Development of a Prediction Score for the Occurrence of Death or Lung Transplantation in Patients With Emphysema Secondary to Alpha-1-anti-tripsin Deficiency (FLARE)
Emphysema linked to alpha-1-antitrypsin deficiency (DAAT): towards a better prediction of risks Emphysema caused by alpha-1-antitrypsin deficiency (DAAT) is a rare genetic disorder that can lead to serious complications, such as the need for a lung transplant or death, affecting up to 15% of patients. The only specific treatment available is a weekly infusion of alpha-1-antitrypsin (IV-AAT), an expensive and burdensome therapy.
Currently, there is no reliable model to predict the course of the disease in these patients. Our study, conducted in several French hospitals, aims to develop a prediction tool combining clinical, biological, functional data and advanced medical image analysis (lung CT). This model will make it possible to identify the most at-risk patients, in order to better adapt their care, anticipate transplant needs and avoid unnecessary treatments for low-risk patients.
Ultimately, this approach could also improve access to care for patients who need it most, while optimizing health system resources.
Panoramica dello studio
Stato
Descrizione dettagliata
Context. Emphysema secondary to alpha-1-anti-trypsin deficiency (AATD) is a genetic rare disease, but with pejorative events such as death or lung transplantation (LT) which affect up to 15% of patients. Aside from standard medical care for COPD management, the only specific treatment as augmentation therapy for severe AATD, is weekly intravenous alpha-1 antitrypsin (IV-AAT) which is still expensive and restrictive. Several prognostic scores for tobacco-related COPD have been developed but, none of them have been validated in AATD, neither have included quantitative chest CT imaging while they have been associated with mortality in emphysema. Therefore, we aim to develop a prediction model combining clinical, biological, functional and quantitative CT data (including radiomics) for mortality or LT to identify at-risk patients with emphysema secondary to AATD.
Methods: From several French hospitals, we'll conduct a multicenter retrospective study based on data collected in usual care among patients over 18-year-old, with an available chest CT. We'll collect clinical data (BMI, mMRC dyspnea scale), respiratory function parameters and quantitative imaging data (including radiomics) from the initial CT from AATD patients secondary to ZZ, Znull, ZMalton, Z and rare mutations. We'll then validate our results on an independent external database from the European AADT cohort (EARCO), with specific dedicated funding.
Perspectives: To develop a prediction model to identify the AATD patients at risk of clinical deterioration, defined by death or LT allowing for personalized care, in order to: 1. anticipate registration on the transplant list, 2. optimize overall management, including pharmacological (IV-AAT) and non-pharmacological management. 3. to avoid cost-prohibitive and constraining IV-AAT infusion for low risk patients For Health policy, finding a way to target high-risk patients may help a better access for IV-AAT to appropriate individuals.
Tipo di studio
Iscrizione (Stimato)
Contatti e Sedi
Contatto studio
- Nome: Maéva ZYSMAN, MD, PhD
- Numero di telefono: +335 57 65 63 38
- Email: maeva.zysma@chu-bordeaux.fr
Backup dei contatti dello studio
- Nome: Margot GENAUD
- Numero di telefono: +335 25 35 21 94
- Email: margot.genaud@chu-bordeaux.fr
Luoghi di studio
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Bron, Francia, 69677
- Reclutamento
- Hospices Civils de Lyon
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Contatto:
- Jean-Francois MORNEX, MD, PhD
- Numero di telefono: +334 72 11 80 17
- Email: jean-francois.mornex@univ-lyon1.fr
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Investigatore principale:
- Jean-Francois MORNEX, MD, PhD
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Lille, Francia, 59000
- Reclutamento
- CHU de Lille
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Contatto:
- Olivier LE ROUZIC, MD, PhD
- Numero di telefono: +333 20 16 05 30
- Email: Olivier.LEROUZIC@chu-lille.fr
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Investigatore principale:
- Olivier LE ROUZIC, MD, PhD
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Paris, Francia, 75018
- Reclutamento
- Hopital Bichat Claude-Bernard
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Contatto:
- Vincent BUNEL GOURDY, MD
- Numero di telefono: +331 40 25 61 01
- Email: vincent.bunel@aphp.fr
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Investigatore principale:
- Vincent BUNEL GOURDY, MD
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Pessac, Francia, 33600
- Reclutamento
- Bordeaux University Hospital
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Contatto:
- Maéva ZYSMAN, MD, PhD
- Numero di telefono: +335 57 65 63 38
- Email: maeva.zysma@chu-bordeaux.fr
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Contatto:
- Margot GENAUD
- Numero di telefono: +335 25 35 21 94
- Email: margot.genaud@chu-bordeaux.fr
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Investigatore principale:
- Maéva ZYSMAN, MD,PhD
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Criteri di partecipazione
Criteri di ammissibilità
Età idonea allo studio
- Adulto
- Adulto più anziano
Accetta volontari sani
Metodo di campionamento
Popolazione di studio
Descrizione
Inclusion criteria:
- diagnosed between 2010 and 2025
- in the pulmonology department
- diagnosis of emphysema and COPD secondary to alpha-1 antitrypsin deficiency ZZ, Znull, ZMalton, Z and rare mutations,
- emphysema according to the initial thoracic CT scan (+/- 12 months after diagnosis).
Exclusion criteria:
- Age <18 years
- Patient opposed to the use of their data for research purposes
- Patient deprived of liberty by judicial decision
- Patient not affiliated with a social security scheme
- no CT scan available
- no lung function test available the year around CT scan
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
Coorti e interventi
Gruppo / Coorte |
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Emphysema secondary to alpha-1-anti-trypsin deficiency (AATD)
The subjects included will be any patients followed and diagnosed between 2010 and 2025 in the pulmonology department for emphysema and COPD secondary to alpha-1 antitrypsin deficiency ZZ, Znull, ZMalton, Z and rare mutations, based on the diagnosis of emphysema made from an initial thoracic CT scan (+/- 12 months after diagnosis).
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Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
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Evaluation of vital status
Lasso di tempo: 5 years
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Death within 5 years of emphysema diagnosis.
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5 years
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Evaluation of transplantation status
Lasso di tempo: 5 years
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Lung transplantation within 5 years of emphysema diagnosis.
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5 years
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Collaboratori e investigatori
Sponsor
Pubblicazioni e link utili
Pubblicazioni generali
- McElvaney NG, Burdon J, Holmes M, Glanville A, Wark PA, Thompson PJ, Hernandez P, Chlumsky J, Teschler H, Ficker JH, Seersholm N, Altraja A, Makitaro R, Chorostowska-Wynimko J, Sanak M, Stoicescu PI, Piitulainen E, Vit O, Wencker M, Tortorici MA, Fries M, Edelman JM, Chapman KR; RAPID Extension Trial Group. Long-term efficacy and safety of alpha1 proteinase inhibitor treatment for emphysema caused by severe alpha1 antitrypsin deficiency: an open-label extension trial (RAPID-OLE). Lancet Respir Med. 2017 Jan;5(1):51-60. doi: 10.1016/S2213-2600(16)30430-1. Epub 2016 Dec 2.
- Ho ESY, Ellis PR, Kavanagh D, Subramanian D, Stockley RA, Turner AM. Proposal and Validation of the Minimum Clinically Important Difference in Emphysema Progression. Chronic Obstr Pulm Dis. 2025 Mar 27;12(2):109-116. doi: 10.15326/jcopdf.2024.0511.
- Stolk J, Stockley RA, Piitulainen E, Stoel BC. Relationship between Change in Lung Density and Long-Term Progression of Lung Function. Am J Respir Crit Care Med. 2015 Jul 1;192(1):114-6. doi: 10.1164/rccm.201502-0370LE. No abstract available.
- Sieluk J, Levy J, Sandhaus RA, Silverman H, Holm KE, Mullins CD. Costs of Medical Care Among Augmentation Therapy Users and Non-Users with Alpha-1 Antitrypsin Deficiency in the United States. Chronic Obstr Pulm Dis. 2018 Nov 8;6(1):6-16. doi: 10.15326/jcopdf.6.1.2017.0187.
- Gildea TR, Shermock KM, Singer ME, Stoller JK. Cost-effectiveness analysis of augmentation therapy for severe alpha1-antitrypsin deficiency. Am J Respir Crit Care Med. 2003 May 15;167(10):1387-92. doi: 10.1164/rccm.200209-1035OC. Epub 2003 Feb 5.
- Fraughen DD, Ghosh AJ, Hobbs BD, Funk GC, Meischl T, Clarenbach CF, Sievi NA, Schmid-Scherzer K, McElvaney OJ, Murphy MP, Roche AD, Clarke L, Strand M, Vafai-Tabrizi F, Kelly G, Gunaratnam C, Carroll TP, McElvaney NG. Augmentation Therapy for Severe Alpha-1 Antitrypsin Deficiency Improves Survival and Is Decoupled from Spirometric Decline-A Multinational Registry Analysis. Am J Respir Crit Care Med. 2023 Nov 1;208(9):964-974. doi: 10.1164/rccm.202305-0863OC.
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Maggiori informazioni
Termini relativi a questo studio
Termini MeSH pertinenti aggiuntivi
- Processi patologici
- Malattie genetiche, congenite
- Malattie delle vie respiratorie
- Malattie dell'apparato digerente
- Malattie polmonari
- Malattie del fegato
- Enfisema sottocutaneo
- Malattie e anomalie congenite, ereditarie e neonatali
- Condizioni patologiche, segni e sintomi
- Enfisema
- carenza di alfa 1-antitripsina
Altri numeri di identificazione dello studio
- CHUBX 2024/85
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