Reem Masarwa

Tell us a bit about your background and how you ended up studying in this field.

Early in my work at the pediatric department at the Hadassah-Hebrew University Children’s Hospital, I noticed the limited number of high-quality large population-based studies of drug safety in children. I came to realize my desire to focus on pharmacoepidemiologic research. In 2014, I decided to pursue a PhD in clinical pharmacy at the School of Pharmacy at the Hebrew University of Jerusalem, where I developed methodological and clinical expertise in epidemiological methods and clinical training, with particular focus on clinical drug safety, meta-analyses, and pediatric pharmacotherapy. During my PhD I learned that McGill University was a leading research centre in pharmacoepidemiology. My doctoral training solidified my desire to pursue a career as a pharmacoepidemiologist, with a primary research focus on the effectiveness and safety of drugs in children. I therefore decided to pursue training in pharmacoepidemiology at McGill University under the supervision of Drs. Kristian B. Filion and Robert W. Platt.

Give us a short summary of your current or recent research.

My current research focuses on the utilization, safety, and effectiveness of prescription drugs in children, an understudied and vulnerable population. Many times, drugs are used “off-label” in this population, without clinical trials, and data are often extrapolated from adult studies. We started with a utilization study to examine general prescribing patterns and trends of prescription drugs in the past 20 years in the United Kingdom. We found increases in the prescribing of ADHD drugs, drugs for gastrointestinal reflux, antipsychotics, and anxiolytics. We also found a decrease in the prescribing of antibiotics, cough preparations, and analgesics. Based on the results of this study and recent safety warnings, we will examine the safety of acid-suppressing drugs in children, specifically proton pump inhibitors and their potential association with increased risk for nutritional deficiencies. In the future, we will also examine the safety of “off-label” prescribing of antipsychotics in children with ADHD, and their potential associations with cardio-metabolic adverse effects in children. Through my studies, I will be able to answer relevant clinical questions in pediatrics and further examine the methodological challenges that may arise in pediatric pharmacoepidemiolgy.

What excites you the most about the research you are doing or hope to do in the future?

What excites me most about my research is that no matter what the results are they will be clinically relevant, and I will be able to either alert clinicians or decision makers or provide reassurance as to the safety of prescription drugs. I am excited to be able to use real-world data to answer questions regarding drug safety in children, and explore new study designs not previously applied in pharmacoepidemiological pediatric studies. Adding this evidence to the literature will assist both clinicians and researchers in daily decision-making, as I often struggled to find relevant information while I was working at the Children’s Hospital.

Are there aspects of the work that you find particularly challenging?

The main challenge in studies of drug effects in children is having sufficient power (sample size) and prevalent drug exposure. Many times, observational studies in children are underpowered to detect a difference between the drug of interest and the comparator drug or unexposed arm. The transition from an environment where I combined clinical work with research work in the school of pharmacy to a pure research environment was particularly challenging. I had much to learn about study design, administrative data, coding and data analyses. After one year, I started to feel more comfortable and already saw first results of my first projects (quantitative bias analysis), and presented the results at the Drug Safety and Effectiveness Network Annual meeting at Ottawa in 2020.

What are your career goals?

My ultimate goal is to pursue a career as pediatric epidemiologist, and to develop an independent research program that focuses on drug safety in children. I would also enjoy working as a scientist and combine research work with teaching. I would like to have a career in which I can constantly learn new things, and be able to be productive and contribute to the pediatric research community.

How has CNODES impacted your studies or career trajectory?

CNODES has provided me with great training and networking opportunities. I have had the chance to learn from the leading researchers in the field, and to network with researchers nationally and internationally. Through CNODES I have been able to share my research by presenting at the Drug Safety and Effectiveness Network Annual meeting in 2020, and at the CNODES Semi-Annual Meeting in 2020. CNODES has encouraged me to pursue my career goals and focus my research on studies of drug effects in children.

Outside of work and studies, what are you passionate about?

I am passionate about hiking, trekking, cooking, and learning languages. Prior to the pandemic, each year I would choose a hiking trail around the world and do it. After the pandemic, I hope to hike in Yukon and Alberta. I enjoy cooking very much and I find it similar to following a prescription drug just like I did as a pharmacist. I am currently learning French and hopefully will be fluent soon and add it to my other 4 languages!

Selected recent publications

Masarwa R, Platt R, Filion K. Acetaminophen use during pregnancy and the risk of attention deficit hyperactivity disorder: A causal association or bias? 2019. Paediatr Perinat Epidemiol. 2020 Jan;34(3):309-317

Masrwa R, Brunetti VC, Aloe S, Henderson M, Platt R, Filion K. The Efficacy and Safety of Metformin for Obesity Children and Adolescents: A Meta-analysis. February 18 2021. Pediatrics. doi: 10.1542/2020-000123.