Clinical trial NCT06736158: Early Genomic Testing for Inherited Bleeding Disorders
Official title: Early Genomic Testing for Inherited Bleeding Disorders in Patients Without a Diagnosis After First Line Testing: a Randomized Controlled Trial
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: NA
Conditions: Bleeding Disorder
Keywords: blood coagulation disorders
bleeding disorder
Lead sponsor: Queen's University
Sponsor class: OTHER
Collaborators: name: Unity Health Toronto
name: The Ottawa Hospital
First posted: 2024-12-16
Enrollment: 212
Sex: ALL
Minimum age (years): 12
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: DIAGNOSTIC

Brief summary: The investigators aim to test the introduction of genomic testing early in the diagnostic pathway for inherited bleeding disorders in patients who have not received a diagnosis after first-line testing.

The goal of this clinical trial is to test the introduction of genomic testing early in the diagnostic pathway for patients referred to Hematology for a suspected inherited bleeding disorder. The main questions it aims to answer are:

1. Does adding early genomic testing increase the number of patients who are diagnosed?
2. Does adding early genomic testing decrease the overall time to diagnosis?
3. Is it cost-effective to include early genomic testing in the diagnostic pathway?

The investigators will compare with a control group of participants who are receiving standard care (no early genomic testing).

Participants will randomized to a standardized diagnostic testing plus early genomic testing group or to the standardized diagnostic testing group only (with the possibility of being offered genomic testing after 1 year in the study).

Detailed description: With the current standardized diagnostic testing process up to 50% of people referred with significant bleeding symptoms will be classified as bleeding disorder of unknown cause (BDUC), defined as those with a positive bleeding score but in whom all current diagnostic test results are repeatedly normal. Incorporating genomic testing early in the diagnostic pathway could significantly improve diagnostic yield, reduce diagnostic delay, alleviate patient anxiety, and allow for more prompt symptom recognition and targeted treatment.

Eligibility criteria: Inclusion Criteria:

* New patient referred for abnormal bleeding.
* Hemostasis expert clinician determined abnormal bleeding history AND family history of bleeding
* OR no family history of bleeding but hemostasis expert clinician determined severe bleeding history.

Exclusion Criteria:

* Prior diagnosis of an inherited bleeding disorder.
* Acquired cause of bleeding (i.e., medication known to cause bleeding, significant renal or hepatic disease)

Primary outcomes:
measure: Diagnostic yield
timeFrame: One year
Secondary outcomes:
measure: Time to diagnosis
timeFrame: One year
measure: Patient Burden
timeFrame: One year
measure: Health Related Quality of Life
timeFrame: One year
measure: Cost-effectiveness analysis
timeFrame: 2 years
measure: Economic Impact
timeFrame: 2 years
Other outcomes:
Locations:
city: Kingston
country: Canada
facility: Queen's University/Kingston Health Sciences Centre
state: Ontario
city: Ottawa
country: Canada
facility: The Ottawa Hospital
state: Ontario
city: Toronto
country: Canada
facility: Unity Health
state: Ontario
Study officials:
affiliation: Queen's University
name: Paula D James, MD, FRCPC
role: PRINCIPAL_INVESTIGATOR
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