- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03376893
Epidemiology of Silent and Overt Strokes in Sickle Cell Disease (ESCD)
August 21, 2023 updated by: Michael DeBaun, Vanderbilt University Medical Center
The Epidemiology of Silent and Overt Strokes in Adults With Sickle Cell Disease: a Prospective Cohort Study
Sickle Cell Disease (SCD) is a rare disease occurring in an estimated 100,000 individuals, often poor and underserved, in the US.
Silent and overt strokes contribute significantly to morbidity in adults with SCD, resulting in functional impairment, challenges with school and job performance, and premature death.
Five NIH-funded randomized controlled trials have identified therapies to prevent silent and overt strokes in children with SCD, including monthly blood transfusion therapy (for preventing initial and recurrent strokes) and hydroxyurea (for preventing initial strokes).
Despite the observation that at least 99% of children with SCD in high-income countries reach adulthood, and approximately 60% of adults will experience one or more strokes (~50% with silent strokes and ~10% with overt strokes), no stroke trials have established therapeutic approaches for adults with SCD.
For adults with SCD, inadequate evidence-based guidelines exist for secondary stroke prevention strategies.
Applying stroke prevention strategies in children may not be effective for stroke prevention in adults with SCD, particularly given the high rate of co-morbidities.
Identifying subgroups of adults with SCD and higher incidence coupled with the contribution of established stroke risk factors in the general population (smoking, diabetes, obesity, renal disease) will provide the requisite data required for the first-ever phase III clinical trials focused on secondary stroke prevention in adults.
Study Overview
Status
Recruiting
Detailed Description
In three adult SCD centers, we will conduct a prospective cohort study to test the primary hypothesis that the incidence of infarct recurrence (stroke or silent stroke) or new strokes in adults with silent strokes treated with hydroxyurea will be greater than in those without strokes treated with hydroxyurea.
We will test two secondary hypotheses: 1) adults with SCD and silent strokes have cognitive morbidity when compared to adults with SCD without silent strokes, and 2) adults with SCD and strokes receiving regular blood transfusion will have a higher incidence of infarct recurrence than those with SCD without strokes.
The aims include Aim 1: Compare the incidence of new overt and silent strokes in adults with SCD and silent strokes to a comparison group of adults without silent strokes or overt strokes.
Aim 2: Compare the cognitive morbidity of those with silent strokes and overt strokes to those without strokes.
Aim 3: Compare the incidence of new overt and silent stroke in adults with SCD and overt strokes receiving transfusion to adults with SCD without silent or overt strokes treated with hydroxyurea.
All clinical information and neuroimaging will be centrally adjudicated with masked and experienced neurology and neuroradiology committees.
Data generated after completion of this proposal are critical for developing the first-ever phase III trials for secondary stroke prevention therapies in adults with SCD.
Study Type
Observational
Enrollment (Estimated)
60
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Leshana Saint Jean, PhD
- Phone Number: 6158751992
- Email: leshana.saint.jean@vumc.org
Study Contact Backup
- Name: Samantha Davis, Masters
- Phone Number: +1 (615) 875-7956
- Email: samantha.davis.1@vumc.org
Study Locations
-
-
Alabama
-
Birmingham, Alabama, United States, 35233
- Recruiting
- University of Alabama at Birmingham
-
Contact:
- Jeffrey Lebensburger, DO
- Phone Number: 205-638-9285
- Email: jlebensburger@peds.uab.edu
-
-
Missouri
-
Saint Louis, Missouri, United States, 63110
- Recruiting
- Washington University School of Medicine
-
Contact:
- Allison A King, MD
- Phone Number: 314-454-4291
- Email: king_a@wustl.edu
-
-
Tennessee
-
Nashville, Tennessee, United States, 37232
- Recruiting
- Vanderbilt University Medical Center
-
Contact:
- Samantha Davis, Masters
- Phone Number: 615-875-7956
- Email: samantha.davis.1@vumc.org
-
Contact:
- Leshana Saint-Jean, PhD
- Phone Number: 615-875-1992
- Email: leshana.saint.jean@vumc.org
-
Nashville, Tennessee, United States, 37232-9000
- Recruiting
- Vanderbilt University Medical Center
-
Contact:
- Samantha Davis, Masters
- Phone Number: +1 (615) 875-7956
- Email: samantha.davis.1@vumc.org
-
Contact:
- Lori C. Jordan, PhD, MD
- Phone Number: 5-3040 615-875-7956
- Email: lori.jordan@vumc.org
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Sampling Method
Non-Probability Sample
Study Population
Participants will be patient volunteers from the sickle cell disease clinics of participating study sites.
Description
Inclusion Criteria:
- Participants with sickle cell disease on hemoglobin analysis and/or other confirmatory documentation of phenotype
- Patients ≥ 18 years of age
- Patients followed regularly (at least two visits per year) in the hematology clinics
- Patients who have demonstrated adherence with follow-up visits for ≥ 3 years
- Patients willing to be followed prospectively for a minimum of 3.5 years and agree to a standard care exit MRI/MRA of the brain, as well as MRI/MRA every 12 to 18 months or participation in VUMC AHA trial with Dr. Jordan as PI. These are adults with SCA aged 18-40 years at study entry, enrolled with any infarct status (none, SCI or overt stroke) and followed prospectively.
- Willingness to comply with study protocol, routine clinic visits
Exclusion criteria:
- Participants judged to be non-compliant by the hematologist based on previous experience in terms of clinic appointments and following advice
- Participants with contraindications to MRI, including individuals with MRI-incompatible foreign metal objects
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Observational Models: Cohort
- Time Perspectives: Prospective
Cohorts and Interventions
Group / Cohort |
---|
SCA with overt stroke
Participants have sickle cell disease and a history of overt stroke.
|
SCA with silent stroke
Participants have sickle cell disease and a history of silent stroke.
|
SCA with no stroke
Participants have sickle cell disease and no history of stroke.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Adjudication of silent stroke in those with reported history of silent stroke and hydroxyurea therapy
Time Frame: Study enrollment
|
Based on results of an MRI exam and a neurological exam, performed by a physician, the Neuroradiology Committee and the Neurology Committee will come to consensus on whether a silent stroke has occurred.
Radiologically, silent stroke will be defined as a FLAIR T2W hyperintensity greater than 3 mm, visible in two planes.
Neurologically, a silent stroke has no neurological sequelae.
|
Study enrollment
|
Adjudication of new strokes in those with history of silent stroke and on hydroxyurea therapy
Time Frame: Every 12 to 18 months after enrollment
|
Based on results of an MRI exam and a neurological exam, performed by a physician, the Neuroradiology Committee and the Neurology Committee will come to consensus on whether a NEW stroke has occurred since the last exams, and if so, whether it is a silent stroke or overt stroke.
Radiologically, silent stroke will be defined as a FLAIR T2W hyperintensity greater than 3 mm, visible in two planes.
Neurologically, a silent stroke has no neurological sequelae.
|
Every 12 to 18 months after enrollment
|
Adjudication of new strokes in those with history of silent stroke and on hydroxyurea therapy
Time Frame: At study exit (at least 3.5 years after enrollment)
|
Based on results of an MRI exam and a neurological exam, performed by a physician, the Neuroradiology Committee and the Neurology Committee will come to consensus on whether a NEW stroke has occurred since the last exams, and if so, whether it is a silent stroke or overt stroke.
Radiologically, silent stroke will be defined as a FLAIR T2W hyperintensity greater than 3 mm, visible in two planes.
Neurologically, a silent stroke has no neurological sequelae.
|
At study exit (at least 3.5 years after enrollment)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Cognitive morbidity in those with silent or overt stroke
Time Frame: Study enrollment
|
All participants will complete the NIH Toolbox CB.
The NIH Toolbox CB allows for the evaluation of several cognitive constructs and yields individual measure scores as well as a composite score.
This measure will serve as a baseline for all participants.
|
Study enrollment
|
Cognitive morbidity in those with silent or overt stroke
Time Frame: Every 12 to 18 months after enrollment
|
Participants will complete the NIH Toolbox CB.
The NIH Toolbox CB allows for the evaluation of several cognitive constructs and yields individual measure scores as well as a composite score.
Results will be compared to the previous measurement(s) to determine if change has occurred.
|
Every 12 to 18 months after enrollment
|
Cognitive morbidity in those with silent or overt stroke
Time Frame: At study exit (at least 3.5 years after enrollment)
|
Participants will complete the NIH Toolbox CB.
The NIH Toolbox CB allows for the evaluation of several cognitive constructs and yields individual measure scores as well as a composite score.
Results will be compared to the previous measurement(s) to determine if change has occurred.
|
At study exit (at least 3.5 years after enrollment)
|
Adjudication of overt stroke in those with reported history of overt stroke and on transfusion therapy
Time Frame: Study enrollment
|
Based on results of an MRI exam and a neurological exam, performed by a physician, the Neuroradiology Committee and the Neurology Committee will come to consensus on whether an overt stroke has occurred.
|
Study enrollment
|
Adjudication of new strokes in those with history of overt stroke and on transfusion therapy
Time Frame: Every 12 to 18 months after enrollment
|
Based on results of an MRI exam and a neurological exam, performed by a physician, the Neuroradiology Committee and the Neurology Committee will come to consensus on whether a NEW stroke has occurred since the last exams, and if so, whether it is a silent stroke or overt stroke.
Radiologically, silent stroke will be defined as a FLAIR T2W hyperintensity greater than 3 mm, visible in two planes.
Neurologically, a silent stroke has no neurological sequelae.
|
Every 12 to 18 months after enrollment
|
Adjudication of new strokes in those with history of overt stroke and on transfusion therapy
Time Frame: At study exit (at least 3.5 years after enrollment)
|
Based on results of an MRI exam and a neurological exam, performed by a physician, the Neuroradiology Committee and the Neurology Committee will come to consensus on whether a NEW stroke has occurred since the last exams, and if so, whether it is a silent stroke or overt stroke.
Radiologically, silent stroke will be defined as a FLAIR T2W hyperintensity greater than 3 mm, visible in two planes.
Neurologically, a silent stroke has no neurological sequelae.
|
At study exit (at least 3.5 years after enrollment)
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Michael R DeBaun, MD, MPH, Vanderbilt University Medical Center
- Principal Investigator: Lori C. Jordan, PhD, MD, Vanderbilt University Medical Center
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
June 2, 2017
Primary Completion (Estimated)
December 31, 2025
Study Completion (Estimated)
December 31, 2026
Study Registration Dates
First Submitted
December 8, 2017
First Submitted That Met QC Criteria
December 12, 2017
First Posted (Actual)
December 19, 2017
Study Record Updates
Last Update Posted (Actual)
August 22, 2023
Last Update Submitted That Met QC Criteria
August 21, 2023
Last Verified
August 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 161434
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Stroke
-
University Hospital, GhentRecruitingStroke | Stroke, Ischemic | Stroke, Acute | Stroke Sequelae | Stroke HemorrhagicBelgium
-
Moleac Pte Ltd.RecruitingStroke | Stroke, Ischemic | Stroke Sequelae | Stroke, Cardiovascular | Strokes Thrombotic | Stroke, Embolic | Stroke, CryptogenicSingapore, Philippines
-
Moleac Pte Ltd.Not yet recruitingStroke | Stroke, Ischemic | Stroke Sequelae | Stroke, Cardiovascular | Strokes Thrombotic | Stroke, Embolic | Stroke, Cryptogenic
-
IRCCS San Camillo, Venezia, ItalyRecruitingStroke | Stroke, Ischemic | Stroke Sequelae | Stroke HemorrhagicItaly
-
Vanderbilt University Medical CenterPatient-Centered Outcomes Research Institute; University of Alabama at BirminghamEnrolling by invitationStroke | Stroke, Ischemic | Stroke, Acute | Stroke Sequelae | Engagement, Patient | Stroke HemorrhagicUnited States
-
University of MinnesotaAmerican Occupational Therapy FoundationRecruitingStroke | Stroke Sequelae | Stroke Hemorrhagic | Stroke IschemicUnited States
-
University of British ColumbiaCanadian Institutes of Health Research (CIHR); Michael Smith Foundation for...RecruitingStroke | Stroke, Ischemic | Stroke Hemorrhagic | Chronic StrokeCanada
-
University of CincinnatiMedical University of South Carolina; University of California, Los Angeles; University...RecruitingStroke | Stroke, Ischemic | Stroke, Acute | Stroke HemorrhagicUnited States
-
Turkish Stroke Research and Clinical Trials NetworkElectroCore INC; Turkish Neurological SocietyCompletedStroke | Stroke, Ischemic | Stroke, Acute | Stroke, HemorrhagicTurkey
-
University of LiegeCompletedStroke, Acute | Stroke Hemorrhagic | Stroke, ComplicationBelgium