Status: Finalised
First registered on:
08/04/2015
Last updated on:
06/09/2021
1. Study identification
EU PAS Register NumberEUPAS9200
Official titleCohort Study of the Relative Incidence of Major Cardiovascular Events Among Patients Initiating Prucalopride Versus a Matched Comparator Cohort
Study title acronym
Study typeObservational study
Brief description of the studyThe primary objective of this study is to estimate, in real-world settings, the adjusted incidence rate ratio (IRR) and 95% confidence interval (CI) for major adverse cardiovascular events (MACE) in initiators of prucalopride versus initiators of polyethylene glycol 3350 (PEG). Prucalopride and PEG are both used to treat chronic constipation in women for whom laxatives do not work. The primary objective of this study is to estimate, in real-world settings, the adjusted incidence rate ratio (IRR) and 95% confidence interval (CI) for major adverse cardiovascular events (MACE) in initiators of prucalopride versus initiators of polyethylene glycol 3350 (PEG). Prucalopride and PEG are both used to treat chronic constipation in women for whom laxatives do not work. Drugs similar to prucalopride have been associated with adverse cardiovascular events in the past. This study is being done to gain a better understanding of the safety of prucalopride. The study will be implemented in five health care data sources in three countries: in the United Kingdom, the Clinical Practice Research Datalink (CPRD), The Health Improvement Network (THIN), and the Information Services Division of Scotland; in Germany, the German Pharmacoepidemiological Research Database; and in Sweden, the Swedish National Registers. Individuals in the databases will be included in the study if they were 18 years and older, were treated for chronic constipation and meet the criteria of at least 1 year of electronic data before study entry and at least 1 year of enrolment with their GP (for CPRD and THIN). The study period starts January 1, 2010, and will end at the latest available data at each database at the time of analysis. The primary cardiovascular outcome MACE, is a composite of any of the following: (1) hospitalization for nonfatal acute myocardial infarction, (2) hospitalization for nonfatal stroke, and (3) in-hospital cardiovascular death.
Was this study requested by a regulator?Yes: United States
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
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 Gilsenan
First name Alicia
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
Countries in which this study is being conducted
International study
Germany
Sweden
United Kingdom
3. Study timelines: initial administrative steps, progress reports and final report
PlannedActual
Date when funding contract was signed29/08/201429/08/2014
Start date of data collection28/02/201509/04/2015
Start date of data analysis
Date of interim report, if expected
Date of final study report31/12/201721/12/2017
4. Sources of funding
Please provide estimates of the percentage of funding by source for this study
Names(s)Approximate % funding
Pharmaceutical companiesShire Pharmaceuticals100
Charities
Government body
Research councils
EU funding scheme
5. Contact details for enquiries
Scientific Enquiries
Title Dr
Last name Gilsenan
First name Alicia
Address line 13040 Cornwallis Rd
Address line 2PO Box 12194
Address line 3
CityResearch Triangle Park
Postcode27709
CountryUnited States
Phone number (incl. country code)19195418745
Alternative phone number
Fax number (incl. country code)19195416630
Public Enquiries
Title Dr
Last name Gilsenan
First name Alicia
Address line 13040 Cornwallis Rd
Address line 2PO Box 12194
Address line 3
CityResearch Triangle Park
Postcode27709
CountryUnited States
Phone number (incl. country code)19195418745
Alternative phone number
Fax number (incl. country code)19195416630
6. Study drug(s) information
Substance class (ATC Code)A06AX05 (prucalopride)
Substance class (ATC Code)A06AD15 (macrogol)
7. Medical conditions to be studied
Medical condition(s)Yes
Acute myocardial infarction
Ischaemic stroke
Haemorrhagic stroke
Cardiac death
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 subjects66900
Additional information
For the final report, we estimate there will be 11,150 prucalopride initiators and 55,750 PEG initiators (Total sample size = 66,900) 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
ISD Scotland, United Kingdom
Sources of data
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 estimate the adjusted incidence rate ratio and 95% confidence interval for major adverse cardiovascular events—defined as the composite of hospitalization for acute myocardial infarction, hospitalization for stroke, and in-hospital cardiovascular death—in initiators of prucalopride versus initiators of polyethylene glycol 3350, adjusting for CV risk factors and other confounders.
Are there primary outcomes?Yes
Major adverse cardiovascular events (MACE)—defined as the composite of hospitalization for acute myocardial infarction (AMI), hospitalization for stroke, and in-hospital cardiovascular death
Are there secondary outcomes?Yes
Individual components of MACE – Hospitalization for AMI, hospitalization for stroke, in-hospital cardiovascular death
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 they experience one of the following: an event under study, death, prescription for the other study medication, 7 days after the end of the last prescription/dispensing for the index medication, termination of health plan, or end of the study period.
15. Data analysis plan
Please provide a brief summary of the analysis method
For each cohort, the prevalence of baseline risk factors for MACE will be described. Incidence rates of each outcome of interest will be calculated for the prucalopride and PEG cohorts, and IRRs will be estimated. Within each data source, propensity scores will be developed by modeling use of prucalopride against CV risk factors that could be confounders. After stratifying cohort-specific incidence rates by propensity score decile and by data source, the coordinating center will conduct an overall analysis combining the results across all data sources to calculate overall summary incidence rate and IRR estimates. Overall incidence rates will be age- and sex-standardized to the distribution of person-years in the prucalopride cohort across all data sources by age category and sex. Overall IRRs will be standardized to the distribution of propensity score deciles in the prucalopride cohort across all data sources.
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
Gilsenan A, Fortuny J, Cainzos-Achirica M, Cantero AF, Flynn RWV, Garcia-Rodriguez L, et al. Cardiovascular safety of prucalopride in patients with chronic constipation: a multinational population-based cohort study. Drug Saf. 2019. https://doi.org/10.1007/s40264-019-00835-0.https://link.springer.com/article/10.1007%2Fs40264-019-00835-0
Fortuny J, Gilsenan A, Cainzos-Achirica M, Cantero AF, Flynn RWV, Garcia-Rodriguez L, et al. Study design and cohort comparability in a study of major cardiovascular events in new users of prucalopride versus polyethylene glycol 3350. Drug Saf. 2019. https://doi.org/10.1007/s40264-019-00836-z.https://link.springer.com/article/10.1007%2Fs40264-019-00836-z
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
