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.
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
- National Comprehensive Cancer Network Drugs and Biologics Compendium
- United States Pharmacopeia Drug Information for the Health Professional
"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
"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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