs, while keeping the DLP according to the EBD, EU HBD or IBD.
2.2.2. PSUR Reporting Period
Each PSUR should cover the period of time since the last PSUR and should be
submitted within 60 days after the DLP. Gaps are not allowed. Overlapping should be
avoided.
DLPs should be set according to the EU Birth Date (EBD, date of the first marketing
authorisation within the European Union) of a VMP or its International Birth Date
(IBD, date of the first marketing authorisation for the product granted to the MAH in
any country in the world), or the EU HBD (EU Harmonised Birth Date for VMPs
included in the work sharing initiative on PSUR assessments).
Preparation of PSURs according to the International Birth Date:
VMPs, which are also authorised outside the EU, will have an IBD. This is the date of
the first marketing authorisation for the product granted to the MAH in any country in
the world. For VMPs first authorised in the EU, the EBD is the IBD. For administrative
convenience, if desired by the MAH, the IBD may be designated as the last day of the
same month.
In order to harmonise PSURs internationally, the MAH may use the IBD to determine
the DLPs in the EEA rather than the EBD. If the IBD is used, the first DLP must be
within 6 months of the EBD, unless other requirements have been laid down at the time
of granting the MA. Regardless of whether the IBD or EBD is used, the PSUR should
be submitted within the 60 days following the DLP, taking into account that the date of
submission of the PSUR is in compliance with the stipulated submission schedule.
For the purpose of the PSUR the relevant dataset should be locked at the DLPs and, as
relevant, extracted from the database for analysis (frozen) in relation to the product. Upto-date safety data, i.e. data that becomes known to the MAH after the DLP and which
may influence the evaluation should also be included in the PSUR (see section 3.1.10).
For purely nationally authorised VMPs that are marketed, the MAH may wish to
synchronise national birth dates with the IBD. Such a step may be feasible and should
be discussed with DGV.
For nationally authorised VMPs, including those authorised through the MRP or DCP,
where national birth dates are used to determine the submissions of PSURs, the MAHs
and NCAs voluntarily may agree on an EU HBD which may be the IBD. Thus the first
PSUR to be submitted in the EU should be based on the EU HBD and should cover a
period in accordance with the life cycle of the VMP in the EU (6 months, 1 year or 3
years). When PSURs have previously been submitted in MS based on different national
birth dates, DGV accept that there may be an overlap between the last PSUR based on a
national birth date and the first PSUR based on the EU HBD.
3.
The reaction terms used in the PSUR should be in accordance with the VeDDRA
terminology.
The structure of a PSUR should follow the guidance given in section 3.1 Content
Periodic Safety Update Reports Marketed Products.
of
For non-marketed products without any reports of adverse events an abridged PSUR is
considered sufficient (see section 3.2 Content of Periodic Safety Update Reports
Non-marketed products).
For the presentation of data within the PSUR it is strongly recommended to use the
templates, tabulations and tables given in Annex.
3.1
For marketed VMPs, the PSUR should fulfil the following format and content:
3.1.1 MAH and product details
Each PSUR should include:
i)
ii)
iii)
The MA number(s)
iv)
v)
vi)
vii)
The date of initial placing of the product on the EEA market, understood as the
date when the first presentation of the product was first placed on the market in
any MS.
viii)
Chronological order of PSUR (e.g. 1st 6 month PSUR after initial placing on the
market)
the PSUR. If evaluation of safety data leads to any proposed changes in the SPC, these
should be described, see Part I Section 3.1.9.
For VMPs authorised through MRP or DCP, this will be the mutually accepted SPC
in English.
For nationally authorised VMPs, the specific national SPC in Portuguese language
should be included.
For some VMPs, the number of doses (individual units) sold is equivalent to the
number of animals treated (e.g. anthelmintic boli, flea collars). For VMPs
formulated as pastes, aerosols, eye/ear preparations or other formulations where it is
likely that each unit of VMP (for example, syringe, single dose pipettes) will be
dispensed for the treatment of an individual animal, the number of individual units
sold should be considered equivalent to the number of animals treated.
For the majority of pharmaceutical VMPs, the number of animals treated will be a
function of:
- Authorised treatment regimen (daily dose (mg/kg) x duration of treatment
(days)) as detailed on the authorised SPC. Where a range for dose or duration of
Standard weight
(kg)
550
20
5
550
150
50
160
60
25
60
10
1
2
10
1.5
It is expected that the values used for estimation of the number of animals treated
would be representative of the conditions of use of the VMP. For VMPs authorised
for more than one species it is difficult to calculate individual species exposure.
However, it is suggested to estimate the number of animals treated for all authorised
species individually using the estimated conditions of use of the VMP
In the first instance, the ratio of the number of animals expressing an adverse event
(reports assigned a causality code of A, B, O, including O1, N) during a period to the
amount of VMP sold during that period should be computed:
No of animals with adverse event during
period
Ratio of animals with adverse event =
No of doses sold during the period
This calculation is based on data that tends to be accurate and can be used reliably to
monitor trends from one PSUR to the next. Any increase in this ratio relative to
previous PSURs may signal a problem and the need for more detailed evaluation of the
pharmacovigilance data.
Calculation 2 Incidence
The incidence (%) of adverse reactions (reports of adverse events assigned a causality
code of A, B or O, including O1) should be calculated by dividing the total number of
animals reacting during the period by an estimate of the number of animals treated
during the period of the report and multiplying by 100.
No of animals reacting during period
(coded A. B or O and O1) x 100
% Incidence =
Estimated No of animals treated during the period
For VMPs authorised in multiple MS, incidence should be calculated individually for
each MS where sales have occurred.
This calculation may then be revised to exclude O and O1 coded reports (that is, this
calculation would focus on A-probable - and B-possible -coded reports only).
The values included in the calculation of incidence must be justified. It is expected that
the values used for estimation of the number of animals treated would be representative
of the conditions of use of the VMP. All assumptions used for calculation should
explicitly be stated.
Overall incidences are calculated for the EEA in total, regardless of the route of
authorisation of the VMP.
3.1.6 Data review
The report should include a data review based on the MAHs analysis (including
causality assessment) of the individual adverse events reported during the period
concerned by the PSUR.
The analysis of the adverse events reported should be supported by tables or tabulations
summarising the main findings. It may be helpful, especially for PSURs which contain a
large number of adverse events, to introduce summary tabulations and prepare separate
tables e.g. for serious expected reactions, serious unexpected reactions, non-serious
unlisted reactions (not mentioned in the SPC), or on basis of VEDDRA categories on
organ level (e.g. System Organ Class (SOC) or Preferred Term (PT) level).
The data review should be structured as follows:
Non-spontaneous Reports
A narrative overview of available data from other sources (e.g. post-authorisation safety
studies, published adverse event reports, user experience studies) should be included in
this section. The data should be analysed and discussed as part of the benefit-risk
assessment.
The overview should include a review of all adverse event reports eligible for expedited
reporting that were received during the PSUR period from post-authorisation safety
studies.
Summaries from post-authorisation safety studies should be included once final results
become available, and should consider all adverse events reported from the study.
A bibliographic listing of the scientific articles that address adverse events and which
are found in a widely accepted search engine published during the PSUR period that
pertains to the VMP should be included as an appendix. Information on databases used
should be provided. The literature search should primarily be product-based.
Additionally, a bibliographic line listing of the studies that address adverse events and
for which the MAH is the sponsor, should be included as an appendix.
3.1.8 Other Information
Adverse events arising from prescription errors or medication errors, including those
due to invented names of VMPs or similar appearance (e.g. mix-up with another VMP)
should be reported in PSURs.
Where names convey misleading therapeutic connotations, there may be a risk for
misuse or abuse of the product. Adverse events arising from such misuse or abuse
should be reported in PSURs.
A summary report on medication errors, including those due to name confusion,
occurring with the VMP should be submitted as an annex to the PSUR.
3.1.9 Overall safety evaluation
Together with concise summary information on all adverse events, the PSUR should
include a scientific analysis of the data presented and a critical evaluation of the benefitrisk balance of the product in light of any new or changing pharmacovigilance
information, written by a suitably qualified expert for pharmacovigilance. It should
clearly be stated, whether further investigations will be necessary and whether the
wording of the SPC needs to be changed.
This section should include (lack of significant new information should be mentioned
for each):
any environmental issues, caused by the VMP under normal conditions of use
any urgent safety issues that occurred during the period covered:
indicate whether the safety information remain in line with the cumulative
experience to date and the SPC or whether changes should be made to the SPC or
other product information, and
The overall safety evaluation should primarily be organised by VeDDRA System Organ
Class (SOC) terminology rather than by categories like serious/non-serious or known
reactions/new reactions; the latter properties should still be covered under each SOC.
An increase in the frequency of reports for known adverse events is considered as
relevant new information. Although increased reporting should be discussed in the
PSUR, it is not possible to provide specific guidance as to what constitutes increased
reporting or what method should be used for quantifying this. The MAH should provide
details of the methods that have been used. Judgement should be used in such situations
to determine whether the data reflect a meaningful change in occurrence of adverse
events or in the safety profile and whether an explanation can be proposed for such a
change (e.g. species or number of animals exposed, duration of exposure).
10
ii)
iii)
iv)
v)
11
iv)
vii)
Species;
viii)
Age(s);
ix)
x)
xi)
xii)
xiii)
xiv)
The standard information required in the PSUR for human adverse reactions related to
the use of a VMP includes:
i)
ii)
iii)
Date(s) of exposure;
iv)
v)
vi)
Occupation;
vii)
Nature of accident/exposure:
viii)
ix)
x)
3.2
12
For authorised VMPs that are not marketed or distributed anywhere and for which no
adverse events (either in animals or in human beings) was observed in any additional
trial (e.g. clinical trial, post-authorisation safety study) abridged PSURs are considered
sufficient, which should contain the following elements only:
date of EBD/IBD
chronological order of the PSUR (e.g. 1st 6 monthly PSUR before initial placing on
the market)
a declaration of the MAHs QPPV, that as the VMP was not marketed or
distributed anywhere in the world during the reporting period and as no adverse
event (either in animals or in human beings) was observed in any additional trial
(e.g. clinical trial, post-authorisation safety study), the benefit-risk balance afforded
by the VMP has not changed since the date of the MA.
4.1
As part of the renewal application documents related to safety, the MAH needs to
prepare or submit either a PSUR Summary Bridging Report supported, if needed, by a
PSUR Addendum Report, or one PSUR in circumstances where the PSUR submission
schedule is in synchrony with the renewal submission schedule.
4.1.1 PSUR Summary Bridging Report
For the purpose of the renewal application, the MAH should submit a PSUR Summary
Bridging Report, bridging all previously submitted PSURs. If, however, a PSUR
covering the period since authorisation or last renewal is due at the time of submission
of the renewal application, the PSUR replaces the need for a PSUR Summary Bridging
Report. It is accepted that previously submitted PSURs should not be re-submitted,
provided that a list of original submission dates is appended to the Summary Bridging
Report.
The PSUR Summary Bridging Report should not contain any new data but should
provide a succinct summary, bridging and summarising previously submitted
consecutive PSURs. The PSUR data should not be repeated but cross-referenced to
individual PSURs. The format of the PSUR Summary Bridging Report should be
identical to that of the usual PSUR, but the content should consist of summary
highlights and an overview of data from the attached (or referenced) PSURs.
A Summary Bridging Report should contain the following for the period covered by all
subsequent PSURs:
13
Introduction (a brief description of the purpose of the document specifying the time
periods covered and cross-referencing any referenced PSURs);
Worldwide marketing authorisation status (number of countries which have
approved the product);
An overview of regulatory authority or MAH-initiated actions for safety reasons
(an integrated summary of actions taken if appropriate);
An overview of changes (proposed or completed) to the SPC and package leaflet, to
the Reference Safety Information Document (if applicable) (See further below),
based on pharmacovigilance grounds (significant changes over the entire period);
An overview of exposure data (estimation of the total number of animals exposed
in the time period) as well as incidence data (in animal and in human);
An overview of individual reports (brief statement outlining the total number of
reports presented in the series of PSURs). When there is an important specific
safety concern that has not been adequately discussed in one or more PSURs, it
may be appropriate to include summary tabulation for the types of reports of
concern presenting adverse events, pointing out any differences from prior
tabulations. In this case, there should be a clear understanding that the tables should
be generated from live databases, which change over time as reports are updated.
These tables should then reflect the most up-to-date data available at the time they
are generated. It is recognised that the report/event counts in these summary tables
may differ somewhat from the contents of the individual tables in the PSURs. A
general statement describing the differences should be provided;
An overview of studies (a brief summary of important targeted post-authorisation
safety studies);
An overview of the reported information related to investigations of insufficient
withdrawal period arising from the use of the VMP, lack of expected efficacy,
adverse events related to off-label use or any potential environmental problems
Other information (only highly significant safety information received after the
DLP);
Overview of the safety concerns and conclusion (unresolved key issues).
In addition, the Summary Bridging Report should also contain information highlighting
any significant differences between the approved SPC and the proposed SPC.
Depending on the length of time and amount of safety data between the DLP of the
previous PSUR and the renewal application, it may become necessary to provide an
Addendum Report to the PSUR Summary Bridging Report.
4.1.2 PSUR Addendum Report for renewals
A PSUR Addendum Report is an update to the most recently completed PSUR when a
safety update is required outside the usual EBD- or IBD-based PSUR submission
schedule for a renewal application.
Because the renewal is an independent process, a PSUR Addendum Report does not
change the submission schedule for PSURs nor has it influence on the DLPs of PSURs,
as its content will be part of the following regular PSUR.
14
The Addendum Report should summarise the safety data received between the DLP of
the most recent PSUR and the date 60 days prior to the renewal application submission
date, or a date as agreed with DGV. In general, DGV accepts any solution provided that
it will not be any gap between this PSUR DLP and next PSUR.
It is not intended that the Addendum Report should provide an in-depth analysis of the
additional cases, as these should be included in the next regularly scheduled or
requested PSUR. Depending on the circumstances and the volume of additional data
since the last scheduled report, an Addendum Report may follow the PSUR format or a
simplified presentation.
The proposed simplified presentation should include the following sections, containing
any new information or changes beyond the most recent PSUR to which the Addendum
Report refers:
4.2
The periodicity of PSUR submission may be amended, as required for any VMP by
DGV, or proposed by the MAH for nationally authorised products. In any way, for
VMP authorised less than 5 years ago, and newly authorised generic VMPs or VMPs
authorised on the basis of informed consent applications, the calendar defined on point
2 of Article 110. of Decreto-Lei n. 148/2008, from 29th July, as amended by DecretoLei n. 314/2009, from 28th October, cannot be changed. Additionally, for any VMPs
that had been already renewed, submission of PSURs at a lower frequency than once
every 3 years is not possible.
Where an amendment is proposed, the Applicant/MAH should submit, as part of the
application, a reasoned request for the amendment. For the MAH shortening a reporting
period by submitting the PSUR earlier (e.g. for synchronisation of PSUR submissions)
is always possible.
In addition, in order to put in place measures facilitating PSUR preparation for MAHs
and work sharing of PSUR assessment among NCAs, harmonisation of birth dates,
renewal dates and/or PSUR submission schedules for VMPs containing the same active
substances may be proposed by the MAH or the NCAs. The principles are outlined on
the Heads of Agencies website. In any way, it is stressed that the calendar defined on
point 2 of Article 110. of Decreto-Lei n. 148/2008, from 29th July, as amended by
Decreto-Lei n. 314/2009, from 28th October, must be fulfilled.
4.3
15
16
PSUR line listing template - PSUR Line listing for suspected adverse events in animals
VETERINARY PHARMACOVIGILANCE SCHEME - PERIODIC SAFETY UPDATE REPORT
MAH FORM FOR REPORTS OF ANIMAL ADVERSE EVENTS
TO A VETERINARY MEDICINAL PRODUCT
PRODUCT:
MARKETING AUTHORISATION HOLDER:
PERIOD OF REPORT FROM .../.../... TO .../.../....
INCIDENCE =
DOSE UNITS =
Date of
Treatment/
Vaccination
Date of
Event
EEA
Reports
and then
THIRD
COUNTRY
REPORTS
(Country Code
-Organisation
ID -Case
Number Ref.)
No.
Treated
Species
and Age
(Juv/Adult)
No.
Reacted
(a)
No.
Died
(b)
Used as
recommended
Yes/No
Other
Products used
Concurrently
VeDDRA
Presenting Signs/
Diagnosis
(Please
ensure
that this
total is
put in)
Causality
(ABON
Code)
Date of
Treatment/
Vaccination
Date of
Event
No.
Treated
Species
and Age
(Juv/Adult)
No.
Reacted
(a)
No.
Died
(b)
Used as
recommended
Yes/No
Other
Products used
Concurrently
VeDDRA
Presenting Signs/
Diagnosis
Causality
(ABON
Code)
17
EEA
Reports
and then
THIRD
COUNTRY
REPORTS
(Country Code
-Organisation
ID -Case
Number Ref.)
(Please
ensure
that this
total is
put in)
EEA
Reports
and then
Date of
Treatment/
Vaccination
Date of
Event
No.
Treated
Species
and Age
(Juv/Adult)
No.
Reacted
(a)
No.
Died
(b)
Was
Product
used as
recommend
ed
Yes/No
Other
Products used
Concurrently
VeDDRA
Presenting Signs/
Diagnosis
(Please
ensure
that this
total is
put in)
THIRD
COUNTRY
REPORTS
(Country
Code Organisation
ID -Case
Number
Ref.)
Causality
(ABON
Code)
18
EEA
Reports
and then
Date of
Treatment/
Vaccination
Date of
Event
No.
Treated
Species
and Age
(Juv/Adult)
No.
Reacted
(a)
No.
Died
(b)
Was
Product
used as
recommend
ed
Yes/No
Other
Products used
Concurrently
VeDDRA
Presenting Signs/
Diagnosis
(Please
ensure
that this
total is
put in)
THIRD
COUNTRY
REPORTS
(Country
Code Organisation
ID -Case
Number
Ref.)
Causality
(ABON
Code)
DATE OF RECEIPT
19
B - PSUR line listing template - PSUR line listing for suspected human adverse events
VETERINARY PHARMACOVIGILANCE SCHEME PERIODIC SAFETY UPDATE REPORT
MAH FORM FOR REPORTS OF HUMAN ADVERSE EVENTS
INVOLVING A VETERINARY MEDICINAL PRODUCT
MARKETING AUTHORISATION HOLDER
PRODUCT:
MARKETING AUTHORISATION NO:
PERIOD OF REPORT FROM -----/-----/----- TO -----/-----/----MAH Case Ref
or World Wide Case
Number
Name(s) or
Unique
Patient(s)
1
Identification
Occupation
Date of
Exposure
Date of
Event
Nature of
Accident/
Exposure
VeDDRA
Outcome of Event
Code)
(Country Code
-Organisation
ID -Case
Number Ref.)
Causality
(ABON
20