Clinical trial NCT04863573: COVID-19 Antibody Responses In Cystic Fibrosis
Official title: COVID-19 Antibody Responses In Cystic Fibrosis: CAR-CF
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Covid19
Cystic Fibrosis
Lead sponsor: Queen's University, Belfast
Sponsor class: OTHER
Collaborators: name: Cystic Fibrosis Foundation
First posted: 2021-04-28
Enrollment: 1000
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Consenting people with cystic fibrosis of any age, genotype, transplant status and disease severity will be eligible to participate in the study. The study population is expected to be representative of the general CF population.

Brief summary: Coronavirus disease 2019 (COVID-19) which is caused by the virus SARS-CoV-2 has resulted in an ongoing global pandemic. It is unclear whether the relatively low number of reported cases of COVID-19 in people with CF (pwCF) is due to enhanced infection prevention practices or whether pwCF have protective genetic/immune factors. This study aims to prospectively assess the proportion of pwCF, including both adults and children with CF who have evidence of SARS-CoV-2 antibodies over a two-year period. This study will also examine whether pwCF who have antibodies for SARS-CoV-2 have a different clinical presentation and what impact this has on their CF disease. The proposed study will recruit pwCF from paediatric and adult CF centres throughout the United Kingdom. Serological testing to detect antibodies will be performed on blood samples taken at month 0, 6, 12, 18 and 24 with additional time-points if bloodwork is available via normal clinical care. Clinical data on, lung function, CF-related medical history, pulmonary exacerbations, antibiotic use, and microbiology and vaccination receipt, will be collected during routine clinical assessments.

Associations will be examined between socio-demographic and clinical variables and serologic testing. The effects of SARS-CoV-2 infection on clinical outcomes and analyse end-points will be examined to explore any age-related or gender-based differences, as well as subgroup analysis of outcomes in lung-transplant recipients and pwCF receiving CFTR modulator therapies. As pwCF receive COVID-19 vaccination a comparison of the development and progression of anti-SARS-CoV-2 antibodies in pwCF following natural infection and vaccination SARS-CoV-2 over time will be performed.

Detailed description: This is a prospective, longitudinal cohort study in people with Cystic Fibrosis (pwCF) that involves repeated serial sampling of participants. This study design was chosen to provide comprehensive information on SARS-CoV-2 seroprevalence changes over time and the subsequent clinical impact on pwCF. The study will be conducted at participating CF centres over a 3-year period. Study participants will include paediatric and adult pwCF. For the UK section of the study, UK investigators in the European Cystic Fibrosis Society-Clinical Trials Network (ECFS-CTN) will be invited to participate. Participating investigators can enrol all eligible pwCF over a 12-month period. Participants are then followed up for 24 months. Participants will donate blood samples at their routine clinic visits. Blood samples will be collected at Day 0 (baseline), at Months 6, 12, 18 and 24 (to coincide with routine clinical reviews). Additional blood samples will be taken opportunistically every time the participant visits the clinic for blood draws. These blood samples could be related to, routine care, annual review visits, pulmonary exacerbations (PEx), CF complications or when initiating new treatments (e.g. CFTR modulators).

Serum from blood samples will be shipped to a central laboratory (Queen's University Belfast) for standardized measurement of SARS-CoV-2 antibodies.

Alongside the blood samples the investigators will also collect clinical data from the patient's health records and will input this data into the case report form (CRF). Clinical data will be collected in conjunction with routine care visits, according to local clinical practice. Investigators will collect data elements from information routinely recorded in the patients' medical records. Data will be collected at baseline, month 6, 12, 18 and 24 as per the study schedule, and at additional blood sampling timepoints as previously explained above. Data collection will include routine data available from CF clinic follow-ups including background demographic information, CF medical history, medications, exacerbation information, sputum microbiology and clinical and lung function parameters. Information on SARS-CoV-2 infection history and vaccine receipt will also be collected.

The maximum follow-up duration of participation in the study for each patient will be 24 months. This study duration (24-month follow-up) is justified as it provides sufficient time to observe changes in antibody prevalence over the course of the COVID-19 pandemic as well as sufficient time to determine long term clinical outcomes for pwCF who are SARS-CoV-2 seropositive. Furthermore, we anticipate the 2-year study follow-up period will provide sufficient time to observe the impact of vaccination on antibody levels given that a number of vaccines are now commercially available.

The investigators will compare the level of antibody responses between natural COVID-19 infection and vaccination in pwCF and how this varies over time. This will be achieved by analyzing seroprevalence and antibody levels according to natural infection and vaccination status and according to time of sample post infection or post vaccination, if known.

Optional Study sample collection:

For participants who consent, a second blood sample will also be drawn into EDTA tubes (plasma). Consent to this optional study sample would allow this sample and any remaining serum (following antibody testing) to be stored for future analysis and allow further research to be carried out on related studies to COVID-19 and CF.

Eligibility criteria: Inclusion Criteria:

• Consenting people with cystic fibrosis of any age, genotype, transplant status and disease severity

Exclusion Criteria:

* Refusal to give informed consent
* Contraindication to venepuncture.

Participants already enrolled in a clinical trial are eligible for enrollment in this study. Inclusion in CAR-CF should not preclude enrollment in other observational clinical trial studies or clinical trials of an investigational medicinal product (CTIMP).

Primary outcomes:
measure: SARS-COV-2 seroprevalence
timeFrame: 3-year period (comprising a 1-year enrollment period and a 2-year follow-up)
measure: Association of SARS-CoV-2 seropositivity, clinical symptoms and clinical outcomes in pwCF
timeFrame: 3-year period (comprising a 1-year enrollment period and a 2-year follow-up)
measure: Longitudinal comparison of the detection of anti-SARS-CoV-2 antibodies in pwCF following natural infection and SARS-CoV-2 vaccination.
timeFrame: 3-year period (comprising a 1-year enrollment period and a 2-year follow-up)
Secondary outcomes:
measure: Serum proteomic and genomic responses of pwCF who are SARS-CoV-2 seropositive and seronegative.
timeFrame: anticipated 5-10 years
Other outcomes:
Locations:
city: Southampton
country: United Kingdom
facility: University Hospital Southampton Nhs Foundation Trust
state: Engladn
city: Birmingham
country: United Kingdom
facility: University Hospitals Birmingham Nhs Foundation Trust
state: England
city: Birmingham
country: United Kingdom
facility: Birmingham Women'S and Children'S Nhs Foundation Trust
state: England
city: Leeds
country: United Kingdom
facility: Leeds Teaching Hospitals Nhs Trust
state: England
city: London
country: United Kingdom
facility: King'S College Hospital Nhs Foundation Trust
state: England
city: London
country: United Kingdom
facility: Royal Brompton & Harefield Nhs Foundation Trust
state: England
city: Nottingham
country: United Kingdom
facility: Nottingham University Hospitals Nhs Trust
state: England
city: Belfast
country: United Kingdom
facility: Queens University Belfast
state: Northern Ireland
city: Glasgow
country: United Kingdom
facility: NHS Greater Glasgow and Clyde
state: Scotland
city: Cardiff
country: United Kingdom
facility: Cardiff & Vale University Lhb
state: Wales
city: Cardiff
country: United Kingdom
facility: Cardiff & Vale University Lhb
state: Wales
Study officials:
affiliation: Queens University Belfast
name: Damian Downey
role: PRINCIPAL_INVESTIGATOR
References: