Enhanced Screening Protocol for Cardiac Sarcoidosis

(PAPLAND Trial)

No longer recruiting at 12 trial locations
GS
NS
TS
TL
Overseen ByTimothy Legenzoff
Age: 18+
Sex: Any
Trial Phase: Academic
Sponsor: Foundation for Sarcoidosis Research
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to find better ways to screen for cardiac sarcoidosis, a condition where inflammation affects the heart. Participants will either follow the usual screening methods, such as checking symptoms and an ECG, or undergo enhanced screening, which includes additional heart tests like an echocardiogram and continuous heart monitoring. Researchers hope these extra tests will detect more cases of cardiac sarcoidosis than the usual methods. Good candidates for the trial are those diagnosed with sarcoidosis who are visiting the study center for the first time and plan to continue their care there annually.

As an unphased trial, this study offers patients the opportunity to contribute to groundbreaking research that could improve future screening methods for cardiac sarcoidosis.

Do I have to stop taking my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications. It seems likely that you can continue them, as the focus is on screening procedures rather than medication changes.

What prior data suggests that this enhanced screening protocol is safe for cardiac sarcoidosis patients?

Research has shown that advanced imaging tests, like those used in the improved screening process, effectively detect cardiac sarcoidosis. In one study with 114 patients, these tests diagnosed cardiac sarcoidosis in 36 patients, indicating that the improved screening methods can help detect the condition early.

Regarding safety, the improved screening uses non-invasive tests such as heart ultrasounds (echocardiograms) and portable heart monitors (ambulatory ECGs). Patients generally find these tests easy to handle, and they have been used in medical practice for a long time without major safety issues. The studies reviewed reported no serious problems from these screening methods, suggesting that the improved screening process should be safe for participants.12345

Why are researchers excited about this trial?

Researchers are excited about the Enhanced Screening Protocol for Cardiac Sarcoidosis because it offers a more comprehensive approach to detecting the disease earlier and more accurately. Unlike routine screenings, which typically involve standard EKGs and symptom checks, this enhanced protocol includes ambulatory ECGs and echocardiograms, providing a deeper look into heart function and potential abnormalities. By catching signs of cardiac sarcoidosis sooner, this method might allow for earlier intervention and better outcomes for patients.

What evidence suggests that this enhanced screening protocol is effective for identifying cardiac sarcoidosis?

Research has shown that improved screening methods can identify more cases of cardiac sarcoidosis. One study found that advanced imaging techniques detected cardiac sarcoidosis in 36 out of 114 patients, a significant increase compared to usual methods. This trial will compare two approaches: the Enhanced Screening Protocol for Cardiac Sarcoidosis, which includes echocardiograms and portable heart monitors, and Routine Screening for Suspected Cardiac Sarcoidosis. Experts recommend these improved screenings because they can detect heart issues early, even if symptoms are mild or not noticeable. Early detection can lead to better management of the condition, potentially improving outcomes for those affected.12367

Who Is on the Research Team?

DC

Dan Culver, DO

Principal Investigator

The Cleveland Clinic

MT

Muhunthan Thillai

Principal Investigator

Royal Papworth Hospital

Are You a Good Fit for This Trial?

This trial is for sarcoidosis patients who plan to continue care at the enrolling center, are visiting for the first time, and meet American Thoracic Society guidelines for diagnosis. It's not for those with a high suspicion of cardiac sarcoidosis, unable to undergo specific heart tests, referred specifically for suspected heart involvement in sarcoidosis, or with severe disease likely leading to death or transplant within a year.

Inclusion Criteria

I have been diagnosed with sarcoidosis according to official guidelines.
First visit to the enrolling center
Intent to continue care at the enrolling center at least annually

Exclusion Criteria

You have been referred to the study center for further evaluation of possible heart sarcoidosis.
You are not able or willing to have an ultrasound and wear a portable ECG device.
I have a severe condition that might cause death or require a transplant within a year.
See 1 more

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

Up to 4 weeks
1 visit (in-person)

Initial Screening

Participants undergo initial screening with echocardiogram and ambulatory ECG

Day 1
1 visit (in-person)

Follow-up Screening

Participants receive follow-up screening with echocardiogram and ambulatory ECG at 24 months

24 months
1 visit (in-person)

Routine Follow-up

Participants undergo routine follow-up with symptom assessment and ECG

12 months
1 phone call/chart review

Long-term Follow-up

Participants are monitored for cardiac sarcoidosis diagnosis over a long-term period

Up to 120 months

What Are the Treatments Tested in This Trial?

Interventions

  • Enhanced Screening Protocol for Cardiac Sarcoidosis
  • Routine Screening for Suspected Cardiac Sarcoidosis
Trial Overview The study compares routine screening (patient history and ECG) versus an enhanced protocol (additional echocardiogram and ambulatory ECG) in detecting cardiac sarcoidosis. Patients without initial signs will be randomly assigned either usual follow-up or enhanced screening at enrollment and after 24 months.
How Is the Trial Designed?
2Treatment groups
Experimental Treatment
Group I: Routine Screening for Suspected Cardiac SarcoidosisExperimental Treatment1 Intervention
Group II: Enhanced Screening Protocol For Cardiac SarcoidosisExperimental Treatment1 Intervention

Find a Clinic Near You

Who Is Running the Clinical Trial?

Foundation for Sarcoidosis Research

Lead Sponsor

Trials
5
Recruited
8,100+

Published Research Related to This Trial

In a review of 26 cancer treatment trials involving 75,598 routine adverse events (RAEs), only 3% were severe or life-threatening, indicating that most RAEs collected are not clinically significant.
The study suggests that 72% of RAEs could be eliminated from monitoring without compromising patient safety or the evaluation of treatment regimens, highlighting the potential for more efficient data collection in clinical trials.
Dealing with a deluge of data: an assessment of adverse event data on North Central Cancer Treatment Group trials.Mahoney, MR., Sargent, DJ., O'Connell, MJ., et al.[2007]
In a study of 1017 Caucasian patients with sarcoidosis, an abnormal ECG was found in 16.3% of patients, and those with an abnormal ECG had a significantly higher risk of developing cardiac sarcoidosis (CS), with 13.2% later diagnosed with CS compared to only 0.1% of those with a normal ECG.
Patients exhibiting both abnormal ECG results and cardiac-related symptoms had an even higher risk of CS (27.5%), highlighting the importance of these factors in early screening and diagnosis, while those with Löfgren's syndrome showed a reduced risk for CS.
Cardiac involvement in Caucasian patients with pulmonary sarcoidosis.Darlington, P., Gabrielsen, A., Sörensson, P., et al.[2022]
Trans-thoracic Echocardiography (TTE) is useful for initial screening of Cardiac Sarcoidosis (CS) and can detect subclinical Left Ventricular dysfunction, but it has limited sensitivity and specificity for diagnosing CS.
Cardiac Magnetic Resonance Imaging (CMR) and Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) are crucial for diagnosing CS, with CMR identifying myocardial scarring and FDG-PET detecting active inflammation, guiding treatment decisions.
Imaging in Suspected Cardiac Sarcoidosis: A Diagnostic Challenge.Ha, FJ., Agarwal, S., Tweed, K., et al.[2021]

Citations

Routine Cardiac Screening in Sarcoidosis PatientsThis protocol is an unblended randomized screening trial will have consecutive patients with no suggestion of cardiac sarcoidosis according to usual screening ...
Optimizing routine screening for cardiac sarcoidosis ...This study evaluated 114 patients with sarcoidosis with 132 advanced imaging events, leading to a diagnosis of CS in 36 patients. Utilizing HRS screening ...
3.pubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov/33592573/
Optimizing routine screening for cardiac sarcoidosis ...The Heart Rhythm Society (HRS) expert consensus statement recommends screening sarcoidosis patients for CS utilizing a symptom screen, EKG, and echocardiogram ...
Diagnosis and Management of Cardiac SarcoidosisCardiac sarcoidosis is an infiltrative cardiomyopathy that results from granulomatous inflammation of the myocardium and may present with ...
Cardiac sarcoidosis: phenotypes, diagnosis, treatment, and ...The typical patient is one with known sarcoidosis found to have cardiac involvement on routine screening or in examinations for mild symptoms ...
Device Therapy in Cardiac Sarcoidosis: Current Review ...Leadless pacing combined with S-ICD represents a potential novel approach to managing cardiac sarcoidosis patients.
Update in Cardiac Sarcoidosis | Annals of the American ...In 31 Finnish patients with suspected cardiac sarcoidosis who had EMBx, repeat and image-guided EMBx increased the sensitivity from 32% to 55%, ...
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