Pharmacovigilance

GLP-1 medications are increasingly used for weight management, and many people share their experiences online. These narratives show why people take the drugs and what they experience, but they remain unstructured and disconnected from formal pharmacovigilance. We therefore present AskGLP1, a system that transforms online patient narratives into a knowledge graph (KG) and answers questions about medication experiences. Through an LLM-assisted pipeline grounded in the MedDRA terminology, AskGLP1 screens nearly 8.5 million Reddit posts for medication experiences and distills 163,135 of them, with 2,506 WebMD reviews, into a KG of 385,790 drug-side-effect and drug-purpose relations. We find that GLP-1 experiences are source- and drug-specific. Online narratives share the most common gastrointestinal symptoms with FAERS, but they foreground everyday burdens such as fatigue and food aversion, whereas FAERS reports more often include injection-site reactions and selected serious diagnoses such as pancreatitis. We further find that posts report less nausea and vomiting for tirzepatide than for semaglutide, more fatigue for Wegovy than Ozempic and for Zepbound than Mounjaro. Evaluations show that the agent answers with verifiable evidence and declines requests for medical advice. Our findings reveal gaps between what FAERS captures and what people report online, and they call for patient-centered approaches to pharmacovigilance. Code, prompts, and evaluation questions are available at https://github.com/ZhaoqianXue/AskGLP1.

Introduction: Increasing volumes of individual case safety reports (ICSRs) challenge expert-led causality assessment in pharmacovigilance. We developed MARCA (Multi-Agent Retrieval-Augmented Causality Assessment), a four-agent framework for Naranjo-based assessment, and evaluated agreement with human experts and exploratory differences between non-RAG and RAG-labelled scores. Methods: MARCA combined scientific literature retrieval, drug-label assessment, objective-evidence classification, and clinical causality reasoning using Gemini 2.5 Pro and DeepSeek-V3.2. Agent-generated rationales informed human-assisted scoring. A consensus expert reference standard covered 215 ICSRs and 1,562 drug-event combinations (DECs) from FAERS (Q1-Q2 2025). Agreement was measured using percentage agreement and Cohen's kappa. Results: Question-level agreement was 96.8% for Naranjo Q2 (kappa = 0.491; 95% CI 0.265-0.663), 85.4% for Q5 (kappa = 0.269; 95% CI 0.180-0.340), and 96.8% for Q10 (kappa = 0.922; 95% CI 0.885-0.951). Final causality classification agreement was 79.4% (95% CI 71.8-85.3; kappa = 0.587, 95% CI 0.450-0.690). In a retrospective subset of 60 DECs, agreement was higher for RAG-labelled than non-RAG scores for Q5 (83.3% vs 65.0%) and Q10 (100.0% vs 18.3%). Discussion: MARCA-assisted assessment showed substantial variation in agreement across Naranjo questions, with lower concordance for alternative causes. Retrospective RAG comparisons are exploratory and do not establish prospective effectiveness.

Background: Growing individual case safety report (ICSR) volumes have intensified demand for scalable automated causality assessment. Large Language Models (LLMs) show promise, yet performance on clinically demanding tasks remains suboptimal and inference-time hyperparameter optimization has not been investigated. Objective: To develop a Gaussian Process (GP)-compatible optimization objective and investigate whether temperature optimization improves LLM-expert agreement on Naranjo causality assessment of FAERS ICSRs. Methods: Expert causality assessments were performed on 723 stratified FAERS cases. OpenAI's GPT-5.2 was evaluated using chain-of-thought (CoT) prompting. Four composite metrics were developed: Weighted Cosine Similarity (WCS), Information-Weighted Agreement Score (IWAS), Entropy-Weighted Agreement and Cosine Similarity Score (EWACS), and Consensus-Weighted Cosine Similarity (CWCS) and Bayesian optimization using a GP surrogate with Probability of Improvement (PoI) acquisition was applied across temperature [0, 2]. Results: GPT-5.2 outperformed prior biomedical LLMs at baseline (T = 0), achieving 74.1% agreement on question 5 and 65.4% on question 10 of Naranjo algorithm. Entropy analysis identified these as the sole informative optimization targets. Temperature showed no systematic population-level effect (\b{eta} = 0.002, p = 0.959). EWACS-guided Bayesian optimization improved causality classification agreement from 45.0% to 72.0% (+27 pp), with the largest gain in Doubtful cases (+42.9 pp). Conclusion: EWACS was identified as the optimal GP-compatible metric. The absence of a universal temperature optimum indicates LLM performance is driven primarily by ICSR content, yet case-specific temperature selection produced meaningful improvements, supporting temperature optimization for LLM-assisted pharmacovigilance.

Patients increasingly seek medication information online, yet safety knowledge for psychiatric drugs is split between regulatory adverse-event records, which are authoritative but abstract, and patient narratives, which are experience-near but unvalidated. Integrating them without conflating evidence and anecdote is especially consequential in psychiatry, where poorly contextualised information can amplify fear, nocebo responses, and non-adherence. Here we develop a provenance-aware, knowledge-graph-based multi-agent framework unifying 466,525 Reddit posts, 60,782 WebMD reviews, and twenty years of U.S. FDA Adverse Event Reporting System records for nine antidepressants. A large-language-model entity-recognition pipeline benchmarked against physician annotations reached highest F1 scores of 0.969 for medications and 0.973 for conditions. The two community platforms were far more concordant with each other (overlap up to a Jaccard similarity of 0.905) than with regulatory reports, indicating that patient-generated data form a partly independent safety signal. For sertraline, many adverse events appeared in community sources hundreds of days before the corresponding FDA date. A Neo4j knowledge graph grounded in ATC-N, ICD-10, and MedDRA vocabularies preserves provenance, keeping every claim traceable and regulatory facts distinct from patient experience. These results establish source-aware integration as a route to more auditable psychiatric medication information, with usefulness and patient benefit to be tested prospectively.

Distinguishing causal adverse drug events (ADEs) from spurious correlations remains a central challenge in pharmacovigilance. The InferBERT framework integrates transformer models with Do-calculus, but its success hinges on the underlying classification model. This study evaluates the impact of model choice in InferBERT, assessing whether simpler models suffice, if domain-specific pre-training helps, whether scaling to LLMs improves causal detection, and the effect of post-hoc calibration. We performed a comparative study on two benchmarks: Analgesics-induced Acute Liver Failure (AILF) and Tramadol-related Mortalities (TRAM). Four models were evaluated-XGBoost (baseline), ALBERT (original InferBERT), BioBERT (biomedical transformer), and Med-LLaMA (medical LLM)-using 5-fold cross-validation repeated over 20 runs. We measured accuracy, Expected Calibration Error (ECE) pre- and post-isotonic regression, and Jaccard concordance of causal terms with PRR, ROR, and EBGM; significance was tested with paired t-tests. BioBERT achieved the highest accuracy on both datasets, while Med-LLaMA underperformed despite its size and parameter-efficient fine-tuning. Domain-specific pre-training was decisive. Calibration improved ECE but had mixed effects on accuracy and causal discovery. BioBERT's superiority also yielded the strongest concordance with traditional pharmacovigilance signals. These results show that domain-specific pre-training provides a clear advantage over simpler baselines and larger LLMs. Investing in manageable, domain-aware models is more effective for computational pharmacovigilance than simply scaling model size.

Veterinary pharmacovigilance systems are essential for monitoring adverse drug events (ADEs), yet existing approaches often fail to capture region-specific toxicity patterns shaped by local biological and regulatory contexts. In Japan, these challenges are amplified by species-specific metabolic differences and reporting practices defined by the Ministry of Agriculture, Forestry, and Fisheries (MAFF). Most prior work relies on prediction-oriented models, limiting mechanistic interpretability. This study proposes a regulatory-integrated unsupervised framework for pattern discovery using the National Veterinary Assay Laboratory (NVAL) database. ADEs are encoded into organ system-aligned representations and adjusted for species-specific reporting biases, enabling cross-species comparison. Similarity-based clustering and dimensionality reduction are applied to identify latent toxicity structures. Analysis of 4,120 high-confidence ADE reports (9,080 drug-ADE combinations) identified three significant species clusters (p < 0.01), including hepatic-dominant patterns in companion animals (0.42 $\pm$ 0.06), renal toxicity in ruminants (0.39 $\pm$ 0.07), and dermatological sensitivity in sheep (0.35 $\pm$ 0.07). Drug-level clustering achieved 83% alignment with pharmacological classes, while cosine similarity outperformed alternative metrics (silhouette score: 0.48; cluster precision: 87%). Regulatory validation showed strong agreement with established classifications. These findings demonstrate that regulation-aligned unsupervised analysis can uncover biologically meaningful, region-specific toxicity patterns, providing an interpretable and scalable framework for veterinary drug safety assessment.

Drug development and pharmacovigilance are frequently bottlenecked by legacy clinical reporting pipelines. These monolithic systems encode regulatory-grade logic but resist AI integration by producing opaque output with no machine-readable intermediate layer. Existing modernization approaches force a choice between full rewrites and incremental refactoring that preserves structural barriers. We present a non-destructive methodological framework achieving AI-driven pharmacoinformatics readiness without altering legacy source code. A metadata layer--comprising a bridge map, a typed Intermediate Representation (IR), and an orchestrator--wraps existing components and re-exposes their outputs as structured data consumable by LLMs. It enables optional incremental consolidation, replacing selected legacy components with metadata-configured core routines while the remainder operates unchanged. Validated on a 558-component SAS reporting library (373,000 lines of code), the framework demonstrated immediate AI-readiness under coexistence mode, yielding machine-readable output. Where consolidation was elected, the modernized core achieved a 92% reduction in proprietary code. Parity validation on 14 report types from a Phase III study achieved cell-level parity of 80% or above on 11 reports (mean 82.7%, best 99.2%). A benchmark using CDISC CDISCPilot01 data achieved 100% parity across 5 reports. LLM experiments confirmed the IR enables automated pharmacovigilance, table summarization, and trial configuration generation. The framework offers a regulation-aware path to AI-integrated clinical reporting, accelerating drug development without interrupting regulatory submissions.

Background: The identification of optimal signal detection methods is hindered by the lack of reliable reference datasets. Existing datasets do not capture when adverse events (AEs) are officially recognized by regulatory authorities, preventing restriction of analyses to pre-confirmation periods and limiting evaluation of early detection performance. This study addresses this gap by developing a time-indexed reference dataset for the European Union (EU), incorporating the timing of AE inclusion in product labels along with regulatory metadata. Methods: Current and historical Summaries of Product Characteristics (SmPCs) for all centrally authorized products (n=1,513) were retrieved from the EU Union Register of Medicinal Products (data lock: 15 December 2025). Section 4.8 was extracted and processed using DeepSeek V3 to identify AEs. Regulatory metadata, including labelling changes, were programmatically extracted. Time indexing was based on the date of AE inclusion in the SmPC. Results: The database includes 17,763 SmPC versions spanning 1995-2025, comprising 125,026 drug-AE associations. The time-indexed reference dataset, restricted to active products, included 1,479 medicinal products and 110,823 drug-AE associations. Most AEs were identified pre-marketing (74.5%) versus post-marketing (25.5%). Safety updates peaked around 2012. Gastrointestinal, skin, and nervous system disorders were the most represented System Organ Classes. Drugs had a median of 48 AEs across 14 SOCs. Conclusions: The proposed dataset addresses a critical gap in pharmacovigilance by incorporating temporal information on AE recognition for the EU, supporting more accurate assessment of signal detection performance and facilitating methodological comparisons across analytical approaches.

ClinicalTrials .gov (CT .gov) is the largest publicly accessible registry of clinical studies, yet its registry-oriented architecture and heterogeneous adverse event (AE) terminology limit systematic pharmacovigilance (PV) analytics. AEs are typically recorded as investigator-reported text rather than standardized identifiers, requiring manual reconciliation to identify coherent safety concepts. We present the ClinicalTrials .gov Transformation Database (CTG-DB), an open-source pipeline that ingests the complete CT .gov XML archive and produces a relational database aligned to standardized AE terminology using the Medical Dictionary for Regulatory Activities (MedDRA). CTG-DB preserves arm-level denominators, represents placebo and comparator arms, and normalizes AE terminology using deterministic exact and fuzzy matching to ensure transparent and reproducible mappings. This framework enables concept-level retrieval and cross-trial aggregation for scalable placebo-referenced safety analyses and integration of clinical trial evidence into downstream PV signal detection.

Combination pharmacotherapy offers substantial therapeutic advantages but also poses substantial risks of adverse drug reactions (ADRs). The accurate prediction of ADRs with interpretable computational methods is crucial for clinical safety management, drug development, and precision medicine. However, managing ADRs remains a challenge due to the vast search space of drug combinations and the complexity of physiological responses. Current graph-based architectures often struggle to effectively integrate multi-scale biological information and frequently rely on fixed association matrices, which limits their ability to capture dynamic organ-level dependencies and generalize across diverse datasets. Here we propose CrossADR, a hierarchical framework for organ-level ADR prediction through cross-layer feature integration and cross-level associative learning. It incorporates a gated-residual-flow graph neural network to fuse multi-scale molecular features and utilizes a learnable ADR embedding space to dynamically capture latent biological correlations across 15 organ systems. Systematic evaluation on the newly constructed CrossADR-Dataset-covering 1,376 drugs and 946,000 unique combinations-demonstrates that CrossADR consistently achieves state-of-the-art performance across 80 distinct experimental scenarios and provides high-resolution insights into drug-related protein protein interactions and pathways. Overall, CrossADR represents a robust tool for cross-scale biomedical information integration, cross-layer feature integration as well as cross-level associative learning, and can be effectively utilized to prevent ADRs in clinical decision-making.

Adverse Drug Reactions (ADRs) are a leading cause of morbidity and mortality. Existing prediction methods rely mainly on chemical similarity, machine learning on structured databases, or isolated target profiles, but often fail to integrate heterogeneous, partly unstructured evidence effectively. We present a knowledge graph-based framework that unifies diverse sources, drug-target data (ChEMBL), clinical trial literature (PubMed), trial metadata (ClinicalTrials.gov), and post-marketing safety reports (FAERS) into a single evidence-weighted bipartite network of drugs and medical conditions. Applied to 400 protein kinase inhibitors, the resulting network enables contextual comparison of efficacy (HR, PFS, OS), phenotypic and target similarity, and ADR prediction via target-to-adverse-event correlations. A non-small cell lung cancer case study correctly highlights established and candidate drugs, target communities (ERbB, ALK, VEGF), and tolerability differences. Designed as an orthogonal, extensible analysis and search tool rather than a replacement for current models, the framework excels at revealing complex patterns, supporting hypothesis generation, and enhancing pharmacovigilance. Code and data are publicly available at https://github.com/davidjackson99/PKI_KG.