Clinical trial NCT01055223: Fracture Risk With Thiazolidinediones
Official title: The Association Between Exposure to Spironolactone or Amiloride and Fracture Risk Among Subjects Treated With Thiazolidinediones
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Fractures, Bone
Type II Diabetes
Keywords: thiazolidinediones
rosiglitazone
amiloride
pioglitazone
fracture
Spironolactone
Lead sponsor: GlaxoSmithKline
Sponsor class: INDUSTRY
First posted: 2010-01-25
Enrollment: 98483
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: CASE_CONTROL
Time perspective: RETROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: The study population will consist of type 2 diabetes patients aged 18 -65 years old exposed to TZD for at least 6 months or at least 12 months. The study will use data from the US health claims database, the Ingenix Impact National Managed Care Database (Impact Database). The Impact Database system is a comprehensive, de-identified U.S. healthcare claims database that is representative of the non-elderly, insurance-carrying population. It includes 89.3 million lives from 1997 to 2008. Approximately 74 percent of all patients in the database have pharmacy benefits and, on average, 25 months of enrollment/claims information. The data are collected from over 46 different healthcare plans serving members across nine census regions.

Brief summary: Treatment with thiazolidinediones (TZD) has recently been reported to possibly increase the risk of fractures in a randomized trial exploring the efficacy of rosiglitazone (RSG), metformin, or glyburide encompassing 4360 patients with type 2 diabetes.

It is hypothesized that spironolactone, a diuretic that is broadly used for the treatment of fluid retention and edema associated with TZD, has a potential protective effect against bone fractures. However, to our knowledge, this has not been tested in diabetic patients treated with TZD. Amiloride is another diuretic that shares with spironolactone the anti mineralocorticoid ion gated channels activity and will be analysed in this study with regard to possible protective effect against bone fracture in combination with TZD.

This study is a nested case-control study conducted among type 2 diabetes subjects exposed to TZD. The study aims to explore if the risk of fracture is reduced among type 2 diabetic subjects exposed to spironolactone and TZD. The study will compare the odds of any low impact fracture, and hand, foot, upper arm, wrist, and hip fracture incidence in subjects treated with TZD+spironolactone and TZD+amiloride compared to subjects treated with TZD only.

The study population will consist of type 2 diabetes patients aged 18 -65 years old exposed to TZD. To be eligible for the study, a subject must have had at least one International Classification of Disease (ICD)-9 code for type 2 diabetes and have at least 6 months or at least 12 months of exposure to TZD (rosiglitazone \[RSG\], pioglitazone \[PIO\] or troglitazone) during their follow-up time available in the database.

Detailed description: Patients were not recruited for nor enrolled in this study. This study is a retrospective observational study. Data from medical records or insurance claims databases are anonymised and used to develop a patient cohort. All diagnoses and treatment are recorded in the course of routine medical practice.

Eligibility criteria: Inclusion Criteria:

* At least one ICD-9 code for type 2 diabetes
* At least 6 months or at least 12 months of exposure to TZD (RSG, PIO or troglitazone) during their follow-up time available in the database (The subject's study period begin date will be defined as the earliest date of their first TZD prescription. Subjects included in the study are required to have at least six months of follow-up time in the database prior to their first TZD prescription)

Exclusion Criteria:

* Subjects with a diagnosis of Paget's disease and osteomalacia
* A history of fracture, osteoporosis or cancer prior to the first prescription of TZD (study begin date)

Primary outcomes:
measure: Number of Low Impact Fractures in Males and Females After 6 Months of Exposure to TZD
timeFrame: From the earliest date of first TZD prescription to the fracture diagnosis date (Cases) or the end of follow-up in the database (Controls) between January 1, 1997 and December 31, 2008
measure: Number of Low Impact Fractures in Males and Females After 12 Months of Exposure to TZD
timeFrame: From the earliest date of first TZD prescription to the fracture diagnosis date (Cases) or the end of follow-up in the database (Controls) between January 1, 1997 to December 31, 2008
Secondary outcomes:
measure: Number of Fractures of the Hand, Foot, Upper Arm, and Wrist in Males and Females After 6 Months of Exposure to TZD
timeFrame: From the earliest date of first TZD prescription to the fracture diagnosis date (Cases) or the end of follow-up in the database (Controls) between January 1, 1997 to December 31, 2008
measure: Number of Fractures of the Hand, Foot, Upper Arm, and Wrist in Males and Females After 12 Months of Exposure to TZD
timeFrame: From the earliest date of first TZD prescription to the fracture diagnosis date (Cases) or the end of follow-up in the database (Controls) between January 1, 1997 to December 31, 2008
measure: Number of Hip Fractures Combined in Males and Females After 6 Months of Exposure to TZD
timeFrame: From the earliest date of first TZD prescription to the fracture diagnosis date (Cases) or the end of follow-up in the database (Controls) between January 1, 1997 to December 31, 2008
measure: Number of Hip Fractures Combined in Males and Females After 12 Months of Exposure to TZD
timeFrame: From the earliest date of first TZD prescription to the fracture diagnosis date (Cases) or the end of follow-up in the database (Controls) between January 1, 1997 to December 31, 2008
Other outcomes:
Locations:
Study officials:
affiliation: GlaxoSmithKline
name: GSK Clinical Trials
role: STUDY_DIRECTOR
References: