1. Study identification
EU PAS Register NumberEUPAS3772
Official titleAssociation between anxiolytic or hypnotic drugs and total mortality
Study title acronym
Study typeObservational study
Brief description of the studyBenzodiazepines and related drugs are indicated either for the short-term treatment of moderate or severe anxiety or insomnia. They could be involved in a wide range of fatal and non-fatal outcomes. However, the ways by which these drugs can lead to an increased mortality are not entirely elucidated. This study intends to investigate the impact of benzodiazepine and related exposure on all cause and specific mortality among cohorts obtained from a representative sample of French beneficiaries of the national health insurance scheme (EGB) and through a large healthcare database (CPRD) in the United Kingdom. Patients > 18 and exposed to at least one benzodiazepine derivative or related substance will be matched to one to 10 unexposed controls , and followed up from their inclusion to either death or 90 days following the last benzodiazepine exposure. All cause and cause specific mortality will be investigated, together with patients’ sociodemographics, medicines use, medical history, and life-style (alcohol, smoking, for CPRD exclusively). Time to death will be analysed using an extended Cox regression model with time-dependent covariates
Was this study requested by a regulator?Yes: EMA
Is the study required by a Risk Management Plan (RMP)?
Not applicable
Regulatory procedure number (RMP Category 1 and 2 studies only)
Other study registration identification numbers and URLs as applicable
2. Research centres and Investigator details
Coordinating study entity
Department/Research groupPharmacoepidemiology research team
Organisation/affiliationUniversity of Toulouse 3 and INSERM 1027
Details of (Primary) lead investigator
Title Dr
Last name Lapeyre-Mestre
First name Maryse
Is this study being carried out with the collaboration of a research network?
No
Other centres where this study is being conducted
Not applicable (single centre)
Countries in which this study is being conducted
International study
France
United Kingdom
3. Study timelines: initial administrative steps, progress reports and final report
PlannedActual
Date when funding contract was signed17/09/201217/09/2012
Start date of data collection17/04/201329/04/2013
Start date of data analysis
Date of interim report, if expected17/07/201323/08/2013
Date of final study report17/09/201307/10/2013
4. Sources of funding
Please provide estimates of the percentage of funding by source for this study
Names(s)Approximate % funding
Pharmaceutical companies
Charities
Government body
Research councils
EU funding scheme
OtherEMA100
5. Contact details for enquiries
Scientific Enquiries
Title Dr
Last name Lapeyre-Mestre
First name Maryse
Address line 137 Allees Jules
Address line 2
Address line 3
CityToulouse
Postcode31000
CountryFrance
Phone number (incl. country code)33-561145960
Alternative phone number33-561145606
Fax number (incl. country code)33-561145928
Public Enquiries
Title Dr
Last name Lapeyre-Mestre
First name Maryse
Address line 137 Allees Jules
Address line 2
Address line 3
CityToulouse
Postcode31000
CountryFrance
Phone number (incl. country code)33-561145960
Alternative phone number33-561145606
Fax number (incl. country code)33-561145928
6. Study drug(s) information
Substance class (ATC Code)M03BX07 ; N03AE01 ; N05BA ; N05CD ; N05CF
7. Medical conditions to be studied
Medical condition(s)No
8. Population under study
Age
Adults (18 - 44 years)
Adults (45 - 64 years)
Adults (65 - 74 years)
Adults (75 years and over)
Sex
Male
Female
9. Number of subjects
Estimated total number of subjects120000
10. Source of data
Is this study being carried out with an established data source?Yes
Data sources registered with ENCePP
Data sources not registered with ENCePP
EGB Echantillon Généraliste des bénéficiaires, France
Sources of data
Administrative database, e.g. claims database
Routine primary care electronic patient registry
11. Scope of the study
What is the scope of the study?
Risk assessment
Primary scope : Risk assessment
12. Main objective(s)
What is the main objective of the study?
The aim of this project will be to investigate mortality associated with benzodiazepine derivatives or related substances exposure
in France and in the UK.
Are there primary outcomes?Yes
All-cause mortality
Are there secondary outcomes?Yes
Cause-specific mortality
13. Study design
What is the design of the study?
Cohort study
14. Follow-up of patients
Will patients be followed up?Yes
Please describe duration of follow up
Patients will be followed up from their inclusion to either death or 90 days following the last benzodiazepine exposure. Study period will be 1999 to 2012 for CPRD, and from 2006 to 2012 for EGB
15. Data analysis plan
Please provide a brief summary of the analysis method
The role of potential confounding or explanatory variables will be taken into account by the extended Cox regression model. A univariate analysis will be first performed to select the variables with a p value<0.2, followed by a multivariate approach using the Cox proportional hazard regression model with time dependent covariates, with stratification on the matched pairs. Continuous variables will be tested for linearity. Relevant interactions between covariates will be checked. Proportional hazards assumption will be tested for all covariates. The estimation of the crude and adjusted Hazard Ratio and their 95% confidence interval will be provided.