We are expanding the Dodd et al1 findings of 11 patients with pathologic gambling associated with drugs prescribed to treat Parkinson disease with data from the Food and Drug Administration Adverse Event Reporting System (AERS) database. The AERS database contains more than 2.5 million voluntary reports of adverse drug events collected since 1968. Among more than 4400 drugs in the AERS, 23 had at least 1 report of gambling. Pramipexole had 39 (58%) of the 67 gambling reports in the AERS. The top higher-than-expected drug-event reporting ratios (“signals”) for gambling occurred with 5 dopaminergic agonists (Table). Pramipexole had the highest signal with an adjusted reporting ratio that was over 380 times greater than expected. In contrast, antipsychotics (which are dopamine antagonists) do not have any adverse event reports of gambling in the AERS. These signals were detected using the Multi-item Gamma Poisson Shrinker (MGPS) statistical algorithm that applies a Bayesian model to simultaneously analyze disproportionality of reporting ratios for each event in the huge AERS database (including gambling) relative to all other events in the whole database.2,3 The higher the adjusted reporting ratio, the greater the strength of the association.2,3 An example of an unadjusted estimate of a reporting ratio follows:
Szarfman A, Doraiswamy PM, Tonning JM, Levine JG. Association Between Pathologic Gambling and Parkinsonian Therapy as Detected in the Food and Drug Administration Adverse Event Database. Arch Neurol. 2006;63(2):299–300. doi:https://doi.org/10.1001/archneur.63.2.299-b
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