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CVD-REAL: Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors

Sponsor
AstraZeneca (Industry)
Overall Status
Completed
CT.gov ID
NCT02993614
Collaborator
(none)
99,999
Enrollment
17
Locations
36.6
Actual Duration (Months)
5882.3
Patients Per Site
160.9
Patients Per Site Per Month

Study Details

Study Description

Brief Summary

CVD-REAL is a multinational, observational cohort study in patients with type 2 diabetes mellitus evaluating the comparative effectiveness of initiating treatment with a sodium-glucose co-transporter-2 (SGLT-2) inhibitor versus another glucose-lowering drug. This study will compare the risk of all-cause mortality and clinically relevant cardiovascular (CV) outcomes respectively in patients who are new users of SGLT-2 inhibitors with those who are new users of other glucose-lowering drugs. CVD-REAL is aiming to collect data from approximately 4 million patients overall, from twelve countries across three major world regions.

Condition or Disease Intervention/Treatment Phase

    Detailed Description

    Type 2 diabetes mellitus remains a major risk factor for cardiovascular disease with an estimated 425 million adults worldwide having diabetes in 2017, with type 2 diabetes mellitus accounting for about 90% of the cases. Recent evidence indicates that certain glucose-lowering therapies are associated with reduction in cardiovascular outcomes. There is, therefore, an urgent need to improve the understanding of the impact of newer classes of glucose-lowering therapies, such as dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose co-transporter-2 (SGLT-2) inhibitors on cardiovascular outcomes in clinical practice.

    CVD-REAL is a comparative effectiveness study that aims to compare new users of SGLT-2 inhibitors with new users of other glucose-lowering drugs with regard to the risk of all-cause mortality and clinically relevant CV outcomes (including stroke, myocardial infarction, and hospitalization for heart failure) respectively. The study is based on data from 12 countries across four major world regions.

    The study is conducted using data from claims, medical records and national health registries from twelve countries combined in two waves. CVD-REAL 1 includes Germany, Denmark, Norway, Sweden, United Kingdom (UK) and United States of America (USA). CVD-REAL 2 comprises Australia, Canada, Israel, Japan, Singapore and South Korea. The study will collect data from approximately 4 million patients from the time they start treatment with a SGLT-2 inhibitor or another glucose-lowering drug (index date) to the end of the follow-up period.

    The Study Population will consist of new users of SGLT-2i and other glucose lowering drugs respectively. These will be compared with all-cause mortality, hospitalization for heart failure, myocardial infarction and stroke during the follow-up period. In addition certain other cardiovascular and renal outcomes will be assessed descriptively in the two groups respectively.

    The study period will range from launch of the first SGLT-2i in each of the countries and end at latest available data in each data source.

    All-cause mortality and the incidence of cardiovascular events will be compared between new users of SGLT-2 inhibitors and the comparator arm using a hazard ratio (relative risk) and corresponding 95% confidence interval. The analysis will be performed using the Cox proportional hazards model or some other appropriate method.

    Matching by propensity scores will be used to balance the potential confounding covariates between the SGLT-2i group and the reference group to ensure that the two groups are as similar as possible at baseline.To achieve sufficient power, a meta-analysis will be applied to integrate the point estimates from each of the individual database analyses and calculate an overall weighted estimate and corresponding 95% CI.

    Study Design

    Study Type:
    Observational
    Actual Enrollment :
    99999 participants
    Observational Model:
    Cohort
    Time Perspective:
    Prospective
    Official Title:
    Characteristics and Cardiovascular and Mortality Outcomes in Patients With Type 2 Diabetes Mellitus Initiating Treatment With Sodium-glucose Co-transporter-2 Inhibitors (SGLT-2i) and Other Glucose Lowering Drugs
    Actual Study Start Date :
    Nov 30, 2017
    Actual Primary Completion Date :
    Dec 17, 2020
    Actual Study Completion Date :
    Dec 17, 2020

    Outcome Measures

    Primary Outcome Measures

    1. CVD REAL1 Incidence of hospitalization for heart failure. / CVD REAL 2 All-cause mortality [From index date up to latest available data of first prescription of an SGLT-2i or a new oGLD in each of the countries ranging from Sep 11 (UK) until Apr 15 (IL) until the last date of data collection or outcome ranging from Sep 15 (US) to Nov 17 (SG)]

      Heart failure events obtained from general practice or hospital records, electronic health records or national health registers; All-cause mortality obtained from linkeage to death national registers

    Secondary Outcome Measures

    1. CVD REAL1 All-cause mortality; CVD REAL 2: Hospitalization for heart failure (HHF), stroke, myocardial infarction (MI) and including composite endpoints [From index date up to latest available data of first prescription of an SGLT-2i or a new oGLD in each of the countries ranging from Sep 11 (UK) until Apr 15 (IL) until the last date of data collection or outcome ranging from Sep 15 (US) to Nov 17 (SG)]

      Events obtained from general practice or hospital records, electronic health records and national health registers. All cause mortality obtained from linkeage to death national registers

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    N/A and Older
    Sexes Eligible for Study:
    All
    Accepts Healthy Volunteers:
    No
    Inclusion Criteria:

    • New user receiving or dispensed prescription of SGLT-2i medication or other glucose lowering drug, oral as well as injectable, including fixed-dose combination (FDC) products containing these medication groups

    • T2DM diagnosis on or prior to the index date

    • ≥ 18 years old at index date

    • 1 year data history in the database prior to the index date

    Exclusion Criteria:

    • Patients with a T1DM diagnosis

    • Patients with gestational diabetes within 1 year before index date

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 Research Site Wilmington Delaware United States 19850
    2 Research Site Melbourne D1690r00015 Australia
    3 Research Site Mississauga D1690r00015 Canada
    4 Research Site Gentofte D1690r00015 Denmark
    5 Research Site Espoo D1690r00015 Finland
    6 Research Site Ulm D1690r00015 Germany
    7 Research Site Raanana D1690r00015 Israel
    8 Research Site Rome D1690r00015 Italy
    9 Research Site Tokyo D1690r00015 Japan
    10 Research Site Seoul D1690r00015 Korea, Republic of
    11 Research Site Oslo D1690r00015 Norway
    12 Research Site Porto D1690r00015 Portugal
    13 Research Site Singapore D1690r00015 Singapore
    14 Research Site Madrid D1690r00015 Spain
    15 Research Site Sodertalje D1690r00015 Sweden
    16 Research Site Taipei D1690r00015 Taiwan
    17 Research Site Luton D1690r00015 United Kingdom

    Sponsors and Collaborators

    • AstraZeneca

    Investigators

    None specified.

    Study Documents (Full-Text)

    None provided.

    More Information

    Additional Information:

    Publications

    None provided.
    Responsible Party:
    AstraZeneca
    ClinicalTrials.gov Identifier:
    NCT02993614
    Other Study ID Numbers:
    • D1690R00015
    First Posted:
    Dec 15, 2016
    Last Update Posted:
    Feb 18, 2021
    Last Verified:
    Feb 1, 2021
    Additional relevant MeSH terms:
    Diabetes Mellitus
    Diabetes Mellitus, Type 2

    Study Results

    No Results Posted as of Feb 18, 2021