An Active Surveillance, Post-Authorization Study to Assess Tofacitinib Utilization Patterns and to Characterize the Safety of Tofacitinib Use in Patients with Moderately to Severely Active Ulcerative Colitis in the Real-World Setting Using Data from a US Administrative Healthcare Claims Database

Study type

• Study topic:
  Disease /health condition

  Human medicinal product
• Study type:
  Non-interventional study
• Scope of the study:
  Drug utilisation

  Safety study (incl. comparative)
• Data collection methods:
  Secondary use of data

Non-interventional study

• Non-interventional study design:
  Cohort
• Non-interventional study design, other:
  Active surveillance

Study drug and medical condition

• Medicinal product name:
  XELJANZ
• Study drug International non-proprietary name (INN) or common name:
  TOFACITINIB CITRATE

  TOFACITINIB
• Anatomical Therapeutic Chemical (ATC) code:
  (L04AF01) tofacitinib

  tofacitinib
• Medical condition to be studied:
  Colitis ulcerative

Population studied

• Short description of the study population:
  The study population will include all patients enrolled in the Marketscan database during the study period who have received ≥1 prescription of tofacitinib. Additionally, for the active surveillance population (to be used for the estimation of incidence rates for the safety events of interest in adult UC patients as described above), a sub-population will be created which will include adult UC patients aged ≥18 years enrolled in the Marketscan database who are initiating treatment with tofacitinib in the course of routine clinical care (Cohort 1). For contextualization and risk characterization purposes, the study will also include the following treatment cohorts: UC patients who initiate biologics, overall and stratified by TNFi/non-TNFi use and number of previous biologic treatments (Cohort 2); UC patients who initiate immunomodulators/immunosuppressants without concurrent biologics (Cohort 3); UC patients naïve to both biologics and immunomodulators/immunosuppressants (Cohort 4).
• Age groups:
  • Children (2 to < 12 years)
  • Adolescents (12 to < 18 years)
  • Adults (18 to < 46 years)
  • Adults (46 to < 65 years)
  • Adults (65 to < 75 years)
  • Adults (75 to < 85 years)
  • Adults (85 years and over)
• Estimated number of subjects:
  11.857

Study design details

• Study design:
  This is a drug utilization and active surveillance study utilizing secondary data from the International Business Machines (IBM) Watson Health MarketScan® Research Databases, a US administrative healthcare claims database
• Main study objective:
  The main objectives are to describe the utilization patterns of tofacitinib in the US with regard to on-label and off-label use, and to estimate the incidence rate of malignancy, excluding non-melanoma skin cancer (NMSC), among adult UC patients who initiate tofacitinib in the course of routine clinical care.
• Setting:
  The IBM Watson Health MarketScan® Research Databases is a US administrative healthcare database containing 143 million unique patients since 1996. It is a nationally representative data sample of Americans with employer-provided health insurance, as well as Medicare, and contains complete information on outpatient prescriptions and both inpatient and outpatient diagnoses.
• Outcomes:
  1. Indication for tofacitinib use, classified as on-label, off-label, or unknown, based on medical events (diagnoses and/or medication use) identifiable around the time of the first ever tofacitinib prescription and,; 2. Malignancy, excluding non-melanoma skin cancer in adult UC patients exposed to tofacitinib in the course of routine clinical care, NMSC, Serious infections, Opportunistic infections (e.g. tuberculosis), Herpes zoster (HZ) reactivation, Major adverse cardiac events (MACE), Venous thromboembolic events (VTE, deep venous thrombosis DVT and pulmonary embolism PE), Hepatic events, Progressive multifocal leukoencephalopathy (PML), Gastrointestinal (GI) perforations, Interstitial lung disease (ILD), Surgery for UC, Death
• Data analysis plan:
  For the drug utilization study, proportions of patients with an on-label, off-label, or unknown tofacitinib indication will be estimated (and described) with corresponding 95% confidence intervals (CIs). For the safety endpoints of interest, descriptive statistics, counts and proportions, cumulative incidence proportions, and incidence rates (number of events per 100 person-years) and associated 2-sided 95% CIs will be calculated as appropriate. Patients with a baseline history of an outcome of interest will be excluded from the calculation of the incidence rate for that particular outcome of interest (e.g. patients with a baseline history of malignancy will be excluded from the calculation of the incidence rate for malignancy). This will be a time to first event analysis based on an index date defined for each cohort with appropriate censoring rules applied (based on therapy switches, end of study, etc.) for those who do not experience an event by end of follow-up period.