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Lilien C, Vrscaj E, Thapaliya G, Deconinck N, De Waele L, Duong T, Haberlová J, Kumhera M, Peirens G, Szabo L, Tahon V, Tang WJ, Benmhammed N, Médard L, Servais L. Patients' Perceptions of Nusinersen Effects According to Their Responder Status. J Clin Med 2024; 13:3418. [PMID: 38929947 PMCID: PMC11205004 DOI: 10.3390/jcm13123418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Background and Objective: Patients with spinal muscular atrophy (SMA) treated with a disease-modifying therapy (DMT) are often classified as responders or non-responders based on the attainment of a specific improvement threshold on validated functional scales. This categorization may significantly impact treatment reimbursement in some countries. The aim of this research is to evaluate the perception of treatments and their benefit by patients considered as responders or non-responders. Methods: In this non-commercial multicenter study, 99 post-symptomatically treated SMA type I-III patients with a median age of 11.2 (0.39-57.4) years at treatment initiation were stratified into three groups based on their treatment outcomes, i.e., those exhibiting clinically significant improvement (N = 41), those with non-clinically significant improvement (N = 18), or those showing no improvement (N = 40). Fifteen months after treatment, the initiation patients or patients' caregivers were assessed using a patient-rated scoring system based on the Patient Global Impression of Change (PGIC) scale, comprising 22 questions targeting important aspects and tasks in the daily life of patients with SMA. Results: We found no statistical difference in the patient perception of treatment benefits in 17 out of 22 domains across patient groups. Conclusions: Our results suggest that functional motor scales do not recapitulate patients' and patients' caregivers' experience of the effect of nusinersen treatment in SMA.
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Affiliation(s)
- Charlotte Lilien
- MDUK Oxford Neuromuscular Centre, Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK; (C.L.); (G.T.)
| | - Eva Vrscaj
- Division of Child Neurology, Reference Center for Neuromuscular Diseases, Department of Paediatrics, University Hospital Liege & University of Liege, 4000 Liege, Belgium; (E.V.); (N.B.); (L.M.)
- Department for Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Bohoričeva 20, 1525 Ljubljana, Slovenia
| | - Gita Thapaliya
- MDUK Oxford Neuromuscular Centre, Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK; (C.L.); (G.T.)
| | - Nicolas Deconinck
- NMRC UZ Gent, Ghent University Hospital, 9000 Ghent, Belgium; (N.D.); (V.T.)
- Neuromuscular Reference Center and Department of Paediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola, HUB, Université Libre de Bruxelles, 1020 Brussels, Belgium
| | - Liesbeth De Waele
- Department of Paediatrics, University Hospitals Leuven, 3000 Leuven, Belgium; (L.D.W.); (G.P.)
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Tina Duong
- John W. Day Lab, Department of Neurology and Neurological Sciences, University of Stanford, Stanford, CA 94305, USA; (T.D.); (W.J.T.)
| | - Jana Haberlová
- Department of Paediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, 150 06 Praha, Czech Republic; (J.H.); (M.K.)
| | - Markéta Kumhera
- Department of Paediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, 150 06 Praha, Czech Republic; (J.H.); (M.K.)
| | - Geertrui Peirens
- Department of Paediatrics, University Hospitals Leuven, 3000 Leuven, Belgium; (L.D.W.); (G.P.)
| | - Lena Szabo
- Paediatric Center, Semmelweis University, 1083 Budapest, Hungary;
| | - Valentine Tahon
- NMRC UZ Gent, Ghent University Hospital, 9000 Ghent, Belgium; (N.D.); (V.T.)
| | - Whitney J. Tang
- John W. Day Lab, Department of Neurology and Neurological Sciences, University of Stanford, Stanford, CA 94305, USA; (T.D.); (W.J.T.)
| | - Noor Benmhammed
- Division of Child Neurology, Reference Center for Neuromuscular Diseases, Department of Paediatrics, University Hospital Liege & University of Liege, 4000 Liege, Belgium; (E.V.); (N.B.); (L.M.)
| | - Laurie Médard
- Division of Child Neurology, Reference Center for Neuromuscular Diseases, Department of Paediatrics, University Hospital Liege & University of Liege, 4000 Liege, Belgium; (E.V.); (N.B.); (L.M.)
| | - Laurent Servais
- MDUK Oxford Neuromuscular Centre, Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK; (C.L.); (G.T.)
- Division of Child Neurology, Reference Center for Neuromuscular Diseases, Department of Paediatrics, University Hospital Liege & University of Liege, 4000 Liege, Belgium; (E.V.); (N.B.); (L.M.)
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Revised upper limb module in type II and III spinal muscular atrophy: 24-month changes. Neuromuscul Disord 2021; 32:36-42. [PMID: 34980538 DOI: 10.1016/j.nmd.2021.10.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 11/23/2022]
Abstract
The aim of the study was to establish 24-month changes in a large cohort of type II and III spinal muscular atrophy (SMA) patients assessed with the Revised Upper Limb Module (RULM), a tool specifically developed to assess upper limb function in SMA. We included 107 patients (54 type II and 53 type III) with at least 24-months follow up. The overall RULM 24-month changes showed a mean decline of -0.79 points. The difference between baseline and 24 months was significant in type II but not in type III patients. There was also a difference among functional subgroups but not in relation to age. Most patients had 24-month mean changes within 2 points, with 23% decreasing more than 2 points and 7% improving by >2 points. Our results suggest an overall progressive decline in upper limb function over 24 months. The negative changes were most notable in type II, in non-ambulant type III and with a different pattern of progression, also in non-sitter type II. In contrast, ambulant type III showed relative stability within the 24-month follow up. These findings will help in the interpretation of the real world data collected following the availability of new therapeutic approaches.
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