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Retrospektivní studie přehledu grafu u pacientů s chronickou dysfunkcí plicního aloštěpu – syndromem obliterující bronchiolitidy (CLAD-BOS) po transplantaci plic

26. srpna 2026 aktualizováno: Zambon SpA
Cílem této studie je popsat pokles usilovného výdechového objemu za 1 sekundu (FEV1) a přirozený vývoj onemocnění u pacientů postižených CLAD-BOS po transplantaci plic a užívajících imunosupresivní léčbu jako standardní péči.

Přehled studie

Postavení

Dokončeno

Podmínky

Detailní popis

Toto je retrospektivní, nadnárodní, multicentrická grafová přehledová studie dospělých pacientů s klinicky diagnostikovaným CLAD-BOS po transplantaci plic. Všechna data budou retrospektivně sbírána ze záznamů pacientů počínaje datem transplantace plic do posledního data dostupných dat, a jako takové nebudou v rámci této studie aplikovány žádné intervence.

Období pozorování pro každého pacienta bude od data transplantace plic do posledního data dostupných údajů nebo úmrtí, podle toho, co nastane dříve, a bude zahrnovat následující časové úseky:

Diagnostické okno: 1. ledna 2013 s nejnovějšími dostupnými údaji.

Typ studie

Pozorovací

Zápis (Aktuální)

284

Kontakty a umístění

Tato část poskytuje kontaktní údaje pro ty, kteří studii provádějí, a informace o tom, kde se tato studie provádí.

Studijní kontakt

Studijní záloha kontaktů

Studijní místa

    • Leuven
      • Leuven, Leuven, Belgie, 3000
        • Universitaire Ziekenhuizen Leuven (UZ Leuven)
    • Ohio
      • Cleveland, Ohio, Spojené státy, 44195
        • Cleveland Clinic Transplantation Center
      • Columbus, Ohio, Spojené státy, 43210
        • The Ohio State University
    • Texas
      • Dallas, Texas, Spojené státy, 75246
        • Baylor Scott and White Health Center for Advanced Heart and Lung Disease
    • Andalusia
      • Córdoba, Andalusia, Španělsko, 14004
        • Hospital Universitario Reina Sofia
    • Cantabria
      • Santander, Cantabria, Španělsko, 39008
        • Hospital Universitario Marques de Valdecilla (HUMV)

Kritéria účasti

Výzkumníci hledají lidi, kteří odpovídají určitému popisu, kterému se říká kritéria způsobilosti. Některé příklady těchto kritérií jsou celkový zdravotní stav osoby nebo předchozí léčba.

Kritéria způsobilosti

Věk způsobilý ke studiu

  • Dospělý
  • Starší dospělý

Přijímá zdravé dobrovolníky

Ne

Metoda odběru vzorků

Ukázka pravděpodobnosti

Studijní populace

Populace studie bude zahrnovat dospělé pacienty ve věku ≥ 18 let, kteří jsou příjemci transplantace plic a u nichž byl diagnostikován CLAD-BOS od prvního ledna 2013 po transplantaci.

Popis

Kritéria pro zařazení:

  1. Dospělí pacienti ve věku ≥ 18 let v den diagnózy CLAD-BOS
  2. Pacienti s diagnózou lékaře CLAD-BOS již od 1. ledna 2013
  3. Pacienti s klinickou diagnózou CLAD-BOS provedenou nejméně 12 měsíců po transplantaci plic
  4. Pacienti dostávali alespoň základní udržovací režim imunosupresivních látek včetně takrolimu, druhé látky, jako je, ale bez omezení, mykofenolát mofetil nebo azathioprin (nebo jiné antiproliferativní činidlo) a systémový kortikosteroid, jako je prednison, jako třetí látka po dobu alespoň 1 měsíce před datem indexu. Dokud bude po výše uvedenou dobu zachován základní udržovací režim, budou pacienti stále považováni za způsobilé pro studii, i když kromě základního udržovacího režimu dostávají další imunosupresiva.

Kritéria vyloučení:

  1. Pacienti se závažným doprovodným onemocněním v době indexu, které podle úsudku lékaře může interferovat s progresí a mortalitou CLAD-BOS (např.
  2. Pacienti, kteří byli v průběhu 4 týdnů před datem indexu nebo během období po diagnóze vystaveni jakémukoli zkoušenému léčivému přípravku
  3. Pacienti s potvrzeným jiným fenotypem CLAD (např. syndrom restriktivního aloštěpu) podle úsudku lékaře.

Studijní plán

Tato část poskytuje podrobnosti o studijním plánu, včetně toho, jak je studie navržena a co studie měří.

Jak je studie koncipována?

Detaily designu

Kohorty a intervence

Skupina / kohorta
CLAD-BOS Cohort
Adult patients with clinically diagnosed chronic lung allograft dysfunction-bronchiolitis obliterans syndrome (CLAD-BOS) following lung transplantation, included in a retrospective observational chart review study. No study-specific interventions were administered.

Co je měření studie?

Primární výstupní opatření

Měření výsledku
Popis opatření
Časové okno
Change Per Year in FEV1 Trajectory Starting From the Onset Date Through the End of the Post-diagnosis Period.
Časové okno: From CLAD-BOS onset up to 3 years post-onset
CLAD-BOS onset was defined as the first occurrence of a forced expiratory volume in 1 second (FEV1) value ≤80% of the patient's post-transplant best FEV1, confirmed by a subsequent measurement ≤80% at least 3 months later, as documented in the medical records. The personal best FEV1 was defined as the mean of the two highest post-transplant FEV1 measurements obtained at least 3 weeks apart, derived from post-transplant spirometry data or identified in clinical records according to physician judgment. The FEV1 value at CLAD-BOS onset served as the baseline for the analysis. Repeated post-onset spirometry measurements collected during routine clinical practice were analyzed using a linear mixed-effects model with random subject-specific effects. Results are reported as model-based estimated mean changes from baseline in FEV1 per year. The reported mean values represent estimates derived from the statistical model.
From CLAD-BOS onset up to 3 years post-onset
Change in FEV1 Trajectory Over Time Starting From the Onset Date Through the End of the Post-diagnosis Period.
Časové okno: From CLAD-BOS onset up to 3 years post-onset
CLAD-BOS onset was defined as the first occurrence of a forced expiratory volume in 1 second (FEV1) value ≤80% of the patient's post-transplant best FEV1, confirmed by a subsequent measurement ≤80% at least 3 months later, as documented in the medical records. The personal best FEV1 was defined as the mean of the two highest post-transplant FEV1 measurements obtained at least 3 weeks apart, derived from post-transplant spirometry data or identified in clinical records according to physician judgment. The FEV1 value at CLAD-BOS onset served as the baseline for the analysis. Repeated post-onset spirometry measurements collected during routine clinical practice were analyzed using a linear mixed-effects model with random subject-specific effects. Results are reported as model-based estimated mean changes from baseline in FEV1 at prespecified time points after onset (1, 2, and 3 years). The reported mean values represent estimates derived from the statistical model.
From CLAD-BOS onset up to 3 years post-onset

Sekundární výstupní opatření

Měření výsledku
Popis opatření
Časové okno
Age at Transplant
Časové okno: At transplant date
This secondary outcome summarizes descriptive characteristics collected at the time of lung transplantation.
At transplant date
Sex at Transplant
Časové okno: At transplant date
This secondary outcome summarizes descriptive characteristics collected at the time of lung transplantation.
At transplant date
Race
Časové okno: At transplant date
This secondary outcome summarizes descriptive characteristics collected at the time of lung transplantation.
At transplant date
Number of Participants With Pre-transplant Medical History and Lung Transplant History
Časové okno: Up to transplant date
This secondary outcome summarizes descriptive characteristics collected at the time of lung transplantation.
Up to transplant date
Time From Lung Transplantation to CLAD-BOS Onset
Časové okno: From transplant date to onset date
This secondary outcome summarizes descriptive characteristics collected at the time of lung transplantation.
From transplant date to onset date
Number of Participants With Clinical Characteristics Following Lung Transplantation (Acute Rejection Events, Presence of Lung Opacities, and Signs, Symptoms, or Other Clinical Records)
Časové okno: From lung transplantation until last date of data available or death. Specifically, from transplantation to CLAD-BOS onset, a median of 40.5 (max 227) months; from CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
Descriptive clinical characteristics collected following lung transplantation in patients diagnosed with CLAD-BOS. Variables included the occurrence of acute rejection events, presence of lung opacities as documented by computed tomography (CT) scans, and signs, symptoms, or other clinical records related to mobility, self-care, usual activities, pain or discomfort, anxiety, and depression. These data were collected for descriptive purposes only.
From lung transplantation until last date of data available or death. Specifically, from transplantation to CLAD-BOS onset, a median of 40.5 (max 227) months; from CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
Percentage of Participants by Donor-specific Antibodies Results
Časové okno: From lung transplantation until last date of data available or death. Specifically, from transplantation to CLAD-BOS onset, a median of 40.5 (max 227) months; from CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
Descriptive clinical characteristics collected following lung transplantation in patients diagnosed with CLAD-BOS. Presence of donor-specific antibodies. These data were collected for descriptive purposes only.
From lung transplantation until last date of data available or death. Specifically, from transplantation to CLAD-BOS onset, a median of 40.5 (max 227) months; from CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
Total Lung Capacity (Plethysmography)
Časové okno: From lung transplantation until last date of data available or death. Specifically, from transplantation to CLAD-BOS onset, a median of 40.5 (max 227) months; from CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months

Descriptive clinical characteristics collected following lung transplantation in patients diagnosed with CLAD-BOS. These data were collected for descriptive purposes only.

All available plethysmography assessments after lung transplantation were considered; therefore, data from multiple time points were collected and presented as mean and standard deviation.

From lung transplantation until last date of data available or death. Specifically, from transplantation to CLAD-BOS onset, a median of 40.5 (max 227) months; from CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
Change Per Year in FVC Trajectory
Časové okno: From CLAD-BOS onset up to 3 years post-onset
Change in Forced vital capacity (FVC) were evaluated from CLAD-BOS onset through the end of the post-diagnosis period. CLAD-BOS onset was defined as the first occurrence of a forced expiratory volume in 1 second (FEV1) value ≤80% of the patient's post-transplant best FEV1, confirmed by a subsequent measurement at least 3 months later. The FVC value at CLAD-BOS onset served as the baseline for the analysis. Repeated post-onset spirometry measurements collected during routine clinical practice were analyzed using a linear mixed-effects model with random subject-specific effects to account for within-subject correlation over time. Results are reported as model-based estimated mean changes from baseline in FVC per year. The reported mean values represent estimates derived from the statistical model.
From CLAD-BOS onset up to 3 years post-onset
Change in FVC Trajectory Over Time
Časové okno: From CLAD-BOS onset up to 3 years post-onset
Change in Forced vital capacity (FVC) were evaluated from CLAD-BOS onset through the end of the post-diagnosis period. CLAD-BOS onset was defined as the first occurrence of a forced expiratory volume in 1 second (FEV1) value ≤80% of the patient's post-transplant best FEV1, confirmed by a subsequent measurement at least 3 months later. The FVC value at CLAD-BOS onset served as the baseline for the analysis. Repeated post-onset spirometry measurements collected during routine clinical practice were analyzed using a linear mixed-effects model with random subject-specific effects to account for within-subject correlation over time. Model-based estimates of mean change from baseline in FVC (absolute values) are reported at prespecified time points after onset (1, 2, and 3 years). The reported mean values represent estimates derived from the statistical model and are accompanied by standard errors.
From CLAD-BOS onset up to 3 years post-onset
Change Per Year in FEV1/FVC Trajectory
Časové okno: From CLAD-BOS onset up to 3 years post-onset

Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were measured by spirometry, and the FEV1/FVC ratio was derived accordingly. CLAD-BOS onset was defined as the first occurrence of an FEV1 value ≤80% of the patient's post-transplant best FEV1, confirmed by a subsequent measurement at least 3 months later, as documented in the medical records.

The FEV1/FVC value at CLAD-BOS onset served as the baseline for the analysis. Repeated post-onset spirometry measurements collected during routine clinical practice were analyzed using a linear mixed-effects model with random subject-specific effects to account for within-subject correlation over time.

Results are reported as model-based estimated mean changes from baseline in FEV1/FVC per year. The reported mean values represent estimates derived from the statistical model.

From CLAD-BOS onset up to 3 years post-onset
Change in FEV1/FVC Trajectory Over Time
Časové okno: From CLAD-BOS onset up to 3 years post-onset

Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were measured by spirometry, and the FEV1/FVC ratio was derived accordingly. CLAD-BOS onset was defined as the first occurrence of an FEV1 value ≤80% of the patient's post-transplant best FEV1, confirmed by a subsequent measurement at least 3 months later, as documented in the medical records.

The FEV1/FVC value at CLAD-BOS onset served as the baseline for the analysis. Repeated post-onset spirometry measurements collected during routine clinical practice were analyzed using a linear mixed-effects model with random subject-specific effects to account for within-subject correlation over time.

Results are reported as model-based estimated mean changes from baseline in FEV1/FVC at prespecified time points after onset (1, 2, and 3 years). The reported mean values represent estimates derived from the statistical model, rather than arithmetic means of observed measurements.

From CLAD-BOS onset up to 3 years post-onset
Change in FEF25-75% Trajectory Over Time
Časové okno: From CLAD-BOS onset up to 3 years post-onset

Change from baseline in Forced mid-expiratory flow (FEF25-75%), expressed as liters per second (L/s), was evaluated to characterize changes in mid-expiratory airflow following CLAD-BOS onset. CLAD-BOS onset was defined as the first occurrence of an FEV1 value ≤80% of the patient's post-transplant best FEV1, confirmed by a subsequent measurement.

Repeated post-onset spirometry measurements collected during routine clinical practice were analyzed using a linear mixed-effects model with random subject-specific effects to account for within-subject correlation over time. Due to non-normal distribution, FEF25-75% values were log-transformed for model fitting. Model-based estimates of mean change from baseline on the original scale are reported at prespecified follow-up time points (at 1, 2 and 3 years).

The reported values represent estimates derived from the statistical model rather than arithmetic means of observed measurements.

From CLAD-BOS onset up to 3 years post-onset
Overall Survival (OS) From CLAD-BOS Onset
Časové okno: From CLAD-BOS onset through death, up to 120 months
Overall survival (OS) was defined as the time from CLAD-BOS onset to death from any cause. OS was calculated as the time from the CLAD-BOS onset date to the earliest of the date of death or the last date the patient was known to be alive, expressed in months using a conversion factor of 30.4375 days per month. Patients who were alive or had unknown vital status at the time of data abstraction were censored at the last date they were known to be alive. Median OS and corresponding 95% confidence intervals were estimated using the Kaplan-Meier method, with confidence intervals calculated using the log-log transformation.
From CLAD-BOS onset through death, up to 120 months
Time to First CLAD-BOS Progression
Časové okno: From CLAD-BOS onset through death (median follow up time 38.6 months)

Time to first CLAD-BOS progression was defined as the time from CLAD-BOS onset to the first documented disease progression.

Progression was defined as the earliest occurrence of any of the following events:

  • an absolute decrease in FEV1 of ≥10% or ≥200 mL from a previously available spirometry assessment with a concomitant absolute decrease in FEV1/FVC of >5% confirmed at least 2 weeks apart;
  • change in CLAD grade severity;
  • re-transplantation;
  • death from respiratory failure;
  • or clinical judgment reporting CLAD-BOS progression in medical records. Patients without documented CLAD-BOS progression at the time of data abstraction were censored at the date of the last available assessment.

Median time to progression and 95% confidence intervals were estimated using the Kaplan-Meier method.

From CLAD-BOS onset through death (median follow up time 38.6 months)
Cumulative Number of CLAD-BOS Progression Events Per Patient
Časové okno: From CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
Cumulative CLAD-BOS progression events were assessed from CLAD-BOS onset through the end of the post-diagnosis follow-up period. CLAD-BOS progression was defined as the earliest occurrence of an absolute decrease in FEV1 of ≥10% or ≥200 mL combined with an absolute decrease in FEV1/FVC of >5% confirmed by a subsequent assessment, change in CLAD grade severity, re-transplantation, death from respiratory failure, or clinical judgment reporting CLAD-BOS progression in patient records. Event counts and rates were analyzed using a negative binomial regression model with an offset for follow-up time.
From CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
Hospitalization Rate Due to Respiratory Failure
Časové okno: From CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
The rate of hospitalizations due to respiratory failure was assessed from the CLAD-BOS onset date through the end of the post-diagnosis period. Hospitalization events attributed to respiratory failure were identified from patient medical records. Event rates were estimated using a negative binomial regression model with an offset for patient observation time to account for variable observation duration. Results are reported as rates per year with 95% confidence intervals.
From CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
Number of Participants With Newly Diagnosed Cases of Concomitant Respiratory Diseases
Časové okno: From CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months

The number of participants with concomitant respiratory diseases was assessed in the Full Analysis Set. Concomitant respiratory diseases were identified from patient records and coded using MedDRA (version 27.0) terminology. Results are summarized as the number and percentage of patients with at least one concomitant respiratory disease.

Only concomitant respiratory disease categories reported in ≥ 5% of patients are presented.

From CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
Concomitant Treatments and Procedures for CLAD-BOS Starting From the Post-transplant Date Through the End of the Post-diagnosis Period
Časové okno: From lung transplantation until last date of data available or death. Specifically, from transplantation to CLAD-BOS onset, a median of 40.5 (max 227) months; from CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months

The use of concomitant treatments and procedures for CLAD-BOS following lung transplantation was assessed in the Full Analysis Set based on medical record review.

Concomitant treatments and procedures were defined as those administered or performed after CLAD-BOS onset.

Results are reported as the number and percentage of patients receiving at least one concomitant treatment or procedure. Concomitant treatments were coded using WHO Drug Dictionary terminology (version March 2024), and procedures were summarized descriptively.

Only treatments and procedures reported in ≥ 5% of patients are presented.

From lung transplantation until last date of data available or death. Specifically, from transplantation to CLAD-BOS onset, a median of 40.5 (max 227) months; from CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
Number of Participants With Newly Diagnosed Cases of Concomitant Non-respiratory Diseases
Časové okno: From CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
The number of participants with concomitant non-respiratory diseases was assessed in the Full Analysis Set based on medical record review. Concomitant non-respiratory diseases were coded using MedDRA (version 27.0) preferred terms and summarized descriptively. Results are reported as the number and percentage of patients with at least one concomitant non-respiratory disease. Only non-respiratory disease categories reported in ≥ 5% of patients are presented.
From CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months

Spolupracovníci a vyšetřovatelé

Zde najdete lidi a organizace zapojené do této studie.

Sponzor

Vyšetřovatelé

  • Ředitel studie: Paola Castellani, MD, Zambon SpA

Termíny studijních záznamů

Tato data sledují průběh záznamů studie a předkládání souhrnných výsledků na ClinicalTrials.gov. Záznamy ze studií a hlášené výsledky jsou před zveřejněním na veřejné webové stránce přezkoumány Národní lékařskou knihovnou (NLM), aby se ujistily, že splňují specifické standardy kontroly kvality.

Hlavní termíny studia

Začátek studia (Aktuální)

27. června 2024

Primární dokončení (Aktuální)

9. dubna 2025

Dokončení studie (Aktuální)

9. dubna 2025

Termíny zápisu do studia

První předloženo

8. července 2024

První předloženo, které splnilo kritéria kontroly kvality

15. července 2024

První zveřejněno (Aktuální)

16. července 2024

Aktualizace studijních záznamů

Poslední zveřejněná aktualizace (Aktuální)

1. září 2026

Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality

26. srpna 2026

Naposledy ověřeno

1. srpna 2026

Více informací

Termíny související s touto studií

Další identifikační čísla studie

  • Z8000N01

Plán pro data jednotlivých účastníků (IPD)

Plánujete sdílet data jednotlivých účastníků (IPD)?

NE

Informace o lécích a zařízeních, studijní dokumenty

Studuje lékový produkt regulovaný americkým FDA

Ne

Studuje produkt zařízení regulovaný americkým úřadem FDA

Ne

produkt vyrobený a vyvážený z USA

Ne

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