Status: Ongoing
First registered on:
30/04/2020
Last updated on:
19/07/2023
1. Study identification
EU PAS Register NumberEUPAS34201
Official titleA post-authorization safety study (PASS) to evaluate the paternal exposure to valproate and the risk of neurodevelopmental disorders including autism spectrum disorders as well as congenital abnormalities in offspring - a population-based retrospective study
Study title acronym
Study typeObservational study
Brief description of the studyThis population-based retrospective cohort study using secondary data from national registries within Norway, Denmark and Sweden aims to examine the association between paternal exposure to valproate at conception and the risk of Neurodevelopmental disorders (NDD), including Autism spectrum disorder (ASD), as well as Congenital Malformations (CM) in offspring. The primary objective is to investigate the risk of NDD, including ASD, in offspring paternally exposed to valproate (monotherapy), compared to lamotrigine or levetiracetam (composite monotherapy) treatment at the time of conception. Secondary objectives are to 1) investige the risk of CM in live and non-live offspring paternally exposed to valproate (monotherapy), compared to lamotrigine or levetiracetam (composite monotherapy) treatment at the time of conception, in Norway and Denmark; 2) describe the anti-epileptic drug (AED) exposure (posology and duration) data and health characteristics of male patients prescribed AEDs (including valproate and lamotrigine/levetiracetam) in treatment of epilepsy and other indications at the time of conception of their offspring, both for NDD and CM cohort; and 3) identify potentially important risk factors for outcomes of interest, in offspring paternally exposed to valproate (monotherapy) or lamotrigine or levetiracetam (composite monotherapy) at the time of conception, by examining AED exposure and health characteristics of the offspring and their mothers. Additional exploratory and sensitivity analyses apply (such as narrow case definition for primary outcome with a focus on ASD). Separate cohorts for analysis will be created where medical record linkage between offspring (<12 years), mother and father is available; the NDD cohort will consist of live births and the CM cohort will consist of live births, stillbirths and spontaneous abortions during gestation (2nd or 3rd trimester) for Norway and Denmark, and live births only for Sweden.
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)EMEA/H/A-31/1454
Other study registration identification numbers and URLs as applicable
2. Research centres and Investigator details
Coordinating study entity
Centre to which the investigator belongsIQVIA
Department/Research groupGloDaSt, IQVIA
Organisation/affiliationIQVIA
Details of (Primary) lead investigator
Title Dr
Last name Bierrenbach
First name Ana Luiza
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
Denmark
Norway
Sweden
3. Study timelines: initial administrative steps, progress reports and final report
PlannedActual
Date when funding contract was signed09/10/2018
Start date of data collection01/09/202021/10/2020
Start date of data analysis
Date of interim report, if expected13/08/202122/11/2021
Date of final study report28/02/2023
4. Sources of funding
Please provide estimates of the percentage of funding by source for this study
Names(s)Approximate % funding
Pharmaceutical companiesA Consortium of Marketing Authorization Holders for valproate and related substances100
Charities
Government body
Research councils
EU funding scheme
5. Contact details for enquiries
Scientific Enquiries
Title Dr
Last name Bierrenbach
First name Ana Luiza
Address line 1Rua Padre João Manuel, 188
Address line 2Apt. 12
Address line 3
CitySão Paulo
Postcode01411-000
CountryBrazil
Phone number (incl. country code)55-1198-7962402
Alternative phone number
Fax number (incl. country code)
Public Enquiries
Title Dr
Last name Bierrenbach
First name Ana Luiza
Address line 1Rua Padre João Manuel, 188
Address line 2Apt. 12
Address line 3
CitySão Paulo
Postcode01411-000
CountryBrazil
Phone number (incl. country code)55-1198-7962402
Alternative phone number
Fax number (incl. country code)
6. Study drug(s) information
Substance class (ATC Code)N03A (ANTIEPILEPTICS)
7. Medical conditions to be studied
Medical condition(s)Yes
Multiple congenital abnormalities
Neurodevelopmental disorder
Autism spectrum disorder
Bipolar disorder
Epilepsy
Migraine
Pregnancy
8. Population under study
Age
Preterm newborns
Term newborns (0-27 days)
Infants and toddlers (28 days - 23 months)
Children (2 - 11 years)
Sex
Male
Female
9. Number of subjects
Estimated total number of subjects4080
Additional information
The eligible population of linked family unit with paternal valproate exposure is estimated as: n=940 between 2004-2017 for Norway, n=1495 between 1995-2017 for Denmark, and n=1645 between 2005-2017 for Sweden. This study should have a sufficient number of paternally exposed valproate offspring to observe a HR of 2.0 for the primary endpoint NDD, including ASD, with 5% significance and 80% power.
10. Source of data
Is this study being carried out with an established data source?Yes
Data sources not registered with ENCePP
Norwegian National Registries, Norway
Swedish National Registries, Sweden
Danish National Registries, Denmark
Sources of data
Administrative database, e.g. claims database
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 investigate the risk of NDD, including ASD, in offspring paternally exposed to valproate (monotherapy), compared to lamotrigine or levetiracetam (composite monotherapy) treatment at the time of conception.
Are there primary outcomes?Yes
The primary outcome of interest is NDD, including ASD in offspring up to twelve years of age based on ICD-10 diagnostic codes, as recorded in the National Patient Registries
Are there secondary outcomes?Yes
The secondary outcome of interest is a composite of CM diagnosed in offspring up to twelve years of age, stillbirths and spontaneous abortions based on ICD-10 diagnostic codes, as recorded in the National Patient Registries and Medical Birth Registries.
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 follow-up period for the offspring will be from birth to maximum 12 years of age.
15. Data analysis plan
Please provide a brief summary of the analysis method
For NDD and CM cohort by country, demographic and clinical characteristics of father at conception date, mother and offspring at delivery (index date) will be described overall and by paternal exposure group. Paternal AED exposure and maternal AED exposure will be characterised by cluster analysis. For NDD, risk and time to onset will be described overall and by paternal exposure group. A propensity-score (PS) matched Cox proportional hazards regression model will estimate a hazard ratio (+95%CI) between offspring paternally exposed to valproate and offspring paternally exposed to lamotrigine/levetiracetam. For CM, a PS-matched logistic regression model will estimate the odds ratio (+95%CI) of CM between offspring paternally exposed to valproate and offspring paternally exposed to lamotrigine/levetiracetam. Incidence % (+95%CI) will be calculated both for the composite CM endpoint and specific CM target body system organ groups (Norway/Denmark only). Data may be pooled via meta-analyse
16. ENCePP seal
Are you requesting the ENCePP seal for this study?
No
17. Full protocol
Available when the study ends
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
Submitted
