Evidence map›Paper›PMID 41681041›Full record

ArticlePharmacoepidemiology and drug safety2026

Performance of the Self-Controlled Case Series for Drug Safety Signal Detection: A Multi-Database Study.

Astrid Coste, Angel Y S Wong, Francois Haguinet, Andrew Bate, Ian J Douglas

Abstract readComparative Study
In one paragraph

Article in Pharmacoepidemiology and drug safety, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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0cells of the map it votes in
1citing papers in PubMed
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1 · What the graph read from it

What it found

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2 · The registry

The trial behind it

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

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5 · Who and what money

Authors and funding

5 authors.

Astrid CosteDepartment of Non-Communicable Diseases Epidemiology, LSHTM, London, UK.ORCID https://orcid.org/0000-0003-4207-7447
Angel Y S WongDepartment of Non-Communicable Diseases Epidemiology, LSHTM, London, UK.ORCID https://orcid.org/0000-0002-8618-7333
Francois HaguinetGSK, London, UK.
Andrew BateDepartment of Non-Communicable Diseases Epidemiology, LSHTM, London, UK.ORCID https://orcid.org/0000-0003-3151-3653
Ian J DouglasDepartment of Non-Communicable Diseases Epidemiology, LSHTM, London, UK.

Funding

GlaxoSmithKline
6 · The paper itself

Abstract

backgroundDifferences in performance of the Self-Controlled Case Series (SCCS) for signal detection have been reported across different databases. However, there has been limited comparative analysis of performance and it remains unknown whether combinations of databases could enable more effective signal detection.

objectivesThis study aims to compare the performance of the SCCS for signal detection across several data sources, and to determine whether combinations of databases can improve SCCS performance.

methodsWe applied the SCCS to macrolides and fluoroquinolone antibiotics, in four databases: Merative MarketScan Commercial Claims and Medicare, the Clinical Practice Research Datalink (CPRD) Aurum and the Système National des Données de Santé. We developed a reference set of 104 positive controls and 58 negative controls, using a taxonomy framework to ensure the selected drug outcome pairs are theoretically well suited to the SCCS design. The observation period lasted 2 years, with a 30-day risk-window after each dispensing. Diagnostic performance was measured using sensitivity, specificity and area under the receiver operating curve (AUC) with respect to the product labels, both for individual and combinations of databases.

resultsThe sensitivity of the SCCS ranged from 0.57-0.89 across individual databases, and the specificity from 0.43-0.77 when limited to drug-outcome pairs sufficiently powered. The combination of all databases achieved the maximum sensitivity of 0.89 (0.41 specificity) for the full reference set, and a sensitivity of 1 (0.35 specificity) for drug outcome pairs with enough power. Whilst AUCs ranged from 0.66 to 0.71 across individual databases, the highest performing combination was CPRD plus MarketScan Commercial Claims (0.76 AUC).

conclusionsUsing a carefully designed reference set of drug-outcome pairs well suited to the study design, the SCCS performance varied substantially by database due to differences in population, reporting, healthcare and coding systems and prescribing patterns. Multi-database studies showed increased performance of SCCS for signal detection.

Indexed as

Adverse Drug Reaction Reporting SystemsAnti-Bacterial AgentsDatabases, FactualDrug-Related Side Effects and Adverse ReactionsArea Under CurveFluoroquinolonesHumansMedicarePharmacovigilanceSensitivity and SpecificityUnited StatesAnti-Bacterial AgentsFluoroquinolonesclaims dataelectronic health recordspharmacoepidemiologypharmacovigilancereal‐world dataself‐controlled case seriessignal detection

Identifiers

PMID41681041
PMCPMC12901761

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.