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Drug analytics on Embase
Smart data for drug development,
repurposing and safety based on triple
indexing
Ivan Krstic, PhD
Senior Product Development Manager Embase
July 27th 2016
2
Agenda
Data analytics based on manually extracted semantic relationships
between:
– Drug – Disease
• Adverse Reaction
• Therapy
– Drug – Drug
• Interactions
• Combination
• Comparison
very valuable for:
• Drug repurposing
• Drug development
• Drug safety
3
Fatigue
564
Everolimus
Drug
interaction
Drug
comparison
Drug
therapy
Adverse
drug
reaction
Drug
combination
Tumor
neuroendocrine
320
Paclitaxel
221
Exemestane
259
Bevacizumab
270
Erythromycin
26
Rifampicin
28
Ketoconazole
28
Azathioprine
65
Paclitaxel
172
Rapamycin
192
Breast
cancer
633
Kidney
carcinoma
993
Diarrhea
570
Stomatitis
616
Manually
extracted
semantic
relationships
4
Indexing for Embase is a manual process
performed by trained indexers with a biomedical
background, with the exception of articles designated
for automatic indexing.
Indexers read and analyze the full text of articles in
order to identify relevant concepts, and index them with
the most specific Emtree terms.
Index terms are controlled by the Emtree thesaurus
resulting in consistent coverage of concepts that
may be expressed in many different ways in the
literature.
Indexing principles
5
Indexing: subheadings
Subheadings are Emtree terms that are also used as concept
qualifiers for drugs, diseases and devices to refine their meaning,
providing a very precise idea of what an article covers.
Important
Definition
Drug subheadings
6
Indexing: key subheadings
Concept Key Subheading
drug adverse drug reaction
drug drug combination
drug drug comparison
drug drug interaction
drug drug therapy
device adverse device effect
device device comparison
disease drug therapy
disease side effect
Nine subheadings are denoted key subheadings.
Important
Definition
7
Indexing: triple-linking
Triple-indexing is a three level indexing of the full text of an article,
and it consists of:
‒ Concept (drug or device or disease)
‒ Key subheading (relationship)
‒ Linked concept (e.g. stomatitis, hypertension, nausea, etc.)
Triple indexing has started in Q1 of 2007 for the drug triples (drug
therapy from Q2 of 2009). Devices began in Q2 of 2014.
Important
Definition
Everolimus Adverse
drug
reaction
Stomatitis
Manually Extracted Semantic Relationships
8
How can the Manually Extracted Semantic Relationships
be searched
Filter options
For each drug, device and
disease manually
extracted semantic
relationships can be
identified and filtered
(simple search a drug and
use drug filter)
Search query language
'everolimus'/'drug therapy'/'breast cancer'
9
How are the Manually Extracted Semantic Relationships
displayed?
In individual results
10
How are the manually extracted semantic relationships
displayed?
In filters
Drug repositioning
12
Drug repositioning to treat (rare) diseases
Compounds targeted for repositioning have already gone through extensive
preclinical testing and have shown safety in their original indication.
The key benefits are:
Shorter development time
Lower development costs - safety profiles of the products will have
already been established
Higher success rates
13
Manually extracted drug-disease relationships for drug
repositioning
Drug therapy = Used as a drug subheading to identify a drug used to treat
disease / indication (including curative, palliative, symptomatic or prophylactic
treatment)
Everolimus
Drug
therapy
Tumor
neuroendocrine
320
Breast
cancer
633
Kidney
carcinoma
993 Important
Definition
Everolimus (Afinitor®)
15
Everolimus (Afinitor®)
http://clincancerres.aacrjournals.org/content/16/5/1368
mTOR Signalling in cancer:
• Positively regulates cell growth
and proliferation
• Positively regulates cellular
metabolism & adenosine
triphosphate (ATP) production
• Promotes angiogenesis
• Promotes cell growth by
negatively regulating
degradative processes in cells
Mechanism of Action: mTOR inhibitor (inhibits the mammalian target of
rapamycin)
mTOR inhibitors can be used to block the multiple biologic effects caused by
the aberrant activation of mTOR found in several cancer types.
16
Everolimus is approved for various conditions
• Advanced kidney cancer (US FDA approved in March 2009)
• Prevention of organ rejection after renal transplant (April 2010)
• Subependymal giant cell astrocytoma (SEGA) associated with tuberous
sclerosis (TS) (October 2010)
• Progressive or metastatic pancreatic neuroendocrine tumors not surgically
removable (May 2011)
• Breast cancer in post-menopausal women with advanced hormone-receptor
positive, in conjunction with exemestane (July 2012)
• Prevention of organ rejection after liver transplant (Feb 2013
• Progressive, well-differentiated non-functional, neuroendocrine tumors
(NET) of gastrointestinal (GI) or lung origin (February 2016).
Launch Date March 2009
First Full-Year Sales (2010) $243 million
Sales in 2015 $1.6 billion
17
Semantic relationship between Everolimus and treated indications
Everolimus – list of all on-label and off-label use indexed on Embase
18
Relation between approval year and records reporting
direct relationship between drug and indication
Pub. year Kidney cancer
Pancreatic neuroendocrine
tumor
Breast cancer
Neuroendocrine tumor
Tuberous sclerosis
2016 66 17 43 20 10
2015 84 45 82 39 26
2014 102 29 104 29 15
2013 142 74 139 36 26
2012 170 71 124 81 10
2011 190 12 63 69 11
2010 144 2 60 32 3
2009 114 34 21 2
2008 9 2 2
# of published articles for Everolimus per year
Is Tuberous Sclerosis next use to be approved for Everolimus ?
19
Relation between approval year and records reporting
direct relationship between drug and indication
Pub. year Kidney cancer
Pancreatic neuroendocrine
tumor
Breast cancer
Neuroendocrine tumor
Tuberous sclerosis
2016 66 17 43 20 10
2015 84 45 82 39 26
2014 102 29 104 29 15
2013 142 74 139 36 26
2012 170 71 124 81 10
2011 190 12 63 69 11
2010 144 2 60 32 3
2009 114 34 21 2
2008 9 2 2
# of published articles for Everolimus per year
Take-home message: Semantic relationship between drugs and indications
can be used to guide drug repositioning strategies.
Nivolumab
21
Nivolumab
Indications (approved):
• Hodgkin's disease
• malignant melanoma
• non-small cell lung cancer
• renal cell cancer
Off-label use:
• colorectal cancer
• lung cancer
• ovary cancer
22
Nivolumab for Colorectal cancer in Clinical trials
Embase search:
'nivolumab'/'drug therapy'/'colorectal cancer' AND 'nivolumab'/'clinical trial'
Kadcyla (ado-trastuzumab
emtansine)
24
Kadcyla (ado-trastuzumab emtansine)
In a clinical trial of women with advanced HER2 positive breast cancer who
were already resistant to trastuzumab alone
Kadcyla improved median overall survival by 5.8 months (30.9 months vs. 25.1
months) compared to the combination of lapatinib and capecitabine.
25
Potential new use for Kadcyla
Is there an evidence for a new use?
New drug combinations for
combination drugs
27
What is a Drug combination on Embase?
Drug combination = Used as a drug subheading for drugs given in
combination or concomitantly
Everolimus Drug
combination
Paclitaxel
221
Exemestane
259
Bevacizumab
270
Important
Definition
28
Drug combinations for new combinations
Everolimus is approved for breast cancer in post-menopausal women with
advanced hormone-receptor positive, HER2-negative type cancer, in
conjunction with exemestane (FDA July 2012)
29
New combinations for Everolimus
PUBYEAR everolimus-
drug combination- exemestane
everolimus- drug combination-
bevacizumab
2016 14 1 2015 46 17 2014 56 19 2013 73 34 2012 53 54 2011 11 47 2010 2 42 2009 3 36 2008 16 2007 4
Is the combination
with bevacizumab
next to be approved
for the treatment of
kidney cancer or
colorectal cancer?
30
New combinations for Kadcyla
New formulation looks promising – combination of trastuzumab emtansine
(Kadcyla), paclitaxel, and pertuzumab in clinical trials.
Potential new
combination
with
Pertuzumab
Drug-drug interactions
32
What is a drug-drug interaction on Embase?
Drug interaction = alteration of the effects of a drug by reaction with another drug
or drugs, with foods or beverages, or with a preexisting medical condition. Used
as a drug subheading.
Everolimus
Drug
interaction
Erythromycin
26
Rifampicin
28
Ketoconazole
28
Important
Definition
33
Drug-drug interactions
Long list of drug with
reported interactions
with everolimus – to
be listed in the label.
Drug-drug comparison
35
What is a drug-drug comparison on Embase?
Drug comparison = Used as a drug subheading when two or more drugs are
compared within the same study.
Everolimus Drug
comparison
Azathioprine
65
Paclitaxel
172
Rapamycin
192
Important
Definition
36
Seamless access to drug comparison data
Analytical capability provides access to information on drug-drug comparison
in literature.
37
Drug comparison – smooth access to records with clinical
efficacy and safety data
Drug safety
39
What is an Adverse drug reaction on Embase?
Adverse drug reaction = Used as a drug subheading to identify a drug for
which an undesired side effect is reported (when used at therapeutic dose
ranges in humans)
Fatigue
564
Everolimus
Adverse
drug
reaction
Diarrhea
570
Stomatitis
616
Important
Definition
40
Seamless access to safety signals
41
Manually extracted semantic relationships for drug
safety
Safe and rational use of drug
Better risk management
Assess
causalities
42
Everolimus - safety signals per year
Smart data available in Embase helps to improve Risk
Management (Causality assessment and Signal confirmation)
43
Summary
Manually extracted semantic relationships can be used to:
guide drug repositioning strategies
investigate potential for development of combination drugs
identify drug-drug interactions
collect drug-drug comparison information
improve risk management (Causality assessment and Signal
confirmation)
Thank you!
Any questions?
Ivan Krstic, PhD
Senior Product Development Manager Embase