Status: Ongoing
First registered on:
19/03/2020
Last updated on:
15/10/2021
1. Study identification
EU PAS Register NumberEUPAS34204
Official titleComparative assessment of venous thromboembolism and other risks among patients with rheumatoid arthritis treated with baricitinib versus tumor necrosis factor inhibitors - French part of the study program
Study title acronymSafety Outcomes in Patients Treated for RA
Study typeOther: Historical cohort study using the SNDS, the French nationwide claims database
Brief description of the studyRheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease characterized by progressive joint destruction, systemic complications, reduced survival, and a profoundly reduced quality of life among those affected. Baricitinib is a Janus kinase selective inhibitor indicated for treatment of moderate-to-severe RA. Data from clinical trials demonstrate that baricitinib is an effective therapy for RA. During these clinical studies, there was a numerical imbalance in reported venous thromboembolism (VTE) between baricitinib and placebo-treated patients. However, given the limited placebo-treated patients follow-up, it was not possible to support a definitive assessment of the risk of VTE associated with baricitinib treatment, or with other outcomes such as major adverse cardiovascular events (MACE).
The baricitinib marketing authorization holder initiated an international study program to evaluate the risk of VTE, MACE, serious infection, and tuberculosis in a large number of patients treated with baricitinib or tumor necrosis factor inhibitors (TNFi) for RA in multiple country data sources. The present study aims to evaluate the safety of patients with RA treated with baricitinib in the French population, using the French nationwide claims database (Système National des Données de Santé - SNDS).
The cohort will include all patients aged >18 years with RA, who are included in SNDS and are newly treated by baricitinib or TNFi (absence of use in the 180-day period prior to cohort entry) between September 2017 and December 2019. All patients will have a 2-year database history and will be followed until 31 December 2019 or until the first of the following events: occurrence of an event of interest, discontinuation of study treatment plus 30 days or switch to a medication in another exposure cohort, initiation of a concomitant bDMARD or tsDMARD, health plan disenrollment, or death if identified.
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 Dr
Last name Thurin
First name Nicolas
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 signed23/09/2019
Start date of data collection01/06/202008/10/2020
Start date of data analysis01/10/202013/11/2020
Date of interim report, if expected31/05/202107/06/2021
Date of final study report15/12/2021
4. Sources of funding
Please provide estimates of the percentage of funding by source for this study
Names(s)Approximate % funding
Pharmaceutical companiesEli Lilly and Company100
Charities
Government body
Research councils
EU funding scheme
5. Contact details for enquiries
Scientific Enquiries
Title Dr
Last name Thurin
First name Nicolas
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)33557579209
Alternative phone number
Fax number (incl. country code)33557574740
Public Enquiries
Title Dr
Last name Thurin
First name Nicolas
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)33557579209
Alternative phone number
Fax number (incl. country code)33557574740
6. Study drug(s) information
Substance class (ATC Code)L04AA37 (baricitinib)
Substance class (ATC Code)L04AB04 (adalimumab)
Substance class (ATC Code)L04AB01 (etanercept)
Substance class (ATC Code)L04AB02 (infliximab)
Substance class (ATC Code)L04AB05 (certolizumab pegol)
Substance class (ATC Code)L04AB06 (golimumab)
Substance class (ATC Code)L04AA29 (tofacitinib)
7. Medical conditions to be studied
Medical condition(s)Yes
Rheumatoid arthritis
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 subjects5000
Additional information
According to the French National Health insurance open data, 367 patients with at least one dispensing of baricitinib were identified in 2017 (617 boxes were reimbursed), and 2422 patients in 2018 (12213 boxes were reimbursed). Depending on matching ratio between baricitinib users and TNFi users (ranging from 1:1 to 1:3), approximately 5000 to 11 000 patients could be included in the study.
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?
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 the risk of venous thromboembolism (VTE) among patients with RA treated with baricitinib with the risk among similar patients treated with TNFi.
Are there primary outcomes?Yes
Occurrence of venous thromboembolism VTE.
Are there secondary outcomes?Yes
Occurrence of major adverse cardiovascular events (MACE),
Occurrence of serious infection,
Occurrence of tuberculosis.
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 the first dispensing of baricitinib or TNFi until the first of the following: outcome, discontinuation of study treatment plus 30 days or switch to a medication in another exposure cohort, initiation of a concomitant bDMARD or tsDMARD, patient death or end of the study period (31/12/2019).
15. Data analysis plan
Please provide a brief summary of the analysis method
The following analyses will be performed:
- Descriptive analyses of demographic and clinical characteristics, outcomes, drug exposure for patients with baricitinib and with TNFi.
- Comparative analyses using propensity score matching
- If the power of the study is sufficent, cox proportional hazards regression models will be used to compare the risk of an outcome among patients treated with baricitinib versus with TNFi. Any variables that remain unbalanced after propensity score matching may also be included in the regression model. Follow-up time will begin at treatment initiation and continue until censoring. Patients will be censored upon occurrence of an incident event, discontinuation of the study medication plus 30 days, the end of the study period or death.
- Sensitivity analyses to examine the effect of varying the case definition for VTE and to evaluate the existence of a class effect of Janus Kinase (JAK) inhibitors.
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
