All Party Parliamentary Group for Valproate and other AEDs in Pregnancy –

Tuesday 2 February 2022

The officers of the APPG include the Chair, Vice-Chair, Officers, Treasurer & Secretary. Each of them has taken their position in the APPG to be a champion within Parliament, and beyond, for people harmed by Anti Epilepsy medicines . The officers were elected at the APPG Annual General Meeting on 22 February 2022

Today the All Party Parliamentary Group (APPG) held its Annual Election of Officers and duly elected the following persons :

Chair – Cat Smith MP

Vice Chair – Caroline Nokes MP

Vice Chair – Christian Wakeford MP

Officer – Liz Twist MP

Officer – Ben Lake MP

Treasurer – Lord Philip Hunt

Secretariat is provided by INFACT

What is an APPG ?

All-Party Parliamentary Groups (APPGs) are informal, cross-party, interest groups of MPs and Peers interested in a particular issue.
APPGs do not have any power to make laws and are not funded by Parliament. There is a great number of APPGs, covering many and diverse fields such as health, education, transport, defence, finance, the media, and sports.
Some APPGs have existed for many decades whereas others come and go in response to issues of the day.

We encourage all MPs to join this APPG on behalf of their constituents

Objectives and Aims of APPG for Anti Epileptic Drugs in Pregnancy

Listed below are what the APPG plan to achieve with Objectives to provide a forum for MP’s and Peers to discuss Fetal Anti-Convulsant Syndrome related issues:

• To raise areas of concern with Government or other policy makers.

• To seek Statement of Regret, Care Plan for those affected and compensation for the parents of families affected from Government and pharmaceutical companies, and to establish on going funding for the large number of new born and newly diagnosed children

• To raise the profile of Fetal Valproate Spectrum Disorder & Fetal Anti-Convulsant Syndrome within Parliament

• To seek opportunities to help improve the life and services of the sufferer/victim

• To discuss and implement changes required to the law to ensure that consumers are afforded greater protection. Current law appears to provide no effective protection for the consumer.

• To investigate and examine the effectiveness of the principles, departments and systems that exist or need to be implemented to minimise the risk of similar problems recurring in the future.

For more information on this APPG please contact Public Enquiry Point

Janet Williams via email : janet.infact@btinternet.com

Feb 21, 2022Feb 21, 2022

Campaigners Write To Health Secretary after Government continues to ignore thousands of babies disabled by Valproate

Victims of mesh and drugs alleged to harm babies in the womb say they feel ‘ignored’ by the government, which has failed to act on some recommendations made by an independent safety review nearly two years ago.

Campaigners found to have been harmed by medical products have written to the health secretary warning that government inaction is “causing pain and destroying lives” by ignoring review recommendations.

Over 18 months ago, an independent review recommended financial help for people damaged by some products and drugs that had been prescribed by UK doctors.

The government – which set up the Independent Medicines and Medical Devices Safety Review in the first place – has chosen to ignore several of its recommendations

Alleged victims of vaginal mesh, and the drugs valproate and Primodos, have written to Health Secretary Sajid Javid and Maria Caulfield to say they feel ignored.

The letter states: “Our members gave evidence to the two-year-long review, sometimes travelling long distances, often with disabilities.

“Families shared intimate details of their medical problems, their daily struggles, their difficulties parenting, sometimes even their sex lives. The panel, led by Baroness Cumberlege, was set up by the government to listen, assess and direct policy towards the best course of action.

“What was the point of this exercise and the hard work of the panel, if their key recommendations are then ignored by the government?”

The Cumberlege review found those affected by pregnancy test drug Primodos and epilepsy drug valproate, both alleged to damage babies in the womb, suffered “avoidable harm” and that the same was true of many women who had vaginal mesh implants.

The review team said that “the healthcare system is disjointed, siloed, unresponsive and defensive”.

It called for a system of redress to help affected families deal with their problems.

Lisa Hurton’s 10 year-old son, Kieran, was found to be autistic after she took sodium valproate while pregnant.

She told Sky News: “If someone has done wrong, there is blame there and they should be putting this right.

“Its the Government that have hid this. Its nothing to do with drug companies. Its nothing to do with the NHS. At the end of the day its the Government. They’ve known, its written in black and white, its in the Archives and we’ve got proof of this. We’ve had a so called apology from Matt Hancock. At the end of the day thats nothing.

It’s not about full blown compensation and things, this is about our children and how they’re going to be when we’re not here. That’s our greatest worry as a family.”

Criticism from former prime minister

Theresa May, who commissioned the review as prime minister, said in a recent parliamentary debate that “lives have not just been changed, but significantly damaged”.

She said: “People have suffered physically, mentally, socially and often economically.”

Mrs May added that people “suffered constant rejection from the state – by the NHS and government, the very bodies that should have been there to support them.

“The longer it takes the government to fully implement the recommendations of the Cumberlege report, the more rejection these people suffer. Every week that goes by is a further rejection, because the report was very clear: action needs to be taken.”

At the same Westminster Hall debate, earlier this month, Conservative MP Sir Mike Penning said: “What is the department waiting for, like they were with thalidomide, for these people to die?”

The government response

The Department of Health has implemented some of the Cumberlege recommendations, and said: “We cannot ignore the fact that this report is one of several independent reports and inquiries to have concluded that our healthcare system disproportionately fails to listen to women and keep them safe.

“This government is determined to change this, not least through our work to develop the first ever Women’s Health Strategy for England. This report is a powerful call to action, and we are determined to deliver meaningful change through the government’s response.”

Jun 18, 2021Jun 18, 2021

General Medical Council &General Pharmaceutical Council – Strengthened Initiatives Surrounding Prescribing of Sodium Valproate

18 June 2021

This week with the announcement of 20,000 women in the UK receiving a letter about the risks of Sodium Valproate in Pregnancy we have worked and liased with the General Medical Council and The General Pharmaceutical Society in producing further communications and a Video to highlight the risk.

Here at INFACT we welcome and thank all involved in this round of communications and continued effort for safer prescribing with Sodium Valproate.

General Medical Council : This case study is about discussing the risk of taking sodium valproate with a mother who’s been prescribed it for several years.

We’ve developed this case study with the General Pharmaceutical Council and the Nursing and Midwifery Council. While the characters are fictional, the case study is based on several people’s lived experiences, which were generously shared by patients and clinicians.

It highlights the risk of harm created by taking sodium valproate (‘valproate’), a medication for epilepsy that can cause birth defects if taken during pregnancy. Valproate was one of the interventions considered by the Independent Medicines and Medical Devices Safety Review, which reported in July 2020. The Review highlighted that many women had not been properly informed about the risks of taking valproate.

The MHRA’s strengthened regulatory position should mean that no more women are prescribed sodium valproate without discussing the risks of harm and having a Pregnancy Prevention Plan in place. However, for some women already taking valproate but unaware of the risks this can create complex situations and difficult conversations with their healthcare providers. Repeat prescription (GP)

Learning overview

Be familiar with guidelines and developments that affect your work.

Make sure any repeat prescription you sign is safe and appropriate.

Don’t assume a patient’s already been given the information they need about risks of harm. If you haven’t personally spoken to a patient about medication they’re taking, it may be particularly important to review their decision to take it.

Scenario

Dr Wright receives a repeat prescription request for sodium valproate from Millie, who is new to the practice. She sees that a valproate annual risk acknowledgement form has not been completed.

After reviewing Millie’s medical record, Dr Wright becomes concerned because it appears that:

Millie has been prescribed valproate continuously since 2010
she hasn’t seen a neurologist since 2012
she doesn’t appear to be on the pregnancy prevention programme (PPP).

Dr Wright wonders whether Millie has been advised about the risks of taking valproate during pregnancy. She notes that Millie’s two children were both born before 2018 when the Medicines and Healthcare products Regulatory Agency (MHRA)’s strengthened regulatory position came into force. This made it compulsory for GPs to make sure, each time a repeat prescription is issued, that women of childbearing potential on valproate are:

supported by a PPP
have an up to date, signed, Annual Acknowledgement of Risk Form (AARF)
are having an annual review with a specialist.

Dr Wright wonders whether Millie’s valproate use throughout pregnancy may have adversely affected her children.

She asks the practice receptionist to phone Millie and ask her to attend the surgery for a medication review with Dr Wright as soon as possible.Medication review (GP)

General Pharmaceutical Council

This week the General Pharmaceutical Council have also reiterated communications to Pharmacists in England Scotland and Wales. In collaboration with GPC we have created a video explaining the role the Pharmacist has when prescribing Sodium Valproate

Valproate updates ,

We wanted to share with you a letter that NHS England & Improvement are sending to all women and girls taking valproate in England. The letter includes a reminder about the risks of taking valproate during pregnancy and the need for an annual review.

This letter also encourages patients to speak to their doctor or nurse specialist. Your patients taking valproate may also ask to speak to you about the letter and you may want to check with your patients if they have received the letter and if they have any questions about their valproate prescription.

Medicines in Pregnancy Registry NHS Digital and the Medicines and Healthcare products Regulatory Agency (MHRA) have developed a valproate registry.
Data collected in England between April 2018 and September 2020 shows:
47,532 females (ages 0-54) were prescribed one or more prescriptions for valproate in one or more months within the reporting period
180 females were prescribed valproate while pregnant
238 females stopped receiving prescriptions of valproate prior to their pregnancy

Supplying valproate safely to women and girls Pharmacy professionals have a key role in supplying valproate safely. Valproate must not be used in any woman or girl able to have children unless there is a pregnancy prevention programme (PPP) in place.

For women and girls, when they are dispensed valproate, they should expect:to be provided with a Patient Card every time valproate is dispensedfor valproate to be dispensed with a copy of the patient information leaflet, and if repackaged, with a warning on the container supplied to be reminded of the risks in pregnancy and the need for highly effective contraception, and a reminder of the need for annual specialist review to be asked if they have received the Patient GuideYou must make sure that the patient label is not placed over the warning labels or warning sticker on the box. Women taking valproate have shared with us examples of where this has happened.

When patients are visiting pharmacies for pregnancy tests or emergency hormonal contraception remember to ask them about any medications they are taking so you can provide further advice if their medicines are teratogenic.

Find out more about what you need to do in our Focus on supplying medicines safely: sodium valproate.

Watch our film where we speak to two women whose children were affected by exposure to sodium valproate during their pregnancies, to find out why it’s so important to make sure that women are made aware of the risks when dispensing sodium valproate. Valproate case study This in-depth case study explores patient Millie’s interactions with the different healthcare professionals she meets. It explores how to approach difficult conversations and highlights the important role all healthcare professionals have in prescribing and dispensing valproate safely.  How pharmacies can support women and girls taking valproate Find out more in this example of notable practice on supporting people taking valproate from our Knowledge Hub.

Our inspectors check the pharmacy team are following the requirements of the Pregnancy Prevention Programme during inspections.

Jun 14, 2021Jun 14, 2021

Sodium Valproate: The Fetal Valproate Syndrome Tragedy

Written by Sharon Hartles

In this article, Sharon Hartles reflects upon the significant impacts of avoidable harms that have been perpetuated for decades as a result of medical negligence on behalf of the regulator (Committee on Safety of Medicines) that advised the UK Licensing Authority on the safety of medicines and the manufacturer of Epilim (Sanofi). Sharon Hartles is a member of the Open University’s Harm and Evidence Research Collaborative.

Sodium valproate, marketed as Epilim in the UK, has been linked to physical, developmental and neurological harms in the human fetus.

ALAMY https://www.thetimes.co.uk/article/sinn-f-in-senator-urges-inquiry-for-epilim-babies-hr6vlklmf

In the UK, Epilim is the dominant sodium valproate medication used to treat patients at risk of epilepsy associated convulsions. Epilim is an effective anti-convulsant medicine (epilepsy drug) and for this reason it has been licensed for usage since 1973. However, Epilim is also a teratogen; thus exposure to this drug causes an increased risk of physical, developmental and neurological harms in the human embryo or fetus.

Given the fact that sodium valproate is harmful, wherever possible it clearly should not be prescribed to female patients of childbearing age. Despite this, the regulators and Sanofi, the company responsible for manufacturing and marketing Epilim (Sanofi acquired the company from Reckitt-Labaz in or around 1980) chose to keep patients in the dark for decades and did not disclose the known associations. As a consequence, patients were unable to make informed choices, which has resulted in the preventable fetal valproate syndrome tragedy.

According to The independent Medicines and Medical Devices Safety Review, congenital birth defects associated with in utero exposure to sodium valproate include:

Neural tube defects (NTDs), such as spina bifida
Cleft lip and palate
Facial and skull malformations
Heart, kidney, urinary tract and sexual organ malformations
Limb defects
Developmental delay
Autism Spectrum Disorders (ASDs)
Attention Deficit Hyperactivity Disorder
Ear malformations and auditory processing
Skeletal malformation
Arthritis in older children
Effects on the endocrine system
Sexual identity problems (which occur due to a mismatch between genital development and neural / sexual identity development).
Psychomotor issues.
Withdrawal symptoms – associated with prenatal sodium valproate exposure.

Fetal valproate syndrome harms are widely accepted within the clinical and regulatory community, including by: the National Institute for Health and Clinical Excellence (NICE), the Medicines and Healthcare products Regulatory Agency (MHRA) and the European Medicines Agency (EMA).

During the 1960s and 1970s, articles were published drawing attention to the concerns about the teratogenicity and anti-epileptic (anti-convulsant) medication this included research by: Lawrence, 1963, Janz and Fuchs 1964, Meadow 1968, Speidel and Meadow 1972, Lowe, 1973, Fedrick 1973, Hill 1974, Barr, 1974 and Hanson and Smith 1975. Yet, despite the known harms, documents uncovered from The National Archives revealed that in 1973, the Committee on Safety of Medicines (a precursor to the Medicines & Healthcare products Regulatory Agency) thought it best not to make patients aware of the dangers because “it could give rise to fruitless anxiety”.

The controversy surrounding the abhorrent failure to communicate the preventable risks to clinicians and patients was evidenced again because by the early 1980s the regulator and manufacturer was in possession of sufficient information to conclude that Epilim increased the risk of congenital abnormalities. Even though the links between the exposure to sodium valproate and the increased risk of harms to a fetus were well-documented, patients were not informed directly of the link until 2005. In some cases care pathways for women of child-bearing age were not established until 2016. In February 2018, the European Medicines Agency put in measures to avoid valproate exposure in pregnancy.

A visual warning of the pregnancy risks (in the form of text) with other warning symbol on the outer carton.

https://www.chemistanddruggist.co.uk/cpd-article/valproate-pregnancy-prevention-programme

The fetal valproate syndrome tragedy (medical negligence) was entirely avoidable, resulting from a regulation failure and decades of inaction by successive governments to safeguard patients. The true number of individuals’ harmed by sodium valproate in utero since it was licensed in 1973 in the UK is unknown, however, the consensus estimate is around 20,000. More recent evidence suggests that the medical problems associated with fetal valproate syndrome may be passed down the generations.

The role that the regulator and the manufacturer Sanofi have played in creating and perpetuating this tragedy is evident, therefore financial redress should be paid to all those affected by fetal valproate syndrome.

Currently, 27,000 women of child bearing age are taking valproate in the UK. On 2^nd March 2021, in the House of Lords, James O’Shaughnessy, Vice-chair for the All-Party Parliamentary Group for First Do No Harm, reported that since June 2020, 150 babies had been born suffering harms due to sodium valproate exposure. Therefore it is imperative that the Government find ways to minimise the risk of harms to future babies. Beyond this, lessons must be learned and mechanisms put into place to ensure avoidable systemic failures on this scale do not happen again.