Improving Online Access to Drug-Related Information

1. Improving Online Access to Drug-related Information
Jiao Li, Ph.D., Ritu Khare, Ph.D., Zhiyong Lu, Ph.D.
National Center for Biotechnology Information (NCBI)
National Library of Medicine, National Institutes of Health
Introduction Linking drug monographs to diseases of interest
Seeking drug-related information is one of the major activities of today’s Identifying diseases of Ranking diseases of interest
online health consumers. In this work, our goals are: interest from drug monographs • Evidence confidence
(1) To facilitate health consumers to access trustworthy drug information online θ sg
(2) To provide consumers with integrated access to other health resources Resources containing drug-disease relationships = α ∗ pM s g + β ∗ pF s g + γ ∗ pQ s g + 𝛿 ∗ 𝑝 𝐿 (𝑠|𝑔)
Drug monograph 𝑛 𝑀 𝑔,𝑠 𝑛 𝐹 𝑔,𝑠 𝑛 𝑄 𝑔,𝑠 𝑛 𝐿 𝑔,𝑠
e.g., the [Drug] is used for treating [Disease] = 𝛼∗ + 𝛽∗ + 𝛾∗ + 𝛿∗
Disease 𝑛 𝑀 𝑔 𝑛𝐹 𝑔 𝑛𝑄 𝑔 𝑛𝐿 𝑔
· Search drug names Drug monograph
Disease monograph
• Search trends 𝑓 𝑔, 𝑠
e.g., the [Disease] can be treated by [Drug]
§ Active ingredients
Compound 𝑞 𝑠 𝑔 𝑓 𝑔 𝑓 𝑔, 𝑠 ∗ 𝑁
𝜏 𝑠 𝑔 = = =
( e.g., Ibuprofen) Search query 𝑞 𝑠 𝑓 𝑠 𝑓 𝑔 ∗ 𝑓 𝑠
§ Brand names
Gene
e.g., [Drug] [Disease]
𝑁
(e.g., Advil, Motrin)
Literature • Relevant score
Health Consumer
 (1)  (2) Protein e.g., study [Drug] in [Disease]
𝑟 𝑠|𝑔 = 𝜃 𝑠 𝑔 ∗ 𝑒 𝜏 𝑠|𝑔
𝒑 𝑀 𝑠 𝑔 : drug-disease in disease
Literature where, monographs
s: Disease 𝒑 𝑠 𝑔 : drug-disease in drug monographs
𝑭
Clinical Trial Fig 3. Resources containing g: Drug 𝒑 𝑸 𝑠 𝑔 : drug-disease searched by users
drug-disease relationships 𝒑 𝑳 𝑠 𝑔 : drug-disease in scientific literature
Fig 1. Health consumers’ behaviors of seeking drug-related information
Filtering drug-disease M
Results Output: ranked
Enriching drug monographs relationships
Q Q0.1 Q0.05 Q0.01 L0.01 L0.05 L0.1 L
Input: a drug
monograph
diseases of interest
by automatically assigning brand names Statistics-based filter:
Tamsulosin
(tam soo' loe sin)
Enlarged prostate
F
Prostatitis - bacterial
 Drug Monographs  RxNorm Hypergeometric p-value is used to
Why is this medication prescribed?
Tamsulosin is used in men to treat the symptoms of an enlarged
prostate (benign prostatic hyperplasia or BPH) which include
chronic
Ingredient (IN) has_ingredient Brand Name (BN) difficulty urinating (hesitation, dribbling, weak stream, and Prostatitis - nonbacterial
• Each monograph is subject to a drug’s • A standardized Ibuprofen
ingredient_of
Advil measure the significance of relationships incomplete bladder emptying), painful urination, and urinary
frequency and urgency. Tamsulosin is in a class of medications
called alpha blockers. It works by relaxing the muscles in the
- chronic
generic name/active ingredient (e.g., nomenclature has_tradename tradename_of
identified from queries and literature.
prostate and bladder so that urine can flow easily. Cataract
‘Ibuprofen’) rather than its specific drug for clinical drugs Dosage Form (DF) has_dose_form Branded Drug or Package (SBD)
product (e.g., ‘Advil®’) Oral Tablet Advil 100 MG Oral Tablet
• Drug brand
dose_form_of [Obsolete=N]
[Veterinary=N]
Domain knowledge based filter:
• Drugs with same ingredients but related concepts Search query Literature
Drugs in specific physical forms should be
in RxNorm Q_ID Q_Term
different dosage forms may be
applied in specific categories of diseases. Q831368 flomax cataract
described in different monographs.
Drug dose form Disease category Q1129241 tamsulosin cataract
Diclofenac (Transdermal) Ingredient (IN) has_ingredient Brand Name (BN)
Ophthalmic Cream Ophthalmology Q952568 flomax and cataract
Diclofenac (Ophthalmic) Guaifenesin Allfen
ingredient_of surgery
Diclofenac (Topical) Otic Solution Otolaryngology Q235052 flomax cataract
reformulation_of has reformulation
Vaginal Cream Obstetrics & Gynecology surgery
 Brand name vs. Ingredient name Ingredient (IN) has_ingredient Brand Name (BN)
• When searching for drug information, Guaifenesin
Guaiacolsulfonate
ingredient_of Allfen Reformulated Mar 2007
Conclusions
consumers use brand names rather
than generic names. Our study has several practical implications in real-world medical informatics:
• Facilitating consumers to access drug information through brand name search
 Assigning brand names to a given  Assignment Result
• Facilitating consumers to access drug-related disease monographs, and ranking
drug monograph
• Our method is applicable to 957 drug diseases based on evidence confidence and user interest
monographs (1095 in total). • Helping drug monograph editors update drug information such as brand names
• Our method can help human editors update • Accurately characterizing monographs using features like ingredients & dosage forms
Input: A full-text drug monograph
and revise drug information.
References
Identify ingredients and dosage forms
1. Islamaj DR, Murray GC, Neveol A, and Lu Z: Understanding PubMed user search behavior through
Map to RxNorm [2]
log analysis. Database (Oxford) 2009, 2009:bap018.
2. Li J. and Lu Z. Automatic Identification and Normalization of Dosage Forms in Drug Monographs.
Identify brand names in RxNorm BMC Medical Informatics and Decision Making 2012, 12:9.
(1) Ingredient Consistency 3. Li J. and Lu Z. Assigning Brand Names to Drug Monographs in PubMed Health. The AMIA 2011
(2) Dosage Form Consistency
Annual Symposium. 2011. Washington DC, USA
4. MedlinPlus® http://www.nlm.nih.gov/medlineplus/
(3) Obsolescence
5. American Hospital Formulary Service® (AHFS) drug information
(4) Reformulation http://www.ahfsdruginformation.com/
(5) Veterinary 6. A.D.A.M. Medical Encyclopedia http://www.adam.com/MutlimediaEncyclopedia.aspx
7. RxNorm http://www.nlm.nih.gov/research/umls/rxnorm/
8. PubMed® http://www.ncbi.nlm.nih.gov/pubmed/
Output: Brand Names
9. PubMed Health http://www.ncbi.nlm.nih.gov/pubmedhealth/
Acknowledgements
This research was supported by the Intramural Research Program of the National Institutes of Health,
Fig 2. Flowchart for determining brand names National Library of Medicine. We would like to thank our colleagues Dr. Stuart J. Nelson, Dr. John
Kilbourne, and Dr. Olivier Bodenreider for discussing the meaningful use of RxNorm.