Status: Planned
First registered on:
01/08/2017
Last updated on:
14/02/2019
1. Study identification
EU PAS Register NumberEUPAS20169
Official titleTime to treatment intensification in patients receiving metformin+incretin-based medicines versus metformin+other hypoglicemics
Study title acronymTime to treatment intensification with incretins
Study typeObservational study
Brief description of the studyDue to the progressive nature of tipe 2 diabetes, antidiabetic drugs tend to lose their efficacy over time so that treatment intensification is required. Current guidelines recommend metformin as the first choice in newly treated patients with type 2 diabetes. Among possible second-line add-on treatments, incretin-based medicines have been associated to a more durable glycemic control, although available evidence from observational studies is conflicting.
The aim of this study is to the analyse routinely collected Italian admistrative data collected from different local and regional health authorities in order to compare the time to treatment intensification in patients with type 2 diabetes receiving incretin-based medicines versus other non-insulin antidiabetics as add-on therapy to metformin.
Was this study requested by a regulator?No
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
Centre to which the investigator belongsARS
Department/Research groupOsservatorio di Epidemiologia
Organisation/affiliationAgenzia regionale di sanità della Toscana (ARS)
Details of (Primary) lead investigator
Title Dr
Last name Giuseppe
First name Roberto
Is this study being carried out with the collaboration of a research network?
No
Other centres where this study is being conducted
Multiple centres
In total how many centres are involved in this Study?5
Countries in which this study is being conducted
National study
Italy
3. Study timelines: initial administrative steps, progress reports and final report
PlannedActual
Date when funding contract was signed16/01/2017
Start date of data collection15/09/2017
Start date of data analysis
Date of interim report, if expected
Date of final study report31/08/2019
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
OtherThis was a spontaneous initiative of the researchers participating to the project. No fubndings were received from any external source.100
5. Contact details for enquiries
Scientific Enquiries
Title Dr
Last name Giuseppe
First name Roberto
Address line 1Via Pietro Dazzi 1
Address line 250141
Address line 3
CityFlorence
Postcode50141
CountryItaly
Phone number (incl. country code)39-0554624320
Alternative phone number
Fax number (incl. country code)
Public Enquiries
Title Dr
Last name Giuseppe
First name Roberto
Address line 1Via Pietro Dazzi 1
Address line 250141
Address line 3
CityFlorence
Postcode50141
CountryItaly
Phone number (incl. country code)39-0554624320
Alternative phone number
Fax number (incl. country code)
6. Study drug(s) information
Substance class (ATC Code)A10BH (Dipeptidyl peptidase 4 (DPP-4) inhibitors)
Substance class (ATC Code)A10BB (Sulfonylureas)
Substance class (ATC Code)A10BG (Thiazolidinediones)
Substance class (ATC Code)A10 (DRUGS USED IN DIABETES)
Substance class (ATC Code)A10B (repaglinide)
7. Medical conditions to be studied
Medical condition(s)Yes
Type 2 diabetes mellitus
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 subjects20000
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
Regional Administrative databases of Umbria, Italy
Regional Administrative databases of Piedimont, Italy
Administrative database of the Local Helath Authority of Caserta, Italy
Sources of data
Administrative database, e.g. claims database
Pharmacy dispensing records
11. Scope of the study
What is the scope of the study?
Effectiveness evaluation
Primary scope : Effectiveness evaluation
12. Main objective(s)
What is the main objective of the study?
To compare the time to treatment intensification in patients with type 2 diabetes receiving incretin-based medicines versus other non-insulin antidiabetics as add-on therapy to metformin.
Are there primary outcomes?Yes
Treatment intensification, i.e. insulin initiation or add-on of a third non-insulin antidiabetic
Are there secondary outcomes?Yes
1) insulin initiation
2) add-on of a third non-insulin antidiabetic drug
3) switch to a third non-insulin antidiabetic drug
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 starting from the index prescription (first add-on to metformin) up to the occurrence of the study outcome or a censoring event, whichever comes first. Censoring events will be: non-persistence to metformin or the index non-insulin antidiabetic drug, switch to a different non-insulin antidiabetic, end of study period, cancer, death, or emigration.
15. Data analysis plan
Please provide a brief summary of the analysis method
Survival curves describing the time to treatment intensification will be plotted with the Kaplan-Meier method. The log rank test will be used to test the statistical significance of the difference between different groups.
Cox regression models will be applied to estimate hazard ratios, with 95% confidence intervals, and compare the time to treatment intensification from index prescription in patients treated with MET+DPP4i versus those in the other exposure categories. Variables measured at baseline will be included in the model to account for their potential confounding effect.
16. ENCePP seal
Are you requesting the ENCePP seal for this study?
No
17. Full protocol
Available when the study ends
18. Study Results
Not submitted
Please list the 5 most relevant publications using data from your study
ReferenceLink to web-publication
None
19. Other relevant documents
Conflict(s) of interest of
investigator(s)Not submitted
Composition of Steering Group and
ObserversNot submitted
Other documentsNot
submitted
Signed Code of
Conduct Checklist
Not submitted
Signed Code of Conduct Declaration
Not submitted
Signed Checklist for Study
Protocols
Not submitted
