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Automated Detection of Systematic Off-label Drug Use In Free Text of Electronic Health Records

Off-label use of a drug occurs when it is used in a manner that deviates from its FDA label. Studies estimate that 21% of prescriptions are off-label, with only 28% of those uses supported by evidence of safety and efficacy. We have developed methods to detect population level off-label usage using computationally efficient annotation of free text from clinical notes to generate features encoding empirical information about drug-disease mentions. By including additional features encoding prior knowledge about drugs, diseases, and known usage, we trained a highly accurate predictive model that was used to detect novel candidate off-label usages in a very large clinical corpus. We show that the candidate uses are plausible and can be prioritized for further analysis in terms of safety and efficacy.