A Study in Adults to Learn About Inherited Alpha-1 Antitrypsin Deficiency (AATD) and AATD Related Liver Problems (ALPHATUDE)

July 23, 2026 updated by: Takeda

Prospective Observational Study on the Natural History of Alpha-1 Antitrypsin Deficiency and Associated Liver Disease

The liver produces a protein called alpha-1 antitrypsin (AAT). AAT is normally released into the bloodstream. In some people, the liver makes an abnormal version of AAT, called Z-AAT. Z-AAT builds up in liver cells and also leads to low blood levels of AAT (called Alpha-1 Antitrypsin Deficiency or AATD). Over time, this build up leads to different stages of liver problems, if not treated. This is called natural history of AATD.

The main aim of this study is to learn about liver problems caused by AATD in adults when not treated over 4 to 8 years. Other aims are to learn what can predict the AATD-liver condition starting and getting better or worse, describe how this condition is currently being diagnosed and watched in normal care, and describe how the AATD also affects an adult's lung function.

Data in this study will be collected to include medical history of a participant, including the date AATD was first identified and/or the date on which the first AATD-related liver or lung problems were diagnosed. At study start and then every year until study end, participants will be asked to complete questionnaires (called patient-reported outcomes or PROs).

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Study Type

Observational

Enrollment (Estimated)

500

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

Study Locations

  • Austria
      • Vienna, Austria, 1090
  • Germany
      • Aachen, Germany, 52074
        • Recruiting
        • Universitätsklinikum Aachen
        • Principal Investigator:
          • Pavel Strnad
        • Contact:
  • Ireland
      • Dublin, Ireland, Dublin 9
        • Recruiting
        • Beaumont Hospital
        • Contact:
        • Principal Investigator:
          • Gerry McElvaney
  • Spain
      • Barcelona, Spain
        • Recruiting
        • Hospital Universitari Vall d'Hebron
        • Principal Investigator:
          • Monica Pons Delgado
        • Contact:
  • United Kingdom
      • Birmingham, United Kingdom, B15 2GW
        • Recruiting
        • Queen Elizabeth Hospital Birmingham
        • Principal Investigator:
          • Alice Turner
        • Contact:
  • United States
    • Florida
      • Gainesville, Florida, United States, 32608
    • South Carolina
      • Charleston, South Carolina, United States, 29425
        • Recruiting
        • University of South Carolina
        • Principal Investigator:
          • Charlie Strange
        • Contact:
    • Tennessee
      • Nashville, Tennessee, United States, 37212
        • Recruiting
        • Vanderbilt University Medical Center
        • Contact:
        • Principal Investigator:
          • Suzanne Sharpton

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

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

Participants who have already been diagnosed with AATD of genotype/phenotype Pi*ZZ, with or without liver disease manifestation (F0-F4dc), or with genotype/phenotype of Pi*SZ with moderate-advanced or severe liver disease manifestation (F2-F4dc).

Description

Inclusion Criteria:

Participants who meet all the following criteria will be included in the study.

Cohorts 1 and 2:

  1. Willing to provide written informed consent to participate in the study.
  2. >=18 years of age at enrollment in this study.

  3. Participants with documented diagnosis of AATD, meeting the following criteria:

    1. Cohort 1 (AATD-Pi*ZZ genotype/phenotype).

      • Pi*ZZ genotype as documented from rapid genetic assay, sequencing, or polymerase chain reaction (PCR), or Pi*ZZ phenotype as documented from iso-electric focusing (IEF) electrophoresis.

    2. Cohort 2 (AATD-Pi*SZ genotype/phenotype with liver disease manifestation).

      • Pi*SZ genotype as documented from rapid genetic assay, sequencing, or PCR, or Pi*SZ phenotype as documented from IEF electrophoresis, and
      • Moderate-advanced or severe liver disease manifestation as defined by either liver biopsy or surrogate laboratory or imaging measures.

Exclusion Criteria:

Participants who meet any following criteria will be excluded from the study.

  1. Documented AATD genotype/phenotype other than Pi*ZZ or Pi*SZ.
  2. History of liver transplant.
  3. No results for either biopsies, magnetic resonance elastography (MRE), FibroScan (vibration controlled transient elastography [VCTE]), or Aspartate aminotransferase to platelet ratio index (APRI) in the 24 months prior to the index/enrollment date and has none of these tests ordered during the index period (i.e., index date +90 days).

  4. Participants with prior participation in an interventional clinical trial evaluating liver or lung disease, or who have received an investigational AATD-directed therapy under a compassionate use program, will be excluded if they do not present one of the following:

    • A minimum washout period of 6 months has elapsed since the last dose of the investigational product.
    • A history of having received placebo in prior interventional trials (to be evaluated on a case-by-case basis).

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

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Cohort 1: AATD-Pi*ZZ Genotype/Phenotype
Participants who have been diagnosed with Alpha-1 Antitrypsin Deficiency homozygous ZZ (AATD-Pi*ZZ) genotype/phenotype with or without liver disease manifestations (fibrosis- F0-F4dc) will be enrolled and data will be prospectively collected per routine care throughout the follow-up period.
Other: No Intervention
This is an observational study.
Cohort 2: AATD-Pi*SZ Genotype/Phenotype
Participants who have been diagnosed with alpha-1 antitrypsin deficiency heterozygous SZ (AATD-Pi*SZ) genotype/phenotype with moderate-advanced or severe liver disease (F2-F4dc) manifestations will be enrolled and data will be prospectively collected per routine care throughout the follow-up period.
Other: No Intervention
This is an observational study.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of Participants With Liver Disease Progression
Time Frame: Baseline up to 8 years
Liver disease progression will be defined as advancement in greater than or equal to (>=)1 fibrosis stage: example any progression from fibrosis stage F0/F1 to F2, F1 to F2, F2 to F3 etc. and/or occurrence of any of these composite events: a) advancement in >=1 fibrosis stage, b) development of a liver disease-related clinical event, c) model for end-stage liver disease (MELD) score increase, d) newly added on liver transplant list, e) receipt of a liver transplant. The fibrosis stages range from F0 to F4, with F0 indicating no fibrosis and F4 indicating cirrhosis. The MELD score ranges from 6 to 40 with higher scores indicating more severe liver disease and a worse outcome.
Baseline up to 8 years
Time to Liver Disease Progression
Time Frame: Baseline up to 8 years
Time to liver disease progression is defined as time to advancement in >=1 fibrosis stage (example F0/F1 to F2, F2 to F3 etc.) and/or time to the earliest of: Advancement in >=1 fibrosis stage, or development of a liver disease-related clinical event, or MELD score increase or receipt/newly added to transplant list of a liver transplant. The fibrosis stages range from F0 to F4, with F0 indicating no fibrosis and F4 indicating cirrhosis. The MELD score ranges from 6 to 40 with higher scores indicating more severe liver disease and a worse outcome.
Baseline up to 8 years
Time to Liver Disease Trajectory
Time Frame: Baseline up to 8 years
Time to liver disease trajectory is defined as time of transition from F0/F1 to F2, F2 to F3, F3 to F4, F4 to the first decompensating event or liver transplant/listing and first to second decompensating event and all subsequent decompensating events or liver transplant/listing. The fibrosis stages range from F0 to F4, with F0 indicating no fibrosis and F4 indicating cirrhosis.
Baseline up to 8 years
Probability of Transition in Liver Disease Trajectory
Time Frame: Baseline up to 8 years
Probability of liver disease trajectory is defined as probability of transition from F0/F1 to F2, F2 to F3, F3 to F4, F4 to the first decompensating event or liver transplant/listing and first to second decompensating event and all subsequent decompensating events or liver transplant/listing. The fibrosis stages range from F0 to F4, with F0 indicating no fibrosis and F4 indicating cirrhosis.
Baseline up to 8 years
Percentage of Participants With Disease Regression
Time Frame: Baseline up to 8 years
Disease regression is defined as decrease in >=1 fibrosis staging. The fibrosis stages range from F0 to F4, with F0 indicating no fibrosis and F4 indicating cirrhosis.
Baseline up to 8 years
Time to Liver Disease Regression
Time Frame: Baseline up to 8 years
Time to liver disease regression is defined as time to decrease in >=1 fibrosis stage. The fibrosis stages range from F0 to F4, with F0 indicating no fibrosis and F4 indicating cirrhosis.
Baseline up to 8 years
Percentage of Participants With All-cause Mortality and Cause-specific Mortality
Time Frame: Baseline up to 8 years
Cause-specific mortality is defined as mortality due to liver failure or complications of cirrhosis/portal hypertension or hepatocellular carcinoma, or infections secondary to liver failure.
Baseline up to 8 years
Time to Death (All-causes) and Cause-specific Death (Liver Disease-specific Causes)
Time Frame: Baseline up to 8 years
Cause-specific mortality is defined as mortality due to liver failure or complications of cirrhosis/portal hypertension or hepatocellular carcinoma, or infections secondary to liver failure.
Baseline up to 8 years

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Percentage of Participants Who Develop Lung Disease
Time Frame: Baseline up to 8 years
Development of lung disease will be defined as either a forced expiratory volume in 1 second (FEV1) percent (%) predicted of less than (<) 70% or the diagnosis of at least 1 lung condition (chronic obstructive pulmonary disease [COPD], emphysema, bronchiectasis, chronic bronchitis) over the study duration or at specific timepoints.
Baseline up to 8 years
Proportion of Participants With Lung Disease at Baseline who Experience Lung Disease Progression at 4-8 Years
Time Frame: Baseline up to 8 years
Lung disease progression is defined as changes in pulmonary function (defined as >=10% absolute change in FEV1, forced vital capacity [FVC], or diffusing capacity of the lungs for carbon monoxide [DLCO]) over the study duration or at specific timepoints.
Baseline up to 8 years
Characterize Diagnostic and Monitoring Patterns for Liver Disease (Invasive and Non-invasive Assessments)
Time Frame: Baseline up to 8 years
Baseline up to 8 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Takeda

Investigators

  • Study Director: Study Director, Takeda

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Helpful Links

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)

September 25, 2024

Primary Completion (Estimated)

December 31, 2031

Study Completion (Estimated)

December 31, 2031

Study Registration Dates

First Submitted

July 16, 2024

First Submitted That Met QC Criteria

July 16, 2024

First Posted (Actual)

July 22, 2024

Study Record Updates

Last Update Posted (Actual)

July 24, 2026

Last Update Submitted That Met QC Criteria

July 23, 2026

Last Verified

July 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • TAK-999-5008

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

Takeda provides access to the de-identified individual participant data (IPD) for eligible studies to aid qualified researchers in addressing legitimate scientific objectives (Takeda's data sharing commitment is available on https://clinicaltrials.takeda.com/takedas-commitment?commitment=5). These IPDs will be provided in a secure research environment following approval of a data sharing request, and under the terms of a data sharing agreement.

IPD Sharing Access Criteria

IPD from eligible studies will be shared with qualified researchers according to the criteria and process described on https://vivli.org/ourmember/takeda/. For approved requests, the researchers will be provided access to anonymized data (to respect patient privacy in line with applicable laws and regulations) and with information necessary to address the research objectives under the terms of a data sharing agreement.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP
  • ICF
  • CSR

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

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.

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