Coronavirus disease 2019 (COVID-19) which is caused by the virus SARS-CoV-2 has resulted in an ongoing global pandemic. It is unclear whether the relatively low number of reported cases of COVID-19 in people with CF (pwCF) is due to enhanced infection prevention practices or whether pwCF have protective genetic/immune factors. This study aims to prospectively assess the proportion of pwCF, including both adults and children with CF who have evidence of SARS-CoV-2 antibodies over a two-year period. This study will also examine whether pwCF who have antibodies for SARS-CoV-2 have a different clinical presentation and what impact this has on their CF disease. The proposed study will recruit pwCF from paediatric and adult CF centres in Europe. Serological testing to detect antibodies will be performed on blood samples taken at month 0, 6, 12, 18 and 24 with additional time-points if bloodwork is available via normal clinical care. Clinical data on, lung function, CF-related medical history, pulmonary exacerbations, antibiotic use, and microbiology and vaccination receipt, will be collected during routine clinical assessments. Associations will be examined between socio-demographic and clinical variables and serologic testing. We will also examine the effects of SARS-CoV-2 infection on clinical outcomes and analyse end-points to explore any age-related or gender-based differences, as well as subgroup analysis of outcomes in lung-transplant recipients and pwCF receiving CFTR modulator therapies. As pwCF receive COVID-19 vaccination we will perform a comparison of the development and progression of anti-SARS-CoV-2 antibodies in pwCF following natural infection and vaccination SARS-CoV-2 over time.
This is a prospective, longitudinal cohort study in people with Cystic Fibrosis (pwCF) that
involves repeated serial sampling of participants. This study design was chosen to provide
comprehensive information on SARS-CoV-2 seroprevalence changes over time and the subsequent
clinical impact on pwCF. The study will be conducted at participating CF centres over a
3-year period. Study participants will include paediatric and adult pwCF. Participating
investigators can enrol all eligible pwCF over a 12-month period. Participants are then
followed up for 24 months. Participants will donate blood samples at their routine clinic
visits. Blood samples will be collected at Day 0 (baseline), at Months 6, 12, 18 and 24 (to
coincide with routine clinical reviews). Additional blood samples will be taken
opportunistically every time the participant visits the clinic for blood draws. These blood
samples could be related to, routine care, annual review visits, pulmonary exacerbations
(PEx), CF complications or when initiating new treatments (e.g. CFTR modulators).
Serum from blood samples will be shipped to a central laboratory (Queen's University Belfast)
for standardized measurement of SARS-CoV-2 antibodies.
Alongside the blood samples the investigator will also collect clinical data from the
patient's health records and will input this data into the case report form (CRF). Clinical
data will be collected in
conjunction with routine care visits, according to local clinical practice. Investigators
will collect data elements from information routinely recorded in the patients' medical
records. Data will be collected at baseline, month 6, 12, 18 and 24 as per the study
schedule, and at additional blood sampling timepoints as previously explained above. Data
collection will include routine data available from CF clinic follow-ups including background
demographic information, CF medical history, medications, exacerbation information, sputum
microbiology and clinical and lung function parameters. Information on SARS-CoV-2 infection
history and vaccine receipt will also be collected.
The maximum follow-up duration of participation in the study for each patient will be 24
months. This study duration (24-month follow-up) is justified as it provides sufficient time
to observe changes in antibody prevalence over the course of the COVID-19 pandemic as well as
sufficient time to determine long term clinical outcomes for pwCF who are SARS-CoV-2
seropositive. Furthermore, we anticipate the 2-year study follow-up period will provide
sufficient time to observe the impact of vaccination on antibody levels given that a number
of vaccines are now commercially available.
We will compare the level of antibody responses between natural COVID-19 infection and
vaccination in pwCF and how this varies over time. This will be achieved by analyzing
seroprevalence and antibody levels according to natural infection and vaccination status and
according to time of sample post infection or post vaccination, if known.
Optional Study sample collection:
For participants who consent, a second blood sample will also be drawn into EDTA tubes
(plasma). Consent to this optional study sample would allow this sample and any remaining
serum (following antibody testing) to be stored for future analysis and allow further
research to be carried out on related studies to COVID-19 and CF.
Inclusion Criteria:
Consenting people with cystic fibrosis of any age, genotype, transplant status and disease
severity will be eligible to participate in the study. The study population is expected to
be representative of the general CF population.
Exclusion Criteria:
There are no specific exclusion criteria other than refusal to give informed consent, or
contraindication to venepuncture.
Participants already enrolled in a clinical trial are eligible for enrolment in this study.
Inclusion in CAR-CF should not preclude enrolment in other observational clinical trial
studies or clinical trials of an investigational medicinal product (CTIMP).
Sahlgrenska University Hospital
Göteborg, Sweden
Karolinska University Hospital
Huddinge, Sweden
Marita Gilljam, Principal Investigator
Sahlgrenska University Hospital, Sweden