Status: Finalised
First registered on:
21/10/2011
Last updated on:
05/11/2013
1. Study identification
EU PAS Register NumberEUPAS2225
Official titleRisk of Upper Gastrointestinal Complications in Users of Nonsteroidal Anti-inflammatory Drugs
Study title acronym
Study typeObservational study
Brief description of the studyRetrospective cohort study and nested case-control analysis to evaluate the risk of upper gastrointestinal complications (UGIC ) in a cohort of patients receiving NSAIDs between 2001-2008 in the Italian region of Friuli Venezia Giulia (FVG). The study was conducted by a research team from RTI Health Solutions, the Institute of Hygiene and Clinical Epidemiology of the University of Udine and University Hospital of Udine, and the Direzione Centrale della Salute, Integrazione Socio Sanitaria e Politiche Sociali, Udine. The study was based on information from the FVG Regional Health Services Databases and hospital medical charts for the validation of cases of UGIC. The objectives of the study were to (1) estimate the risk of UGIC associated with the use of nimesulide and other individual NSAIDs, (2) evaluate the effect of dose and duration of use of individual NSAIDs and the role of potential risk factors for UGIC, and (3) describe the characteristics of nimesulide users over time.
Was this study requested by a regulator?No
Is the study required by a Risk Management Plan (RMP)?
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 belongsRTI-HS
Department/Research groupPharmacoepidemiology & Risk Management
Organisation/affiliationRTI Health Solutions
Details of (Primary) lead investigator
Title Dr
Last name Perez-Gutthann
First name Susana
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?21
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 signed20/10/2009
Start date of data collection15/12/200908/02/2010
Start date of data analysis01/05/201001/06/2010
Date of interim report, if expected23/03/2011
Date of final study report14/02/201101/07/2011
4. Sources of funding
Please provide estimates of the percentage of funding by source for this study
Names(s)Approximate % funding
Pharmaceutical companiesHelsinn Healthcare, S.A.100
Charities
Government body
Research councils
EU funding scheme
5. Contact details for enquiries
Scientific Enquiries
Title Dr
Last name Perez-Gutthann
First name Susana
Address line 1Trav. Gracia, 56, Atico 1
Address line 2
Address line 3
CityBarcelona
Postcode08006
CountrySpain
Phone number (incl. country code)34932417760
Alternative phone number
Fax number (incl. country code)34934142610
Public Enquiries
Title Dr
Last name Perez-Gutthann
First name Susana
Address line 1Trav. Gracia, 56, Atico 1
Address line 2
Address line 3
CityBarcelona
Postcode08006
CountrySpain
Phone number (incl. country code)34932417760
Alternative phone number
Fax number (incl. country code)34934142610
6. Study drug(s) information
Substance class (ATC Code)M01A (ANTIINFLAMMATORY AND ANTIRHEUMATIC PRODUCTS, NON-STEROIDS)
7. Medical conditions to be studied
Medical condition(s)No
8. Population under study
Age
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 subjects588827
Additional information
251013 Users of nimesulide
10. Source of data
Is this study being carried out with an established data source?Yes
Data sources not registered with ENCePP
Friuli Venezia Giulia (FVG) Regional Health Services Databases, Italy
Medical Charts from 19 hospitals in the FVG Region, Italy
Sources of data
Administrative database, e.g. claims database
Pharmacy dispensing records
Hospital medical records
11. Scope of the study
What is the scope of the study?
Disease epidemiology
Risk assessment
Drug utilisation study
Primary scope : Risk assessment
12. Main objective(s)
What is the main objective of the study?
The objectives of the study are to (1) estimate the risk of UGIC associated with the use of nimesulide and other individual NSAIDs, (2) evaluate the effect of dose and duration of use of individual NSAIDs and the role of potential risk factors for UGIC, and (3) describe the characteristics of nimesulide users over time.
Are there primary outcomes?Yes
Upper gastrointestinal bleeding, perforation, obstruction.
Are there secondary outcomes?No
13. Study design
What is the design of the study?
Cohort study
Case-control study
Drug utilisation study
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
Crude age- and sex-specific incidence rates and 95% confidence intervals of UGIC were estimated for current use of NSAIDs and nonuse of NSAIDs. Incidence rates were stratified by history of peptic ulcer and calendar year. The nested case-control analysis was the main analysis of the study. All confirmed cases of UGIC from the study cohort were included in the analysis. Density-based sampling was used to select 10 controls for each case. We used conditional logistic regression to estimate crude and adjusted odds ratios for the risk of UGIC during the periods of exposure to each individual NSAID with the risk during nonuse of NSAIDs. The model was built manually based on the impact on the effect estimate of NSAIDs and the inclusion of factors associated with increased risk of UGIC, general medical frailty, or with potential selective prescribing of NSAIDs. Effect measure modification was assessed for age, sex, and concurrent use of aspirin, anticoagulants, and oral corticosteroids.
16. ENCePP seal
Are you requesting the ENCePP seal for this study?
No
17. Full protocol
18. Study Results
Please list the 5 most relevant publications using data from your study
ReferenceLink to web-publication
Castellsague J, Pisa F, Rosolen V, Drigo D, Riera-Guardia N, Giangreco M, Clagnan E, Tosolini F, Zanier L, Barbone F, and Perez-Gutthann S. Risk of upper gastrointestinal complications in a cohort of users of nimesulide and other nonsteroidal anti-inflammatory drugs in Friuli Venezia Giulia, Italy. Pharmacoepidemiol Drug Saf. 2013; 22(4): 365–375. Article first published online: 11 DEC 2012 | DOI: 10.1002/pds.3385http://onlinelibrary.wiley.com/doi/10.1002/pds.3385/abstract
Castellsague J, Pisa P, Rosolen V, Riera-Guardia N, Giangreco M, Clagnan E, Tosolini F, Zanier L, Barbone F, Perez-Gutthann S. Use of nimesulide, other NSAIDs, and the risk of upper gastrointestinal complications in Friuli Venezia Giulia, Italy. Pharmacoepidemiol Drug Saf 2011; 20: S178http://www.rtihs.org/request/index.cfm?fuseaction=display&PID=17608
Pisa F, Drigo D, Riera-Guardia N, Castellsague J, Rosolen V, Clagnan E, Tosolini F, Zanier L, Perez-Gutthann S, Barbone F. Validation of primary and secondary ICD9-CM codes for upper gastrointestinal complications in Friuli Venezia Giulia, Italy. Pharmacoepidemiol Drug Saf 2011; 20: S172http://www.rtihs.org/request/index.cfm?fuseaction=display&PID=17613
Pisa P, Castellsague J, Rosolen V, Riera-Guardia N, Giangreco M, Drigo D, Perez-Gutthann S, Barbone F. Impact of Case Validation on Incidence Rates of Upper Gastrointestinal Complications. Pharmacoepidemiol & Drug Saf 2012; 21: (Suppl 3): S178
Pisa F, Castellsague J, Drigo D, Riera-Guardia N, Giangreco M, Rosolen V, Clagnan E, Zanier L, Perez-Gutthann S, Barbone F. Accuracy of International Classification of Diseases, 9th Revision, Clinical Modification codes for upper gastrointestinal complications varied by position and age: a validation study in a cohort of nonsteroidal anti-inflammatory drugs users in Friuli Venezia Giulia, Italy. Pharmacoepidemiol Drug Saf. 2013 Nov;22(11): 1195-1204
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
