Erythropoietic Protoporphyrias: Studies of the Natural History, Genotype-Phenotype Correlations, and Psychosocial Impact
Study Details
Study Description
Brief Summary
The initial objective of this protocol is to assemble a well-documented group of patients with confirmed diagnoses of the erythropoietic protoporphyrias, including autosomal recessive Erythropoietic Protoporphyria (EPP) and X-Linked Protoporphyria (XLP) for clinical, biochemical, and genetic studies. The long-term objectives are (1) to conduct a longitudinal investigation of the natural history, complications, and therapeutic outcomes in people with erythropoietic protoporphyria, (2) to systematically investigate the psychological effects of the erythropoietic protoporphyrias on children and adults, and (3) to investigate the correlation between the identified genotypes and the resulting clinical presentation, also determining the possible interaction of other genetic markers.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
|
Detailed Description
The porphyrias are a group of rare metabolic diseases that may present in childhood or adult life and are due to deficiencies of enzymes in the heme biosynthetic pathway. The most common manifestations are related to accumulation of intermediates in the pathway and usually occur as acute neurological attacks (as in the acute or hepatic porphyrias), or cutaneous photosensitivity (as in the cutaneous porphyrias, including the erythropoietic protoporphyrias). Multiple mutations have been identified in each of the porphyrias. The risk of disability or death from these disorders is significant, in part because diagnosis is often delayed due to lack of adoption of diagnostic testing in clinical practice. Moreover, the natural history of these disorders is not well described and it is not known what determines differences in outcomes. New therapies are needed. For existing therapies, high-quality evidence on short and long term efficacy and safety is generally lacking. Therefore, the purpose of this study of a large group of patients with EPP and XLP is to provide a better understanding of the natural history of these disorders, as affected by available therapies, and to aid in developing new forms of treatment. Much of the data collected on subjects as participants in the Longitudinal Study of the Porphyrias will be accessed for this study specific to the investigation of the erythropoietic protoporphyrias. To maximize the information that can be informative in our objectives, additional data will be collected, including additional biochemical findings and EPP-specific psychosocial parameters.
The Office of Rare Diseases (ORD) of the National Institutes of Health (NIH) established a Rare Diseases Clinical Research Network (RDCRN) in collaboration with other NIH Institutes and currently has funded 19 rare diseases clinical research consortia and one Data Management and Coordinating Center. The Porphyrias Consortium was created as part of the RDCRN, to study the human porphyrias. The Porphyrias Consortium is a consortium of the academic institutions listed in the participating institutions table. All Centers in the Porphyrias Consortium are participating in this study. Additional centers may be added if funding is available.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Participants with Protoporphyrias Individuals with a documented diagnosis of Erythropoietic Protoporphyria (EPP) or X-Linked Protoporphyria (XLP) |
Outcome Measures
Primary Outcome Measures
- The Hospital Anxiety and Depression Scale (HADS) [1 weeks]
Questionnaire with 7 items for anxiety and 7 items for depression, each item is scored on a 4 point response 0 - 3, subscales 0-21, with full range from 0 to 42, with higher score indicating more severe anxiety or depression.
- Illness Perception Questionnaire Revised (IPQR) [1 week]
Each item is scored on a likert scale from 1 (strongly disagree) to 5 (strongly agree). Items within each domain were totaled for final domain scores. Seven domains - Timeline (score 5-25), Consequences (score 6-30), Personal Control (score 6-30), Treatment Control (score 3-15), Illness Coherence (score 5-25), Timeline-Cyclical (score 4-20), and Emotional Representations (score 6-30). A modified version without the identity component was used as it was not applicable in EPP. Higher scores domains indicate overall strong beliefs that the disease is chronic and has a negative impact.
- EPP-Specific Tool [1 week]
Each item was scored from 0-3 on a Likert scale. There are 2 domains: S=disease severity and Q=QoL. Total scale for each domain transferred to 0-100 scale. Higher scores for the S domain reflect lower severity, and higher satisfaction/QoL for the Q domain. Total Score from 0-100, with higher score indicating higher quality of life.
Secondary Outcome Measures
- Sleep Disturbance PROMIS Scores [baseline]
Sleep Subscales: Pain Interference, Depression, Physical Function, Fatigue, Anxiety, Sleep Disturbance, Satisfaction with Social Roles, each subscale scored from 0-100 with higher score indicating more symptoms affecting sleep.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
All subjects must also be enrolled in the Longitudinal Study of the Porphyrias.
-
Willing to sign informed consent form
-
Biochemical findings - A marked increase in erythrocyte protoporphyrin [total erythrocyte protoporphyrin >200 ug/dL, or more than 1.5-fold increase (relative to ULN of 80 ug/dL)], with a predominance of free protoporphyrin (85-100% in EPP and 50-85% in XLP).
-
Molecular findings - one of the following:
-
A disease causing FECH mutation trans to the IVS3-48C>T low expression FECH allele
-
Two disease-causing FECH mutations
-
A gain-of-function ALAS-2 C-terminal deletion/exon 11 mutation (in XLP). If no mutation is found and subjects fulfill criteria 1-3 they are eligible for enrollment.
Exclusion Criteria:
-
cases with elevations of porphyrins in urine, plasma or erythrocytes due to other diseases (i.e. secondary porphyrinuria or porphyrinemia), such as liver and bone marrow diseases [Gibson 2000].
-
patients with a prior diagnosis of porphyria that cannot be documented by review of existing medical records or repeat biochemical or DNA testing.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | University of Alabama, Birmingham | Birmingham | Alabama | United States | 35294-0012 |
| 2 | University of California, San Francisco | San Francisco | California | United States | 94143 |
| 3 | Icahn School of Medicine at Mount Sinai | New York | New York | United States | 10029 |
| 4 | Wake Forest University Health Sciences | Winston-Salem | North Carolina | United States | 27106 |
| 5 | University of Texas Medical Branch | Galveston | Texas | United States | 77555 |
| 6 | University of Utah | Salt Lake City | Utah | United States | 84132 |
Sponsors and Collaborators
- Icahn School of Medicine at Mount Sinai
- Rare Diseases Clinical Research Network
- Office of Rare Diseases (ORD)
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Investigators
- Principal Investigator: Manisha Balwani, MD, Icahn School of Medicine at Mount Sinai
Study Documents (Full-Text)
More Information
Additional Information:
Publications
None provided.- GCO 08-0959-04
- HSM12-00307
- U54DK083909
Study Results
Participant Flow
| Recruitment Details | |
|---|---|
| Pre-assignment Detail |
| Arm/Group Title | Adult Patients With EPP/XLP |
|---|---|
| Arm/Group Description | Individuals with a documented diagnosis of Erythropoietic Protoporphyria (EPP) or X-Linked Protoporphyria (XLP) |
| Period Title: Overall Study | |
| STARTED | 150 |
| COMPLETED | 150 |
| NOT COMPLETED | 0 |
Baseline Characteristics
| Arm/Group Title | Adult Patients With EPP/XLP |
|---|---|
| Arm/Group Description | Individuals with a documented diagnosis of Erythropoietic Protoporphyria (EPP) or X-Linked Protoporphyria (XLP) |
| Overall Participants | 150 |
| Age (years) [Mean (Standard Deviation) ] | |
| Mean (Standard Deviation) [years] |
40.9
(14.5)
|
| Sex: Female, Male (Count of Participants) | |
| Female |
66
44%
|
| Male |
84
56%
|
| Ethnicity (NIH/OMB) (Count of Participants) | |
| Hispanic or Latino |
4
2.7%
|
| Not Hispanic or Latino |
144
96%
|
| Unknown or Not Reported |
2
1.3%
|
| Protoporphyria Type (Count of Participants) | |
| Erythropoietic Protoporphyria - EPP |
143
95.3%
|
| X-Linked Protoporphyria - XLP |
6
4%
|
| Unknown type |
1
0.7%
|
| Age at Onset of Symptoms (years) [Mean (Standard Deviation) ] | |
| Mean (Standard Deviation) [years] |
4.2
(4.5)
|
Outcome Measures
| Title | The Hospital Anxiety and Depression Scale (HADS) |
|---|---|
| Description | Questionnaire with 7 items for anxiety and 7 items for depression, each item is scored on a 4 point response 0 - 3, subscales 0-21, with full range from 0 to 42, with higher score indicating more severe anxiety or depression. |
| Time Frame | 1 weeks |
Outcome Measure Data
| Analysis Population Description |
|---|
| Data only for those who completed instrument included. A protocol modification to add the HADS tool was done after study initiation, therefore not all subjects received all tools. |
| Arm/Group Title | Adult Patients With EPP/XLP |
|---|---|
| Arm/Group Description | Individuals with a documented diagnosis of Erythropoietic Protoporphyria (EPP) or X-Linked Protoporphyria (XLP) |
| Measure Participants | 103 |
| Anxiety |
4.6
(4.1)
|
| Depression |
1.9
(2.1)
|
| Title | Illness Perception Questionnaire Revised (IPQR) |
|---|---|
| Description | Each item is scored on a likert scale from 1 (strongly disagree) to 5 (strongly agree). Items within each domain were totaled for final domain scores. Seven domains - Timeline (score 5-25), Consequences (score 6-30), Personal Control (score 6-30), Treatment Control (score 3-15), Illness Coherence (score 5-25), Timeline-Cyclical (score 4-20), and Emotional Representations (score 6-30). A modified version without the identity component was used as it was not applicable in EPP. Higher scores domains indicate overall strong beliefs that the disease is chronic and has a negative impact. |
| Time Frame | 1 week |
Outcome Measure Data
| Analysis Population Description |
|---|
| Data only for those who completed instrument included. A protocol modification to add the IPQR tool was done after study initiation, therefore not all subjects received all tools. |
| Arm/Group Title | Adult Patients With EPP/XLP |
|---|---|
| Arm/Group Description | Individuals with a documented diagnosis of Erythropoietic Protoporphyria (EPP) or X-Linked Protoporphyria (XLP) |
| Measure Participants | 104 |
| Timeline |
23.4
(2.2)
|
| Consequences |
23.2
(4.3)
|
| Personal Control |
19.0
(4.9)
|
| Treatment Control |
9.2
(2.8)
|
| Illness Coherence |
19.0
(4.2)
|
| Timeline - Cyclical |
10.5
(3.8)
|
| Emotional Representations |
18.8
(5.5)
|
| Title | EPP-Specific Tool |
|---|---|
| Description | Each item was scored from 0-3 on a Likert scale. There are 2 domains: S=disease severity and Q=QoL. Total scale for each domain transferred to 0-100 scale. Higher scores for the S domain reflect lower severity, and higher satisfaction/QoL for the Q domain. Total Score from 0-100, with higher score indicating higher quality of life. |
| Time Frame | 1 week |
Outcome Measure Data
| Analysis Population Description |
|---|
| Data only for those who completed instrument included. A protocol modification to add the EPP-Specific tool was done after study initiation, therefore not all subjects received all tools. |
| Arm/Group Title | Adult Patients With EPP/XLP |
|---|---|
| Arm/Group Description | Individuals with a documented diagnosis of Erythropoietic Protoporphyria (EPP) or X-Linked Protoporphyria (XLP) |
| Measure Participants | 107 |
| S Domain |
58.9
(30.8)
|
| Q Domain |
30.8
(27.4)
|
| Total Score |
54.3
(30.0)
|
| Title | Sleep Disturbance PROMIS Scores |
|---|---|
| Description | Sleep Subscales: Pain Interference, Depression, Physical Function, Fatigue, Anxiety, Sleep Disturbance, Satisfaction with Social Roles, each subscale scored from 0-100 with higher score indicating more symptoms affecting sleep. |
| Time Frame | baseline |
Outcome Measure Data
| Analysis Population Description |
|---|
| *Only those subjects who completed the PROMIS was included |
| Arm/Group Title | Adult Patients With EPP/XLP |
|---|---|
| Arm/Group Description | Individuals with a documented diagnosis of Erythropoietic Protoporphyria (EPP) or X-Linked Protoporphyria (XLP) |
| Measure Participants | 117 |
| Pain Interference |
49.1
(9.7)
|
| Depression |
44.1
(8.4)
|
| Physical Function |
52.5
(7.8)
|
| Fatigue |
46.6
(10.6)
|
| Anxiety |
47.3
(10.0)
|
| Sleep Disturbance |
48.7
(8.9)
|
| Satisfaction with Social Roles |
54.9
(9.3)
|
Adverse Events
| Time Frame | 1 week | |
|---|---|---|
| Adverse Event Reporting Description | ||
| Arm/Group Title | Adult Patients With EPP/XLP | |
| Arm/Group Description | Individuals with a documented diagnosis of Erythropoietic Protoporphyria (EPP) or X-Linked Protoporphyria (XLP) | |
All Cause Mortality |
||
| Adult Patients With EPP/XLP | ||
| Affected / at Risk (%) | # Events | |
| Total | 0/150 (0%) | |
Serious Adverse Events |
||
| Adult Patients With EPP/XLP | ||
| Affected / at Risk (%) | # Events | |
| Total | 0/150 (0%) | |
Other (Not Including Serious) Adverse Events |
||
| Adult Patients With EPP/XLP | ||
| Affected / at Risk (%) | # Events | |
| Total | 0/150 (0%) | |
Limitations/Caveats
More Information
Certain Agreements
Principal Investigators are NOT employed by the organization sponsoring the study.
The only disclosure restriction on the PI is that the sponsor can review results communications prior to public release and can embargo communications regarding trial results for a period that is less than or equal to 60 days. The sponsor cannot require changes to the communication and cannot extend the embargo.
Results Point of Contact
| Name/Title | Dr. Hetanshi Naik |
|---|---|
| Organization | Icahn School of Medicine at Mount Sinai |
| Phone | 212-241-7699 |
| hetanshi.naik@mssm.edu |
- GCO 08-0959-04
- HSM12-00307
- U54DK083909