Transatlantic Active Surveillance on Cardiovascular Safety of NuvaRing (TASC) (TASC)

The objective of this study is to characterize and compare the risks of short- and long-term use of NuvaRing® with marketed combined oral contraceptives.

Study Overview

• Status: Completed
• Conditions: Contraception

Detailed Description

This is a large, multinational, controlled, prospective, active surveillance study of women who are prescribed NuvaRing® or an oral contraceptive (OC). The study follows two cohorts. The cohorts consist of new users (starters and switchers) of two different groups of hormonal contraceptives:

• NuvaRing®
• marketed combined OCs (combined oral contraceptives)

NuvaRing® is a transparent and flexible contraceptive vaginal ring containing etonogestrel and ethinylestradiol (EE). The ring releases 15 mcg EE and 120 mcg etonogestrel daily. After insertion it remains in the upper part of the vagina for 21 days, followed by 7 ring-free days before a new ring is inserted.

The primary objective of this study is to characterize and compare the risks of short- and long-term use of NuvaRing® with marketed combined OCs. The main clinical outcomes of interest for the short and long-term follow-up are:

• Deep Venous Thrombosis (DVT)
• Pulmonary Embolism (PE)
• Acute Myocardial Infarction (AMI)
• Cerebrovascular Accidents (CVA)

Secondary objectives are:

• to analyze the drug utilization pattern of NuvaRing® and marketed OCs in a study population that is representative for typical use of the individual contraceptive methods under routine medical conditions
• to characterize the baseline risk of users of the individual formulations
• to assess the compliance of NuvaRing® users and users of marketed OCs
• to analyze the reasons for discontinuing the treatment with NuvaRing® and/or marketed OCs.

The study will use a non-interference approach to provide standardized, comprehensive, reliable information on these treatments in a routine clinical practice setting.

Study participants will be recruited via an international network of more than 1000 gynecologists. After study entry cohort members will be followed for a period of 30 to 48 months for rare serious safety outcomes. Regular, active contacts with the cohort members by the study team of the Berlin Center for Epidemiology and Health Research (ZEG), Germany will provide the necessary information on health-related events or changes in health status (= active surveillance).

Approximately 15,000 subjects per cohort will be recruited by participating physicians in order to provide approx. 86,000 women-years (WY) of observation. Subjects will be considered for enrollment in this study after the participating physician has determined that NuvaRing® or OC use is appropriate. There will be no specific inclusion/exclusion criteria. All women who are eligible are to be asked by their physician if they are willing to participate. As this a non-interventional study, the possibility to participate in the study should not be discussed with the patient before both - physician and patient - agree upon the prescription.

The study will be conducted in several European countries and the United States.

The study will be divided into 2 phases: a baseline survey which includes an initial consultation at baseline with a participating physician, and a follow-up phase which includes two follow-up contacts within the first year and then annual follow-up contacts for up to 4 years post-baseline.

The study will maintain scientific independence and will be governed by an independent Safety Monitoring and Advisory Council (SMAC). The Berlin Center for Epidemiology and Health Research (ZEG) and its research team will be accountable to the council in all scientific matters. The members of the council will be international experts in relevant scientific fields (e. g., epidemiology, drug safety, gynecology, cardiology, statistics, endocrinology).

• Study Type: Observational
• Enrollment (Actual): 34100

Contacts and Locations

Study Locations

• Germany
  • Berlin, Germany, 10115
    • Berlin Center for Epidemiology and Health Research

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

• Sampling Method: Non-Probability Sample

Study Population

Women prescribed hormonal contraceptives by gynecologists

Description

Inclusion Criteria:

• women who are prescribed NuvaRing® or a combined oral contraceptive and who are new users (Starters, restarters or switchers) of the formulation

Exclusion Criteria:

• women who do not consent to participate in the study

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
1; Users of NuvaRing
2; Users of combined oral contraceptives

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants With Venous Thromboembolism (VTE)	Venous thromboembolism (VTE) associated with the use of hormonal contraceptives that contain both an estrogen and progestin.	Time to event analysis within 48 months
Number of Participants With Arterial Thromboembolism (ATE)	Arterial Thromboembolism (ATE) associated with the use of hormonal contraceptives that contain both an estrogen and progestin.	Time to event analysis within 48 months

Collaborators and Investigators

• Sponsor: Center for Epidemiology and Health Research, Germany
• Collaborators: Organon
• Investigators: Principal Investigator: Juergen C Dinger, MD, PhD, Center for Epidemiology and Health Research Berlin, Germany

Publications and helpful links

General Publications

• Dinger J, Mohner S, Heinemann K. Cardiovascular risk associated with the use of an etonogestrel-containing vaginal ring. Obstet Gynecol. 2013 Oct;122(4):800-808. doi: 10.1097/AOG.0b013e3182a5ec6b.

Study record dates

Study Major Dates

• Study Start: September 1, 2007
• Primary Completion (Actual): March 1, 2012
• Study Completion (Actual): June 1, 2012

Study Registration Dates

• First Submitted: September 4, 2007
• First Submitted That Met QC Criteria: September 4, 2007
• First Posted (Estimate): September 5, 2007

Study Record Updates

• Last Update Posted (Estimate): April 9, 2014
• Last Update Submitted That Met QC Criteria: March 3, 2014
• Last Verified: March 1, 2014

More Information

Terms related to this study

• Keywords: Contraception; Contraceptive Vaginal Ring
• Other Study ID Numbers: ZEG2007_03

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No