Longitudinal Observational Study on the Course of Cystic Fibrosis Lung Disease in Patients Following Newborn Screening

NCT ID: NCT02270476

Last Updated: 2023-11-29

Basic Information

• Recruitment Status: RECRUITING
• Total Enrollment: 200 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2011-12-31
• Study Completion Date: 2030-12-31

Brief Summary

The purpose of this study is to further characterize early CF lung disease in newborns, infants and toddlers with cystic fibrosis (CF).

Detailed Description

Cystic fibrosis (CF) is the most common lethal genetic multisystem disease in Germany. Although life expectancy increased over the last decades, most of the CF patients die in young adulthood due to chronic CF lung disease with respiratory failure. CF lung disease is caused by a disturbed transport of salt and water by airway epithelia and dehydration of airway surfaces as a result of the underlying genetic defect in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gen. Up to now, no causal therapies for the majority of patients with CF are available. Little is known about onset and natural course as well as influencing factors of CF lung disease. Therefore, the first aim of this prospective, multicenter, uncontrolled, non-randomized, explorative longitudinal study is characterization of the onset and early course of CF lung disease. For this reason we will primarily include patients diagnosed by CF newborn screening (CF-NBS) or for any other reason in the first four months of life (early diagnosed, ED). In a second step we will compare data from these patients to those diagnosed clinically later in life (late diagnosed, LD). This will allow us to investigate the effect of early diagnosis and start of therapy. Starting at diagnosis, we will use data from annual routine check-ups (imaging like chest MRI, pulmonary function tests, microbiology from swabs and sputum, laboratory values, anthropometry) as well as data from a facultative, study-related bronchoscopy with lavage (microbiology, inflammation and immunology) for correlation with the course of CF lung disease (generation of hypotheses). Further study-related investigations are monthly telephone interviews on bronchopulmonary symptoms by a study nurse on the basis of a questionnaire and quarterly assessment of health-related quality of life on the basis of a validated questionnaire.

We expect to gain a deeper insight into onset and early course of CF lung disease from the results of this study. So far, there is no trial that investigated the different aspects of CF lung disease (function, morphology, infectiology, inflammation) complementary in a longitudinal setting. We assume that knowledge on the natural history of CF lung disease in the vulnerable phase of early childhood has a great impact on the future development of new therapies (from symptomatic to causal). This shall lead to a further improvement in life expectancy and quality of life of patients with CF.

Conditions

Cystic Fibrosis Lung Disease

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

Early diagnosed (ED)

Children diagnosed with CF in the first 4 months of life.

No interventions assigned to this group

Late diagnosed (LD)

Children diagnosed with CF after the first 4 months of life.

No interventions assigned to this group

Eligibility Criteria

Inclusion Criteria

1. Newly diagnosed patients with Cystic Fibrosis (CF). Diagnosis of CF: at least one of the following three international accepted criteria is fulfilled: i) sweat chloride ≥ 60mEq/L and/or ii) 2 CF-causing mutations in the CFTR gene and/or iii) changes typical for CF in the transepithelial potential difference in nasal or rectal epithelium.

2. Age and mode of diagnosis:

• Early diagnosed (ED): Initial diagnosis following CF-NBS or for other reasons in the first 4 months of life (in preterms corrected age of 4 months) after January 1st, 2006. Other reasons could be prenatal diagnostics, meconium ileus or positive family history.
• Late diagnosed (LD): Diagnosed after the fourth month of life due to clinical symptoms; initial diagnosis after January 1st, 2006.

Exclusion Criteria

All patients are excluded who themselves or whose parents do not want to participate or that withdraw from the study; or those in whom the diagnosis of CF is unsure.

1. Preterms <30th week of gestation

2. Longer period of mechanical ventilation in first 3 months of life

3. A significant medical disease or condition other than CF likely to interfere with the child's ability to complete the entire protocol

4. Previous major surgery except for meconium ileus or atresia of the intestine

5. Other major organ dysfunction, excluding pancreatic or hepatic dysfunction or another condition due to CF

6. Physical findings that would compromise the safety of the subject or the quality of the study data as determined by investigator

7. Chronic lung disease other than CF (e.g. bronchopulmonary dysplasia)

8. History of adverse reaction to medication for sedation or known claustrophobia

Criteria, which lead to a displacement of the procedures in sedation until the child has recovered: - Clinically significant upper airway obstruction as determined by investigator (e.g.

severe laryngomalacia, markedly enlarged tonsils, significant snoring, diagnosed obstructive sleep apnoea)

• Severe gastroesophageal reflux, defined as persistent frequent emesis despite anti-reflux therapy

• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

German Center for Lung Research

OTHER

Sponsor Role: collaborator

Heidelberg University

OTHER

Sponsor Role: lead

Responsible Party

Mirjam Stahl

PI and Leader of Junior Research Group

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Marcus A Mall, MD

Role: PRINCIPAL_INVESTIGATOR

University Hospital Heidelberg

Locations

University Children's Hospital Heidelberg, Cystic Fibrosis Centre

Heidelberg, Baden-Wurttemberg, Germany

Site Status: RECRUITING

University Hospital Gießen and Marburg GmbH

Giessen, Hesse, Germany

Site Status: RECRUITING

Medizinische Hochschule Hannover

Hanover, Lower Saxony, Germany

Site Status: RECRUITING

University Children's Hospital Schleswig-Holstein

Lübeck, Schleswig-Holstein, Germany

Site Status: RECRUITING

Countries

Germany

Central Contacts

Marcus A Mall, MD

Role: CONTACT

Marcus.Mall@med.uni-heidelberg.de

+49 6221 56 4502

Mirjam Stahl, MD

Role: CONTACT

Mirjam.Stahl@med.uni-heidelberg.de

+49 6221 56 37049

Facility Contacts

Marcus A Mall, MD

Role: primary

Marcus.Mall@med.uni-heidelberg.de

+49 6221 56 4502

Mirjam Stahl, MD

Role: backup

Mirjam.Stahl@med.uni-heidelberg.de

+49 6221 56 37049

Lutz Nährlich, MD

Role: primary

lutz.naehrlich@paediat.med.uni-giessen.de

+49 (0) 641 985-57621

Christian Dopfer, MD

Role: primary

dopfer.christian@mh-hannover.de

+49 (0)1761 532 3325

Matthias V Kopp, MD

Role: primary

matthias.kopp@uksh.de

+49 (0) 451 5002550

References

Steinke E, Sommerburg O, Graeber SY, Joachim C, Labitzke C, Nissen G, Ricklefs I, Rudolf I, Kopp MV, Dittrich AM, Mall MA, Stahl M. TRACK-CF prospective cohort study: Understanding early cystic fibrosis lung disease. Front Med (Lausanne). 2023 Jan 6;9:1034290. doi: 10.3389/fmed.2022.1034290. eCollection 2022.

Reference Type: DERIVED

PMID: 36687447 (View on PubMed)

Wucherpfennig L, Wuennemann F, Eichinger M, Schmitt N, Seitz A, Baumann I, Stahl M, Graeber SY, Chung J, Schenk JP, Alrajab A, Kauczor HU, Mall MA, Sommerburg O, Wielputz MO. Longitudinal Magnetic Resonance Imaging Detects Onset and Progression of Chronic Rhinosinusitis from Infancy to School Age in Cystic Fibrosis. Ann Am Thorac Soc. 2023 May;20(5):687-697. doi: 10.1513/AnnalsATS.202209-763OC.

Reference Type: DERIVED

PMID: 36548543 (View on PubMed)

Stahl M, Steinke E, Graeber SY, Joachim C, Seitz C, Kauczor HU, Eichinger M, Hammerling S, Sommerburg O, Wielputz MO, Mall MA. Magnetic Resonance Imaging Detects Progression of Lung Disease and Impact of Newborn Screening in Preschool Children with Cystic Fibrosis. Am J Respir Crit Care Med. 2021 Oct 15;204(8):943-953. doi: 10.1164/rccm.202102-0278OC.

Reference Type: DERIVED

PMID: 34283704 (View on PubMed)

Stahl M, Wielputz MO, Graeber SY, Joachim C, Sommerburg O, Kauczor HU, Puderbach M, Eichinger M, Mall MA. Comparison of Lung Clearance Index and Magnetic Resonance Imaging for Assessment of Lung Disease in Children with Cystic Fibrosis. Am J Respir Crit Care Med. 2017 Feb 1;195(3):349-359. doi: 10.1164/rccm.201604-0893OC.

Reference Type: DERIVED

PMID: 27575911 (View on PubMed)

Other Identifiers

UKH-TRACK-1

Identifier Type: -

Identifier Source: org_study_id