Status: Ongoing
First registered on:
27/02/2019
Last updated on:
12/08/2019
1. Study identification
EU PAS Register NumberEUPAS28564
Official titlePersistence and adherence to novel systemic pharmacological treatment of moderate to severe psoriasis vulgaris – A register-based cohort study in Finland, Sweden, and Norway
Study title acronym
Study typeObservational study
Brief description of the studyPsoriasis vulgaris is an incurable disease, and the aim of the treatment is symptom remission. Novel systemic drugs, including biologic drugs targeting immunomodulating cytokines and the phosphodiesterase 4 inhibitor apremilast, can be used for the treatment of moderate to severe symptoms of the disease. Since psoriasis vulgaris is considered a chronic disease, long-term treatment is necessary to maintain efficacy. The real-world evidence on the treatment patterns of biologics and apremilast in the Nordic countries is limited. The main aim of this retrospective, population- and register-based cohort study is to investigate the persistence and adherence of drugs dispensed from community pharmacies for patients with moderate to severe psoriasis vulgaris. The study will include persons who initiate treatment with adalimumab, brodalumab, etanercept, ustekinumab, secukinumab, ixekizumab, guselkumab, certolizumab pegol, tildrakizumab, or apremilast in Finland, Sweden and Norway during the study period of 2008-2020. The treatment patterns of interest include treatment gaps and restarts as well as switches during a follow-up period of up to 13 years. The study will be based on nationwide registers.
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 group
Organisation/affiliationEPID Research Oy
Details of (Primary) lead investigator
Title Dr
Last name Hakkarainen
First name Katja
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
Finland
Norway
Sweden
3. Study timelines: initial administrative steps, progress reports and final report
PlannedActual
Date when funding contract was signed24/09/2018
Start date of data collection01/07/201914/05/2019
Start date of data analysis30/08/2019
Date of interim report, if expected31/12/2019
Date of final study report30/09/2021
4. Sources of funding
Please provide estimates of the percentage of funding by source for this study
Names(s)Approximate % funding
Pharmaceutical companiesJanssen Pharmaceutica NV100
Charities
Government body
Research councils
EU funding scheme
5. Contact details for enquiries
Scientific Enquiries
Title Dr
Last name Hakkarainen
First name Katja
Address line 1EPID Research Oy
Address line 2Första långgatan 20, 6th Floor
Address line 3
CityGothenburg
PostcodeSE-413 28
CountrySweden
Phone number (incl. country code)46738427442
Alternative phone number
Fax number (incl. country code)
Public Enquiries
Title Dr
Last name Hakkarainen
First name Katja
Address line 1EPID Research Oy
Address line 2Första långgatan 20, 6th Floor
Address line 3
CityGothenburg
PostcodeSE-413 28
CountrySweden
Phone number (incl. country code)46738427442
Alternative phone number
Fax number (incl. country code)
6. Study drug(s) information
Substance class (ATC Code)L04AB04 (adalimumab)
Substance class (ATC Code)L04AC12 (brodalumab)
Substance class (ATC Code)L04AB01 (etanercept)
Substance class (ATC Code)L04AC05 (ustekinumab)
Substance class (ATC Code)L04AC10 (secukinumab)
Substance class (ATC Code)L04AC13 (ixekizumab)
Substance class (ATC Code)L04AC16 (guselkumab)
Substance class (ATC Code)L04AB05 (certolizumab pegol)
Substance class (ATC Code)L04AC17 (tildrakizumab)
Substance class (ATC Code)L04AA32 (apremilast)
7. Medical conditions to be studied
Medical condition(s)Yes
Psoriasis
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 subjects17000
Additional information
The estimated number of subjects is based on study years 2015-2020. From earlier years in the study period, more subjects may be available, but only for few specific drugs that were available at that time.
The number of users of each study drug, included in the study each year, will be followed in the annual interim reports.
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
National Prescription Register, Care Register for Health Care, Register of primary health care visits, Population Register Centre, Cause of death Register, Finland
National Patient Register, Longitudinal Integration Database for Health Insurance and Labour Market Studies (LISA), Total Population Register, Sweden
Norwegian Patient Register, Statistics Norway, National Population Registry, Norway
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?
Drug utilisation study
Effectiveness evaluation
Primary scope : Drug utilisation study
12. Main objective(s)
What is the main objective of the study?
The main aim of this study is to investigate the persistence and adherence of drugs dispensed from community pharmacies for patients with moderate to severe psoriasis vulgaris.
Are there primary outcomes?Yes
The primary outcomes of this study are persistence, proportion of persistent patients, time to non-persistence, hazard ratios associated with non-persistence, adherence, proportion of adherent patients, non-adherence, and odds ratios associated with non-adherence.
Are there secondary outcomes?Yes
The secondary outcomes of this study are patient characteristics (e.g., sociodemographic data, comorbidities, resource utilization, and prior use of conventional systemic treatment for psoriasis vulgaris) for persons initiating treatment with each study drug, and treatment patterns, including treatment gaps, switching, and restart, during the study period.
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
The follow-up of the study persons begins at index date which is defined as the first dispensation date of any of the study drugs during the study period (01 January 2008 until 31 December 2020). The follow-up will end at death, migration abroad, 31st day of continuous inpatient stay, estimated beginning of pregnancy, or end of study period, whichever occurs first.
15. Data analysis plan
Please provide a brief summary of the analysis method
All dispensations of the study drugs during the study period will be included in the analyses. Drug supply will be defined for each dispensation on the basis of number and contents of dispensed package(s) and the dosage instructions according to the summary of product characteristics for the particular drug. MPR, based on the drug supplies, will be used to measure drug adherence. Continuous exposure periods will be defined on the basis of drug supplies and by applying more detailed rules for times when drug exposure periods end. The continuous exposure periods will be used to define PDC by each drug, and to determine treatment persistence. The characteristics of patients initiating treatment with study drugs will be described. Adherence and persistence will be described and compared across study drugs using regression models. Rates of drug switches, restarts, treatment gaps and number and duration of treatment lines will be investigated. Various sensitivity analyses will be performed.
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
