Birth Defects Associated With Exposure to Lamotrigine in Pregnancy (EUROCAT)
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Purpose
In 2007 a case control study was completed within the EUROCAT European network of congenital anomaly registers to test the hypothesis that first trimester lamotrigine monotherapy exposure is associated with an increased risk of isolated oral clefts. This study found no statistically significant increased risk of oral clefts compared with other defects following in utero lamotrigine exposure. The EUROCAT Antiepileptic Drug (AED) Database, established for the original case control study in 2007, will now be expanded to include an additional five to six years worth of data. These data will provide greater power to investigate the risk of isolated oral clefts, specific cleft types and potential associations with additional specific malformation types (e.g. neural tube defects). Data on cases of isolated oral clefts registered between 1993 and 2012 will be extracted from EUROCAT member registers meeting set inclusion criteria (ensuring completeness of outcome and exposure data). The primary comparison group will include all non oral cleft, non chromosomal malformations as the registers do not collect data on non malformed infants. This study will also be powered to include a second control group of chromosomal malformations, very unlikely to be associated with medication exposure. Data on exposure to anti-epileptic drugs (AEDs) during the first trimester of pregnancy will be extracted along with other key covariates including age of mother, history of epilepsy and gestational age of the infant. Primary analyses, using logistic regression, will compare the lamotrigine monotherapy versus no AED use across case and control groups and a secondary analysis will compare lamotrigine monotherapy versus other AED monotherapy (with and without valproate). Data will also be monitored for patterns of lamotrigine exposure across additional specific malformation groups of interest.
| Condition | Intervention |
|---|---|
|
Outcomes of Pregnancy With Non Chromosomal, Non Monogenic, Isolated Oral Clefts Epilepsy Outcomes of Pregnancy With Non Oral Cleft, Non Chromosomal Malformations Outcomes of Pregnancy With Chromosomal Malformations |
Drug: Lamotrigine monotherapy Drug: No anti-epileptic drug exposure Drug: Non lamotrigine anti-epileptic drug monotherapy |
| Study Type: | Observational |
| Study Design: | Observational Model: Case Control Time Perspective: Retrospective |
| Official Title: | Monitoring of Specific Birth Defects Associated With Exposure to Lamotrigine in Pregnancy Through the EUROCAT Network |
- Non chromosomal, non monogenic, isolated oral clefts [ Time Frame: Retrospective case control study. All isolated oral cleft malformations registered on congenital malformation registers participating in the EUROCAT anti-epileptic drug database will be extracted irrespective of timing of diagnosis pre- or post natally. ] [ Designated as safety issue: Yes ]
- Non oral cleft, non chromosomal malformations [ Time Frame: Retrospective case control study. All non oral cleft, non chromsomal malformations recorded on congenital malformation registers participating in EUROCAT anti-epileptic drug database extracted irrespective of diagnosis timing pre or post-natal. ] [ Designated as safety issue: Yes ]
- All chromosomal malformations [ Time Frame: This is a retrospective case control study. All chromosomal malformations recorded on congenital malformation registers participating in the EUROCAT anti-epileptic drug database will be extracted irrespective of timing of diagnosis pre- or post natally. ] [ Designated as safety issue: Yes ]
| Estimated Enrollment: | 1 |
| Study Start Date: | May 2009 |
| Estimated Study Completion Date: | December 2013 |
| Estimated Primary Completion Date: | December 2013 (Final data collection date for primary outcome measure) |
| Groups/Cohorts | Assigned Interventions |
|---|---|
|
Infants/foetuses w/malformations registered in EUROCAT network
Pregnancies resulting in foetus/infant with malformation registered through participating registers within the EUROCAT network
|
Drug: Lamotrigine monotherapy
Exposure to lamotrigine monotherapy in the first trimester of pregnancy (time period from first day of menstrual period to 12th week of gestation).
Drug: No anti-epileptic drug exposure
No exposure to anti-epileptic drugs in the first trimester of pregnancy (time period from first day of menstrual period to 12th week of gestation).
Drug: Non lamotrigine anti-epileptic drug monotherapy
Exposure to non lamotrigine monotherapy (with or without valproate) during the first trimester of pregnancy (time period from the first day of the menstrual period to the 12th week of gestation)
|
Eligibility| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
| Sampling Method: | Probability Sample |
All infants/fetuses with congenital malformations registered on EUROCAT anti-epileptic drug database between 1995 and 2012 (start date depends on date of lamotrigine registration in country of participating register).
EUROCAT is a European network of population-based congenital anomaly registers for surveillance. EUROCAT surveys 1.5 million births per year covering 29% of births in EU Member States.
In 2007, 19 population-based congenital malformation registers within EUROCAT participated in an initial study of the association of lamotrigine exposure in pregnancy and the risk of isolated oral clefts. These registries covered at least part of the population of Austria, Belgium, Croatia, Denmark, Finland, France, Germany, Ireland, Italy, Malta, Norway, Poland, Spain, Switzerland and Wales.
It is anticipated, that if these registers participate in the current study, the study will cover 8 million births and 200,000 congenital malformation registrations between 1995 and 2012.
Inclusion Criteria:
- Individual population-based registers within EUROCAT are eligible to participate if:
- Anti-epileptic drug exposure is recorded for at least 3 per 1000 malformed infants/fetuses (figures below this threshold indicate potential under reporting of medication exposure).
- Specific drug names or complete 7 digit ATC codes are available for at least 80% of AED exposed infants/fetuses.
Exclusion Criteria:
- As above
Contacts and Locations More Information
No publications provided
| Responsible Party: | GlaxoSmithKline |
| ClinicalTrials.gov Identifier: | NCT01055327 History of Changes |
| Other Study ID Numbers: | 113038 |
| Study First Received: | January 21, 2010 |
| Last Updated: | August 30, 2012 |
| Health Authority: | United States: No Health Authority |
Keywords provided by GlaxoSmithKline:
|
Isolated oral clefts lamotrigine EUROCAT congenital malformations anti-epileptic drugs |
Additional relevant MeSH terms:
|
Congenital Abnormalities Epilepsy Brain Diseases Central Nervous System Diseases Nervous System Diseases Lamotrigine Anticonvulsants |
Central Nervous System Agents Therapeutic Uses Pharmacologic Actions Calcium Channel Blockers Membrane Transport Modulators Molecular Mechanisms of Pharmacological Action Cardiovascular Agents |
ClinicalTrials.gov processed this record on May 21, 2013