Immune Thrombotic Thrombocytopenia
Conditions
Keywords
TTP, iTTP, aTTP, Cognitive impairment
Brief summary
1. We expect to find that the silent cerebral infarct (SCI) rate is two fold higher in patients treated without caplacizumab. We also expect to find that the rate of mild and major cognitive impairment in patients treated with caplacizumab within 3 days of starting plasma exchange will be lower than patients treated without caplacizumab. 2. We expect that the differences in cognitive impairment in cases (caplacizumab) versus controls (no caplacizumab) will persist on serial evaluation 1 year later. We also expect that there will be differences in these groups even after adjusting for time since episode and severity of presentation. 3. We expect to find that SCI and cognitive impairment is associated with worse scores on the health related quality of life instrument (SF-36) 4. Based on studies in non-TTP populations, we expect to find that the rate of incident stroke over the period of follow up is at least 2 fold higher in patients that have SCI compared with patients who do not have SCI
Interventions
DRUGCaplacizumab
Early Caplacizumab use
Sponsors
US Thrombotic Microangiopathy Alliance
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Age \>= 18 years 2. Confirmed iTTP based on ADAMS13 activity \< 10 % (or 10-20% with positive inhibitor or antibody) during an acute iTTP episode 3. Only 1 episode of iTTP that was treated with plasma exchange and caplacizumab started within 3 days of diagnosis (or if more than 1 episode, then all episodes treated with plasma exchange and caplacizumab started within 3 days of diagnosis)
Exclusion criteria
1. Any contraindication for MRI (metallic implants, shrapnel, MRI incompatible stents, etc) 2. Unable to speak, read or understand instructions in English (for NIH ToolBox) 3. Combination of iTTP episodes treated without caplacizumab or with caplacizumab. 4. Caplacizumab started at \>= 4 days from diagnosis or for refractory iTTP
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Silent cerebral infarction | 12 months | Silent cerebral infarction (primary endpoint) - SCI is derived from quantitation (number and total volume) of ischemic (infarct-like) lesions shown as foci of T2 and FLAIR hyperintensity. SCI is diagnosed if the participant has an infarct like lesion, at least 3 mm, with normal neurologic examination or an abnormality on examination that is not explained by the location of the brain lesion. We have assembled a panel of 3 neuroradiologists headed by Dr. Doris Lin. Each MRI will be read by 2 radiologists. A third reviewer will serve as a tie breaker in case of disagreement. |
| Cognitive impairment | 12 months | Cognitive impairment (co-primary endpoint) - measured using NIH ToolBox Cognition Battery. Mild and major cognitive impairment are defined as T scores that are 1-2 SD below mean and \> 2SD below mean for any domain, respectively |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| SF-36 scores for quality of life | 12 months | — |
| Patient reported cognitive performance | 12 months | (PROMIS Cognitive Function - Short form 8a) |
| Depression scores on BDI-II | 12 months | — |
Countries
United States
Outcome results
None listed