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Br J Clin Pharmacol. 2019 Apr;85(4):715-721. doi: 10.1111/bcp.13843. Epub 2019 Feb 16.

Post-marketing dosing changes in the label of biologicals.

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Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.
Medicines Evaluation Board, Utrecht, The Netherlands.
Foundation Pharmacy for Hospitals in Haarlem, Haarlem, The Netherlands.
Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands.



The aim of this study was to evaluate post-marketing label changes in dosing information of biologicals.


Biologicals authorized between 2007 and 2014 by the European Medicines Agency (EMA) were included and followed up from marketing authorization until 31 December 2016 or date of withdrawal of the marketing authorization. The primary outcome of the study was defined as label change in dosing information for the initially approved indication. Incidence of changes, type of change and mean time to change were assessed. As a secondary outcome, label changes in dosing information for extended indications were assessed.


A total of 71 biologicals were included. Dosing information in the label changed for the initial indication during follow-up for eight products (11%). In one of the eight products the change concerned an increase in dose. Also, a change in dosing frequency was identified in three products, for one product a recommendation was added that therapy could be initiated with or without a loading dose, and for one product the minimum dose was removed and a maximum dose was added. For the remaining product the dose was decreased due to safety issues. For 30 products (42%) the indication was extended at least once. No changes in dosing information were observed for the extended indications (n = 59) during follow-up.


This study showed that in 11% of the biologicals, the dosing for the initial indication in the label was changed. In contrast to small molecules, the dose was rarely reduced for safety reasons.


biologicals; dosing information; label; post-marketing

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