- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04432168
The TAPS Trial - Fetoscopic Laser Surgery for Twin Anemia Polycythemia Sequence
The TAPS Trial - Fetoscopic Laser Surgery for Twin Anemia-Polycythemia Sequence - a Multicenter Open-Label Randomized Controlled Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Rationale: Monochorionic twins share one placenta and are connected to each other via vascular anastomoses at the placental surface, allowing the blood to transfer bi-directionally between the two fetuses. Unbalanced inter-twin blood transfusion can result in twin anemia-polycythemia sequence (TAPS). Management options include: fetoscopic laser surgery, intrauterine blood transfusion (IUT) with or without partial exchange transfusion (PET), preterm delivery, selective feticide and expectant management. The optimal treatment for TAPS is not clear. Fetoscopic laser surgery is the only causative treatment option, but data on the feasibility of this procedure are mainly based on case reports and small cohort studies. A large randomized controlled trial is needed to evaluate the possible beneficial effect of fetoscopic laser surgery and to determine the optimal treatment option for TAPS.
Objective: The aim of this trial is to investigate whether fetoscopic laser surgery improves the outcome for TAPS twins as compared to the control group (standard care consisting of expectant management, IUT, preterm delivery). The hypothesis is that fetoscopic laser therapy will improve neonatal outcome by prolonging pregnancy.
Study design: International multi-centered open-label randomized controlled trial to assess whether fetoscopic laser surgery (experimental group) improves the outcome of TAPS twins compared to standard care (control group).
Study population: Monochorionic twin pregnancies with TAPS stage ≥ 2 (spontaneous or post-laser) diagnosed between 20 and 28 weeks of gestation.
Intervention: In the experimental group fetoscopic laser surgery is performed, whereas the control group is treated with standard care (expectant management, IUT (with PET), selective feticide and/or preterm delivery, depending on the opinion of the fetal surgeon).
Main study endpoints: The primary outcome is gestational age at birth. Secondary outcomes include: perinatal mortality or severe neonatal morbidity, hematological complication, procedure related complications and long-term neurodevelopmental outcome at 2 years.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Femke Slaghekke, MD PhD
- Phone Number: +31 71 52 97211
- Email: f.slaghekke@lumc.nl
Study Contact Backup
- Name: Lisanne Tollenaar, BSc
- Phone Number: +31653413875
- Email: l.s.a.tollenaar@lumc.nl
Study Locations
-
-
Lombardy
-
Milan, Lombardy, Italy, 20154
- Recruiting
- Vittore Buzzi Children's Hospital
-
Contact:
- Mariano Lanna, MD PhD
- Email: info@terapiafetale.it
-
Principal Investigator:
- Mariano Lanna, MD PhD
-
-
-
-
South-Holland
-
Leiden, South-Holland, Netherlands, 2333ZA
- Recruiting
- Leiden University Medical Center
-
Contact:
- Dick Oepkes, MD PhD
- Phone Number: +31715261688
- Email: d.oepkes@lumc.nl
-
Contact:
- Femke Slaghekke, MD PhD
- Phone Number: +31715297211
- Email: f.slaghekke@lumc.nl
-
Principal Investigator:
- Dick Oepkes, MD PhD
-
Sub-Investigator:
- Enrico Lopriore, MD PhD
-
Sub-Investigator:
- Femke Slaghekke, MD PhD
-
Sub-Investigator:
- Lisanne Tollenaar, BSc
-
-
-
-
-
Barcelona, Spain, 08035
- Recruiting
- Vall D'Hebron University Hospital
-
Contact:
- Carlota Rodo, MD PhD
- Email: crodo@vhebron.net
-
Contact:
- Silivia Arevalo, MD PhD
- Email: siareval@vhebron.net
-
Principal Investigator:
- Carlota Rodo, MD PhD
-
Sub-Investigator:
- Silivia Arevalo, MD PhD
-
Sub-Investigator:
- Pablo Garcia-Manau, MD PhD
-
-
-
-
Södermanland
-
Stockholm, Södermanland, Sweden, 141 86
- Not yet recruiting
- Karolinska University Hospital
-
Contact:
- Lotta Herling, MD PhD
- Email: lotta.herling@sll.se
-
Principal Investigator:
- Lotta Herling, MD PhD
-
-
-
-
Connecticut
-
New Haven, Connecticut, United States, 208327
- Not yet recruiting
- Yale University
-
Contact:
- Ozan Bahtiyar, MD PhD
-
Principal Investigator:
- Ozan Bahtiyar, MD PhD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Monochorionic twin pregnancy complicated by either spontaneous or post-laser twin anemia polycythemia sequence (TAPS), stage ≥ 2, diagnosed between 20+0 and till 28+0 weeks of gestation
- Women aged 18 years or more, who are able to consent.
- Written informed consent to participate in this randomized controlled trial, forms being approved by the Ethical Committees.
Exclusion Criteria:
- TAPS stage 1
- TAPS stage≥ 2, diagnosed within 1 week after laser surgery for twin-twin transfusion syndrome (TTTS) (a large inter-twin middle cerebral artery peak systolic velocity difference within a week after laser for TTTS is likely to related to hemodynamic reequilibration, and is usually not based on TAPS)
- Triplet pregnancies, or higher order multiple pregnancies
- TAPS cases that already underwent an intrauterine treatment (with the exception of laser surgery for TTTS in post-laser TAPS cases)
- Congenital abnormalities (including severe cerebral injury) in one or both twins
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Fetoscopic Laser Surgery
fetoscopic laser coagulation of the vascular anastomoses at the placental surface
|
Fetoscopic Photocoagulation of the connecting vascular anastomoses on the surface of the placenta.
Other Names:
|
Other: Standard Treatment
Expectant management, IUT (with or without PET), preterm delivery
|
In the control group, the choices of treatment include expectant management, intrauterine transfusion (IUT) (with or without partial exchange transfusion (PET)) or preterm delivery, depending on the judgment of the fetal surgeon with regard to the gestational age and state of the disease.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Gestational Age at Birth
Time Frame: 2 weeks after expected date of birth
|
Gestational age: completed weeks + additional days since the first day of the last menstruational period of the mother.
|
2 weeks after expected date of birth
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of patients with perinatal mortality
Time Frame: 42 days (28 days neonatal period+2 weeks postdates) after expected date of birth
|
Perinatal mortality is defined as fetal death or neonatal death (demise of a liveborn child within 28 days after birth)
|
42 days (28 days neonatal period+2 weeks postdates) after expected date of birth
|
Number of patients with severe neonatal morbidity
Time Frame: 42 days (28 days neonatal period+2 weeks postdates) after expected date of birth
|
Severe neonatal morbidity is defined as the presence of at least one of the following:
|
42 days (28 days neonatal period+2 weeks postdates) after expected date of birth
|
Number of patients with hematological complications
Time Frame: 2 weeks after expected date of birth
|
Hematological complications are defined as the presence of at least one of the following:
|
2 weeks after expected date of birth
|
Number of patients with procedure-related complications
Time Frame: 2 weeks after expected date of birth
|
Procedure-related complications are defined as at least one of the following:
|
2 weeks after expected date of birth
|
Number of patient with mild neurodevelopmental impairment
Time Frame: 2 years after expected date of birth
|
Mild neurodevelopmental impairment is defined as at least one of the following:
|
2 years after expected date of birth
|
Number of patients with severe neurodevelopmental impairment
Time Frame: 2 years after expected date of birth
|
Severe neurodevelopmental impairment is defined as at least one of the following:
|
2 years after expected date of birth
|
Number of patients with behavioral problems
Time Frame: 2 years after expected date of birth
|
Behavioral problems are defined as a T-score ≥ 64 for one of the following broad band scales: total problem score, Internalizing problems (anxious/depressed, withdrawn, somatic complaints), Externalizing problems (rule-breaking, aggressive behavior) as measured with the Child Behaviour Checklist 1.5-5 years
|
2 years after expected date of birth
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Dick Oepkes, MD PhD, Leiden University Medical Center
Publications and helpful links
General Publications
- Lopriore E, Middeldorp JM, Oepkes D, Kanhai HH, Walther FJ, Vandenbussche FP. Twin anemia-polycythemia sequence in two monochorionic twin pairs without oligo-polyhydramnios sequence. Placenta. 2007 Jan;28(1):47-51. doi: 10.1016/j.placenta.2006.01.010. Epub 2006 Mar 3.
- Robyr R, Lewi L, Salomon LJ, Yamamoto M, Bernard JP, Deprest J, Ville Y. Prevalence and management of late fetal complications following successful selective laser coagulation of chorionic plate anastomoses in twin-to-twin transfusion syndrome. Am J Obstet Gynecol. 2006 Mar;194(3):796-803. doi: 10.1016/j.ajog.2005.08.069.
- Sananes N, Veujoz M, Severac F, Barthoulot M, Meyer N, Weingertner AS, Kohler M, Guerra F, Gaudineau A, Nisand I, Favre R. Evaluation of the Utility of in utero Treatment of Twin Anemia-Polycythemia Sequence. Fetal Diagn Ther. 2015;38(3):170-8. doi: 10.1159/000380822. Epub 2015 Mar 17.
- Slaghekke F, Favre R, Peeters SH, Middeldorp JM, Weingertner AS, van Zwet EW, Klumper FJ, Oepkes D, Lopriore E. Laser surgery as a management option for twin anemia-polycythemia sequence. Ultrasound Obstet Gynecol. 2014 Sep;44(3):304-10. doi: 10.1002/uog.13382. Epub 2014 Aug 4.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- NL6442700018
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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 Twin Anemia Polycythemia Sequence
-
Medical University of GrazKlinikum Wels-Grieskirchen; Medical University of Vienna; Landesklinkum Wiener... and other collaboratorsRecruitingTwin Pregnancy With Antenatal Problem | Twin Dichorionic Diamniotic Placenta | Twin Monochorionic Monoamniotic Placenta | Twin-To-Twin Transfusion SyndromeAustria
-
Seattle Children's HospitalRecruitingMonochorionic Diamniotic Placenta | Twin to Twin Transfusion as Antepartum ConditionUnited States
-
Eunice Kennedy Shriver National Institute of Child...Children's Hospital Medical Center, CincinnatiUnknownTwin to Twin Transfusion SyndromeUnited States
-
Shengjing HospitalNot yet recruiting
-
University of TennesseeRegional Medical Center, Regional One HealthCompletedTwin to Twin Transfusion SyndromeUnited States
-
Jimmy EspinozaNot yet recruitingTwin to Twin Transfusion SyndromeUnited States
-
University of Southern CaliforniaActive, not recruitingTwin Twin Transfusion SyndromeUnited States
-
University of South FloridaCompletedTwin Twin Transfusion SyndromeUnited States
-
Assistance Publique - Hôpitaux de ParisSociété Française d'Hypentension ArtérielleActive, not recruitingTwin to Twin Transfusion SyndromeFrance
-
Columbia UniversityCompletedTwin Twin Transfusion SyndromeUnited States
Clinical Trials on Fetoscopic Laser Surgery
-
Assistance Publique - Hôpitaux de ParisCompletedInfant, Newborn, Diseases | Anemia, Neonatal | Hematologic Disease | Blood and Blood DisordersUnited States, Canada, France
-
Boston Children's HospitalNot yet recruitingPregnancy Complications | Maternal; Procedure | Vasa Previa | In Utero Procedure Affecting Fetus or NewbornUnited States
-
Seattle Children's HospitalRecruitingMonochorionic Diamniotic Placenta | Twin to Twin Transfusion as Antepartum ConditionUnited States
-
Eunice Kennedy Shriver National Institute of Child...Children's Hospital Medical Center, CincinnatiUnknownTwin to Twin Transfusion SyndromeUnited States
-
Hanmin LeeRecruitingCongenital Diaphragmatic HerniaUnited States
-
Southwest Oncology GroupNational Cancer Institute (NCI)TerminatedHead and Neck CancerUnited States
-
University Hospital, BonnUniversitätsmedizin MannheimWithdrawnDiaphragmatic HerniaGermany
-
Fondazione IRCCS Istituto Nazionale dei Tumori,...Not yet recruitingCervical Cancer | HPV | Cervix Lesion | Vagina Disease
-
University of NinevehCompleted
-
Groupe Hospitalier Paris Saint JosephWithdrawn