1. Study identification
EU PAS Register NumberEUPAS6769
Official titleStudy of Acute Liver Transplant-III: Prospective study of drug-exposed acute liver failure (ALF) in European liver transplant centers
Study title acronymSALT-III
Study typeObservational study
Brief description of the studyThe first SALT (Study of Acute Liver Transplant) study was a retrospective, multicentre, multi-country study of drug-exposed ALF registered for liver transplantation (ALFT), over the years 2005-2007. In the 52 contributing centres in seven participating European countries, 9479 patients were registered for transplantation, 600 for ALF, of which 302 without clinical aetiology were exposed to a drug within 30 days, the most commonly found being paracetamol, even without overdose. The SALT-I study created a network of these liver transplant centres in seven European countries. It also accumulated a considerable body of data on drug-exposed acute liver failure in Europe. The main objective of SALT-I concerned only the risks associated with NSAIDs.
The SALT-II study extended the retrospective part of SALT to 2008-2013, thus increasing its power. In the 21 French contributing centres, 559 ALFT patients were identified, of which 214 without clinical aetiology exposed to a drug within 30 days, the most commonly found being paracetamol, even without overdose (as for SALT-I).
This SALT-III study took advantage of this network of liver transplantation centres to do a prospective case-population surveillance of liver transplantations for drug-related ALF.
The prospective nature of the SALT-III study had to allow for better quality data acquisition for drug-related liver transplantation, within a systematic alert system. The objective was to build a surveillance network of liver transplant centres in France that provide real-time assessment of emerging risks related to drugs newly introduced to the market, allowing for earlier signal identification of a major drug-related public health issue. SALT-III was conducted in 17 French liver transplantation centres over the years 2015-2016. Because of difficulties for including prospectively eligible patients (emergency medical care), it was decided to retrospectively include eligible ALFT patients not identified in time.
Was this study requested by a regulator?No
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 grouppharmacoepidemiology
Organisation/affiliationUniversity of Bordeaux
Details of (Primary) lead investigator
Title Professor
Last name MOORE
First name Nicholas
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?17
Countries in which this study is being conducted
National study
France
3. Study timelines: initial administrative steps, progress reports and final report
PlannedActual
Date when funding contract was signed20/12/2013
Start date of data collection01/07/201403/12/2014
Start date of data analysis31/01/2018
Date of interim report, if expected26/05/2015
Date of final study report30/11/201729/05/2018
4. Sources of funding
Please provide estimates of the percentage of funding by source for this study
Names(s)Approximate % funding
Pharmaceutical companies
CharitiesL’Agence nationale de sécurité du médicament et des produits de santé (ANSM)100
Government body
Research councils
EU funding scheme
5. Contact details for enquiries
Scientific Enquiries
Title Professor
Last name MOORE
First name Nicholas
Address line 1Plateforme Bordeaux PharmacoEpi, CIC Bordeaux CIC1401, Université de Bordeaux, Bâtiment Le Tondu - Case 41, 146 rue Léo Saignat
Address line 2
Address line 3
CityBordeaux
Postcode33076
CountryFrance
Phone number (incl. country code)33557574675
Alternative phone number
Fax number (incl. country code)33557574740
Public Enquiries
Title Professor
Last name MOORE
First name Nicholas
Address line 1Plateforme Bordeaux PharmacoEpi, CIC Bordeaux CIC1401, Université de Bordeaux, Bâtiment Le Tondu - Case 41, 146 rue Léo Saignat
Address line 2
Address line 3
CityBordeaux
Postcode33076
CountryFrance
Phone number (incl. country code)33557574675
Alternative phone number
Fax number (incl. country code)33557574740
6. Study drug(s) information
Not applicable (disease/epidemiology study)
7. Medical conditions to be studied
Medical condition(s)Yes
Acute hepatic failure
Liver transplant
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
Hepatic impaired
9. Number of subjects
Estimated total number of subjects120
Additional information
60/year
10. Source of data
Is this study being carried out with an established data source?No
Sources of data
Exposure registry
Patient medical files at the participating liver transplant centers
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 develop the network of liver transplant centres for the prospective identification of drug-related ALFT,
To estimate the risk of drug-exposed ALFT in adults, in the 30 days prior to index date (ID, date of first symptoms), according to the population exposure to the same drugs provided by the national healthcare insurance system.
Are there primary outcomes?Yes
The population event rate for all ALFT cases "without defined clinical cause" exposed to the drug(s) of interest within 30 days prior to ID, expressed as number of cases per million exposed patients over the 2-year study period.
Are there secondary outcomes?Yes
Event rates for ALFT “without defined clinical cause” exposed to the drug(s) of interest within 7, 15, or 90 days prior to ID.
Event rates for ALFT “with a defined clinical cause”, exposed to drugs within 30 days prior to ID, compared to the previous event rates.
Description of cases registered for hepatic transplantation after acute drug overdose.
Identification of paracetamol adducts.
13. Study design
What is the design of the study?
Case-population 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
Descriptive analysis,
Exposure rates in ALFT were compared to the population exposure to the same drugs, provided by the national healthcare insurance system.
The population event rate for all ALFT cases "without a defined clinical cause for ALFT" exposed to the drug(s) of interest within 30 days prior to index date were computed, globally and for each molecule of interest, with reference to person-time exposed (total population drug exposure) or to number of patients exposed for the 2-year period. The estimated rates (with 95% CI) were expressed in cases per million patient-years.