Status: Finalised
First registered on:
30/10/2020
Last updated on:
04/07/2022
1. Study identification
EU PAS Register NumberEUPAS37856
Official titleStudy of impact of EU label changes for fluoroquinolone containing medicinal products for systemic and inhalation use - post-referral prescribing trends
Study title acronym
Study typeObservational study
Brief description of the studyIn November 2018 a referral procedure (EMA/H/A-31/1452) under Article 31 of Directive 2001/83/EC resulting from pharmacovigilance data concluded that serious adverse reactions including tendon, muscle and joint disorders, neurologic and psychiatric disorders listed in the product information of different (fluoro)quinolones could in rare cases become long-lasting, disabling and potentially even irreversible and substantially disrupt patients’ daily activities. To maintain a favourable benefit-risk balance for all (fluoro)quinolone containing medicinal products for systemic use, revised indications, warnings, and other changes to the product information, including direct healthcare professional communication (DHPC) were implemented in EU Member States including recommendations for cessation of prescribing for milder, non-severe or self-limiting infections, and restrictions for other indications. The study objectives are:
1.To determine the drug utilisation and prescription patterns of fluoroquinolone containing medicinal products over the period 2016 and 2020 by
a)estimating monthly incident drug use, stratified by on label indications and off label indications. b)Estimation of early discontinuation proportion
2. To evaluate the impact of regulatory interventions on fluoroquinolone prescribing patterns using time series analysis.
3. To determine prescribers’ compliance with warnings as described in fluoroquinolones SmPC section 4.4, in particular on tendinitis and tendon rupture as well as on aortic aneurysm/dissection
4. To determine monthly incident prescription rates for alternative antibiotics prescribed in patients where systemic or inhalation use fluoroquinolones have previously been prescribed and discontinued. Data from six European countries namely IPCI (the Netherlands), SIDIAP (Catalonia Spain) and IQVIA (UK IMRD, LPD Belgium, DA Germany and LPD France). Data from these databases have been mapped to the OMOP Common Data Model.
Was this study requested by a regulator?Yes: EMA
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 groupIQVIA European Data Science Hub
Organisation/affiliationIQVIA
Details of (Primary) lead investigator
Title Professor
Last name Layton
First name Deborah
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?6
Countries in which this study is being conducted
International study
Belgium
France
Germany
Netherlands
Spain
United Kingdom
3. Study timelines: initial administrative steps, progress reports and final report
PlannedActual
Date when funding contract was signed06/05/2020
Start date of data collection01/01/2016
Start date of data analysis
Date of interim report, if expected
Date of final study report01/06/202201/07/2022
4. Sources of funding
Please provide estimates of the percentage of funding by source for this study
Names(s)Approximate % funding
Pharmaceutical companies
Charities
Government bodyEMA100
Research councils
EU funding scheme
5. Contact details for enquiries
Scientific Enquiries
Title Professor
Last name Layton
First name Deborah
Address line 1210 Pentonville Road
Address line 2
Address line 3
CityLondon
PostcodeN1 9JY
CountryUnited Kingdom
Phone number (incl. country code)44-07825844639
Alternative phone number
Fax number (incl. country code)
Public Enquiries
Title Professor
Last name Layton
First name Deborah
Address line 1210 Pentonville Road
Address line 2
Address line 3
CityLondon
PostcodeN1 9JY
CountryUnited Kingdom
Phone number (incl. country code)44-07825844639
Alternative phone number
Fax number (incl. country code)
6. Study drug(s) information
Substance class (ATC Code)Fluoroquinolones class: J01MA01(Ofloxacin), J01MA02 (Ciprofloxacin), J01MA06 (Norfloxacin), J01MA0 (Lomefloxacin), J01MA12 (Levofloxacin) and J01MA14 (Moxifloxacin)
7. Medical conditions to be studied
Medical condition(s)No
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 subjects800000
Additional information
This study is a characterisation of all patient data captured in the data assets and meeting inclusion criteria for exposure to systemic fluoroquinolones of interest. No hypothesis will be tested. Therefore, sample size calculation for the ability to reject the null hypothesis given an effect size will not be conducted.
10. Source of data
Is this study being carried out with an established data source?Yes
Data sources not registered with ENCePP
LPD France, France
DA Germany, Germany
IMRD, United Kingdom
Sources of data
Administrative database, e.g. claims database
Routine primary care electronic patient registry
11. Scope of the study
What is the scope of the study?
Drug utilisation study
Primary scope : Drug utilisation study
12. Main objective(s)
What is the main objective of the study?
The overall aim of this study is to evaluate the impact of the regulatory actions taken for fluoroquinolone containing medicinal products following the 2018 referral procedure, using healthcare databases of six European countries.
Are there primary outcomes?No
Are there secondary outcomes?No
13. Study design
What is the design of the study?
Cohort 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
This is a drug utilization study with a time series analysis component to identify the potential impact of regulatory interventions on fluoroquinolones prescribing trends. An initial exploratory descriptive analysis will be conducted for each database-specific cohort. Crude and stratified incidence of drug use, drug discontinuation and use of alternative treatment use will be calculated. A Joinpoint regression model will be used to investigate changes in prescribing patterns over calendar time. Prescriber compliance with labelled warnings for use mentioned in the product information will be investigated, as well as, using incidence of drug use across indications and risk factors.
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
None
19. Other relevant documents
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
