Clinical trial NCT03720275: Early and Systematic Screening in Chronic Neuropathy
Official title: Evaluation of a New Diagnostic Approach to Familial Amyloid Neuropathy by Mutation of the TTR Gene in a Population of Idiopathic Chronic Neuropathies
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Amyloid Neuropathies, Familial
Keywords: proportion, TTR-FAP, study, neuropathy
Lead sponsor: University Hospital, Bordeaux
Sponsor class: OTHER
Collaborators: name: University of Bordeaux
First posted: 2018-10-25
Enrollment: 130
Sex: ALL
Minimum age (years): 18
Maximum age (years): 90
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: DIAGNOSTIC

Brief summary: TTR-FAP is a rare disabling inherited disorder that predominantly affects the peripheral nervous system and the heart. Due to an important phenotypic and genetic heterogeneity, the diagnosis is often delayed, preventing therefore early onset treatment. Our project is to evaluate the prevalence of TTR-FAP in a series of 130 patients with from chronic neuropathy of undetermined aetiology through a systematic screening of TTR mutations.

Detailed description: Transthyretin familial amyloid polyneuropathy (TTR-FAP) is an autosomal dominant disorder, highly disabling and life-threatening, resulting of transthyretin (TTR) gene mutation. Clinically, TTR FAP is characterized by progressive sensorimotor and dysautonomic neuropathy, usually fatal within a few years. The disease prevalence is highly variable, with a large genotypic and phenotypic heterogeneity. Early and accurate diagnosis remains essential to propose early treatment. New pharmacotherapies have been developed, such as Tafamidis®, and many patients can avoid liver transplant formerly considered as the only therapeutic option. The prevalence of TTR-FAP disease has been previously estimated in series of patients with severe and progressive neuropathy, frequently leading to a delayed diagnosis. TTR-FAP is also easily suspected when neuropathy is associated with cardiac symptoms or dysautonomia.

Currently, genetic testing of TTR-FAP is targeted and is only prescribed to patients in whom the first-line assessment recommended by the High Authority for Health (HAS) did not identify a cause, and on the basis of a worsening of symptoms. An early diagnosis in those cases would allow earlier treatment and monitoring. No data are available about the prevalence of TTR-FAP in populations of patients with from chronic neuropathy of unknown aetiology, through a systematic screening of TTR mutations.

The diagnosis of TTR-FAP will be performed using standard procedures following international recommendations, requiring genetic analysis of the TTR gene.

The patients with a diagnosis of TTR-FAP confirmed during this study will be seen for an additional visit in the Investigating Centre and proposed suitable follow up, treatment and care.

Eligibility criteria: Inclusion Criteria:

* Patients of both sexes presenting chronically (\> 3 months):

  * neuropathy confirmed by an electroneuromyography
  * without obvious etiology (diabetes, alcohol consumption, renal insufficiency, neurotoxic substances intake, family history of diagnosed hereditary neuropathy)
  * without anomaly of the following biological examinations: fasting blood glucose, blood count, gamma-glutamyl transferases, average cell volume, transaminases, serum creatinine clearance, C-reactive protein, TSH
* Aged 18 to 90 years Patients giving their free and informed consent to participate, after research information

Exclusion Criteria:

* People placed under the protection of justice.
* Patients who are not affiliated or who are not beneficiaries of a social security scheme
* Patients with chronic neuropathy related to a known etiology

Primary outcomes:
measure: Diagnosis of TTR-FAP
timeFrame: Genetic analyzes will be performed every three months from the first inclusion
Secondary outcomes:
measure: Age of patient at diagnosis
timeFrame: at the inclusion visit
measure: History of dysautonomias
timeFrame: at the inclusion visit
measure: Signs of dysautonomias
timeFrame: at the inclusion visit
measure: Weight of patient
timeFrame: at the inclusion visit
measure: Height of patient
timeFrame: at the inclusion visit
measure: Motor deficit of the lower limbs evaluated by a subscore of the Neuropathy Impairment Scale (NIS)
timeFrame: at the inclusion visit
measure: Motor deficit of the upper limbs evaluated by a subscore of the Neuropathy Impairment Scale (NIS)
timeFrame: at the inclusion visit
measure: Sensory deficit evaluated by a subscore of the Neuropathy Impairment Scale (NIS)
timeFrame: at the inclusion visit
measure: Presence / Absence of reflexes osteo-tendinous evaluated by a subscore of the Neuropathy Impairment Scale (NIS)
timeFrame: at the inclusion visit
measure: Presence of orthostatic hypotension
timeFrame: at the inclusion visit
measure: Dysautonomia score
timeFrame: at the inclusion visit
measure: Rasch-built Overall Disability Scale (RODS) score
timeFrame: at the inclusion visit
measure: Overall Neuropathy Limitations Scale (ONLS) score
timeFrame: at the inclusion visit
measure: Electroneuromyography findings (ENMG): axonal, demyelinating or mixed neuropathy).
timeFrame: at the inclusion visit
Other outcomes:
Locations:
city: Bordeaux
country: France
facility: Reference center for neuromuscular diseases
Study officials:
affiliation: University Hospital Bordeaux, France
name: Guilhem Solé, MD
role: PRINCIPAL_INVESTIGATOR
References: