Status: Finalised
First registered on:
27/01/2012
Last updated on:
07/03/2019
1. Study identification
EU PAS Register NumberEUPAS2353
Official titleThe risk of acute liver injury associated with the use of antibiotics. A methodological comparison across epidemiological data sources
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 antibiotics associated with the risk of acute liver injury 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
Centre to which the investigator belongsCEIFE
Department/Research groupFundación Centro Español de Investigación Farmacoepidemiológica
Organisation/affiliationFundación CEIFE
Details of (Primary) lead investigator
Title Dr
Last name Ruigomez
First name Ana
Is this study being carried out with the collaboration of a research network?
Yes
Other centres where this study is being conducted
Multiple centres
In total how many centres are involved in this Study?6
Agencia Espanola de Medicamentos y Productos Sanitarios (AEMPS), Spain
Lægemiddelstyrelsen (DKMA), Denmark
Ludwig-Maximilians-Universität-München (LMU Muenchen), Germany
European Medicines Agency (EMA), United Kingdom
Amgen, United Kingdom
LSHTM, United Kingdom
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 report01/02/201301/07/2013
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, GSK, 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 Ruigomez
First name Ana
Address line 1Almirante 28
Address line 2
Address line 3
CityMadrid
Postcode28004
CountrySpain
Phone number (incl. country code)34915313404
Alternative phone number
Fax number (incl. country code)34915312871
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)J01 (ANTIBACTERIALS FOR SYSTEMIC USE)
7. Medical conditions to be studied
Medical condition(s)Yes
Liver injury
8. Population under study
Age
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 people with historical data sum of all databases approx 55,7 millions.
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
Mondriaan, Netherlands
Bavaria Claims, Germany
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 antibiotics and the risk of acute liver injury 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
Self controlled case-series
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
Descriptive study of the primary study population including all ages, from 1 Jan 2004 to 31 Dec 2009). Prevalence of antibiotic (AB) use stratified by age, by sex, by indication, by number of prescriptions and by AB class. Incidence of first-time liver failure by age, by sex per calendar year. Retrospective Cohort study: estimates of incidence rate ratios and 95% confidence intervals of acute liver injury associated with current AB as compared to non-use with Poisson regression adjusted by age/sex/ and calendar year categories. Case Control Study: estimates of relative risk and 95% confidence intervals using unconditional logistic regression. Age, sex, calendar year, and other variables will be introduced in the model to control for potential confounding. Case-crossover analysis estimates of the odds of having an event (liver injury while exposed to antibiotic drugs will be compared with the odds of having liver injury while unexposed.
16. ENCePP seal
Are you requesting the ENCePP seal for this study?
No
17. Full protocol
18. Study Results
Not submitted
Please list the 5 most relevant publications using data from your study
ReferenceLink to web-publication
Risk of acute liver injury associated with use of antibiotics. Comparative cohort and nested case-control studies using two primary care databases in Europe.
Brauer R, Douglas I, Garcia Rodriguez LA, Downey G, Huerta C, de Abajo F, Bate A, Feudjo Tepie M, de Groot MC, Schlienger R, Reynolds R, Smeeth L, Klungel O, Ruigómez A.
Pharmacoepidemiol Drug Saf. 2016 Mar;25 Suppl 1:29-38. doi: 10.1002/pds.3861. PMID: 27038354https://www.ncbi.nlm.nih.gov/pubmed/27038354
Ascertainment of acute liver injury in two European primary care databases.
Ruigómez A, Brauer R, Rodríguez LA, Huerta C, Requena G, Gil M, de Abajo F, Downey G, Bate A, Tepie MF, de Groot M, Schlienger R, Reynolds R, Klungel O.
Eur J Clin Pharmacol. 2014 Oct;70(10):1227-35. doi: 10.1007/s00228-014-1721-y. Epub 2014 Jul 29.PMID: 25066450https://www.ncbi.nlm.nih.gov/pubmed/25066450
The risk of acute liver injury among users of antibiotic medications: a comparison of case-only studies.
Brauer R, Ruigómez A, Klungel O, Reynolds R, Feudjo Tepie M, Smeeth L, Douglas I.
Pharmacoepidemiol Drug Saf. 2016 Mar;25 Suppl 1:39-46. doi: 10.1002/pds.3846. Epub 2015 Aug 6.
PMID: 26248609https://www.ncbi.nlm.nih.gov/pubmed/26248609
The risk of acute liver injury associated with the use of antibiotics--evaluating robustness of results in the pharmacoepidemiological research on outcomes of therapeutics by a European consortium (PROTECT) project.
Udo R, Tcherny-Lessenot S, Brauer R, Dolin P, Irvine D, Wang Y, Auclert L, Juhaeri J, Kurz X, Abenhaim L, Grimaldi L, De Bruin ML.
Pharmacoepidemiol Drug Saf. 2016 Mar;25 Suppl 1:47-55. doi: 10.1002/pds.3841. Epub 2015 Aug 2.https://www.ncbi.nlm.nih.gov/pubmed/26235335
19. Other relevant documents
Conflict(s) of interest of
investigator(s)Not submitted
Composition of Steering Group and
ObserversNot submitted
Other documents
DescriptionDocumentLatest version
Signed Code of
Conduct Checklist
Not submitted
Signed Code of Conduct Declaration
Not submitted
Signed Checklist for Study
Protocols
Not submitted
