Status: Finalised
First registered on:
30/11/2017
Last updated on:
08/09/2021
1. Study identification
EU PAS Register NumberEUPAS20720
Official titleIntravenous Iron Postauthorisation Safety Study (PASS): Evaluation of the Risk of Severe Hypersensitivity Reactions
Study title acronym
Study typeObservational study
Brief description of the studyIn September 2013, the European Medicines Agency Pharmacovigilance Risk Assessment Committee (EMA-PRAC) recommended that marketing authorisation holders of intravenous iron compounds conduct a postauthorisation safety study (PASS) to further characterise the safety concerns regarding hypersensitivity reactions.
This is a multinational, longitudinal cohort study of new users of intravenous iron compounds conducted in populations covered through electronic health databases and patient registries in Denmark, the Netherlands, France, Germany, and Sweden. The study aims to evaluate the risk of anaphylactic or severe immediate hypersensitivity reactions on the day of or the day after the first intravenous iron use by estimating the incidence proportions of anaphylactic reactions in patients who were first dispensed/administered intravenous iron (new users). Incidence estimates will be calculated for patients overall, by group of intravenous iron product, and by type of intravenous iron product. Risk ratios will be used to compare the risk of anaphylaxis between intravenous iron groups and among the various intravenous iron types at the first exposure. The risk of anaphylactic reactions among new users of an intravenous anaphylaxis marker (penicillin), a compound for which anaphylaxis is a well-recognised side effect, will be estimated to provide context for the risk in users of intravenous iron.
Was this study requested by a regulator?Yes: EMA
Is the study required by a Risk Management Plan (RMP)?
EU RMP category 1 (imposed as condition of marketing authorisation)
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 Mrs
Last name Gutierrez
First name Lia
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?9
Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
University Hospital of Cologne - Board of Trustees for Dialysis and Kidney Transplantation (KfH-QiN), Cologne, Germany
Countries in which this study is being conducted
International study
Denmark
France
Germany
Netherlands
Sweden
3. Study timelines: initial administrative steps, progress reports and final report
PlannedActual
Date when funding contract was signed01/02/201716/03/2017
Start date of data collection30/03/201809/03/2018
Start date of data analysis
Date of interim report, if expected
Date of final study report30/03/202029/04/2020
4. Sources of funding
Please provide estimates of the percentage of funding by source for this study
Names(s)Approximate % funding
Pharmaceutical companiesIV Iron Marketing Authorisation Holders (MAH) Consortium, comprising 17 MAHs (see Annex 3 in protocol for full list)100
Charities
Government body
Research councils
EU funding scheme
5. Contact details for enquiries
Scientific Enquiries
Title Mrs
Last name Gutierrez
First name Lia
Address line 1Av. Diagonal, 605, 9-1
Address line 2
Address line 3
CityBarcelona
Postcode08028
CountrySpain
Phone number (incl. country code)34-932417764
Alternative phone number34-932417766
Fax number (incl. country code)34-937608507
Public Enquiries
Title Mrs
Last name Gutierrez
First name Lia
Address line 1Av. Diagonal, 605, 9-1
Address line 2
Address line 3
CityBarcelona
Postcode08028
CountrySpain
Phone number (incl. country code)34-932417764
Alternative phone number34-932417766
Fax number (incl. country code)34-937608507
6. Study drug(s) information
Substance class (ATC Code)B03AC (Iron, parenteral preparations)
7. Medical conditions to be studied
Medical condition(s)Yes
Anaphylactic reaction
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
Other population
Renal impaired
9. Number of subjects
Estimated total number of subjects250000
Additional information
Preliminary data on intravenous iron use from the 2014 and 2016 study feasibility evaluations suggest that approximately 250,000 to 300,000 patients with intravenous iron prescriptions could be included, possibly more.
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
The Health Services Database of the Central Denmark Region, Denmark
Tthe French National Information System Inter Plans Health Insurance Database (SNIIRAM), France
The Registry of the KfH: Registry of the Curatorium for Dialysis and Kidney Transplantation and its Quality in Nephrology programme (KfH QiN), Germany
The German Institute of Medical Documentation and Information (DIMDI)/Daten-transparenzverordnung (DaTraV) database, Germany
Swedish National Health Registries, Sweden
Sources of data
Disease/case registry
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?
Risk assessment
Primary scope : Risk assessment
12. Main objective(s)
What is the main objective of the study?
To assess the risk of anaphylactic or severe immediate hypersensitivity reactions on the day of or the day after the first intravenous iron use among patients with various indications for intravenous iron, overall and by groups and types, and to compare the risk between intravenous iron groups (i.e., dextrans vs. non-dextrans) and among the various intravenous iron types.
Are there primary outcomes?Yes
Anaphylactic reactions or severe immediate hypersensitivity reactions.
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?Yes
Please describe duration of follow up
Patients will be followed from their cohort entry date to the first occurrence of one of the following: study outcome, death, study period end, switch between types of intravenous (IV) iron, concurrent use of IV iron and IV anaphylaxis marker, day 2 (main analysis) after the first selected if iron product that qualified the patient for cohort entry, or disenrollment from the data source.
15. Data analysis plan
Please provide a brief summary of the analysis method
Descriptive statistics will be calculated to summarise baseline characteristics at cohort entry by groups and specific intravenous iron types and for the cohorts of intravenous penicillin. Propensity scores will be estimated by using multivariable logistic regression, with the dependent variable 1 for the primary intravenous iron group (or type) of interest or 0 for the comparator intravenous iron group (or type) and all of the prespecified covariates included as independent variables. If numbers are adequate, incidence proportions and risk ratios will be estimated individually in each data source by intravenous iron group and for each intravenous iron type, using iron sucrose as the common comparator group. Analyses will be conducted in each data source separately, and pooled estimates will be calculated if deemed appropriate.
16. ENCePP seal
Are you requesting the ENCePP seal for this study?
Yes
17. Full protocol
18. Study Results
Please list the 5 most relevant publications using data from your study
ReferenceLink to web-publication
Gutierrez L, Bezemer ID, Dress J, Ehrenstein V, Forstner M, Franzoni C, Lassalle R, Linder M, Droz-Perroteau C, Odsbu I, Overbeek JA, Perez-Gutthann S, Pisa FE, Rascher K, Rasouliyan L, Reinold J, Rothman KJ, Saigi-Morgui N, Schaller M, Smits E, Timmer A, Toft G, von Gersdorff G, Fortuny J. Challenges in conducting a multinational European study of severe hypersensitivity reactions among recipients of intravenous iron. Poster presented at the 35th ICPE International Conference on Pharmacoepidemiology & Therapeutic Risk Management; August 27, 2019. Philadelphia, PA. [abstract] Pharmacoepidemiol Drug Saf. 2019 Aug 20; 28(S2):640https://www.rtihs.org/sites/default/files/29674%20Gutierrez%202019%20Challenges%20in%20conducting%20a%20multinational%20European%20study%20of%20severe%20hypersensitivity%20reactions%20among%20recipients%20of%20intravenous%20iron.pdf
Gutierrez L, Blin P, Dress J, Droz-Perroteau C, Ehrenstein V, Franzoni C, Kollhorst B, Lassalle R, Linder M, Moore N, Odsbu I, Overbeek J, Perez-Gutthann S, Schink T, Rascher K, Rasouliyan L, Reinold J, Rothman KJ, Saigi-Morgui N, Schaller M, Smits E, Timmer A, Toft G, von Gersdorff G, Intravenous Iron Consortium, Fortuny J. A multinational European study of anaphylaxis among recipients of intravenous iron. Poster presented at the 2020 36th ICPE International Virtual Conference on Pharmacoepidemiology & Therapeutic Risk Management; September 16, 2020.https://www.rtihs.org/sites/default/files/30541%20Gutierrez%202020%20A%20multinational%20European%20study%20of%20anaphylaxis%20among%20recipients%20of%20intravenous%20iron.pdf
Fortuny J, von Gersdorff G, Lassalle R, Linder M, Overbeek J, Reinold J, Toft G, Timmer A, Dress J, Blin P, Droz-Perroteau C, Ehrenstein V, Franzoni C, Herings R, Kollhorst B, Moore N, Odsbu I, Perez-Gutthann S, Schink T, Rascher K, Rasouliyan L, Rothman KJ, Saigi-Morgui N, Schaller M, Smits E, Forstner M; Intravenous Iron Consortium, Bénichou J, Bircher AJ, Garbe E, Rampton DS, Gutierrez L. Use of intravenous iron and risk of anaphylaxis: A multinational observational post-authorisation safety study in Europe. Pharmacoepidemiol Drug Saf. 2021 Jun 28. doi: 10.1002/pds.5319.PMID: 34181291https://pubmed.ncbi.nlm.nih.gov/34181291/
Dominik de Sordi, Sanny Kappen, Fabian Otto-Sobotka, Anke Kulschewski, Andreas Weyland, Lia Gutierrez, Joan Fortuny, Jonas Reinold, Tania Schink, Antje Timmer. Validity of hospital ICD-10-GM codes to identify anaphylaxis. Pharmacoepidemiol Drug Saf
. 2021 Aug 21. doi: 10.1002/pds.5348.PMID: 34418227https://onlinelibrary.wiley.com/doi/10.1002/pds.5348
19. Other relevant documents
Other documents
DescriptionDocumentLatest version
