Study type

Study topic

DiseaseĀ /health condition
Human medicinal product

Study type

Non-interventional study

Scope of the study

Assessment of risk minimisation measure implementation or effectiveness

Data collection methods

Secondary use of data
Non-interventional study

Non-interventional study design

Cohort
Study drug and medical condition

Anatomical Therapeutic Chemical (ATC) code

(A10AE) Insulins and analogues for injection, long-acting
Insulins and analogues for injection, long-acting
(A10BB) Sulfonylureas
Sulfonylureas
(A10BG) Thiazolidinediones
Thiazolidinediones
(A10BH) Dipeptidyl peptidase 4 (DPP-4) inhibitors
Dipeptidyl peptidase 4 (DPP-4) inhibitors

Medical condition to be studied

Diabetes mellitus
Population studied

Short description of the study population

66 years and older Medicare fee-for-service beneficiaries (20% random sample) who were enrolled in Medicare Part A, B, and D plans for at least one calendar month during 2007-2012 and initiating incretin-based drugs (GLP-1ra or DPP-4i) or other antidiabetic drugs (TZDs, sulfonylureas or long-acting insulins).

Age groups

Adults (65 to < 75 years)
Adults (75 to < 85 years)
Adults (85 years and over)

Special population of interest

Other

Special population of interest, other

Diabetes mellitus patients

Estimated number of subjects

175000
Study design details

Main study objective

The primary objective of this study is to examine the effect of initiation of incretin-based therapies (DPP-4s and GLP-1s) relative to other anti-diabetic therapies (sulfonylureas, TZDs and long-acting insulins) on the incidence of colorectal cancer based on a new-user active comparator design.

Outcomes

Incidence of colorectal cancer, Incidence of colorectal cancer or benign colorectal tumors, incidence of diagnostic work-up

Data analysis plan

New-users of incretin-based therapies will be compared with new users of sulfonylureas, TZDs or long-acting insulins with respect to incidence of colorectal cancer diagnosis and the incidence of colorectal cancer or benign colorectal tumors. Using propensity score weighting methods, Inverse Probability of Treatment Weighting (IPTW) and Standardized MorbidityRatio Weighting (SMRW), we will implement COX models overall and stratified by time since initiation. Balance of the covariates will be assessed in the weighted pseudo-population and within deciles of the propensity score. Inverse probability weighted Kaplan-Meyer survival functions will be compared between our cohorts, adjusted for the same baseline covariates. The main effect measure estimate will be standardized hazard ratios with the assumptionthat there is no unmeasured confounding. Please see full protocol for additional details and description of secondary and sensitivity analyses.