Status: Finalised
First registered on:
02/08/2016
Last updated on:
18/11/2022
1. Study identification
EU PAS Register NumberEUPAS14567
Official titleBenefit-risk of arterial thrombotic prevention with rivaroxaban for atrial fibrillation in daily clinical practice
Study title acronymBROTHER
Study typeOther: Study using the French health insurance and hospital-discharge database
Brief description of the studyThe research question is to assess the one-year and two-year benefit-risk of rivaroxaban for stroke prevention in atrial fibrillation (SPAF) compared to vitamin K antagonists (VKA) and dabigatran among new anticoagulant users. The main objective is to compare the one-year and two-year risk of the following individual outcomes: stroke and systemic embolism (SSE), major bleeding and death, between new users of anticoagulant for SPAF during drug exposure: rivaroxaban versus VKA, and rivaroxaban versus dabigatran (standard and reduced doses). Secondary outcomes were clinically relevant bleeding (CRB), acute coronary syndrome (ACS) and a composite criterion of SSE, major bleeding or death. This is a cohort study in the French national healthcare claims and hospitalisation database (SNDS, Système National des Données de Santé) including new users of rivaroxaban, dabigatran, or VKA for SPAF with a follow-up for at least one year and up to two years per subject, and three-year history. The index date will be that of the first dispensation of rivaroxaban, dabigatran, or VKA in 2013 or 2014. Data will be extracted from 2010 to 2015. Outcomes analysis will be performed during drug exposure for matched patients on high-dimensional propensity score (hdPS), and all patients with hdPS adjustment.
Was this study requested by a regulator?Yes: France
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 applicableNone
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
Not applicable (single centre)
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 signed01/02/2016
Start date of data collection24/08/2016
Start date of data analysis16/11/2016
Date of interim report, if expected
Date of final study report20/11/2018
4. Sources of funding
Please provide estimates of the percentage of funding by source for this study
Names(s)Approximate % funding
Pharmaceutical companiesBayer Pharma AG100
Charities
Government body
Research councils
EU funding scheme
5. Contact details for enquiries
Scientific Enquiries
Title Dr
Last name Blin
First name Patrick
Address line 1146 Rue Leo Saignat
Address line 2
Address line 3
CityBordeaux
Postcode
CountryFrance
Phone number (incl. country code)33557574675
Alternative phone number
Fax number (incl. country code)
Public Enquiries
Title Dr
Last name Blin
First name Patrick
Address line 1146 Rue Leo Saignat
Address line 2
Address line 3
CityBordeaux
Postcode
CountryFrance
Phone number (incl. country code)33557574675
Alternative phone number
Fax number (incl. country code)
6. Study drug(s) information
Substance class (ATC Code)B01AA (Vitamin K antagonists)
Substance class (ATC Code)B01AF01 (rivaroxaban)
Substance class (ATC Code)B01AE07 (dabigatran etexilate)
7. Medical conditions to be studied
Medical condition(s)Yes
Atrial fibrillation
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 subjects150000
10. Source of data
Is this study being carried out with an established data source?Yes
Data sources not registered with ENCePP
SNDS, Système National des Données de Santé (French national healthcare insurance system database), France
Sources of data
Administrative database, e.g. claims database
11. Scope of the study
What is the scope of the study?
Disease epidemiology
Risk assessment
Drug utilisation study
Effectiveness evaluation
Primary scope : Risk assessment
12. Main objective(s)
What is the main objective of the study?
The main objective is to compare the one-year and two-year risk of the following individual outcomes: SSE, major bleeding and death between new users of anticoagulant for SPAF during drug exposure: rivaroxaban versus VKA, and rivaroxaban versus dabigatran (standard and reduced doses).
Are there primary outcomes?Yes
SSE as a hospitalisation with primary diagnosis of ischemic/undefined stroke, or other systemic arterial embolism or surgical procedure for systemic arterial embolism; Major bleeding as a hospitalisation with primary diagnosis of haemorrhagic stroke or other critical organ or site bleeding, or other bleeding with blood transfusion during hospital stay, or resulting in death; All-cause of death.
Are there secondary outcomes?Yes
Composite of SSE, major bleeding and death; CRB as a hospitalisation with primary diagnosis of haemorrhagic stroke (linked or associated diagnosis also included), or other critical organ or site bleeding, or gastro-intestinal or urogenital or other bleeding; ACS as a hospitalisation with main diagnosis of myocardial infarction or unstable angina; drug use; Healthcare resources use and costs.
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 start on the date of the first dispensation of rivaroxaban, dabigatran or VKA in 2013 or 2014 and end 31 December 2015.
15. Data analysis plan
Please provide a brief summary of the analysis method
Statistical analysis will be carried out according to a documented and approved Statistical Analysis Plan (SAP). The SAP describes statistical analysis as foreseen at the time of planning study. Statistical analysis will be performed after database lock using SAS® software. Blind double programming will be used for main outcome measures.
Primary outcomes will be analysed using survival methods: Kaplan-Meier estimate or cumulative incidence function estimate for cumulative incidence of clinical outcomes, Cox proportional hazard risk model or Fine and Gray model to compare incidence for outcomes between rivaroxaban versus dabigatran, and rivaroxaban versus VKA (standard and reduced doses), for hdPS matched patients, and all patients with hdPS adjustment.
The analysis of healthcare costs during the drug exposure will be performed as an “intent-to-treat” analysis. Costs will be estimated according to treatment group from national health insurance and collective perspectives.
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
Effectiveness and Safety of Rivaroxaban 15 or 20 mg Versus Vitamin K Antagonists in Nonvalvular Atrial Fibrillation.
Blin P, Fauchier L, Dureau-Pournin C, Sacher F, Dallongeville J, Bernard MA, Lassalle R, Droz-Perroteau C, Moore N.
Stroke. 2019 Aug 8:STROKEAHA119025824. doi: 10.1161/STROKEAHA.119.025824.https://doi.org/10.1161/STROKEAHA.119.025824
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
