Status: Ongoing
First registered on:
15/07/2019
Last updated on:
10/05/2023
1. Study identification
EU PAS Register NumberEUPAS29177
Official titleDual antiplatelet therapy for prolonged secondary prevention of acute coronary events
Study title acronymDEEPSPACE
Study typeOther: Historical cohort study using the SNDS, the French nationwide claims database
Brief description of the studyDual antiplatelet therapy (DAPT) is recommended for 1 year after an acute coronary syndrome (ACS), but the benefits and risks of longer duration of DAPT remain disputed. The PEGASUS-TIMI 54 clinical trial found a beneficial effect of prolonged DAPT with ticagrelor in chronic stable high-risk patients, but its generalizability is uncertain. The latest recommendations from the ESC remain relatively conservative considering that extension of DAPT beyond 1 year (up to 3 years) in the form of aspirin plus ticagrelor 60 mg bis in die may be considered in patients who have tolerated DAPT without a bleeding complication and having an additional risk factor for ischaemic events. In this context, the DEEPSPACE study purpose is to compare, in real-life, event rate (i.e. composite criterion of MI, stroke, major bleeding, or death; and composite criterion of MI, stroke or death; and individual events) on DAPT with any of the three P2Y12 antagonists (clopidogrel, ticagrelor, or prasugrel) plus aspirin to aspirin alone, over 3 years beyond one year after MI, using the French nationwide claims database (SNDS). The cohort will include all patients hospitalised for an initial MI (trigger event) between 2013 and 2014, and having 1 year of event-free DAPT after this initial MI. The index date will be the 1st anniversary of discharge from trigger event, and each patient will be followed 3 years or until death and will have 2-year history prior the index date in the database. 50 000 expected patients will be included in the study after 1-year event-free on DAPT with an event occurrence estimate to 5 200 composite events and 1 000 deaths. The outcomes will be described over the 3-year follow-up period according to treatment groups in terms of incidence rate, cumulative incidence rate (Kaplan-Meier estimator or Cumulative Incidence Function), and their association with antiplatelet therapy exposure (Cox proportional hazards models or Fine and Grey models).
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
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 signed21/06/2019
Start date of data collection31/12/201926/02/2020
Start date of data analysis01/01/202003/05/2020
Date of interim report, if expected
Date of final study report30/06/2023
4. Sources of funding
Please provide estimates of the percentage of funding by source for this study
Names(s)Approximate % funding
Pharmaceutical companies
Charities
Government bodyFrench Ministry of Health (PHRCN-18-0745)100
Research councils
EU funding scheme
5. Contact details for enquiries
Scientific Enquiries
Title Professor
Last name Moore
First name Nicholas
Address line 1University of Bordeaux
Address line 2146 Rue Léo Saignat
Address line 3Bâtiment du Tondu - Case 41
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 1University of Bordeaux
Address line 2146 Rue Léo Saignat
Address line 3Bâtiment du Tondu - Case 41
CityBordeaux
Postcode33076
CountryFrance
Phone number (incl. country code)33557574675
Alternative phone number
Fax number (incl. country code)33557574740
6. Study drug(s) information
Substance class (ATC Code)B01AC04 (clopidogrel)
Substance class (ATC Code)B01AC24 (ticagrelor)
Substance class (ATC Code)B01AC22 (prasugrel)
Substance class (ATC Code)B01AC06 (acetylsalicylic acid)
7. Medical conditions to be studied
Medical condition(s)Yes
Acute coronary syndrome
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 subjects50000
10. Source of data
Is this study being carried out with an established data source?Yes
Data sources not registered with ENCePP
SNDS NATIONAL CLAIMS 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
Primary scope : Risk assessment
12. Main objective(s)
What is the main objective of the study?
The main objective is to compare event rates between DAPT with any of the three P2Y12 antagonists plus aspirin versus aspirin alone, over 3 years beyond one year after initial MI.
Are there primary outcomes?Yes
Composite of all-cause death, MI (STEMI, NSTEMI), stroke (ischemic or undefined), or major bleeding.
Are there secondary outcomes?Yes
Composite of all-cause death, MI (STEMI, NSTEMI) and stroke (ischemic or undefined stroke), and each of mentioned outcomes individually.
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 index date is the one-year anniversary date for the discharge of each subject from initial MI, identified from 01/01/2013 to 31/12/2014. The study follow-up period will start on the study index date occurring from 01/01/2014 to 31/12/2015 and will end three years later, or until date of death.
15. Data analysis plan
Please provide a brief summary of the analysis method
TIncidence rate will be estimated using Kaplan-Meier estimator (for all-cause death and composite criteria) and cumulative incidence function for all single outcomes except death, to take into account death as a competing risk. The association between exposure and outcome will be performed using Cox proportional hazards risk model for outcomes including death, and Fine and Gray competing risks model for non-fatal outcomes, with a time-dependent variable for DAPT-SAPT exposure, and adjusted on a high-dimensional disease risk score (hdDRS) plus time dependent variables for SP-CVD drugs, oral antidiabetics, insulin, anticoagulants, NSAIDs, corticoids and proton pump inhibitors. HdDRS will be estimated for the primary composite outcome, the secondary composite outcome, and major bleeding alone, and variables will be selected using a combination of Principal Component Analysis and Lasso regression.
16. ENCePP seal
Are you requesting the ENCePP seal for this study?
No
17. Full protocol
Not submitted
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
Not submitted
