Status: Ongoing
First registered on:
25/11/2016
Last updated on:
08/06/2020
1. Study identification
EU PAS Register NumberEUPAS16424
Official titlePost-authorisation safety study to assess the risk of urinary tract malignancies in relation to empagliflozin exposure in patients with type 2 diabetes: a multi-database European study
Study title acronymPASS DiabCancer
Study typeObservational study
Brief description of the studyJardiance (empagliflozin), a highly potent and selective inhibitor of the sodium-glucose cotransporter 2 (SGLT-2), was approved in Europe in May 2014 for the treatment of type 2 diabetes mellitus (T2D) to improve glycaemic control in adults. Synjardy (empagliflozin/metformin HCl) was approved in Europe in May 2015.
As part of the risk management plan, Boehringer Ingelheim International GmbH (BI) has committed to conduct a post-authorisation safety study (PASS) to evaluate safety of empagliflozin regarding urinary tract malignancies in incident users of empagliflozin compared to incident users of dieptidyl peptidase-4 (DPP-4) inhibitors and incident users of SGLT-2 inhibitors. The inclusion of renal cancer as a potential risk was based on preclinical toxicology findings and clinical cases of bladder cancer observed with other SGLT-2 inhibitors.
This PASS will be conducted using routinely collected health information from the UK, Finland, and Sweden, through an observational cohort study among adult patients with type 2 diabetes mellitus and at least 12 months of continuous enrollment in the UK CPRD, Finland or Swedish national registries. New users of empagliflozin will be compared to new users of dipeptidyl peptidase-4 (DPP-4) inhibitors and to new users of other SGLT-2 inhibitors. Estimations will be made on the crude and adjusted incidence rates and adjusted incidence rate ratios of the primary and secondary outcomes. Primary outcomes are urinary tract cancers, bladder cancer, and renal cancer. Secondary outcomes include non-renal, non-bladder urinary tract cancers.
Was this study requested by a regulator?Yes: EMA
Is the study required by a Risk Management Plan (RMP)?
EU RMP category 3 (required)
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 Fabian
First name Hoti
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
Sweden
United Kingdom
3. Study timelines: initial administrative steps, progress reports and final report
PlannedActual
Date when funding contract was signed05/04/2016
Start date of data collection15/11/201616/11/2016
Start date of data analysis01/12/2020
Date of interim report, if expected31/03/202113/03/2017
Date of final study report30/06/2022
4. Sources of funding
Please provide estimates of the percentage of funding by source for this study
Names(s)Approximate % funding
Pharmaceutical companiesBoehringer Ingelheim International GmbH100
Charities
Government body
Research councils
EU funding scheme
5. Contact details for enquiries
Scientific Enquiries
Title Dr
Last name Fabian
First name Hoti
Address line 1EPID Research Oy
Address line 2Metsänneidonkuja 6
Address line 3
CityEspoo
Postcode02130
CountryFinland
Phone number (incl. country code)358-40-5391919
Alternative phone number
Fax number (incl. country code)
Public Enquiries
Title Dr
Last name Fabian
First name Hoti
Address line 1EPID Research Oy
Address line 2Metsänneidonkuja 6
Address line 3
CityEspoo
Postcode02130
CountryFinland
Phone number (incl. country code)358-40-5391919
Alternative phone number
Fax number (incl. country code)
6. Study drug(s) information
Substance class (ATC Code)A10BX12 (empagliflozin)
Substance class (ATC Code)A10BD20 (metformin and empagliflozin)
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 subjects56100
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
Hospital Episode Statistics, Cancer Registry, ONS mortality statistics, United Kingdom
National Patient Register, Swedish Cancer Registry, Cause of Death Register, National Diabetes Register, Sweden
Finnish prescription register, Care register for health care (HILMO), Register of primary health care visits (AvoHILMO), Finnish cancer register, Regional EMR records, Finland
Sources of data
Disease/case registry
Administrative database, e.g. claims database
Routine primary care electronic patient registry
Pharmacy dispensing records
Population-wide registers in Sweden and Finland contain information e.g. on medication purchases, hospitalisations, cancers and deaths. UK CPRD contains the anonymised longitudinal medical records managed by GPs working the NHS primary care setting.
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 main objective of the study is to estimate, among patients with type 2 diabetes mellitus, the risk of all urinary tract cancers and those of bladder and renal cancers also separately in patients initiating empagliflozin compared to patients initiating a DPP-4 inhibitors and to patients initiating other SGLT-2 inhibitors
Are there primary outcomes?Yes
The primary outcomes of interest for this study are urinary tract cancers, bladder cancer, and renal cancer.
Are there secondary outcomes?Yes
The secondary outcome of interest for this study is non-renal, non-bladder urinary tract cancers (referred to as other urinary tract cancers). Non-renal, non-urinary bladder urinary tract cancers include ureter and urethra cancers.
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 index date is defined as the date of first purchase/prescription of empagliflozin, other SGLT-2 inhibitor, or DPP-4 inhibitor during the study period (2014-2020). The maximum follow-up time for an individual will be 6 years. For primary analyses, the follow-up time will begin 6 months after the index date (lag period to account for empirical induction/promotion period of cancer).
15. Data analysis plan
Please provide a brief summary of the analysis method
The main data analyses will be conducted in two stages: (i) construction of the propensity score (PS)-matched cohorts (for each comparison) (ii) estimating the effect of exposure to empagliflozin on the outcomes using adjusted hazard ratio compared to those exposed to DPP-4 inhibitor or SGLT-2 inhibitor and their respective incidence rates. Patients starting combination of empagliflozin and metformin (fixed-dose or free combination) will be compared with patients starting combination of another DPP-4 inhibitor or SGLT-2 inhibitor and metformin.
Incidence rates (crude and adjusted) will be presented for each exposure group and stratified by relevant variables using the Poisson regression approach. Relative risks will be presented as hazard ratios adjusted for relevant variables using the Cox’s proportional hazards model with the time-varying covariate approach. The adjusted hazard ratios and incidence rates will be presented along with 95% confidence intervals for the risk estimate
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
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
