Status: Finalised
First registered on:
30/07/2015
Last updated on:
28/01/2021
1. Study identification
EU PAS Register NumberEUPAS10446
Official titlePost-Authorisation Safety Study of Agomelatine and the Risk of Hospitalisation for Acute Liver Injury
Study title acronym
Study typeOther: Post-Authorization Safety Study (PASS)
Brief description of the studyThis is a large, multinational, longitudinal retrospective cohort and nested case-control study using 5 European databases aiming at comparing the risk of hospitalisation for acute liver injury (ALI) in patients initiating treatment with agomelatine and other antidepressants with the risk in patients initiating treatment with citalopram used as a common reference group.
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 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 Pladevall
First name Manel
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?5
Southern Denmark University, Denmark
Countries in which this study is being conducted
International study
Denmark
Germany
Spain
Sweden
3. Study timelines: initial administrative steps, progress reports and final report
PlannedActual
Date when funding contract was signed01/04/2015
Start date of data collection29/01/201618/01/2016
Start date of data analysis
Date of interim report, if expected30/09/201629/09/2016
Date of final study report12/12/201712/12/2017
4. Sources of funding
Please provide estimates of the percentage of funding by source for this study
Names(s)Approximate % funding
Pharmaceutical companiesLes Laboratoires Servier100
Charities
Government body
Research councils
EU funding scheme
5. Contact details for enquiries
Scientific Enquiries
Title Ms
Last name PERCHERON
First name Christèle
Address line 150, rue Carnot
Address line 2
Address line 3
CitySuresnes cedex
Postcode92284
CountryFrance
Phone number (incl. country code)33155727191
Alternative phone number
Fax number (incl. country code)
Public Enquiries
Title Ms
Last name PERCHERON
First name Christèle
Address line 150, rue Carnot
Address line 2
Address line 3
CitySuresnes cedex
Postcode92284
CountryFrance
Phone number (incl. country code)33155727191
Alternative phone number
Fax number (incl. country code)
6. Study drug(s) information
Substance class (ATC Code)N06AX22 (agomelatine)
7. Medical conditions to be studied
Medical condition(s)Yes
Major depression
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 subjects65000
Additional information
65,000 to 92,000 users of agomelatine
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
EpiChron, Spain
Danish Health Registries, Denmark
Sources of data
Administrative database, e.g. claims database
Routine primary care electronic patient registry
Pharmacy dispensing records
Hospital discharge data
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?
Primary objective: to estimate, with the nested case-control analysis, the fully adjusted odds ratio of hospitalisation for ALI comparing patients initiating treatment with agomelatine and other antidepressants with patients initiating citalopram used as a common reference group.
Are there primary outcomes?Yes
Primary endpoint: hospital diagnosis for ALI identified with specific ICD-9-CM or ICD-10-CM1 diagnosis codes (common in all the study data sources).
Are there secondary outcomes?Yes
Secondary endpoint : Hospital diagnosis for ALI identified with specific and non-specific ICD-9-CM or ICD-10-CM1 diagnosis codes evaluated only in Spain/Denmark in which validation of this less specific outcome will be possible.
Tertiary endpoint : 1/specific and non-specific codes identified in both hospital and ambulatory settings. 2/evaluated in all data sources but validated in Spain/Denmark
13. Study design
What is the design of the study?
Cohort study
Case-control 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
Cohort analysis 1/Crude and age- and sex-standardised incidence rates of hospitalisation for ALI for current use of agomelatine and each antidepressant.2/Kaplan-Meier to estimate crude cumulative incidence of ALI at monthly intervals after first dispensing of agomelatine and each antidepressant.3/Age- and sex-adjusted incidence rate ratios for agomelatine and each antidepressant during current use, compared with citalopram current use.
Nested case-control analysis: 1/Cases and controls will be matched on age, calendar year of start date, and sex.2/Using density-based sampling, controls will have follow-up proportionate to cases and index date of case will be assigned to matched controls.3/For all endpoints, risk of ALI in current users agomelatine and current users other antidepressants will be compared with risk in current users of citalopram, adjusting for confounders using conditional logistic regression.4/Sensitivity analyses to include assessment recent/past use antidepressants
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
Pladevall-Vila, M., Pottegård, A., Schink, T. et al. Risk of Acute Liver Injury in Agomelatine and Other Antidepressant Users in Four European Countries: A Cohort and Nested Case–Control Study Using Automated Health Data Sources. CNS Drugs (2019) 33: 383https://doi.org/10.1007/s40263-019-00611-9
Forns J, Pottegård A, Reinders T, Poblador-Plou B, Morros R, Brandt L, et al. Antidepressant use in Denmark, Germany, Spain, and Sweden between 2009 and 2014: incidence and comorbidities of antidepressant initiators. J Affect Disord. 2019 Feb 6;249:242-52.https://doi.org/10.1016/j.jad.2019.02.010
Forns J, Cainzos-Achirica M, Hellfritzsch M, Morros R, Poblador-Plou B, Hallas J, Giner-Soriano M, Prados-Torres A, Pottegard A, Cortes J, Castellsague J, Jacquot E, Deltour N, Perez-Gutthann S, Pladevall M. Validity of ICD-9 and ICD-10 codes used to identify acute liver injury: A study in three European data sources. Pharmacoepidemiol Drug Saf 2019 Jul;28(7):965-75https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6618105/pdf/PDS-28-965.pdf
Pladevall M, Hallas J, Schink T, Morros R, Poblador B, Forns J, Maja H, Reinders T, Giner-Soriano M, Prados-Torres A, Cainzos-Achirica M, Pottegård A, Kollhorst B, Cortés J, Aguado J, Perlemuter G, Castellsagué J, Jacquot E, Deltour N, Perez-Gutthann S. Agomelatine and Risk of Hospitalisation for Acute Liver Injury: Nested Case–Control Analysis in Three European Countries (abstract # 644). Poster presentation at The 33rd International Conference on Pharmacoepidemiology & Therapeutic Risk Management; August 26–30, 2017. Montréal, Canada. Pharmacoepidemiology and drug safety 2017; 26(Suppl. 2): 389.https://www.rtihs.org/publications/agomelatine-and-risk-hospitalization-acute-liver-injury-nested-case-control-study-spain
M. Pladelvall, A. Pottegard, T. Schink, J. Reutfors, R. Morros, B. Poblador-Plou, A. Timmer, J. Forns, M. Hellfritzsch, T. Reinders, D. Hagg, M. Giner-Soriano, A. Prados-Torres, M. Cainzos-Achirica, J. Hallas, B. Kollhorst, L. Brandt, J. Cortés, J. Aguado, G. Perlemuter, B. Falissard, J. Castellsagué, E. Jacquot, N. Deltour, S. Perez-Gutthann. Agomelatine and other antidepressants and the risk of acute liver injury (ALI), a post authorisation safety study (PASS) in four European countries. Poster presentation at the 31st European Congress of Neuropsychopharmacology (ECNP), 6-9 October 2018, Barcelona.https://www.ecnp.eu/presentationpdfs/73/P.860.pdf
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
