1. Study identification
EU PAS Register NumberEUPAS2382
Official titleUse of antidepressants and risk of hip/femur fracture. A methodological comparison across data sources and epidemiological design.
Study title acronym
Study typeObservational study
Brief description of the studyThe studies described in this protocol are all performed within the framework of PROTECT (Pharmacoepidemiological Research on Outcomes of Therapeutics by a European ConsorTium) Work Package 2 and Working Group 1. The primary aim of these studies is to develop, test and disseminate methodological standards for the design, conduct and analysis of Pharmacoepidemiological (PE) studies applicable to different safety issues and using different data sources. To achieve this, results from PE studies on 5 key Drug / adverse events (D-AEs) pairs performed in different databases will be evaluated. The use of antidepressants associated with the risk of hip/femur fracture is one of the key D-Ae pair of interest. Therefore, emphasis will be on the methodological aspects of the studies in this protocol and not on the clinical consequences of studying the association under investigation.
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
Department/Research groupDivision of Pharmacoepidemiology & Pharmacotherapy
Organisation/affiliationUtrecht Institute for Pharmaceutical Sciences
Details of (Primary) lead investigator
Title Dr
Last name Gardarsdottir
First name Helga
Is this study being carried out with the collaboration of a research network?
Yes
PROTECT
Other centres where this study is being conducted
Multiple centres
In total how many centres are involved in this Study?6
Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Spain
European Medicines Agency (EMA), United Kingdom
Lægemiddelstyrelsen (Danish Medicines Agency) (DKMA), Denmark
Ludwig-Maximilians-Universität-München (LMU Muenchen), Germany
MerckSerono, Switzerland
Countries in which this study is being conducted
International study
Denmark
Germany
Netherlands
Spain
United Kingdom
3. Study timelines: initial administrative steps, progress reports and final report
PlannedActual
Date when funding contract was signed19/08/200919/08/2009
Start date of data collection03/10/201103/10/2011
Start date of data analysis
Date of interim report, if expected
Date of final study report01/09/201401/03/2016
4. Sources of funding
Please provide estimates of the percentage of funding by source for this study
Names(s)Approximate % funding
Pharmaceutical companiesAmgen, AstraZeneca, Genzyme, GlaxoSmithKline, MerckSerono, Novartis, Roche, Pfizer50
Charities
Government body
Research councils
EU funding schemeInnovative Medicines Initiative (IMI)50
5. Contact details for enquiries
Scientific Enquiries
Title Dr
Last name Gardarsdottir
First name Helga
Address line 1Utrecht University
Address line 2David de Wied building
Address line 3Universiteitsweg 99
CityUtrecht
Postcode3584 GA
CountryNetherlands
Phone number (incl. country code)31302537324
Alternative phone number
Fax number (incl. country code)
Public Enquiries
Title Dr
Last name Kurz
First name Xavier
Address line 1European Medicines Agency
Address line 27 Westferry Circus
Address line 3Canary Wharf
CityLondon
PostcodeE14 4HB
CountryUnited Kingdom
Phone number (incl. country code)442074188400
Alternative phone number
Fax number (incl. country code)
6. Study drug(s) information
Substance class (ATC Code)N06AA (Non-selective monoamine reuptake inhibitors)
Substance class (ATC Code)N06AB (Selective serotonin reuptake inhibitors)
7. Medical conditions to be studied
Medical condition(s)Yes
Hip fracture
Femur fracture
8. Population under study
Age
Preterm newborns
Term newborns (0-27 days)
Infants and toddlers (28 days - 23 months)
Children (2 - 11 years)
Adolescents (12 - 17 years)
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 subjects55700000
Additional information
Estimated total number of subjects with historical data all databases approx 55,7millions
Per database (in millions):
DKMA: total=6
Mondriaan: total= 1.4 (GP), 13.5 (pharmacy), 1.2 (claims)
GPRD: total=11.2
BIFAP: total=3.2
Bavaria Claims: total=10.5
THIN: total=8.7
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
BIFAP, Spain
Bavaria Claims, Germany
Mondriaan, Netherlands
Sources of data
Administrative database, e.g. claims database
Routine primary care electronic patient registry
Pharmacy dispensing records
11. Scope of the study
What is the scope of the study?
Disease epidemiology
Risk assessment
Analysis of discrepancies in results between different databases
Primary scope : Analysis of discrepancies in results between different databases
12. Main objective(s)
What is the main objective of the study?
To assess the association between the use of antidepressants and the risk of hip/femur fracture with different study designs across different primary care databases and to compare the results between databases, across designs to evaluate the impact of design/database/population differences on the outcome of the studied association.
Are there primary outcomes?No
Are there secondary outcomes?No
13. Study design
What is the design of the study?
Cohort study
Case-control study
Case-crossover
Descriptive study= description of exposure and/or outcome in the whole database during a defined period of time
14. Follow-up of patients
Will patients be followed up?Not applicable/no follow-up
15. Data analysis plan
Please provide a brief summary of the analysis method
Retrospective cohort:
incidence rates (IR) of hip/femur fractures (outcome) will be calculated in current, recent & past users. Past use will be the reference category. Poisson regression (regr) will be used to estimate age & gender adjusted IRR. Time-dependent Cox proportional hazards models will also be used to calculate HR and 95% CIs.
Nested case control:
Conditional logistic regr analysis will be used to estimate the risk of the outcome associated with the current use of AD as compared to past use. The risks will be calculated in terms of odds ratios (OR) with corresponding 95% CI.
case-crossover
For each case, the cumulative exposure will be assessed in the 6 months before the index date (at-risk period). For each case up to 4 control moments will be defined at 6 months intervals starting immediately prior to the at-risk period. Cumulative exposure will also be assessed in these 'control' person moments.Conditional logistic regression analysis will be done