Menopausal Symptoms
Conditions
Keywords
Postmenopause, HRT
Brief summary
The objective of the active surveillance study is to compare incidence rates of serious adverse events in users of all types of newly prescribed oral continuous combined HRT products. The primary focus is the assessment of pertinent cardiovascular outcomes (such as venous and arterial thromboembolism) in new HRT users for up to 8.5 years.
Detailed description
The safety of a novel drug product containing a new chemical entity should be assessed in an extensive post marketing safety surveillance program. It is also prudent to assess both, the safety outcomes that relate specifically to the targeted population, as well as those that could potentially be related to the special pharmacological characteristics of the novel drug product. Differentiating between the inherent background population risk and a potential incremental risk due to treatment is often challenging. Active safety surveillance using valid epidemiological study designs has been proven to be a pertinent and reliable method to approach this endeavour. The primary objective of the study, the European Active Surveillance Study of Women taking HRT (EURAS-HRT), is to compare incidence rates of serious adverse events in users of all types of newly prescribed oral continuous combined HRT products. This active surveillance study will assess pertinent cardiovascular outcomes in new HRT users over a study period of up to 8.5 years. Also, all other serious adverse events will be reported. The new drug product under surveillance in the EURAS - HRT study contains the novel synthetic progestagen drospirenone (DRSP) combined with estradiol. As estrogen/progestagen combinations increase the risk for thromboembolism, all new drug products that contain a novel estrogen or progestagen should be investigated for their influence on venous and arterial thromboembolic events rates. A large, prospective, controlled cohort study of OC users (EURAS OC study), which compared DRSP-containing OC users with other OC users, demonstrated that DRSP is not associated with an increased incidence for any of the above-mentioned adverse events in OC users. However, because OC users are two to three decades younger than the typical HRT user the results of the OC study can only partially be extrapolated to older age groups. The participating women will complete a baseline survey using a self-administered questionnaire to describe the baseline risk. After 6 months, 12 months, and then on an annual basis, they will fill out a questionnaire in which they record complaints and events during the use of the prescribed HRTs. All adverse outcomes (including cancer) occurring during the observational period will be evaluated additionally. Reported serious adverse events will be validated and analyzed. As study participants may switch from oral continuous combined products to other oral or non-oral HRT products the outcomes for these preparation are recorded too. However, these results represent not the scientific focus of the study. Based on experience obtained in previous HRT studies, complex sources of bias and confounding are expected. Multivariate methods will therefore be used to adjust for confounding.
Interventions
None listed
Sponsors
Study design
Eligibility
Inclusion criteria
* All women aged 40 or more years who started use of a new oral HRT at the time of inclusion in the study
Exclusion criteria
* Women who do not consent to participate in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Venous Thromboembolism (e.g., Deep Venous Thrombosis and Pulmonary Embolism) | within 8.5 years | Venous thromboembolism (VTE) linked to the use of continuous combined HRT containing both drospirenone (DRSP) and estradiol (E2) or to other oral continuous combined HRT preparations. |
| Arterial Thromboembolism (e.g., Acute Myocardial Infarction and Stroke) | within 8.5 years | Arterial thromboembolism (ATE) linked to the use of continuous combined HRT containing both drospirenone (DRSP) and estradiol (E2) or to other oral continuous combined HRT preparations. |
Countries
Germany
Participant flow
Recruitment details
Overall, 31,321 patients were recruited for the EURAS HRT study. 724 patients were excluded due to protocol violations (e.g., patient agreed to participate but never started to use the new HRT preparation or continued to use a previously prescribed preparation).
Participants by arm
| Arm | Count |
|---|---|
| DRSP/E2 Users of oral continuous combined preparations containing 2mg DRSP and 1mg estradiol | 10,043 |
| ooccHRT Users of other oral continuous combined HRT preparations containing other progestogens | 13,384 |
| ooHRT Users of oral but not continuous combined HRT preparations | 4,113 |
| Non-oral HRT Users of non-oral HRT preparations | 3,057 |
| Total | 30,597 |
Baseline characteristics
| Characteristic | DRSP/E2 | ooccHRT | ooHRT | Non-oral HRT | Total |
|---|---|---|---|---|---|
| Age, Continuous | 52.4 years STANDARD_DEVIATION 6.4 | 55.1 years STANDARD_DEVIATION 6.9 | 52.9 years STANDARD_DEVIATION 8.3 | 56.2 years STANDARD_DEVIATION 7.7 | 54.0 years STANDARD_DEVIATION 7.3 |
| Region of Enrollment Europe | 10043 participants | 13384 participants | 4113 participants | 3057 participants | 30597 participants |
| Sex: Female, Male Female | 10043 Participants | 13384 Participants | 4113 Participants | 3057 Participants | 30597 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 0 / 10,043 | 0 / 13,384 | 0 / 4,113 | 0 / 3,057 |
| serious Total, serious adverse events | 707 / 10,043 | 1,998 / 13,384 | 576 / 4,113 | 508 / 3,057 |
Outcome results
Arterial Thromboembolism (e.g., Acute Myocardial Infarction and Stroke)
Arterial thromboembolism (ATE) linked to the use of continuous combined HRT containing both drospirenone (DRSP) and estradiol (E2) or to other oral continuous combined HRT preparations.
Time frame: within 8.5 years
Population: The number of participants refers to the ITT study population. During the course of the study, women could for example stop hormonal treatment at any point of time. Therefore, the woman-years of exposure for each group are provided in addition.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| DRSP/E2 | Arterial Thromboembolism (e.g., Acute Myocardial Infarction and Stroke) | 15 participants |
| ooccHRT | Arterial Thromboembolism (e.g., Acute Myocardial Infarction and Stroke) | 95 participants |
| ooHRT | Arterial Thromboembolism (e.g., Acute Myocardial Infarction and Stroke) | 33 participants |
| Non-oral HRT | Arterial Thromboembolism (e.g., Acute Myocardial Infarction and Stroke) | 23 participants |
Venous Thromboembolism (e.g., Deep Venous Thrombosis and Pulmonary Embolism)
Venous thromboembolism (VTE) linked to the use of continuous combined HRT containing both drospirenone (DRSP) and estradiol (E2) or to other oral continuous combined HRT preparations.
Time frame: within 8.5 years
Population: The number of participants refers to the ITT study population. During the course of the study, women could for example stop hormonal treatment at any point of time. Therefore, the woman-years of exposure for each group are provided in addition.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| DRSP/E2 | Venous Thromboembolism (e.g., Deep Venous Thrombosis and Pulmonary Embolism) | 24 participants |
| ooccHRT | Venous Thromboembolism (e.g., Deep Venous Thrombosis and Pulmonary Embolism) | 74 participants |
| ooHRT | Venous Thromboembolism (e.g., Deep Venous Thrombosis and Pulmonary Embolism) | 21 participants |
| Non-oral HRT | Venous Thromboembolism (e.g., Deep Venous Thrombosis and Pulmonary Embolism) | 12 participants |