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With the rapid progress of computer technology and development of electronic health records, pharmacoepidemiologic studies using multiple databases across and within nations have become feasible and popular in recent years. Multinational pharmacoepidemiologic studies (MPES) provide opportunities to compare drug utilization and effects across countries, to study rare exposures and outcomes, and to collaborate across nations. Multiple networks in North America, Europe, and Asia/Pacific region have emerged to support MPES and national and cross-national collaborations. We highlight the challenges of MPES and respective solutions with examples, including non-database pharmacoepidemiologic studies for low resource countries, distributed network approaches to address data privacy issues, considerations for biases due to variations in data structure, coding, and practice/behaviors of health care providers and patients. Because there are no standard recommendations in designing and conducting MPES, transparency is the key to adequate conduct and interpretation of the studies. More efforts in developing and standardizing the methods for MPES are required. |
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