- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04237935
Replication of the PLATO Antiplatelet Trial in Healthcare Claims Data
July 25, 2023 updated by: Shirley Vichy Wang, Brigham and Women's Hospital
Investigators are building an empirical evidence base for real world data through large-scale replication of randomized controlled trials.
The investigators' goal is to understand for what types of clinical questions real world data analyses can be conducted with confidence and how to implement such studies.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
This is a non-randomized, non-interventional study that is part of the RCT DUPLICATE initiative (www.rctduplicate.org) of the Brigham and Women's Hospital, Harvard Medical School.
It is intended to replicate, as closely as is possible in healthcare insurance claims data, the trial listed below/above.
Although many features of the trial cannot be directly replicated in healthcare claims, key design features, including outcomes, exposures, and inclusion/exclusion criteria, were selected to proxy those features from the trial.
Randomization is also not replicable in healthcare claims data but was proxied through a statistical balancing of measured covariates according to standard practice.
Investigators assume that the RCT provides the reference standard treatment effect estimate and that failure to replicate RCT findings is indicative of the inadequacy of the healthcare claims data for replication for a range of possible reasons and does not provide information on the validity of the original RCT finding.
Study Type
Observational
Enrollment (Actual)
27960
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Massachusetts
-
Boston, Massachusetts, United States, 02120
- Brigham and Women's Hospital
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
N/A
Sampling Method
Non-Probability Sample
Study Population
This study will involve a new user, parallel group, cohort study design comparing ticagrelor 90mg twice daily to clopidogrel 75mg daily.
The patients will be required to have continuous enrollment during the baseline period of 180 days before initiation of ticagrelor 90mg or the comparator drug (cohort entry date).
Follow-up for the outcome (3P-MACE), begins the day after drug initiation.
Description
Please see: https://drive.google.com/drive/folders/1WD618wrywYjEaXzfLTcuK-VCcnb6b-gV for full code and algorithm definitions.
Market availability of ticagrelor in the U.S. started on 2011-07-20.
- For Marketscan: 2011-07-20 to 2017-12-31 (end of data availability).
- For Optum: 2011-07-20 to 2019-03-31 (end of data availability).
Inclusion Criteria:
1-4 ALL REQUIRED
- 1. Hospitalized for potential ST-segment elevation or non-ST-segment elevation ACS, with onset during the previous 24 hours, documented by cardiac ischemic symptoms due to atherosclerosis of ≥10 minutes' duration at rest
- 2. ≥18 years of age
- 3. Not pregnant. Urinary and/or blood pregnancy tests are to be performed in women of child-bearing potential and repeated at least every 6 months. Women of child-bearing potential must be using ≥2 forms of reliable contraception, including one barrier method.
- 4. With informed consent 1-4 AND 5A OR 5B
5A. ≥2 of the following:
- 1. ST-segment changes on ECG indicating ischemia. ST-segment depression or transient elevation ≥ 1 mm in two or more 2 contiguous leads"
- 2. Positive biomarker indicating myocardial necrosis. Troponin I or T or CK-MB greater than the upper limit of normal
3. One of the following:
- ≥60 y of age
- Previous MI or CABG
- CAD with ≥50% stenosis in ≥2 vessels
- Previous ischemic stroke, TIA (hospital-based diagnosis), carotid stenosis (≥50%), or cerebral revascularization
- Diabetes mellitus
- Peripheral artery disease
- Chronic renal dysfunction
- OR
- 5B. Persistent ST-segment elevation ≥1 mm (not known to be preexisting or due to a coexisting disorder) in ≥2 contiguous leads or new LBBB plus primary PCI planned.
Exclusion Criteria:
Drug related
- 1. Contraindication to clopidogrel or other reason that study drug should not be administered (eg, hypersensitivity, moderate or severe liver disease, active bleeding or bleeding history, major surgery within 30 days)"
- 2. Oral anticoagulation therapy that cannot be stopped
- 3. Fibrinolytic therapy planned or within the previous 24 h
- 4. Concomitant oral or IV therapy with strong CYP3A inhibitors (ketoconazole, itraconazole, voriconazole, telithromycin, clarithromycin, nefazodone, ritonavir, saquinavir, nelfinavir, indinavir, atazanavir, grapefruit juice N1 L/d), CYP3A substrates with narrow therapeutic indices (cyclosporine, quinidine), or strong CYP3A inducers (rifampin/rifampicin, phenytoin, carbamazepine)
Treatment related
- 1. Index event is an acute complication of PCI
- 2. PCI after index event and before first study dose
Medical
- 1. Increased risk of bradycardiac events
- 2. Dialysis required
- 3. Known clinically important thrombocytopenia
- 4. Known clinically important anemia
- 5. Any other condition that may put the patient at risk or influence study results in the investigators' opinion (eg, cardiogenic shock, severe hemodynamic instability, active cancer)
General
- 1. Participant in another investigational drug or device study within 30 days
- 2. Pregnancy or lactation
- 3. Any condition that increases the risk for noncompliance or being lost to follow-up
- 4. Involvement in the planning or conduct of the study
- 5. Previous enrollment or randomization in this study
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Clopidogrel 75 mg
Reference group
|
Clopidogrel 75 mg dispensing claim is used as the reference group
|
Ticagrelor 90 mg
Exposure group
|
Ticagrelor 90 mg dispensing claim is used as the exposure group
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Relative hazard of 3-P MACE (composite outcome of Stroke, MI, and Mortality)
Time Frame: Through study completion (a median of 163-219 days)
|
Relative hazard of 3-point major adverse cardiovascular events (MACE), i.e., non-fatal myocardial infarction, non-fatal stroke, or all-cause/CV mortality- Please refer to uploaded protocol for full definition due to size limitations.
|
Through study completion (a median of 163-219 days)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Relative hazard of Hospital admission for MI
Time Frame: Through study completion (a median of 163-219 days)
|
Relative hazard of Hospital admission for MI - Please refer to uploaded protocol for full definition due to size limitations.
|
Through study completion (a median of 163-219 days)
|
Relative hazard of Hospital admission for stroke
Time Frame: Through study completion (a median of 163-219 days)
|
Relative hazard of Hospital admission for stroke - Please refer to uploaded protocol for full definition due to size limitations.
|
Through study completion (a median of 163-219 days)
|
Relative hazard of All-cause mortality/CV mortality
Time Frame: Through study completion (a median of 163-219 days)
|
Relative hazard of All-cause mortality/CV mortality- Please refer to uploaded protocol for full definition due to size limitations.
|
Through study completion (a median of 163-219 days)
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Relative hazard of Major bleeding (Control outcome)
Time Frame: Through study completion (a median of 163-219 days)
|
Relative hazard of Major bleeding (Control outcome) - Please refer to uploaded protocol for full definition due to size limitations.
|
Through study completion (a median of 163-219 days)
|
Relative hazard of Pneumonia (Control outcome)
Time Frame: Through study completion (a median of 163-219 days)
|
Relative hazard of Pneumonia (Control outcome) - Please refer to uploaded protocol for full definition due to size limitations.
|
Through study completion (a median of 163-219 days)
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Shirley Wang, PhD, ScM, Brigham and Women's Hospital
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
September 22, 2019
Primary Completion (Actual)
February 18, 2021
Study Completion (Actual)
February 18, 2021
Study Registration Dates
First Submitted
January 17, 2020
First Submitted That Met QC Criteria
January 17, 2020
First Posted (Actual)
January 23, 2020
Study Record Updates
Last Update Posted (Actual)
July 27, 2023
Last Update Submitted That Met QC Criteria
July 25, 2023
Last Verified
July 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2018P002966-DUP-PLATO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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