Best Evidence Analyses and Commentary

Reliability (Credibility) of Compendia Methods for Off-Label Cancer Uses
February 26, 2009

In a previous Drugs in the News the association between the American Society of Health-system Pharmacists' (ASHP) American Hospital Formulary Service Drug Information (AHFS-DI) and the Foundation for Evidence Based Medicine (FEBM) to review off-label cancer drug uses was noted. This association creates an apparent conflict of interest and gives the ASHP plausible deniability that ASHP does not accept industry money to list off-label cancer uses in AHFS-DI.

A review published February 17, 2009 Annals of Internal Medicine (Ann Intern Med. 2009;150: 336-343) critically examined the methods used by six drug compendia to evaluate off-label cancer drug uses. The six compendia are:

  • American Hospital Formulary Service Drug Information
  • Clinical Pharmacology
  • Drug Facts and Comparisons
  • DRUGDEX Information System
  • National Comprehensive Cancer Network Drugs and Biologics Compendium
  • United States Pharmacopeia Drug Information for the Health Professional

The authors concluded:

"Current compendia lack transparency and do not seem to follow systematic methods to review or update evidence."

The following observation by the Annals authors raises the broader question about the quality of the methods used to include off label uses of non-cancer drugs and the drug information contained in these references in general.

"Cited evidence was scanty and inconsistent across compendia, which raises questions about the processes by which evidence is identified and selected to generate recommendations, the potential biases or conflicts of interest that affect decisions of whether to include an indication or how to present the evidence, and the comprehensiveness and quality of the evidence that the compendia include."

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