Status: Ongoing
First registered on:
15/01/2016
Last updated on:
18/10/2022
1. Study identification
EU PAS Register NumberEUPAS12116
Official titleComparison of the Risk of Cancer Between Patients With Type 2 Diabetes Exposed to Dapagliflozin and Those Exposed to Other Antidiabetic Treatments
Study title acronym
Study typeObservational study
Brief description of the studyThis is a multinational cohort database study to estimate the incidence of female breast cancer and bladder cancer, by insulin use at cohort entry, in patients who are prescribed dapagliflozin compared to patients prescribed other specific oral antidiabetic drugs. Dapagliflozin and other antidiabetic drugs are used to treat type 2 diabetes mellitus. Because of the mechanism of action for dapagliflozin and results from small safety monitoring studies, there is interest in further evaluating the safety of dapagliflozin in a large populations.
The study will be implemented in four administrative health care data sources in three countries: in the United Kingdom, the Clinical Practice Research Datalink (CPRD); in the United States, the Centers for Medicare and Medicaid Services (CMS) Medicare databases and the HealthCore Integrated Research Database (HIRDSM); and, in the Netherlands, the PHARMO Database Network. Individuals in the databases will be included in the study if they meet the following age criteria; 40 years or older (CPRD and PHARMO), 40 to 64 years (HIRD) or 65 years or older (Medicare); and if they did not have type 1 diabetes, were treated with one of the study drugs and meet the criteria of at least 180 days of electronic data before their first prescription of the study drug. The study period starts November 13, 2012 in CPRD, November 1, 2013 in PHARMO and January 9, 2014 in the United States data sources, and will end at the latest available data at each database at the time of analysis.
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 applicableD1690R00007
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 Ms
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?3
Healthcore, United States
Countries in which this study is being conducted
International study
Netherlands
United Kingdom
United States
3. Study timelines: initial administrative steps, progress reports and final report
PlannedActual
Date when funding contract was signed12/02/201512/02/2015
Start date of data collection29/01/201601/02/2016
Start date of data analysis
Date of interim report, if expected30/12/201622/11/2016
Date of final study report28/02/2025
4. Sources of funding
Please provide estimates of the percentage of funding by source for this study
Names(s)Approximate % funding
Pharmaceutical companiesAstra Zeneca100
Charities
Government body
Research councils
EU funding scheme
5. Contact details for enquiries
Scientific Enquiries
Title Ms
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)34932417764
Alternative phone number
Fax number (incl. country code)
Public Enquiries
Title Dr
Last name AstraZeneca
First name Clinical Study Information Center
Address line 11800 Concord Pike
Address line 2PO Box 15437
Address line 3
CityWilmington
Postcode19850
CountryUnited States
Phone number (incl. country code)0018772409479
Alternative phone number
Fax number (incl. country code)
6. Study drug(s) information
Substance class (ATC Code)A10BX09 (dapagliflozin)
Substance class (ATC Code)A10BD15 (metformin and dapagliflozin)
Single-Constituent (Substance INN)DAPAGLIFLOZIN
Product NameFarxiga
CountryUnited States
Substance INN(s)DAPAGLIFLOZIN
Product NameXigduo XR
CountryUnited States
Substance INN(s)DAPAGLIFLOZIN
METFORMIN
Product NameForxiga
CountryUnited Kingdom
Substance INN(s)DAPAGLIFLOZIN
Product NameXigduo
CountryUnited Kingdom
Substance INN(s)DAPAGLIFLOZIN
METFORMIN
7. Medical conditions to be studied
Medical condition(s)Yes
Breast cancer
Bladder cancer
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 subjects1800000
Additional information
The total sample size across all databases is approximately 1.8 million. We estimated that at the end of the study there will be 850,000 dapagliflozin exposed person-years and 3,400,000 unexposed person-years across all data sources.
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
Healthcore, United States
Medicare, United States
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 compare, among patients with type 2 diabetes who are new users of dapagliflozin and patients who are new users of antidiabetic drugs in classes other SGLT2 inhibitors, insulin monotherapy, metformin monotherapy, or sulfonylurea monotherapy (1) the incidence of breast cancer and sex-specific incidence of bladder cancer, by insulin use at cohort entry and pioglitazone use.
Are there primary outcomes?Yes
Female breast cancer and bladder cancer
Are there secondary outcomes?Yes
Composite incidence of selected cancers among males (prostate, colon/rectum, lung, stomach, non-Hodgkin lymphoma (NHL), and melanoma of skin) and among females (colon/rectum, lung, corpus uteri, ovary, stomach, NHL and melanoma of skin).
Frequency of health care utilization measures during follow up.
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 index date (date of first study drug prescription or dispensing) until the earliest of occurrence of one of the following: first occurrence of any one of the study endpoints, death, addition of a non-dapagliflozin SGLT2 inhibitor, disenrollment from the study database or transfer out of the GP practice, or end of the study period.
15. Data analysis plan
Please provide a brief summary of the analysis method
Descriptive statistics will be calculated to compare baseline characteristics at cohort entry between dapagliflozin users versus comparator antidiabetic users separately for each outcome. Propensity scores will be estimated by using logistic regression, with measured potential predictors of the cancer outcome as independent variables in the regression model and actual exposure group (dapagliflozin or comparator) as the outcome. Incidence rates of each outcome will be estimated during exposure time at risk for dapagliflozin initiators and comparators. The incidence rates will also be estimated within categories of cumulative dose of exposure. Unadjusted incidence rate ratios (IRRs) of the outcomes of interest with 95% confidence intervals in dapagliflozin users versus other AD users will be calculated, and adjusted using propensity score–stratified analysis. Analyses will be conducted in each data source separately, and a pooled estimate will be calculated if deemed appropriate.
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
Gutierrez L, Beachler D, Overbeek J, McQuay L, Yin R, Kuiper J, McGrath L, Jemison J, Houben E, Lanes S, Gilsenan A, van Herk-Sukel M. Characteristics of New Users of Dapagliflozin and Other Antidiabetic Drugs; United States (US), United Kingdom (UK), and the Netherlands. Pharmacoepidemiol Drug Saf. 2017;26(Suppl. 2):128-29. doi: 10.1002/pds.4275.https://onlinelibrary.wiley.com/doi/epdf/10.1002/pds.4275
Zhou CK, Dinh J, Danysh HE, Johannes C, Gutierrez L, Schmid R, Arana A, Kaye JA, Pladevall-Vila M, Garcia-Albeniz X, Gangemi K, Yin R, Ruzafa JC, Gilsenan A, Beachler DC. Validity of claims‐based algorithms to identify acute kidney injury, acute liver injury, severe complications of urinary tract infections, breast cancer, and bladder cancer among patients with type 2 diabetes: A pilot study. Pharmacoepidemiol Drug Saf. 2019;28(S2):157. doi: 10.1002/pds.4864.https://onlinelibrary.wiley.com/doi/epdf/10.1002/pds.4864
Gutierrez L, Danysh HE, Aguado J, Hunt PR, Kaye JA, Garcia-Albeniz X, Gilsenan A. Value of adding secondary read diagnosis codes to identify breast cancer and bladder cancer in the clinical practice research datalink: A pilot validation study. Pharmacoepidemiol Drug Saf. 2020;29(Suppl. 3):401. doi: 10.1002/pds.5114.https://onlinelibrary.wiley.com/doi/epdf/10.1002/pds.5114
Danysh HE, Gilsenan A, Beachler DC, Kaye JA, Garcia-Albeniz X, Schmid R, Hunter, S, Hunt PR, Aguado J, Calingaert B, Layton JB, Gutierrez L. Validation of breast cancer and bladder cancer among patients with type 2 diabetes mellitus in medicare: A pilot study. Pharmacoepidemiol Drug Saf. 2020;29(Suppl. 3):396-97. doi: 10.1002/pds.5114.https://onlinelibrary.wiley.com/doi/epdf/10.1002/pds.5114
Dinh J, Danysh HE, Johannes C, Gutierrez L, Schmid R, Arana A, Kaye JA, Pladevall-Vila M, Garcia-Albeniz X, Hunt PR, Gilsenan A, Beachler DC, Zhou CK. Description of acute kidney injury and breast cancer outcome validation processes across three databases. Pharmacoepidemiol Drug Saf. 2020;29(Suppl. 3):571. doi: 10.1002/pds.5114.https://onlinelibrary.wiley.com/doi/epdf/10.1002/pds.5114
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
