Hereditary transthyretin amyloidosis polyneuropathy in patients with carpal tunnel syndrome in Russia - LOCUS

Study identifier:D8451R00001

ClinicalTrials.gov identifier:NCT06414746

EudraCT identifier:N/A

CTIS identifier:N/A

Recruiting

Official Title

A multicenter observational retrospective-prospective study of prevalence, clinical characteristics of hereditary transthyretin amyloidosis polyneuropathy in Russian patients undergoing surgery for CTS in real clinical practice

Medical condition

Hereditary transthyretin amyloidosis

Phase

N/A

Healthy volunteers

Study drug

Sex

All

Estimated Enrollment

800

Study type

Observational

Age

18 Years - n/a

Date

Study Start Date: 29 Dec 2023

Estimated Primary Completion Date: 30 Jun 2025

Estimated Study Completion Date: 30 Jun 2025

Study design

Allocation: N/A
Endpoint Classification: -
Intervention Model: -
Masking: -
Primary Purpose: -

Verification:

Verified 01 Sept 2024 by AstraZeneca

Collaborators

Inclusion and exclusion criteria

Inclusion Criteria

for the retrospective phase are:
1. Patients with the established diagnosis of CTS.
2. Bilateral involvement of carpal tunnel established between the 1st January 2021 and the 31st December 2024 (both patients who underwent CTS surgical intervention and without it are enrolled).
3. Age ≥ 18 years at the time of CTS diagnosis.
4. Provided written informed consent for the prospective phase of the study (including molecular genetic testing).
5. Presence of ≥1 of the following features (red flags):
a. CIDP or polyneuropathy of unknown etiology in the family history;
b. Spinal canal stenosis of the lumbar region;
c. Autonomic dysfunction, defined by the presence of ≥1 of the following symptoms –
i. Gastrointestinal complaints (constipation, chronic diarrhea, or both);
ii. Erectile dysfunction;
iii. Orthostatic hypotension;
d. Gait disorders;
e. Sweating disorders, anhidrosis.
f. Paresthesia and burning of the skin of the distal extremities
g. Distal symmetrical paresis
h. Hypotrophy and hypotension of limb muscles, areflexia
i. Biceps tendon rupture
j. Aortic valve stenosis
k. Diagnosis of HFpEF
l. Unexplained weight loss ≥5 kilos at any timepoint since the onset of symptoms of CTS;
m. Left ventricular hypertrophy (based on electro- or echocardiographic criteria documented in the patient’s medical record);
n. Heart rhythm disorders;
o. Renal abnormalities, defined by ≥1 of the following features –
i. Documented diagnosis of chronic kidney disease (CKD);
ii. Decreased estimated glomerular filtration rate (eGFR <60 mL/min/1.73m2);
iii. Increased serum creatinine (SCr) above reference range of the local laboratory;
iv. Albuminuria (≥30 mg/g of creatinine or ≥30 mg/24h);
v. Proteinuria (according to urinalysis results);
p. Ophthalmology disorder defined by ≥1 of the following features –
i. Vitreous body inclusions (opacification);
ii. Glaucoma;
iii. Pupillary disorders;
iv. Vitrectomy
6. Absence of previously established ATTR PN diagnosis (ICD-10 code Е85.1, «Neuropathic hereditary familial amyloidosis»).

Exclusion Criteria

1. Participation in any interventional trial within the period since identification of bilateral involvement of carpal tunnel until the end of current study.
The following criteria apply for non-inclusion of patients into the prospective part of the study:
2. Previously performed TTR genetic testing;
3. Verified B12 deficiency;
4. History of alcohol abuse according to the patient’s medical record.

ATTR PN is a genotypically, phenotypically and geographically variable disease with a poor prognosis, albeit available disease-modifying drugs can change the disease trajectory. Thus country-specific epidemiologic data collection and identification of early stage PN, including previously misdiagnosed patients, is crucial to improve outcomes and quality of life. However, no observational studies on the epidemiology of ATTR PN in the whole Russian population, or in patients with CTS, have been performed. Therefore, there is a need to conduct a large-scale observational study to determine the prevalence of ATTR PN in Russia, obtain information on patients’ clinical characteristics, and determine their medical needs. The approaches to diagnosis of ATTR PN in Russia over the past few years have been characterized by the use of heterogenous methods, partially explained by the lack of availability of molecular genetic testing, which is essential to diagnose the presence of pathogenic mutation in patients with hereditary ATTR PN. Thus, recent introduction of such tests into routine clinical practice may allow to assess reliable epidemiologic data including estimation of true ATTR PN prevalence among patients with CTS, which can often be the first manifestation of the disease. Earlier recognition, in turn, may lead to timely treatment initiation and change in the prognostic outlook of ATTR PN patients. In order to assess the prevalence of ATTR PN in patients undergoing surgery for CTS in Russia this study will retrospectively include patients with the diagnosis of CTS undergoing surgery between the 1st January 2021 and the 1st September 2024. Suspicion of ATTR PN will be assessed in each case, and diagnostic tests (comprehensive neurological examination including nerve conduction study (NCS) combined with molecular genetic testing) to confirm or exclude the disease will be conducted prospectively in eligible patients. In addition to that, clinical features, concomitant manifestations, and diagnosed genotypes will be analyzed to examine characteristic ATTR PN patient profiles in the Russian Federation.

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Documents available

Trial Results Summaries
Available here

Contacts

Contact

AstraZeneca Clinical Study Information Center

1-877-240-9479

[email protected]