Carpal Tunnel Syndrome Clinical Trial
— LOCUSOfficial title:
A Multicenter Observational Retrospective-prospective Study of Prevalence, Clinical Characteristics of Hereditary Transthyretin Amyloidosis Polyneuropathy in Russian Patients Undergoing Surgery for CTS in Real Clinical Practice
This is a multicenter observational study consisting of retrospective and prospective phases. The retrospective phase will entail secondary data collection from electronic or paper medical records of patients who underwent surgery for CTS to assess their probability of having ATTR PN.
Status | Recruiting |
Enrollment | 880 |
Est. completion date | December 31, 2024 |
Est. primary completion date | December 31, 2024 |
Accepts healthy volunteers | No |
Gender | All |
Age group | N/A and older |
Eligibility | Inclusion Criteria: for the retrospective phase are: 1. Patients with the established diagnosis of CTS undergoing surgical intervention between the 1st January 2021 and the 1st September 2024. 2. Age = 18 years at the time of surgery. Additional inclusion criteria for the prospective phase are: 3. Provided written informed consent for the prospective phase of the study (including molecular genetic testing). 4. Bilateral CTS; 5. Presence of =1 of the following features (red flags): 1. CIDP or polyneuropathy of unknown etiology in the family history; 2. Spinal canal stenosis of the lumbar region; 3. Autonomic dysfunction, defined by the presence of =1 of the following symptoms: i. gastrointestinal complaints (constipation, chronic diarrhea, or both); ii. erectile dysfunction; iii. orthostatic hypotension; 4. Gait disorders; 5. Sweating disorders, anhidrosis. 6. Paresthesia and burning of the skin of the distal extremities 7. Distal symmetrical paresis 8. Hypotrophy and hypotension of limb muscles, areflexia 9. Biceps tendon rupture 10. Aortic valve stenosis 11. Diagnosis of HFpEF 12. Unexplained weight loss =5 kilos at any timepoint since the onset of symptoms of CTS; 13. Left ventricular hypertrophy (based on electro- or echocardiographic criteria documented in the patient's medical record); 14. Heart rhythm disorders; 15. Renal abnormalities, defined by =1 of the following features - i. documented diagnosis of chronic kidney disease (CKD); ii. decreased estimated glomerular filtration rate (eGFR <60 mL/min/1.73m2); iii. increased serum creatinine (SCr) above reference range of the local laboratory; iv. albuminuria (=30 mg/g of creatinine or =30 mg/24h ); v. proteinuria (according to urinalysis results). 16. Ophthalmology disorder defined by =1 of the following features - i. vitreous body inclusions (opacification); ii. Glaucoma; iii. pupillary disorders; iv. vitrectomy 6. Absence of previously established ATTR PN diagnosis (ICD-10 code ?85.1, "Neuropathic hereditary familial amyloidosis"). Exclusion Criteria: for the retrospective phase are: 1. Participation in any interventional trial within the period since surgical intervention until the end of current study. Additional exclusion criteria for the prospective phase are: 2. Previously performed TTR genetic testing; 3. Verified B12 deficiency; 4. History of alcohol abuse according to the patient's medical record. |
Country | Name | City | State |
---|---|---|---|
Russian Federation | Research Site | Moscow | |
Russian Federation | Research Site | Saint-Petersburg |
Lead Sponsor | Collaborator |
---|---|
AstraZeneca |
Russian Federation,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | To define the prevalence of ATTR PN in patients undergoing surgery for CTS in routine clinical practice in the Russian Federation | In order to achieve primary objective, the proportion of patients with confirmed diagnosis of ATTR PN (presence of TTR gene mutation according to the results of molecular genetic testing and clinical symptoms and/or signs of polyneuropathy) among those who underwent surgery for CTS will be calculated. | Up to 12 months | |
Secondary | To assess general demographic characteristics of patients with ATTR PN in Russia - Mean age (years) at the onset of CTS symptoms | up to 12 months | ||
Secondary | To assess general demographic characteristics of patients with ATTR PN in Russia: Mean age (years) at the onset of polyneuropathy symptoms | up to 12 months | ||
Secondary | to assess general demographic characteristics of patients with ATTR PN in Russia: Proportion of patients with late (>50 years) diagnosis of ATTR PN | up to 12 months | ||
Secondary | to assess general demographic characteristics of patients with ATTR PN in Russia: Mean age (years) at the time of CTS surgery | up to 12 months | ||
Secondary | to assess general demographic and clinical characteristics of patients with ATTR PN in Russia - Number and proportion of patients with specific characteristic of index CTS download | Left hand;
Right hand; Both hands; First procedure; Second and later procedures |
up to 12 months | |
Secondary | to assess general demographic and clinical characteristics of patients with ATTR PN in Russia: Proportion of patients with CTS recurrence after surgery | up to 12 months | ||
Secondary | to assess general demographic and clinical characteristics of patients with ATTR PN in Russia: Proportion of patients undergoing repeat surgery for CTS after the index operation | up to 12 months | ||
Secondary | to assess general demographic and clinical characteristics of patients with ATTR PN in Russia: Proportion of patients with PN progression after surgery | up to 12 months | ||
Secondary | to assess general demographic and clinical characteristics of patients with ATTR PN in Russia - Proportion of patients with different number of red flags: | 1 red flag;
2 red flags; 3 red flags; 4-5 red flags; 6-10 red flags; >10 red flags; |
up to 12 months | |
Secondary | to assess general demographic and clinical characteristics of patients with ATTR PN in Russia: Mean age (years) at ATTR PN diagnosis | up to 12 months | ||
Secondary | to assess general demographic and clinical characteristics of patients with ATTR PN in Russia: Proportion of women and men | up to 12 months | ||
Secondary | to assess general demographic and clinical characteristics of patients with ATTR PN in Russia - Mean body mass index (BMI) and proportion of patients with different BMI dimensions at the time of surgery and at Visit 1: | Underweight (BMI <18.5 kg/m2);
Normal weight (BMI =18.5 and <25 kg/m2); Overweight (BMI =25 and <30 kg/m2); Obesity (BMI =30 kg/m2) |
up to 12 months | |
Secondary | to assess general demographic and clinical characteristics of patients with ATTR PN in Russia: Proportion of patients with a history of unexplained weight loss (=5 kg) at any point since symptom onset | up to 12 months | ||
Secondary | to assess general demographic and clinical characteristics of patients with ATTR PN in Russia: Mean and median time from CTS symptom onset (months) to ATTR PN diagnosis | up to 12 months | ||
Secondary | To assess general demographic and clinical characteristics of patients with ATTR PN in Russia: Median number of physicians seen since symptom onset before the correct ATTR PN diagnosis | up to 12 months | ||
Secondary | To assess general demographic and clinical characteristics of patients with ATTR PN in Russia: Median number of hospitalizations for PN before the correct ATTR PN diagnosis | up to 12 months | ||
Secondary | to assess general demographic and clinical characteristics of patients with ATTR PN in Russia - Number of patients with previously established incorrect diagnosis according to medical records, specifically with: | CIDP;
Lumbar/sacral radiculopathy; Lumbar canal stenosis; Paraproteinaemic peripheral neuropathy; Chronic progressive sensory/sensorimotor axonal idiopathic PN; AL amyloidosis; Fibromyalgia; Other (specify) |
up to 12 months | |
Secondary | To describe data on the presence of cardiovascular, neurological and other comorbidities in Russian patients with ATTR PN: Proportion of patients with family history of neuropathic disease | up to 12 months | ||
Secondary | To describe data on the presence of cardiovascular, neurological and other comorbidities in Russian patients with ATTR PN: Proportion of patients with specific peripheral neurological manifestations: | Neuropathic pain (allodynia, hyperalgesia);
Progressive sensory disturbances (loss of temperature, pain, other sensation); Paresthesia, dysesthesia; Progressive motor disturbances; Walking difficulty, gait disorder; Balance disorder |
up to 12 months | |
Secondary | To describe data on the presence of cardiovascular, neurological and other comorbidities in Russian patients with ATTR PN: Proportion of patients with specific Polyneuropathy Disability (PND) classes: | 0;
I; II; IIIA; IIIB; IV; |
up to 12 months | |
Secondary | To describe data on the presence of cardiovascular, neurological and other comorbidities in Russian patients with ATTR PN - Proportion of patients with specific distribution of polyneuropathy symptoms: | Upper-limb;
Lower-limb; Both upper-limb and lower-limb |
up to 12 months | |
Secondary | To describe data on the presence of cardiovascular, neurological and other comorbidities in Russian patients with ATTR PN - Number of patients with autonomic neurological manifestations, including specifically: | Orthostatic hypotension;
Syncope; Gastrointestinal motility disorders - i. Constipation; ii. Early satiety; iii. Diarrhea; iv. Nausea, vomiting; Erectile dysfunction; Neurogenic bladder; Recurrent urinary infections; Anhidrosis; |
up to 12 months | |
Secondary | To describe data on the presence of cardiovascular, neurological and other comorbidities in Russian patients with ATTR PN - Number of patients with concomitant cardiac manifestations, including specifically: | Left ventricular hypertrophy;
Left bundle branch block; Atrioventricular block; Heart failure with preserved ejection fraction; Elevated serum N-terminal-proB-type natriuretic peptide (NT-proBNP) concentration; Cardiac valve stenosis; Cardiac valve regurgitation; Tachyarrhythmia; Other (specify); None; |
up to 12 months | |
Secondary | Number of patients taking specific groups of cardiovascular medications at the time of CTS surgery and at the time of prospective visit: | Angiotensin converting enzyme inhibitor (ACEI) (specify);
Angiotensin receptor blocker (ARB) (specify); Angiotensin receptor and neprilysin inhibitor (ARNI); Sodium-glucose transporter type 2 inhibitor (SGLT2i) (specify); Mineralocorticoid receptor antagonist (MRA) (specify); Beta-blocker (specify); Diuretic (specify); Other cardiovascular (CV) medications (specify); Other (specify); |
up to 12 months | |
Secondary | To describe data on the presence of cardiovascular, neurological and other comorbidities in Russian patients with ATTR PN - Number of patients with concomitant ophthalmologic manifestations, including specifically | Vitreous body inclusions (opacification);
Glaucoma; Abnormal conjunctival vessels; Papillary abnormalities; Dry eye; Other (specify); |
up to 12 months | |
Secondary | To describe data on the presence of cardiovascular, neurological and other comorbidities in Russian patients with ATTR PN - Number of patients with concomitant musculoskeletal manifestations, including specifically: | Spinal stenosis;
Osteoarthritis, including hip and knee arthroplasty; Trigger finger; Charcot's joints; Biceps tendon rupture; Rotator cuff injury; Other (specify); |
up to 12 months | |
Secondary | Mean and median serum NT-proBNP (pg/ml) concentration | up to 12 months | ||
Secondary | Proportion of patients with laboratory confirmed paraproteinemia | up to 12 months | ||
Secondary | Mean and median urine albumin-creatinine ratio (UACR, mg/g of creatinine) | up to 12 months | ||
Secondary | Proportion of patients with diagnosed CKD, including specifically | Stage C1;
Stage C2; Stage C3a; Stage C3b; Stage C4; Stage C5; |
up to 12 months | |
Secondary | Number of patients with concomitant renal dysfunction, including specifically | Elevated SCr level (based on the local laboratory reference range);
Decreased eGFR (<60 ml/min/1.73m2); Presence of albuminuria (=30 mg/g creatinine (=30 mg/g of creatinine or =30 mg/24h); Presence of proteinuria (according to urinalysis results); Ultrasound signs of amyloid nephropathy; |
up to 12 months | |
Secondary | Number of patients with confirmed length-dependent peripheral sensory-motor neuropathy based on NCS results | up to 12 months | ||
Secondary | Mean and median measured peripheral sensory nerve conduction velocities | Left Medial;
Left Ulnar; Left Sural; Right Medial; Right Ulnar; Right Sural; |
up to 12 months | |
Secondary | Number of patients with reduced peripheral sensory nerve conduction velocity at =1 site | up to 12 months | ||
Secondary | Mean and median measured peripheral motor nerve conduction velocities | Left Medial;
Left Ulnar; Left Tibial; Left Peroneal; Right Medial; Right Ulnar; Right Tibial; Right Peroneal; |
up to 12 months | |
Secondary | Number of patients with reduced motor sensory nerve conduction velocity at =1 site | up to 12 months | ||
Secondary | Mean and median measured sensory action potential (SAP) amplitudes | Left Medial;
Left Ulnar; Left Sural; Right Medial; Right Ulnar; Right Sural |
up to 12 months | |
Secondary | Number of patients with reduced/absent SAP amplitude at =1 site | up to 12 months | ||
Secondary | Mean and median measured distal compound muscle action potential (dCMAP) amplitudes | Left Medial;
Left Ulnar; Left Tibial; Left Peroneal; Right Medial; Right Ulnar; Right Tibial; Right Peroneal |
up to 12 months | |
Secondary | Mean and median measured proximal compound muscle action potential (pCMAP) amplitudes | Left Medial;
Left Ulnar; Left Tibial; Left Peroneal; Right Medial; Right Ulnar; Right Tibial; Right Peroneal |
up to 12 months | |
Secondary | Number of patients with reduced/absent dCMAP amplitude at =1 site | up to 12 months | ||
Secondary | Number of patients with reduced/absent pCMAP amplitude at =1 site | up to 12 months | ||
Secondary | Proportion of patients with each score by each parameter of neurological examination | up to 12 months | ||
Secondary | Number of patients in the specific categories of the modified Rankin scale | Score 1 (no significant disability);
Score 2 (slight disability); Score 3 (moderate disability); Score 4 (moderately severe disability); Score 5 (severe disability); |
up to 12 months | |
Secondary | Proportion of patients with specific number of points according to Inflammatory Neuropathy Cause and Treatment (INCAT) upper extremity scale | 0 points;
1 point; 2 points; 3 points; 4 points; 5 points |
up to 12 months | |
Secondary | Median number of points according to INCAT upper extremity scale | up to 12 months | ||
Secondary | Proportion of patients with specific number of points according to INCAT lower extremity scale | 0 points;
1 point; 2 points; 3 points; 4 points; 5 points |
up to 12 months | |
Secondary | Median number of points according to INCAT lower extremity scale | up to 12 months | ||
Secondary | Mean and median number of points according to combined clinical and electrophysiological score | up to 12 months | ||
Secondary | To describe data on the results of genetic testing for ATTR in CTS patients undergoing surgery:Number and proportion of patients with specific TTR gene mutations | Val30Met;
Ile107Val; Phe33Leu; Ala81Val; Ser23Asn; Ala25Thr; Val32Ala; Thr40Asn; Gly47Ala; Glu54Gln; Tyr69Phe; Glu92Lys; Thr119Met; Other |
up to 12 months | |
Secondary | to assess general demographic and clinical characteristics of patients with ATTR PN in Russia - Proportion of patients with previously established incorrect diagnosis according to medical records, specifically with: | CIDP;
Lumbar/sacral radiculopathy; Lumbar canal stenosis; Paraproteinaemic peripheral neuropathy; Chronic progressive sensory/sensorimotor axonal idiopathic PN; AL amyloidosis; Fibromyalgia; Other (specify); |
up to 12 months | |
Secondary | To describe data on the presence of cardiovascular, neurological and other comorbidities in Russian patients with ATTR PN - proportion of patients with autonomic neurological manifestations, including specifically: | manifestations, including specifically:
Orthostatic hypotension; Syncope; Gastrointestinal motility disorders - i. Constipation; ii. Early satiety; iii. Diarrhea; iv. Nausea, vomiting; Erectile dysfunction; Neurogenic bladder; Recurrent urinary infections; Anhidrosis; |
up to 12 months | |
Secondary | To describe data on the presence of cardiovascular, neurological and other comorbidities in Russian patients with ATTR PN - proportion of patients with concomitant cardiac manifestations, including specifically: | Left ventricular hypertrophy;
Left bundle branch block; Atrioventricular block; Heart failure with preserved ejection fraction; Elevated serum N-terminal-proB-type natriuretic peptide (NT-proBNP) concentration; Cardiac valve stenosis; Cardiac valve regurgitation; Tachyarrhythmia; Other (specify); None; |
up to 12 months | |
Secondary | proportion of patients taking specific groups of cardiovascular medications at the time of CTS surgery and at the time of prospective visit: | Angiotensin converting enzyme inhibitor (ACEI) (specify);
Angiotensin receptor blocker (ARB) (specify); Angiotensin receptor and neprilysin inhibitor (ARNI); Sodium-glucose transporter type 2 inhibitor (SGLT2i) (specify); Mineralocorticoid receptor antagonist (MRA) (specify); Beta-blocker (specify); Diuretic (specify); Other cardiovascular (CV) medications (specify); Other (specify); |
up to 12 months | |
Secondary | To describe data on the presence of cardiovascular, neurological and other comorbidities in Russian patients with ATTR PN - proportion of patients with concomitant ophthalmologic manifestations, including specifically | Vitreous body inclusions (opacification);
Glaucoma; Abnormal conjunctival vessels; Papillary abnormalities; Dry eye; Other (specify); |
up to 12 months | |
Secondary | To describe data on the presence of cardiovascular, neurological and other comorbidities in Russian patients with ATTR PN - proportion of patients with concomitant musculoskeletal manifestations, including specifically: | Spinal stenosis;
Osteoarthritis, including hip and knee arthroplasty; Trigger finger; Charcot's joints; Biceps tendon rupture; Rotator cuff injury; Other (specify); |
up to 12 months | |
Secondary | proportion of patients with concomitant renal dysfunction, including specifically | Elevated SCr level (based on the local laboratory reference range);
Decreased eGFR (<60 ml/min/1.73m2); Presence of albuminuria (=30 mg/g creatinine (=30 mg/g of creatinine or =30 mg/24h); Presence of proteinuria (according to urinalysis results); Ultrasound signs of amyloid nephropathy; |
up to 12 months | |
Secondary | proportion of patients with confirmed length-dependent peripheral sensory-motor neuropathy based on NCS results | up to 12 months | ||
Secondary | proportion of patients with reduced peripheral sensory nerve conduction velocity at =1 site | up to 12 months | ||
Secondary | proportion of patients with reduced motor sensory nerve conduction velocity at =1 site | up to 12 months | ||
Secondary | proportion of patients with reduced/absent SAP amplitude at =1 site | up to 12 months | ||
Secondary | proportion of patients with reduced/absent dCMAP amplitude at =1 site | up to 12 months | ||
Secondary | proportion of patients with reduced/absent pCMAP amplitude at =1 site | up to 12 months | ||
Secondary | proportion of patients in the specific categories of the modified Rankin scale | -a) Score 1 (no significant disability); b) Score 2 (slight disability); c) Score 3 (moderate disability); d) Score 4 (moderately severe disability); e) Score 5 (severe disability | up to 12 months |
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