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Desguerre I, Barrois R, Audic F, Barnerias C, Chabrol B, Davion JB, Durigneux J, Espil-Taris C, Gomez-Garcia de la Banda M, Guichard M, Isapof A, Nougues MC, Laugel V, Le Goff L, Mercier S, Pervillé A, Richelme C, Thibaud M, Sarret C, Schweitzer C, Testard H, Trommsdorff V, Vanhulle C, Walther-Louvier U, Altuzarra C, Chouchane M, Ropars J, Quijano-Roy S, Cances C. Real-world multidisciplinary outcomes of onasemnogene abeparvovec monotherapy in patients with spinal muscular atrophy type 1: experience of the French cohort in the first three years of treatment. Orphanet J Rare Dis 2024; 19:344. [PMID: 39272200 PMCID: PMC11401247 DOI: 10.1186/s13023-024-03326-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/18/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Spinal muscular atrophy type 1 (SMA1) is the most severe and early form of SMA, a genetic disease with motor neuron degeneration. Onasemnogene abeparvovec gene transfer therapy (GT) has changed the natural history of SMA1, but real-world data are scarce. METHODS A French national expert committee identified 95 newly diagnosed treatment-naive SMA1 patients between June 2019 and June 2022. We prospectively report on children treated with GT as the first and only therapy who had more than one-year of follow-up. RESULTS Forty-six SMA1 patients received GT. Twelve patients received other treatments. Patients with respiratory insufficiency were oriented toward palliative care after discussion with families. Twenty-nine of the treated patients with more than 12 months of follow-up were included in the follow-up analysis. Among them, 17 had 24 months of follow-up. The mean age at treatment was 7.5 (2.1-12.5) months. Twenty-two patients had two SMN2 copies, and seven had three copies. One infant died in the month following GT due to severe thrombotic microangiopathy, and another died due to respiratory distress. Among the 17 patients with 24 months of follow-up, 90% required spinal bracing (15/17), three patients required nocturnal noninvasive ventilation, and two needed gastrostomy. Concerning motor milestones at the 24-month follow-up, all patients held their head, 15/17 sat for 30 s unassisted, and 12/17 stood with aid. Motor scores (CHOPINTEND and HINE-2) and thoracic circumference significantly improved in all patients. CONCLUSIONS Our study shows favorable motor outcomes and preserved respiratory and feeding functions in treatment-naive SMA1 infants treated by GT as the first and only therapy before respiratory and bulbar dysfunctions occurred. Nevertheless, almost all patients developed spinal deformities.
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Affiliation(s)
- Isabelle Desguerre
- IHU Imagine, Paris University, 24, Boulevard du Montparnasse, 75015, Paris, France
- Department of Pediatric Neurology, French Reference Center for Neuromuscular Diseases, AP-HP, Hôpital Necker-Enfants Malades, 149 rue de sèvres, 75015, Paris, France
| | - Rémi Barrois
- Department of Pediatric Neurology, French Reference Center for Neuromuscular Diseases, AP-HP, Hôpital Necker-Enfants Malades, 149 rue de sèvres, 75015, Paris, France.
| | - Frédérique Audic
- Department of Pediatric Neurology, French Reference Center for Neuromuscular Diseases, Hôpital Timone Enfants, 264 rue Saint-Pierre, 13385, Marseille, France
| | - Christine Barnerias
- Department of Pediatric Neurology, French Reference Center for Neuromuscular Diseases, AP-HP, Hôpital Necker-Enfants Malades, 149 rue de sèvres, 75015, Paris, France
| | - Brigitte Chabrol
- Department of Pediatric Neurology, French Reference Center for Neuromuscular Diseases, Hôpital Timone Enfants, 264 rue Saint-Pierre, 13385, Marseille, France
| | - Jean Baptiste Davion
- Department of Pediatric Neurology, French Reference Center for Neuromuscular Diseases, Lille University Hospital Center, 2 avenue Oscar Lambret, 59000, Lille, France
| | - Julien Durigneux
- Department of Pediatric Neurology, French Reference Center for Neuromuscular Diseases, Angers University Hospital Center, 4 rue Larrey, 49933, Angers, France
| | - Caroline Espil-Taris
- Department of Pediatric Neurology, French Reference Center for Neuromuscular Diseases, Pellegrin University Hospital Center, Hôpital des Enfants, place Amélie-Raba-Léon, 33086, Bordeaux, France
| | - Marta Gomez-Garcia de la Banda
- Pediatric Neurology and ICU Department, Garches Reference Center for Neuromuscular Diseases (NEIF for FILNEMUS; RPC for Euro-NMD ERN), AP-HP Paris-Saclay Université, Hôpital Raymond Poincaré (UVSQ), 104 boulevard Raymond Poincaré, 92380, Garches, France
| | - Marine Guichard
- Department of Pediatric Neurology and Handicaps, French Competence Center for Neuromuscular Diseases, Boulevard Tonnellé, Hôpital Clocheville, 2 Boulevard Tonnellé, 37000, Tours, France
| | - Arnaud Isapof
- Department of Pediatric Neurology, AP-HP, French Reference Center for Neuromuscular Diseases, Hôpital Armand Trousseau, 26 avenue du Docteur Arnold-Netter, 75012, Paris, France
| | - Marie Christine Nougues
- Department of Pediatric Neurology, AP-HP, French Reference Center for Neuromuscular Diseases, Hôpital Armand Trousseau, 26 avenue du Docteur Arnold-Netter, 75012, Paris, France
| | - Vincent Laugel
- Department of Pediatric Neurology, French Reference Center for Neuromuscular Diseases, Strasbourg University Hospital Center, Hôpital de Hautepierre, 1 avenue Molière, 67098, Strasbourg, France
| | - Laure Le Goff
- Department of Neuromuscular Pathology, French Reference Center for Neuromuscular Diseases, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, -Bron, 59 boulevard Pinel, 69677, Lyon-Bron, France
| | - Sandra Mercier
- Department of Medical Genetics, French Reference Center for Neuromuscular Diseases, Nantes University Hospital Center, 1 Place Alexis-Ricordeau, 44093, Nantes, France
| | - Anne Pervillé
- Department of Pediatrics, French Competence Center for Neuromuscular Diseases, Hôpital d'Enfants ASFA, CS 81010, 97404, Saint Denis Cedex, Réunion, France
| | - Christian Richelme
- Department of Pediatric Neurology, French Reference Center for Neuromuscular Diseases, Nice University Hospital Center, Hôpital Lenval, 57 Avenue de la Californie, 06200, Nice, France
| | - Marie Thibaud
- Department of Pediatrics, French Reference Center for Neuromuscular Diseases, American Memorial Hospital, Reims University Hospital Center, 49 Rue Cognacq Jay, 51092, Reims, France
| | - Catherine Sarret
- CMR Neuromusculaire, French Reference Center for Neuromuscular Diseases, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France
| | - Cyril Schweitzer
- Department of Infant Medicine, French Reference Center for Neuromuscular Diseases, Nancy University Hospital Center, Rue du Morvan, 54511, Vandoeuvre lès Nancy, France
| | - Hervé Testard
- Department of Pediatric Neurology, French Competence Center for Neuromuscular Diseases, Grenoble University Hospital Center, Hôpital Couple Enfant, Quai Yermolof, 38700, Grenoble, France
| | - Valérie Trommsdorff
- Department of Pediatrics, French Reference Center for Neuromuscular Diseases, University Hospital Center, Avenue François Mitterrand, BP 350, 97448, Saint Pierre Cedex, Réunion, France
| | - Catherine Vanhulle
- Department of Pediatrics, French Competence Center for Neuromuscular Diseases, Rouen University Hospital Center, Charles Nicolle, 1 Rue de Germont, 76031, Rouen, France
| | - Ulrike Walther-Louvier
- Department of Pediatric Neurology, French Greater South‒West Reference Center for Neuromuscular Diseases, Hôpital Gui de Chauliac, University Hospital Center Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Cécilia Altuzarra
- Department of Pediatrics, French Reference Center for Neuromuscular Diseases, Besançon University Hospital Center - Hôpital Jean Minjoz, 3 boulevard A. Fleming, 25030, Besançon, France
| | - Mondher Chouchane
- Department of Pediatric Neurology, French Competence Center for Neuromuscular Diseases, Dijon University Hospital Center, Hôpital d'Enfants, 14 rue Paul Gaffarel, 21079, Dijon, France
| | - Juliette Ropars
- LaTIM INSERM UMR 1101, French Reference Center for Neuromuscular Diseases Brest University Hospital Center, Hôpital Morvan, Boulevard Tanguy Prigent, 29609, Brest, France
| | - Susana Quijano-Roy
- Pediatric Neurology and ICU Department, Garches Reference Center for Neuromuscular Diseases (NEIF for FILNEMUS; RPC for Euro-NMD ERN), AP-HP Paris-Saclay Université, Hôpital Raymond Poincaré (UVSQ), 104 boulevard Raymond Poincaré, 92380, Garches, France
| | - Claude Cances
- Department of Pediatric Neurology, French Greater South‒West Reference Center for Neuromuscular Diseases, Hôpital des Enfants, University Hospital Center Toulouse, 330 av de Grande Bretagne-TSA, 31059, Toulouse, France
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Alajjuri MA, Abusamra R, Mundada V, Narayan O. Real-World Data in Children with Spinal Muscular Atrophy Type 1 on Long-Term Ventilation Receiving Gene Therapy: A Prospective Cohort Study. Adv Respir Med 2024; 92:338-347. [PMID: 39311111 PMCID: PMC11417828 DOI: 10.3390/arm92050032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/17/2024] [Accepted: 08/19/2024] [Indexed: 09/26/2024]
Abstract
Patients with spinal muscular atrophy type 1 (SMA-1) requiring invasive ventilation can be eligible for gene therapy if they tolerate at least 8 h off ventilation per day. We aimed to assess the short-term safety and efficacy of gene therapy (onasemnogene abeparvovec; Zolgensma) on respiratory function in SMA-1 patients ventilated via tracheostomy pre-gene therapy. A prospective cohort study included 22 patients. Patients were weaned off ventilation for at least 8 h daily by optimizing ventilator settings and duration, using cough augmentation, managing excessive airway secretions, enhancing nutrition, screening for respiratory bacterial colonization, and treating infections. Gene therapy was administered at a median age of 26 (Q1: 18, Q3: 43) months with a mean follow-up period of 7.64 (SD: 6.50) months. Gene therapy was safe and effective in resolving paradoxical breathing, improving cough ability, reducing airway secretions, and enhancing CHOP-INTEND scores. The clinical assessment and management implemented pre-gene therapy were effective in safely weaning patients for at least 8 h off ventilation daily. Gene therapy at a late age was safe and effective over the short-term period; however, long-term follow-up is recommended. In conjunction with gene therapy, high-quality clinical care is beneficial and should be paired with gene therapy.
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Affiliation(s)
- Mohammad Ala’ Alajjuri
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates;
- Dubai Health, Dubai, United Arab Emirates
| | - Rania Abusamra
- Department of Pediatric Pulmonology, Mediclinic City Hospital, Dubai, United Arab Emirates;
| | - Vivek Mundada
- Department of Pediatric Neuroscience, Aster DM Healthcare, Medcare Women and Children Hospital, Dubai, United Arab Emirates;
| | - Omendra Narayan
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates;
- Department of Pediatric Pulmonology, American Hospital, Dubai, United Arab Emirates
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Barrois R, Griffon L, Barnerias C, Gitiaux C, Desguerre I, Fauroux B, Khirani S. Polysomnography findings and respiratory muscle function in infants with early onset spinal muscular atrophy after gene replacement as monotherapy: A prospective study. Sleep Med 2024; 119:335-341. [PMID: 38749258 DOI: 10.1016/j.sleep.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 05/02/2024] [Accepted: 05/05/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Gene replacement therapy (onasemnogene abeparvovec) is associated with an improvement of the prognosis of children with spinal muscular atrophy, but information on long-term respiratory outcome is scarce. The aim of this study was to report the polysomnography findings and respiratory muscle function of infants with treatment-naive spinal muscular atrophy type 1 and 2 up to 24 months after onasemnogene abeparvovec monotherapy. METHODS A clinical and motor evaluation, respiratory muscle function testing, and polysomnography were performed repeatedly. RESULTS Fifteen spinal muscular atrophy patients (1 presymptomatic, 7 type 1b, 6 type 1c, and 1 type 2) were included at a median age of 8.6 months (range 3.8-12.6) and followed for 24 months. The thoracic over head circumference ratio was close to normal at baseline (median 1.00 (range 0.90-1.05)) and increased significantly over time. All polysomnography and nocturnal gas exchange parameters were within normal ranges at baseline (median apnea-hypopnea index 2.5 events/hour (range 0.4-5.3)) and follow-up. The inspiratory muscle strength was normal at baseline but tended to slightly decrease over time and the expiratory muscle strength was low at any time especially for patients with recurrent respiratory infections (median (range) at baseline in cmH2O: crying esophageal pressure 54 (30-110), crying transdiaphragmatic pressure 65 (35-107), gastric pressure during maximal cough 26 (10-130), esophageal pressure during maximal cough 61 (38-150)). Only 3 patients required noninvasive ventilation. CONCLUSION A continuous respiratory monitoring of spinal muscular atrophy patients during the first years of life following onasemnogene abeparvovec monotherapy seems recommended despite the normality of polysomnography parameters.
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Affiliation(s)
- Rémi Barrois
- Clinical Neurophysiology Department, AP-HP, Hôpital Necker Enfants Malades, Paris, France; Centre Borelli - UMR 9010 Centre Borelli, Gif-sur-Yvette, France; Paris Cité University, Paris, France.
| | - Lucie Griffon
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France; Université de Paris Cité, EA 7330 VIFASOM, Paris, France
| | - Christine Barnerias
- Centre de Référence des Pathologies Neuromusculaires Paris-Nord-Est, AP-HP, Hôpital Necker Enfants Malades, Paris, France
| | - Cyril Gitiaux
- Clinical Neurophysiology Department, AP-HP, Hôpital Necker Enfants Malades, Paris, France; Paris Cité University, Paris, France; Centre de Référence des Pathologies Neuromusculaires Paris-Nord-Est, AP-HP, Hôpital Necker Enfants Malades, Paris, France
| | - Isabelle Desguerre
- Centre de Référence des Pathologies Neuromusculaires Paris-Nord-Est, AP-HP, Hôpital Necker Enfants Malades, Paris, France; Pediatric Neurology Department, AP-HP, Hôpital Necker-Enfants Malades, Paris, France; Université Paris Cité, IHU Imagine, Paris, France
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France; Université de Paris Cité, EA 7330 VIFASOM, Paris, France
| | - Sonia Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France; Université de Paris Cité, EA 7330 VIFASOM, Paris, France; ASV Santé, Gennevilliers, France
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Amirav I, Rabin N, Levi S, Har-Even Cohn R, Lior Y, Shiran S, Sagi L, Fatal A, Zvirin A, Honen Y, Lavie M, Kimmel R. Non-ionizing measurement and quantification of bell-shaped chests in spinal muscular atrophy: a pilot study. Front Pediatr 2024; 12:1256445. [PMID: 38374878 PMCID: PMC10876057 DOI: 10.3389/fped.2024.1256445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/22/2024] [Indexed: 02/21/2024] Open
Abstract
Background Spinal Muscular Atrophy (SMA) is manifested by deformation of the chest wall, including a bell-shaped chest. We determined the ability of a novel non-ionizing, non-volitional method to measure and quantify bell-shaped chests in SMA. Methods A 3D depth camera and a chest x-ray (CXR) were used to capture chest images in 14 SMA patients and 28 controls. Both methods measure the distance between two points, but measurements performed by 3D analysis allow for the consideration of the curve of a surface (geodesic measurements), whereas the CXR allows solely for the determination of the shortest path between two points, with no regard for the surface (Euclidean measurements). The ratio of the upper to lower chest distances was quantified to distinguish chest shape in imaging by both the 3D depth camera and the CXR, and the ratios were compared between healthy and SMA patients. Results The mean 3D Euclidean ratio of distances measured by 3D imaging was 1.00 in the control group and 0.92 in the SMA group (p = 0.01), the latter indicative of a bell-shaped chest. This result repeated itself in the ratio of geodesic measurements (0.99 vs. 0.89, respectively, p = 0.03). Conclusion The herein-described novel, noninvasive 3D method for measuring the upper and lower chest distances was shown to distinguish the bell-shaped chest configuration in patients with SMA from the chests of controls. This method bears several advantages over CXR and may be readily applicable in clinical settings that manage children with SMA.
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Affiliation(s)
- Israel Amirav
- Pediatric Pulmonology Unit, Dana-Dwek Children’s Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Neta Rabin
- Pediatric Pulmonology Unit, Dana-Dwek Children’s Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sapir Levi
- Pediatric Pulmonology Unit, Dana-Dwek Children’s Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronly Har-Even Cohn
- Pediatric Pulmonology Unit, Dana-Dwek Children’s Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yotam Lior
- Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shelly Shiran
- Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Radiology Department, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Liora Sagi
- Pediatric Pulmonology Unit, Dana-Dwek Children’s Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviva Fatal
- Pediatric Pulmonology Unit, Dana-Dwek Children’s Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Zvirin
- Department of Computer Sciences, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Yaron Honen
- Department of Computer Sciences, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Moran Lavie
- Pediatric Pulmonology Unit, Dana-Dwek Children’s Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Kimmel
- Department of Computer Sciences, The Technion, Israel Institute of Technology, Haifa, Israel
- Department of Electrical and Computer Engineering, The Technion, Israel Institute of Technology, Haifa, Israel
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Audic F. Gene therapy in spinal muscular atrophy. Arch Pediatr 2023; 30:8S12-8S17. [PMID: 38043977 DOI: 10.1016/s0929-693x(23)00222-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Infantile SMA is a neuromuscular disease caused by the motor neuron degeneration, depending on the age of appearance of clinical signs and the evolution of the disease, three types of decreasing severity have been defined. SMA is caused by mutations or deletions of the SMN1 gene and disease. Various therapies aimed at increasing SMN protein levels have been developed. Gene therapy is part of the therapeutic arsenal now available for the treatment of SMA under certain conditions. It uses the scAAV9 vector carrying a functional copy of SMN1 to restore SMN protein expression at the cellular level. Because the adeno-associated virus genome is maintained as it is an episome, a single intravenous administration is sufficient to producing a long-lasting therapeutic effect. The effectiveness of gene replacement therapy in patients with SMA has been demonstrated in various studies. It is now clear that treatment as early as possible provides better clinical results. However, this treatment must be carried out in a suitable medical environment, with close monitoring initially due to potentially serious side effects. In France, this treatment has been available since 2019. A national committee of experts involved in the treatment of pediatric SMA patients has established that pediatric patients with SMA decide on the indications for disease-modifying therapies (DMT) in children. The French Spinal Muscular Atrophy Registry (SMA France Registry) was established in January 2020. The registry includes all patients with genetically confirmed SMN1-related SMA. All patients treated with GT are systematically included in the registry. As of July 21, 2023: 72 patients with SMA have been treated with GT in France since June 2019. The arrival of new treatments reveals new clinical phenotypes of SMA which constitute a new management challenge. Treatment as early as possible is also a very important factor for a favorable outcome and calls for presymptomatic screening. However, the arrival of these new treatments, extremely expensive raises other socio-economic questions. © 2023 Published by Elsevier Masson SAS on behalf of French Society of Pediatrics.
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Affiliation(s)
- Frédérique Audic
- Centre de Référence des Maladies Neuromusculaires de l'enfant PACARARE, Service de Neuropédiatrie, Hôpital Timone Enfants, 264 rue Saint Pierre, 14 13385 Marseille Cedex 5, France.
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Alves RMR, Van Der Linden V, de Andrade LB. Comprehensive assessment model for patients with spinal muscular atrophy: proposal of tools for clinical practice and real-world studies. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:377-379. [PMID: 36820780 PMCID: PMC10004283 DOI: 10.1590/1806-9282.20221608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/15/2022] [Indexed: 02/22/2023]
Affiliation(s)
- Renalli Manuella Rodrigues Alves
- Instituto de Medicina Integral Professor Fernando Figueira, Pós-graduação em Saúde Integral – Recife (PE), Brazil
- Hospital Otávio de Freitas, Departamento de Reabilitação – Recife (PE), Brazil
- Corresponding author:
| | - Vanessa Van Der Linden
- Hospital Maria Lucinda/Raros, Serviço de Doenças Raras – Recife (PE), Brazil
- Universidade Federal de Pernambuco, Centro de Ciências da Saúde – Recife (PE), Brazil
| | - Lívia Barbosa de Andrade
- Instituto de Medicina Integral Professor Fernando Figueira, Pós-graduação em Saúde Integral – Recife (PE), Brazil
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Menard J, Seferian AM, Fleurence E, Barzic A, Binoche A, Labouret G, Coutier L, Vuillerot C, Bieleu BM, Gomez Garcia de la Banda M, Corvol H, Servais L, Taytard J. Respiratory management of spinal muscular atrophy type 1 patients treated with Nusinersen. Pediatr Pulmonol 2022; 57:1505-1512. [PMID: 35307979 DOI: 10.1002/ppul.25899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/23/2022] [Accepted: 03/16/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The recent development of disease-modifying treatments in spinal muscular atrophy (SMA) type 1 shifted these patients' management from palliative to proactive. The aim of this study was to assess patients' nocturnal gas exchanges before noninvasive ventilation (NIV) initiation and their clinical evolution to determine if capnia is a good criterion to decide when to introduce respiratory support. PATIENTS AND METHODS This multicentric retrospective study reports the respiratory management and evolution of 17 SMA type 1 children (10 females) for whom treatment with Nusinersen was initiated between 2016 and 2018. RESULTS Median [interquartile range-IQR] age at diagnosis and at first Nusinersen injection was of 4 [3;8] and 4 [3;9] months, respectively. Patients were followed during 38 [24;44] months. Thirteen (76%) patients were started on NIV at a median [IQR] age of 12 [9;18] months. Repeated hospitalizations and intensive care unit admissions were needed for 11 of them. Blood gas and nocturnal gas exchange recordings performed before NIV initiation were always normal. 9/13 X-ray performed before NIV showed atelectasis and/or acute lower respiratory tract infections. There was a significant decrease in the total number of hospital admissions between the first and second year of treatment (p = 0.04). CONCLUSION This study shows that patients do not present with nocturnal hypoventilation before respiratory decompensations and NIV initiation, and suggests that a delay in NIV initiation might result in respiratory complications. There is a need for disease-centered guidelines for the respiratory management of these patients, including NIV indications.
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Affiliation(s)
- Joris Menard
- Department of Pediatric Pulmonology, Armand Trousseau University Hospital, Paris, France
| | | | | | - Audrey Barzic
- Department of Pediatric, Fondation Ildys, Brest, France
| | - Alexandra Binoche
- Pediatric Intensive Care Unit Department, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Géraldine Labouret
- Department of Pediatric Pulmonology and Allergology, Children's Hospital, Toulouse, France
| | - Laurianne Coutier
- Department of Pediatric Pulmonology and Allergology, Reference Center for Cystic Fibrosis, Hôpital Mère Enfant, Bron, France.,U1028, CNRL, Lyon 1 University, Lyon, France
| | - Carole Vuillerot
- Service de Rééducation Pédiatrique Infantile "L'Escale", Hôpital Mère Enfant, Hospices Civils de Lyon, Lyon, France.,Neuromyogen Institute, CNRS UMR 5310-INSERM U1219, Lyon University, Lyon, France
| | - Blaise M Bieleu
- Department of Pediatric Neurology and ICU, AP-HP Université Paris Saclay, Hôpital Raymond Poincaré, Garches, France.,Centre de Référence des Maladies Neuromusculaires Garches-Necker-Mondor-Hendaye (GNMH), Centre Nord- Est- Ile de France, Réseau national des maladies neuromusculaires, FILNEMUS, France.,European Reference Center Network (Euro-NMD ERN)
| | - Marta Gomez Garcia de la Banda
- Department of Pediatric Neurology and ICU, AP-HP Université Paris Saclay, Hôpital Raymond Poincaré, Garches, France.,Centre de Référence des Maladies Neuromusculaires Garches-Necker-Mondor-Hendaye (GNMH), Centre Nord- Est- Ile de France, Réseau national des maladies neuromusculaires, FILNEMUS, France.,European Reference Center Network (Euro-NMD ERN).,URC APHP Paris-Saclay 4 Institut de Myologie, Paris 5 APHP Raymond Poincaré Hospital, Garche, France
| | - Harriet Corvol
- Department of Pediatric Pulmonology, Armand Trousseau University Hospital, Paris, France.,Sorbonne Université, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Laurent Servais
- Department of Paediatrics, MDUK Oxford Neuromuscular Center, University of Oxford, Oxford, UK.,Division of Child Neurology Reference Center for Neuromuscular Disease, Department of Pediatrics, Centre Hospitalier Universitaire de Liège, University Hospital Liège & University, Liège, Belgium
| | - Jessica Taytard
- Department of Pediatric Pulmonology, Armand Trousseau University Hospital, Paris, France.,UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, Paris, France.,European Reference Network-Lung (ERN-Lung)
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Agosto C, Salamon E, Giacomelli L, Papa S, Benedetti F, Benini F. Effect of the COVID-19 Pandemic on Children With SMA Receiving Nusinersen: What Is Missed and What Is Gained? Front Neurol 2021; 12:704928. [PMID: 34621235 PMCID: PMC8491612 DOI: 10.3389/fneur.2021.704928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Nusinersen is the first oligonucleotide-based drug that is approved for the treatment of spinal muscular atrophy. In January 2020, the WHO declared COVID-19 a pandemic and nusinersen-provider centers had to postpone planned infusions for some children along with other related interventions. Considering the important contribution that the intrathecal infusions and other support activities could have on the quality of life of spinal muscular atrophy patients and their families, this emergency could have a relevant impact on the course of the pathology. The present work aims to assess the clinical and social issues that arise for spinal muscular atrophy children in care at the referral pediatric palliative care Centre of Padua (Veneto) from a delay in nusinersen infusions, resulting from the contingent COVID-19 restrictions. This evaluation has been carried out in both the short and long term after the first lockdown period and can be considered as a "proxy" of a situation of a possible delay in administration or management of infusions, due to other different causes.
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Affiliation(s)
- Caterina Agosto
- Pediatric Pain and Palliative Care Service, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Eleonora Salamon
- Pediatric Pain and Palliative Care Service, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | | | | | | | - Franca Benini
- Pediatric Pain and Palliative Care Service, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
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Hully M, Barnerias C, Chabalier D, Le Guen S, Germa V, Deladriere E, Vanhulle C, Cuisset JM, Chabrol B, Cances C, Vuillerot C, Espil C, Mayer M, Nougues MC, Sabouraud P, Lefranc J, Laugel V, Rivier F, Louvier UW, Durigneux J, Napuri S, Sarret C, Renouil M, Masurel A, Viallard ML, Desguerre I. Palliative Care in SMA Type 1: A Prospective Multicenter French Study Based on Parents' Reports. Front Pediatr 2020; 8:4. [PMID: 32133329 PMCID: PMC7039815 DOI: 10.3389/fped.2020.00004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/07/2020] [Indexed: 01/30/2023] Open
Abstract
Spinal muscular atrophy type 1 (SMA-1) is a severe neurodegenerative disorder, which in the absence of curative treatment, leads to death before 1 year of age in most cases. Caring for these short-lived and severely impaired infants requires palliative management. New drugs (nusinersen) have recently been developed that may modify SMA-1 natural history and thus raise ethical concerns about the appropriate level of care for patients. The national Hospital Clinical Research Program (PHRC) called "Assessment of clinical practices of palliative care in children with Spinal Muscular Atrophy Type 1 (SMA-1)" was a multicenter prospective study conducted in France between 2012 and 2016 to report palliative practices in SMA-1 in real life through prospective caregivers' reports about their infants' management. Thirty-nine patients were included in the prospective PHRC (17 centers). We also studied retrospective data regarding management of 43 other SMA-1 patients (18 centers) over the same period, including seven treated with nusinersen, in comparison with historical data from 222 patients previously published over two periods of 10 years (1989-2009). In the latest period studied, median age at diagnosis was 3 months [0.6-10.4]. Seventy-seven patients died at a median 6 months of age[1-27]: 32% at home and 8% in an intensive care unit. Eighty-five percent of patients received enteral nutrition, some through a gastrostomy (6%). Sixteen percent had a non-invasive ventilation (NIV). Seventy-seven percent received sedative treatment at the time of death. Over time, palliative management occurred more frequently at home with increased levels of technical supportive care (enteral nutrition, oxygenotherapy, and analgesic and sedative treatments). No statistical difference was found between the prospective and retrospective patients for the last period. However, significant differences were found between patients treated with nusinersen vs. those untreated. Our data confirm that palliative care is essential in management of SMA-1 patients and that parents are extensively involved in everyday patient care. Our data suggest that nusinersen treatment was accompanied by significantly more invasive supportive care, indicating that a re-examination of standard clinical practices should explicitly consider what treatment pathways are in infants' and caregivers' best interest. This study was registered on clinicaltrials.gov under the reference NCT01862042 (https://clinicaltrials.gov/ct2/show/study/NCT01862042?cond=SMA1&rank=8).
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Affiliation(s)
- Marie Hully
- Pediatric Neurology Department, Necker-Enfants Malades Hospital, APHP, Paris, France.,Physical Rehabilitation Department, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Christine Barnerias
- Pediatric Neurology Department, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Delphine Chabalier
- Pediatric Neurology Department, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Sophie Le Guen
- Clinical Research Department, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Virginie Germa
- Physical Rehabilitation Department, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Elodie Deladriere
- Physical Rehabilitation Department, Necker-Enfants Malades Hospital, APHP, Paris, France
| | | | - Jean-Marie Cuisset
- Pediatric Neurology Department and Neuromuscular Diseases Reference Center, CHU, Lille, France
| | - Brigitte Chabrol
- Pediatric Neurology Department, La Timone Hospital, APHM, Marseille, France
| | - Claude Cances
- Pediatric Neurology Department, Enfants Hospital, Toulouse, France
| | - Carole Vuillerot
- Pediatric Physical Rehabilitation Department, Femme Mère Enfants Hospital, Bron, France
| | - Caroline Espil
- Pediatric Neurology Department, Pellegrin Hospital, Bordeaux, France
| | - Michele Mayer
- Pediatric Neurology Department, Armand Trousseau Hospital, APHP, Paris, France
| | | | | | - Jeremie Lefranc
- Pediatric Neurology Department, Morvan Hospital, Brest, France
| | - Vincent Laugel
- Pediatric Neurology Department, Hautepierre Hospital, Strasbourg, France
| | - Francois Rivier
- Pediatric Neurology Department & Neuromuscular Diseases Reference Center AOC, CHU Montpellier, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Ulrike Walther Louvier
- Pediatric Neurology Department & Neuromuscular Diseases Reference Center AOC, CHU Montpellier, Montpellier, France
| | - Julien Durigneux
- Pediatric Neurology Department, University Hospital, Angers, France
| | - Sylvia Napuri
- Pediatric Department, South Hospital, Rennes, France
| | - Catherine Sarret
- Pediatric Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Michel Renouil
- Pediatric Department, St-Pierre Hospital, Saint-Denis, France
| | - Alice Masurel
- Genetic Department, Children Hospital, CHU Dijon, Dijon, France
| | - Marcel-Louis Viallard
- Palliative Care Team, Necker-Enfants Malades Hospital, APHP, Paris, France.,Research Team "ETRES", UMR des Cordeliers, Université de Paris, Paris, France
| | - Isabelle Desguerre
- Pediatric Neurology Department, Necker-Enfants Malades Hospital, APHP, Paris, France
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