Spontaneous reporting of adverse drug reactions as an outlet for patient dismay? The case of Levothyrox® change of excipients

Following minor changes of excipients of Levothyrox (R), the French Pharmacovigilance Database was overwhelmed by patients' spontaneous reports of adverse drug reactions associated with the new formula. After noticing that most of these reports differed from those related to other drugs, we aimed to characterize their features and compared them with spontaneous reports associated with other chronic treatments as comparators. We randomly sampled patient reports associated with either Levothyrox (R) new formula (n = 200) or comparator drugs (n = 200) from March 2017 till March 2018 from the National Pharmacovigilance Database. We evaluated the number of incriminated drugs and adverse drug reactions per report and verified whether they were expected or not according to the Summary of Product Characteristics. Levothyrox (R)-associated reports included, on average, more adverse drug reactions (8 +/- 4) than comparators (2 +/- 2, P < 0.01) and mentioned mostly one drug (98.5% of reports), whereas comparators mentioned two at least (P < 0.001). The quantitative distribution of adverse drug reactions per report differed quite significantly, appearing almost Gaussian for Levothyrox (R) whereas Poisson-like for comparators (P < 0.0001). Age did not differ significantly in the two groups (54.2 vs. 49.7, NS), but female predominated in Levothyrox (R) group (94.5%) as compared with comparators (60.8%, P < 0.001). A mere third of the Levothyrox (R)-associated adverse drug reactions were deemed expected, versus two thirds for comparators (P < 0.001). The pattern of spontaneous reports associated with Levothyrox (R), whether fueled by media or influenced by social networks, appears atypical, as compared with that of comparators. Such reports, by their abundance, may impair the automatic detection of relevant concomitant signals.

Automated summary

Following changes in the excipients of Levothyrox (R), the French Pharmacovigilance Database received numerous spontaneous reports of adverse drug reactions associated with the new formula. These reports were found to be more frequent, with different characteristics compared to reports related to other drugs.