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Coratti G, Bovis F, Pera MC, Scoto M, Montes J, Pasternak A, Mayhew A, Muni‐Lofra R, Duong T, Rohwer A, Dunaway Young S, Civitello M, Salmin F, Mizzoni I, Morando S, Pane M, Albamonte E, D'Amico A, Brolatti N, Sframeli M, Marini‐Bettolo C, Sansone VA, Bruno C, Messina S, Bertini E, Baranello G, Day J, Darras BT, De Vivo DC, Hirano M, Muntoni F, Finkel R, Mercuri E. Determining minimal clinically important differences in the Hammersmith Functional Motor Scale Expanded for untreated spinal muscular atrophy patients: An international study. Eur J Neurol 2024; 31:e16309. [PMID: 38656662 PMCID: PMC11236020 DOI: 10.1111/ene.16309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/21/2024] [Accepted: 04/04/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND PURPOSE Spinal muscular atrophy (SMA) is a rare and progressive neuromuscular disorder with varying severity levels. The aim of the study was to calculate minimal clinically important difference (MCID), minimal detectable change (MDC), and values for the Hammersmith Functional Motor Scale Expanded (HFMSE) in an untreated international SMA cohort. METHODS The study employed two distinct methods. MDC was calculated using distribution-based approaches to consider standard error of measurement and effect size change in a population of 321 patients (176 SMA II and 145 SMA III), allowing for stratification based on age and function. MCID was assessed using anchor-based methods (receiver operating characteristic [ROC] curve analysis and standard error) on 76 patients (52 SMA II and 24 SMA III) for whom the 12-month HFMSE could be anchored to a caregiver-reported clinical perception questionnaire. RESULTS With both approaches, SMA type II and type III patients had different profiles. The MCID, using ROC analysis, identified optimal cutoff points of -2 for type II and -4 for type III patients, whereas using the standard error we found the optimal cutoff points to be 1.5 for improvement and -3.2 for deterioration. Furthermore, distribution-based methods uncovered varying values across age and functional status subgroups within each SMA type. CONCLUSIONS These results emphasize that the interpretation of a single MCID or MDC value obtained in large cohorts with different functional status needs to be made with caution, especially when these may be used to assess possible responses to new therapies.
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Affiliation(s)
- Giorgia Coratti
- Pediatric NeurologyUniversità Cattolica del Sacro CuoreRomeItaly
- Centro Clinico NemoFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
| | - Francesca Bovis
- Department of Health Sciences (DISSAL)University of GenoaGenoaItaly
| | - Maria Carmela Pera
- Pediatric NeurologyUniversità Cattolica del Sacro CuoreRomeItaly
- Centro Clinico NemoFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
| | - Mariacristina Scoto
- Dubowitz Neuromuscular CentreUCL Great Ormond Street Institute of Child Health & MRC Centre for Neuromuscular DiseasesLondonUK
| | | | - Amy Pasternak
- Boston Children's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Anna Mayhew
- John Walton Muscular Dystrophy Research CentreNewcastle University and Newcastle Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | - Robert Muni‐Lofra
- John Walton Muscular Dystrophy Research CentreNewcastle University and Newcastle Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | - Tina Duong
- Department of Neurology TDStanford UniversityPalo AltoCaliforniaUSA
| | - Annemarie Rohwer
- Dubowitz Neuromuscular CentreUCL Great Ormond Street Institute of Child Health & MRC Centre for Neuromuscular DiseasesLondonUK
| | | | | | | | - Irene Mizzoni
- Unit of Neuromuscular and Neurodegenerative DisordersBambino Gesù Children's Hospital IRCCSRomeItaly
| | - Simone Morando
- Center of Myology and Neurodegenerative DisordersIRCCS Istituto Giannina GasliniGenoaItaly
| | - Marika Pane
- Pediatric NeurologyUniversità Cattolica del Sacro CuoreRomeItaly
- Centro Clinico NemoFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
| | | | - Adele D'Amico
- Unit of Neuromuscular and Neurodegenerative DisordersBambino Gesù Children's Hospital IRCCSRomeItaly
| | - Noemi Brolatti
- Center of Myology and Neurodegenerative DisordersIRCCS Istituto Giannina GasliniGenoaItaly
| | - Maria Sframeli
- Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly
| | - Chiara Marini‐Bettolo
- John Walton Muscular Dystrophy Research CentreNewcastle University and Newcastle Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | - Valeria Ada Sansone
- NEMO Clinical CenterMilanItaly
- Department of Biomedical Sciences for HealthUniversity of MilanMilanItaly
| | - Claudio Bruno
- Center of Myology and Neurodegenerative DisordersIRCCS Istituto Giannina GasliniGenoaItaly
| | - Sonia Messina
- Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly
| | - Enrico Bertini
- Unit of Neuromuscular and Neurodegenerative DisordersBambino Gesù Children's Hospital IRCCSRomeItaly
| | - Giovanni Baranello
- Dubowitz Neuromuscular CentreUCL Great Ormond Street Institute of Child Health & MRC Centre for Neuromuscular DiseasesLondonUK
- National Institute for Health Research Great Ormond Street Hospital Biomedical Research CentreLondonUK
| | - John Day
- Department of Neurology TDStanford UniversityPalo AltoCaliforniaUSA
| | - Basil T. Darras
- Boston Children's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | | | - Michio Hirano
- Columbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Francesco Muntoni
- Dubowitz Neuromuscular CentreUCL Great Ormond Street Institute of Child Health & MRC Centre for Neuromuscular DiseasesLondonUK
- National Institute for Health Research Great Ormond Street Hospital Biomedical Research CentreLondonUK
| | - Richard Finkel
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Eugenio Mercuri
- Pediatric NeurologyUniversità Cattolica del Sacro CuoreRomeItaly
- Centro Clinico NemoFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
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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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AlTawari A, Zakaria M, Kamel W, Shaalan N, Elghazawi GAI, Ali MEA, Salota D, Attia A, Elanay EEA, Shalaby O, Alqallaf F, Mitic V, Bastaki L. Nusinersen Treatment for Spinal Muscular Atrophy: Retrospective Multicenter Study of Pediatric and Adult Patients in Kuwait. Neurol Int 2024; 16:631-642. [PMID: 38921951 PMCID: PMC11206794 DOI: 10.3390/neurolint16030047] [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: 04/16/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
Spinal muscular atrophy is a neuromuscular genetic condition associated with progressive muscle weakness and atrophy. Nusinersen is an antisense oligonucleotide therapy approved for the treatment of 5q spinal muscular atrophy in pediatric and adult patients. The objective of this clinical case series is to describe the efficacy and safety of nusinersen in treating spinal muscular atrophy in 20 pediatric and 18 adult patients across six treatment centers in Kuwait. Functional motor assessments (Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders, Hammersmith Functional Motor Scale Expanded, and Revised Upper Limb Module) were used to assess changes in motor function following nusinersen treatment. The safety assessment involved clinical monitoring of adverse events. The results demonstrate clinically meaningful or considerable improvement in motor performance for nearly all patients, lasting over 4 years in some cases. A total of 70% of patients in the pediatric cohort and 72% of patients in the adult cohort achieved a clinically meaningful improvement in motor function following nusinersen treatment. Additionally, nusinersen was well-tolerated in both cohorts. These findings add to the growing body of evidence relating to the clinical efficacy and safety of nusinersen.
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Affiliation(s)
- Asma AlTawari
- Pediatric Department, Neurology Unit, Al Sabah Hospital, Shuwaikh Industrial 70050, Kuwait
| | | | - Walaa Kamel
- Neurology Department, Ibn Sina Hospital, Shuwaikh Industrial 70050, Kuwait
| | - Nayera Shaalan
- Neurology Department, Ibn Sina Hospital, Shuwaikh Industrial 70050, Kuwait
| | | | | | - Dalia Salota
- Pediatric Department, Neurology Unit, Al Sabah Hospital, Shuwaikh Industrial 70050, Kuwait
| | - Amr Attia
- Pediatric Department, Neurology Unit, Al Sabah Hospital, Shuwaikh Industrial 70050, Kuwait
| | | | - Osama Shalaby
- Pediatric Department, Al Jahra Hospital, Al Jahra 003200, Kuwait
| | - Fatema Alqallaf
- Pediatric Department, Neurology Unit, Mubarak Hospital, Jabriya 46300, Kuwait
| | - Vesna Mitic
- Pediatric Department, Al Farwaniya Hospital, Al Farwaniya 85000, Kuwait
| | - Laila Bastaki
- Kuwait Medical Genetics Center, Shuwaikh Industrial 70050, Kuwait
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Novikov A, Maldova M, Shamantseva N, Shalmiev I, Shoshina E, Epoyan N, Krutikova N, Moshonkina T. Non-Invasive Spinal Cord Stimulation for Motor Rehabilitation of Patients with Spinal Muscular Atrophy Treated with Orphan Drugs. Biomedicines 2024; 12:1162. [PMID: 38927369 PMCID: PMC11200420 DOI: 10.3390/biomedicines12061162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/17/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Spinal muscular atrophy (SMA) is an orphan disease characterized by the progressive degeneration of spinal alpha motor neurons. In recent years, nusinersen and several other drugs have been approved for the treatment of this disease. Transcutaneous spinal cord stimulation (tSCS) modulates spinal neuronal networks, resulting in changes in locomotion and posture in patients with severe spinal cord injury and stroke. We hypothesize that tSCS can activate motor neurons that are intact and restored by medication, slow the decline in motor activity, and contribute to the development of motor skills in SMA patients. Thirty-seven children and adults with SMA types 2 and 3 participated in this study. The median duration of drug treatment was over 20 months. The application of tSCS was performed during physical therapy for 20-40 min per day for ~12 days. Outcome measures were specific SMA motor scales, goniometry of contractured joints, and forced vital capacity. Significant increases in motor function, improved respiratory function, and decreased contracture were observed in both type 2 and 3 SMA participants. The magnitude of functional changes was not associated with participant age. Further studies are needed to elucidate the reasons for the beneficial effects of spinal cord electrical stimulation on SMA.
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Affiliation(s)
- Anton Novikov
- EirMED, 10 Vsevolod Vishnevsky St., 197136 St. Petersburg, Russia
| | - Maria Maldova
- EirMED, 10 Vsevolod Vishnevsky St., 197136 St. Petersburg, Russia
| | - Natalia Shamantseva
- Pavlov Institute of Physiology, Russian Academy of Sciences, 6 Makarova Enb., 199034 St. Petersburg, Russia
| | - Ivan Shalmiev
- EirMED, 10 Vsevolod Vishnevsky St., 197136 St. Petersburg, Russia
| | - Elena Shoshina
- EirMED, 10 Vsevolod Vishnevsky St., 197136 St. Petersburg, Russia
| | - Natalia Epoyan
- EirMED, 10 Vsevolod Vishnevsky St., 197136 St. Petersburg, Russia
| | | | - Tatiana Moshonkina
- Pavlov Institute of Physiology, Russian Academy of Sciences, 6 Makarova Enb., 199034 St. Petersburg, Russia
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Brakemeier S, Lipka J, Schlag M, Kleinschnitz C, Hagenacker T. Risdiplam improves subjective swallowing quality in non-ambulatory adult patients with 5q-spinal muscular atrophy despite advanced motor impairment. J Neurol 2024; 271:2649-2657. [PMID: 38358553 PMCID: PMC11055773 DOI: 10.1007/s00415-024-12203-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND 5q-associated spinal muscular atrophy (SMA) is characterized by the progressive loss of motor neurons with consecutive weakness and atrophy of the limb, respiratory, and bulbar muscles. While trunk and limb motor function improve or stabilize in adults with SMA under nusinersen and risdiplam treatment, the efficacy on bulbar function in this age group of patients remains uncertain. However, it is important to assess bulbar dysfunction, which frequently occurs in the disease course and is associated with increased morbidity and mortality. METHODS Bulbar function was evaluated prospectively in 25 non-ambulatory adults with type 2 and 3 SMA before and 4 and 12 months after risdiplam treatment initiation using the Sydney Swallow Questionnaire (SSQ) and the bulbar subscore of the Amyotrophic Lateral Sclerosis Functional Rating Scale Revised (b-ALSFRS-R). Extremity function was assessed using the Hammersmith Functional Motor Scale Expanded (HFMSE) and Revised Upper Limb Module (RULM). RESULTS Subjective swallowing quality, measured with the SSQ, improved after 12 months of therapy with risdiplam. For the b-ALSFRS-R, a non-significant trend towards improvement was observed. The RULM score improved after 12 months of risdiplam therapy, but not the HFMSE score. HFMSE and RULM scores did not correlate with the SSQ but the b-ALSFRS-R score at baseline. CONCLUSIONS The improvement in subjective swallowing quality under risdiplam treatment, despite an advanced disease stage with severe motor deficits, strengthens the importance of a standardized bulbar assessment in addition to established motor scores. This may reveal relevant treatment effects and help individualize treatment decisions in the future.
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Affiliation(s)
- S Brakemeier
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - J Lipka
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - M Schlag
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - C Kleinschnitz
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - T Hagenacker
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
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Hadouiri N, Fournel I, Thauvin-Robinet C, Jacquin-Piques A, Ornetti P, Gueugnon M. Walking test outcomes in adults with genetic neuromuscular diseases: a systematic literature review of their measurement properties. Eur J Phys Rehabil Med 2024; 60:257-269. [PMID: 38300152 PMCID: PMC11114158 DOI: 10.23736/s1973-9087.24.08095-x] [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: 06/16/2023] [Revised: 12/11/2023] [Accepted: 01/19/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Neuromuscular diseases (NMDs) include a large group of heterogeneous diseases. NMDs frequently involve gait disorders, which affect quality of life. Several walking tests and tools have been described in the literature, but there is no consensus regarding the use of walking tests and tools in NMDs or of their measurement properties for walking outcomes. The aim of this review is to present an overview of walking tests, including their measurement properties when used in adults with inherited or genetic NMDs. The aim is to help clinicians and researchers choose the most appropriate test for their objective. EVIDENCE ACQUISITION A systematic review was conducted after consulting MEDLINE (via PubMed), EMBASE, Science direct, Google Scholar and Cochrane Central Register of Controlled Trials databases for published studies in which walking outcome measurement properties were assessed. The validity, reliability, measurement error and responsiveness properties were evaluated in terms of statistical methods and methodological design qualities using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. EVIDENCE SYNTHESIS We included 46 studies in NMDs. These studies included 15 different walking tests and a wide variety of walking outcomes, assessed with six types of walking tools. Overall, the 6MWT was the most studied test in terms of measurement properties. The methodological design and statistical methods of most studies evaluating construct validity, reliability and measurement error were "very good." The majority of outcome measurements were valid and reliable. However, studies on responsiveness as minimal important difference or minimal important change were lacking or were found to have inadequate methodological and statistical methods according to the COSMIN guidelines. CONCLUSIONS Most walking outcomes were found to be valid and reliable in NMDs. However, in view of the growing number of clinical trials, further studies are needed to clarify additional measurement properties.
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Affiliation(s)
- Nawale Hadouiri
- Department of Physical Medicine and Rehabilitation, Dijon-Bourgogne University Hospital, Dijon, France -
- UMR-Inserm 1231, Génétique des Anomalies du Développement (GAD), Bourgogne Franche-Comté University, Dijon, France -
- INSERM, CIC 1432, Clinical Investigation Center, Plurithematic Module, Technological Investigation Platform, Dijon-Bourgogne University Hospital, Dijon, France -
| | - Isabelle Fournel
- Clinical Investigation Center, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | - Christel Thauvin-Robinet
- UMR-Inserm 1231, Génétique des Anomalies du Développement (GAD), Bourgogne Franche-Comté University, Dijon, France
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (TRANSLAD), CHU Dijon Bourgogne, Dijon, France
- Centre de Référence Maladies Rares "Maladies neurogénétiques", CHU Dijon Bourgogne, Dijon, France
| | - Agnès Jacquin-Piques
- Centre de Compétences Maladies Rares "Maladies neuromusculaires", Department of Neurology, Dijon University Hospital, Dijon, France
| | - Paul Ornetti
- Department of Rheumatology, Dijon-Bourgogne University Hospital, Dijon, France
- INSERM, UMR1093-CAPS, Bourgogne Franche-Comté University, Dijon, France
| | - Mathieu Gueugnon
- INSERM, CIC 1432, Clinical Investigation Center, Plurithematic Module, Technological Investigation Platform, Dijon-Bourgogne University Hospital, Dijon, France
- INSERM, UMR1093-CAPS, Bourgogne Franche-Comté University, Dijon, France
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Bjelica B, Wohnrade C, Cespedes I, Osmanovic A, Schreiber-Katz O, Petri S. Risdiplam therapy in adults with 5q-SMA: observational study on motor function and treatment satisfaction. BMC Neurol 2024; 24:67. [PMID: 38368338 PMCID: PMC10873992 DOI: 10.1186/s12883-024-03562-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/02/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND We aimed to describe the experience of a single neuromuscular center in Germany in treating adult spinal muscular atrophy (SMA) patients with risdiplam and to analyze motor function and treatment satisfaction during a follow-up period up to 20 months. METHODS Fourteen patients with type 2 or 3 SMA (seven with SMA type 2, six with SMA type 3; age range: 18-51) were included. The Revised Upper Limb Module (RULM) and the Hammersmith Functional Motor Scale Expanded (HFMSE) were recorded at baseline and at follow-up (month 4, 8, 12, 16, 20). Treatment adverse events were collected at every follow-up visit. Patients' treatment satisfaction was assessed by the Treatment Satisfaction Questionnaire for Medication (TSQM). RESULTS Half of the patients reached the 20-month follow-up. Based on the HFMSE score, no patients had clinically meaningful improvement. Twelve remained stable (92.3%), two showed transient clinically meaningful deterioration (15.4%) and one experienced lasting clinically meaningful deterioration (7.7%). Based on the RULM scores, seven patients were either stable or demonstrated clinically meaningful improvement (53.8%) and six showed clinically meaningful deterioration (46.2%). There was no treatment withdrawal during the follow-up. The most common adverse events were skin rash/increased skin sensitivity to sunlight (n = 3), diarrhea (n = 3), aphthous ulcer (n = 3) and abdominal pain (n = 2). Most patients stated to be at least "satisfied" with the medication. CONCLUSIONS Risdiplam was well tolerated. Half of the patients remained stable or improved after risdiplam initiation. Larger and multicentric studies are needed to better understand the long-term effects of risdiplam in adult SMA.
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Affiliation(s)
- Bogdan Bjelica
- Department of Neurology, Hannover Medical School, 1, Carl-Neuberg-Straße, Hannover, 30625, Germany.
| | - Camilla Wohnrade
- Department of Neurology, Hannover Medical School, 1, Carl-Neuberg-Straße, Hannover, 30625, Germany
| | - Iraima Cespedes
- Department of Neurology, Hannover Medical School, 1, Carl-Neuberg-Straße, Hannover, 30625, Germany
| | - Alma Osmanovic
- Department of Neurology, Hannover Medical School, 1, Carl-Neuberg-Straße, Hannover, 30625, Germany
- Essen Center for Rare Diseases (EZSE), University Hospital Essen, Essen, Germany
| | - Olivia Schreiber-Katz
- Department of Neurology, Hannover Medical School, 1, Carl-Neuberg-Straße, Hannover, 30625, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, 1, Carl-Neuberg-Straße, Hannover, 30625, Germany
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Salort-Campana E, Solé G, Magot A, Tard C, Noury JB, Behin A, De La Cruz E, Boyer F, Lefeuvre C, Masingue M, Debergé L, Finet A, Brison M, Spinazzi M, Pegat A, Sacconi S, Malfatti E, Choumert A, Bellance R, Bedat-Millet AL, Feasson L, Vuillerot C, Jacquin-Piques A, Michaud M, Pereon Y, Stojkovic T, Laforêt P, Attarian S, Cintas P. Multidisciplinary team meetings in treatment of spinal muscular atrophy adult patients: a real-life observatory for innovative treatments. Orphanet J Rare Dis 2024; 19:24. [PMID: 38268028 PMCID: PMC10809505 DOI: 10.1186/s13023-023-03008-6] [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: 08/13/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND In 2017, a new treatment by nusinersen, an antisense oligonucleotide delivered by repeated intrathecal injections, became available for patients with spinal muscular atrophy (SMA), whereas clinical trials had mainly involved children. Since 2020, the oral, selective SMN2-splicing modifier risdiplam has been available with restrictions evolving with time. In this peculiar context of lack of data regarding adult patients, many questions were raised to define the indications of treatment and the appropriate follow-up in this population. To homogenize access to treatment in France, a national multidisciplinary team meeting dedicated to adult SMA patients, named SMA multidisciplinary team meeting, (SMDTs) was created in 2018. Our objective was to analyze the value of SMDTs in the decision-making process in SMA adult patients and to provide guidelines about treatment. METHODS From October 2020 to September 2021, data extracted from the SMDT reports were collected. The primary outcome was the percentage of cases in which recommendations on validating treatment plans were given. The secondary outcomes were type of treatment requested, description of expectations regarding treatment and description of recommendations or follow-up and discontinuation. Data were analyzed using descriptive statistics. Comparisons between the type of treatment requested were performed using Mann-Whitney test or the Student t test for quantitative data and the Fisher's exact test or the χ2 test for qualitative data. RESULTS Cases of 107 patients were discussed at the SMDTs with a mean age of 35.3 (16-62). Forty-seven were SMA type 2, and 57 SMA type 3. Twelve cases were presented twice. Out of 122 presentations to the SMDTs, most of requests related to the initiation of a treatment (nusinersen (n = 46), risdiplam (n = 54), treatment without mentioning preferred choice (n = 5)) or a switch of treatment (n = 12). Risdiplam requests concerned significantly older patients (p = 0.002), mostly SMA type 2 (p < 0.0001), with greater disease severity in terms of motor and respiratory function compared to requests for nusinersen. In the year prior to presentation to the SMDTs, most of the patients experienced worsening of motor weakness assessed by functional tests as MFM32 or other meaningful scales for the most severe patients. Only 12% of the patients discussed had a stable condition. Only 49/122 patients (40.1%) expressed clear expectations regarding treatment. The treatment requested was approved by the SMDTs in 72 patients (67.2%). The most common reasons to decline treatment were lack of objective data on the disease course prior discussion to the SMDTs or inappropriate patient's expectations. Treatment requests were more likely to be validated by the SMDTs if sufficient pre-therapeutic functional assessment had been performed to assess the natural history (55% vs. 32%) and if the patient had worsening rather than stable motor function (p = 0.029). In patients with approved treatment, a-priori criteria to define a further ineffectiveness of treatment (usually after 14 months of treatment) were proposed for 67/72 patients. CONCLUSIONS In the context of costly treatments with few controlled studies in adults with SMA, in whom assessment of efficacy can be complex, SMDTs are 'real-world observatories' of great interest to establish national recommendations about indications of treatment and follow-up.
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Affiliation(s)
- Emmanuelle Salort-Campana
- Service de Neurologie du Pr Attarian, Centre de Référence des Maladies Neuromusculaires PACA Réunion Rhône Alpes, Timone University Hospital, Aix-Marseille University, 264 Rue Saint-Pierre, 13385, Marseille Cedex 05, France.
- Inserm UMR_S 910 Medical Genetics and Functional Genomics, Aix Marseille Université, Marseille, France.
- FILNEMUS, Marseille, France.
| | - Guilhem Solé
- Centre de Référence des Maladies Neuromusculaires AOC, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
- FILNEMUS, Marseille, France
| | - Armelle Magot
- Laboratoire d'Explorations Fonctionnelles, Hôtel-Dieu, Centre de Référence des Maladies Neuromusculaires AOC, CHU de Nantes, Nantes, France
- FILNEMUS, Marseille, France
| | - Céline Tard
- Centre de Référence des Maladies Neuromusculaires Nord Est Ile de France, Lille, France
- FILNEMUS, Marseille, France
| | - Jean-Baptiste Noury
- Reference Centre for Neuromuscular Diseases AOC, University Hospital of Brest, Brest, France
- FILNEMUS, Marseille, France
| | - Anthony Behin
- Centre de Référence des Maladies Neuromusculaires Nord/Est/Île-de-France, Institut de Myologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
- FILNEMUS, Marseille, France
| | - Elisa De La Cruz
- Centre de Référence des Maladies Neuromusculaires AOC, CHU et Université de Montpellier, Montpellier, France
- UVSQ, Paris-Saclay University, Paris, France
| | - François Boyer
- Pôle de Médecine Physique et de Réadaptation, Hôpital Universitaire Reims-Champagne-Ardenne, CHU Sébastopol, Centre de Référence des Maladies Neuromusculaires Nord Est Ile de France, Reims, France
- FILNEMUS, Marseille, France
| | - Claire Lefeuvre
- Nord-Est-Ile-de-France, Service de Neurologie, FHU Phenix, Centre de Référence de Pathologie Neuromusculaire, Raymond Poincaré University Hospital, Garches, APHP, Garches, France
- FILNEMUS, Marseille, France
| | - Marion Masingue
- Centre de Référence des Maladies Neuromusculaires Nord/Est/Île-de-France, Institut de Myologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
- FILNEMUS, Marseille, France
| | - Louise Debergé
- Centre de Référence des Maladies Neuromusculaires AOC, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
- FILNEMUS, Marseille, France
| | - Armelle Finet
- Service de Neurologie du Pr Attarian, Centre de Référence des Maladies Neuromusculaires PACA Réunion Rhône Alpes, Timone University Hospital, Aix-Marseille University, 264 Rue Saint-Pierre, 13385, Marseille Cedex 05, France
- FILNEMUS, Marseille, France
| | - Mélanie Brison
- Centre de Réference des Maladies Neuromusculaires PACA Réunion Rhône Alpes Service de Neurologie, CHU de Saint-Etienne, Saint-Étienne, France
- FILNEMUS, Marseille, France
| | - Marco Spinazzi
- Department of Neurology, Centre Hospitalier Universitaire d'Angers, Angers, France
- FILNEMUS, Marseille, France
| | - Antoine Pegat
- Service de Neurologie C, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 69500, Bron, France
- Service d'Explorations Fonctionnelles Neurologiques, Hôpital Neurologique Pierre Wertheimer, 69500, Bron, France
- FILNEMUS, Marseille, France
| | - Sabrina Sacconi
- Service Système Nerveux Périphérique & Muscle, Centre de Référence des Maladies Neuromusculaires PACA Réunion Rhône Alpes, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
- FILNEMUS, Marseille, France
| | - Edoardo Malfatti
- APHP, Centre de Référence de Pathologie Neuromusculaire Nord-Est-Ile-de-France, Henri Mondor Hospital, University Paris-Est, Créteil, France
- FILNEMUS, Marseille, France
| | - Ariane Choumert
- Department of Rare Neurological Diseases, Centre de Référence des Maladies Neuromusculaires PACA Réunion Rhône Alpes, CHU de la Réunion, Saint-Pierre, France
- FILNEMUS, Marseille, France
| | - Rémi Bellance
- CeRCa, Site Constitutif de Centre de Référence Caribéen des Maladies Neuromusculaires Rares, CHU de Martinique, Hôpital P. Zobda-Quitman, Fort-de-France, France
- FILNEMUS, Marseille, France
| | | | - Léonard Feasson
- Physiology and Exercise Laboratory EA4338, Centre de Référence des Maladies Neuromusculaires PACA Réunion Rhône Alpes, Rhône-Alpes Bellevue Hospital, University Hospital Center of Saint-Étienne, Saint-Étienne, France
- FILNEMUS, Marseille, France
| | - Carole Vuillerot
- Service de Médecine Physique et Réadaptation Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69677, Bron Cedex, France
- FILNEMUS, Marseille, France
| | - Agnès Jacquin-Piques
- Department of Clinical Neurophysiology, CHU Dijon Bourgogne, Dijon, France
- FILNEMUS, Marseille, France
| | - Maud Michaud
- Department of Neurology, Nancy University Hospital, Nancy, France
- FILNEMUS, Marseille, France
| | - Yann Pereon
- Laboratoire d'Explorations Fonctionnelles, Hôtel-Dieu, Centre de Référence des Maladies Neuromusculaires AOC, CHU de Nantes, Nantes, France
- FILNEMUS, Marseille, France
| | - Tanya Stojkovic
- Centre de Référence des Maladies Neuromusculaires Nord/Est/Île-de-France, Institut de Myologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
- FILNEMUS, Marseille, France
| | - Pascal Laforêt
- Nord-Est-Ile-de-France, Service de Neurologie, FHU Phenix, Centre de Référence de Pathologie Neuromusculaire, Raymond Poincaré University Hospital, Garches, APHP, Garches, France
- UVSQ, Paris-Saclay University, Paris, France
- FILNEMUS, Marseille, France
| | - Shahram Attarian
- Service de Neurologie du Pr Attarian, Centre de Référence des Maladies Neuromusculaires PACA Réunion Rhône Alpes, Timone University Hospital, Aix-Marseille University, 264 Rue Saint-Pierre, 13385, Marseille Cedex 05, France
- Inserm UMR_S 910 Medical Genetics and Functional Genomics, Aix Marseille Université, Marseille, France
- FILNEMUS, Marseille, France
| | - Pascal Cintas
- Service de Neurologie, CHU de Toulouse Purpan, Place du Docteur Baylac TSA 40031, 8. Centre de Référence des Maladies Neuromusculaires AOC, 31059, Toulouse Cedex 9, France
- FILNEMUS, Marseille, France
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9
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Wolfe A, Stimpson G, Ramsey D, Coratti G, Dunaway Young S, Mayhew A, Pane M, Rohwer A, Muni Lofra R, Duong T, O'Reilly E, Milev E, Civitello M, Sansone VA, D'Amico A, Bertini E, Messina S, Bruno C, Albamonte E, Mazzone E, Main M, Montes J, Glanzman AM, Zolkipli-Cunningham Z, Pasternak A, Marini-Bettolo C, Day JW, Darras BT, De Vivo DC, Baranello G, Scoto M, Finkel RS, Mercuri E, Muntoni F. Disease Trajectories in the Revised Hammersmith Scale in a Cohort of Untreated Patients with Spinal Muscular Atrophy types 2 and 3. J Neuromuscul Dis 2024; 11:665-677. [PMID: 38427497 DOI: 10.3233/jnd-230211] [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: 03/03/2024]
Abstract
Background Spinal muscular atrophy (SMA) is a neuromuscular disorder characterised by progressive motor function decline. Motor function is assessed using several functional outcome measures including the Revised Hammersmith Scale (RHS). Objective In this study, we present longitudinal trajectories for the RHS in an international cohort of 149 untreated paediatric SMA 2 and 3 patients (across 531 assessments collected between March 2015 and July 2019). Methods We contextualise these trajectories using both the Hammersmith Functional Motor Scale Expanded (HFMSE) and Revised Upper Limb Module (RULM). At baseline, this cohort included 50% females and 15% of patients had undergone spinal fusion surgery. Patient trajectories were modelled using a natural cubic spline with age, sex, and random effects for each patient. Results RHS and HFMSE scores show similar trends over time in this cohort not receiving disease modifying therapies. The results confirm the strong correlation between the RHS and RULM previously observed in SMA types 2 and 3a. Scoliosis surgery is associated with a reduction of 3 points in the RHS, 4.5 points in the HFMSE for the SMA 2 population, and a reduction of 11.8 points in the RHS, and 13.4 points in the HFMSE for the SMA 3a populations. When comparing the RHS and RULM, there is a lower correlation in the type 3a's than the type 2 patients. In the SMA 2 population, there is no significant difference between the sexes in either the RHS or HFMSE trajectories. There is no significant difference in the RULM trajectory in the SMA 2 or 3a participants by sex. Conclusions This study demonstrates that the RHS could be used in conjunction with other functional measures such as the RULM to holistically detect SMA disease progression. This will assist with fully understanding changes that occur with treatments, further defining trajectories and therapy outcomes.
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Affiliation(s)
- Amy Wolfe
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, UK
- Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
- National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Georgia Stimpson
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, UK
- National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | | | - Giorgia Coratti
- Pediatric Neurology Unit, Catholic University, Rome, Italy
- Centro Clinico Nemo, U.O.C. Neuropsichiatria Infantile Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Anna Mayhew
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
| | - Marika Pane
- Pediatric Neurology Unit, Catholic University, Rome, Italy
- Centro Clinico Nemo, U.O.C. Neuropsichiatria Infantile Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Annemarie Rohwer
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, UK
- National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Robert Muni Lofra
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
| | | | - Emer O'Reilly
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, UK
- National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Evelin Milev
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, UK
- National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Matthew Civitello
- St. Jude Children's Research Hospital, Memphis, USA
- Nemours Children's Hospital and University of Central Florida College of Medicine, Orlando, USA
| | - Valeria A Sansone
- The NEMO Center in Milan, Neurorehabilitation Unit, University of Milan, ASST Niguarda Hospital, Milan, Italy
| | - Adele D'Amico
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Enrico Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sonia Messina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Claudio Bruno
- Center of Translational and Experimental Myology and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, IRCCS Istituto Giannina Gaslini and University of Genoa, Genoa, Italy
| | - Emilio Albamonte
- The NEMO Center in Milan, Neurorehabilitation Unit, University of Milan, ASST Niguarda Hospital, Milan, Italy
| | - Elena Mazzone
- Pediatric Neurology Unit, Catholic University, Rome, Italy
- Centro Clinico Nemo, U.O.C. Neuropsichiatria Infantile Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marion Main
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | | | | | - Amy Pasternak
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Chiara Marini-Bettolo
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
| | | | - Basil T Darras
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Giovanni Baranello
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, UK
- National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Mariacristina Scoto
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, UK
- National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Richard S Finkel
- St. Jude Children's Research Hospital, Memphis, USA
- Nemours Children's Hospital and University of Central Florida College of Medicine, Orlando, USA
| | - Eugenio Mercuri
- Pediatric Neurology Unit, Catholic University, Rome, Italy
- Centro Clinico Nemo, U.O.C. Neuropsichiatria Infantile Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Muntoni
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, UK
- National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
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10
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Cho J, Lee J, Kim J, Lee H, Kim MJ, Lee YJ, Yum MS, Byun JH, Lee CG, Lee YM, Lee J, Chae JH. Nusinersen demonstrates effectiveness in treating spinal muscular atrophy: findings from a three-year nationwide study in Korea. Front Neurol 2023; 14:1294028. [PMID: 38192577 PMCID: PMC10773909 DOI: 10.3389/fneur.2023.1294028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/05/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction Nusinersen is the first drug approved for spinal muscular atrophy (SMA) treatment. In this study, we aimed to evaluate the long-term safety and efficacy of nusinersen, assess the therapeutic effects based on the treatment initiation timing and baseline motor function, and explore the perception of functional improvement from either parents or patients, utilizing 3-year nationwide follow-up data in South Korea. Methods We enrolled patients with SMA who were treated with nusinersen under the National Health Insurance coverage, with complete motor score records available and a minimum treatment duration of 6 months. To evaluate the motor function of patients, the Hammersmith Infant Neurological Examination-2 (HINE-2) was used for type 1 and the Expanded Hammersmith Functional Motor Scale (HFMSE) was used for types 2 and 3 patients. A significant improvement was defined as a HINE-2 score gain ≥5 for patients with type 1 and an HFMSE score ≥ 3 for patients with types 2 and 3 SMA. Effects of treatment timing were assessed. Patients with type 2 were further categorized based on baseline motor scores for outcome analysis. We also analyzed a second dataset from five tertiary hospitals with the information on parents/patients-reported impressions of improvement. Results The study comprised 137 patients, with 21, 103, and 13 patients representing type 1, 2, and 3 SMA, respectively. At the 3-year follow-up, the analysis encompassed 7 patients with type 1, 12 patients with type 2, and none with type 3. Nearly half of all enrolled patients across SMA types (42.8, 59.2 and 46.2%, respectively) reached the 2-year follow-up for analysis. Patients with type 1 SMA exhibited gradual motor function improvement over 1-, 2-, and 3-year follow-ups (16, 9, and 7 patients, respectively). Patients with type 2 SMA demonstrated improvement over 1-, 2-, and 3-year follow-ups (96, 61 and 12 patients, respectively). Early treatment from symptom onset resulted in better outcomes for patients with type 1 and 2 SMA. In the second dataset, 90.7% of 108 patients reported subjective improvement at the 1-year follow-up. Conclusion Nusinersen treatment for types 1-3 SMA is safe and effective in long-term follow-up. Early treatment initiation was a significant factor affecting long-term motor outcome.
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Affiliation(s)
- Jaeso Cho
- Department of Genomic Medicine, Seoul National University Children’s Hospital, Seoul, Republic of Korea
| | - Jiwon Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jihye Kim
- Health Insurance Review & Assessment Service (HIRA), HIRA Research Institute, Wonju, Republic of Korea
| | - Hyunjoo Lee
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min-Jee Kim
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yun Jeong Lee
- Department of Pediatrics, Kyungpook National University Hospital, Kyungpook, Republic of Korea
| | - Mi-Sun Yum
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ji-Hye Byun
- Health Insurance Review & Assessment Service (HIRA), HIRA Research Institute, Wonju, Republic of Korea
| | - Chong Guk Lee
- Health Insurance Review & Assessment Service (HIRA), HIRA Research Institute, Wonju, Republic of Korea
| | - Young-Mock Lee
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeehun Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong-Hee Chae
- Department of Genomic Medicine, Seoul National University Children’s Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
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11
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Tang WJ, Gu B, Montalvo S, Dunaway Young S, Parker DM, de Monts C, Ataide P, Ni Ghiollagain N, Wheeler MT, Tesi Rocha C, Christle JW, He Z, Day JW, Duong T. Assessing the Assisted Six-Minute Cycling Test as a Measure of Endurance in Non-Ambulatory Patients with Spinal Muscular Atrophy (SMA). J Clin Med 2023; 12:7582. [PMID: 38137651 PMCID: PMC10743820 DOI: 10.3390/jcm12247582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/16/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Assessing endurance in non-ambulatory individuals with Spinal Muscular Atrophy (SMA) has been challenging due to limited evaluation tools. The Assisted 6-Minute Cycling Test (A6MCT) is an upper limb ergometer assessment used in other neurologic disorders to measure endurance. To study the performance of the A6MCT in the non-ambulatory SMA population, prospective data was collected on 38 individuals with SMA (13 sitters; 25 non-sitters), aged 5 to 74 years (mean = 30.3; SD = 14.1). The clinical measures used were A6MCT, Revised Upper Limb Module (RULM), Adapted Test of Neuromuscular Disorders (ATEND), and Egen Klassifikation Scale 2 (EK2). Perceived fatigue was assessed using the Fatigue Severity Scale (FSS), and effort was assessed using the Rate of Perceived Exertion (RPE). Data were analyzed for: (1) Feasibility, (2) Clinical discrimination, and (3) Associations between A6MCT with clinical characteristics and outcomes. Results showed the A6MCT was feasible for 95% of the tested subjects, discriminated between functional groups (p = 0.0086), and was significantly associated with results obtained from RULM, ATEND, EK2, and Brooke (p < 0.0001; p = 0.029; p < 0.001; p = 0.005). These findings indicate the A6MCT's potential to evaluate muscular endurance in non-ambulatory SMA individuals, complementing clinician-rated assessments. Nevertheless, further validation with a larger dataset is needed for broader application.
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Affiliation(s)
- Whitney J. Tang
- Department of Neurology and Clinical Neurosciences, Stanford University, Palo Alto, CA 94305, USA; (W.J.T.); (S.D.Y.); (C.T.R.); (Z.H.); (J.W.D.)
| | - Bo Gu
- Department of Neurology and Clinical Neurosciences, Stanford University, Palo Alto, CA 94305, USA; (W.J.T.); (S.D.Y.); (C.T.R.); (Z.H.); (J.W.D.)
| | - Samuel Montalvo
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Palo Alto, CA 94305, USA; (S.M.); (J.W.C.)
| | - Sally Dunaway Young
- Department of Neurology and Clinical Neurosciences, Stanford University, Palo Alto, CA 94305, USA; (W.J.T.); (S.D.Y.); (C.T.R.); (Z.H.); (J.W.D.)
| | - Dana M. Parker
- Department of Neurology and Clinical Neurosciences, Stanford University, Palo Alto, CA 94305, USA; (W.J.T.); (S.D.Y.); (C.T.R.); (Z.H.); (J.W.D.)
| | - Constance de Monts
- Department of Neurology and Clinical Neurosciences, Stanford University, Palo Alto, CA 94305, USA; (W.J.T.); (S.D.Y.); (C.T.R.); (Z.H.); (J.W.D.)
| | - Paxton Ataide
- Department of Neurology and Clinical Neurosciences, Stanford University, Palo Alto, CA 94305, USA; (W.J.T.); (S.D.Y.); (C.T.R.); (Z.H.); (J.W.D.)
| | - Noirin Ni Ghiollagain
- Department of Neurology and Clinical Neurosciences, Stanford University, Palo Alto, CA 94305, USA; (W.J.T.); (S.D.Y.); (C.T.R.); (Z.H.); (J.W.D.)
| | - Matthew T. Wheeler
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Palo Alto, CA 94305, USA; (S.M.); (J.W.C.)
| | - Carolina Tesi Rocha
- Department of Neurology and Clinical Neurosciences, Stanford University, Palo Alto, CA 94305, USA; (W.J.T.); (S.D.Y.); (C.T.R.); (Z.H.); (J.W.D.)
| | - Jeffrey W. Christle
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Palo Alto, CA 94305, USA; (S.M.); (J.W.C.)
| | - Zihuai He
- Department of Neurology and Clinical Neurosciences, Stanford University, Palo Alto, CA 94305, USA; (W.J.T.); (S.D.Y.); (C.T.R.); (Z.H.); (J.W.D.)
| | - John W. Day
- Department of Neurology and Clinical Neurosciences, Stanford University, Palo Alto, CA 94305, USA; (W.J.T.); (S.D.Y.); (C.T.R.); (Z.H.); (J.W.D.)
| | - Tina Duong
- Department of Neurology and Clinical Neurosciences, Stanford University, Palo Alto, CA 94305, USA; (W.J.T.); (S.D.Y.); (C.T.R.); (Z.H.); (J.W.D.)
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12
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Kelly KM, Mizell J, Bigdeli L, Paul S, Tellez MA, Bartlett A, Heintzman S, Reynolds JE, Sterling GB, Rajneesh KF, Kolb SJ, Elsheikh B, Arnold WD. Differential impact on motor unit characteristics across severities of adult spinal muscular atrophy. Ann Clin Transl Neurol 2023; 10:2208-2222. [PMID: 37735861 PMCID: PMC10723249 DOI: 10.1002/acn3.51906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 08/22/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE To test the hypotheses that decomposition electromyography (dEMG) motor unit action potential (MUAP) amplitude and firing rate are altered in SMA; dEMG parameters are associated with strength and function; dEMG parameters are correlated with traditional electrophysiological assessments. METHODS Ambulatory and non-ambulatory adults with SMA on nusinersen and healthy controls were enrolled. MUAPs were decomposed from multielectrode surface recordings during 30-s maximum contraction of the abductor digiti minimi (ADM). Isometric strength, upper limb function, patient-reported function, and standard electrophysiologic measures of the ADM (compound muscle action potential [CMAP], single motor unit potential [SMUP], motor unit number estimation [MUNE]) were collected. RESULTS dEMG MUAP amplitudes were higher in ambulatory versus control and non-ambulatory groups and were higher in controls versus non-ambulatory SMA. In contrast, dEMG firing rates were higher in ambulatory versus non-ambulatory and control groups but similar between non-ambulatory and control. dEMG parameters showed moderate to strong positive correlation with strength and function whereas CMAP and MUNE better correlated with function than strength. SMUP did not correlate with strength, function, or dEMG MUAP amplitude. dEMG parameters show overall good test-retest reliability. INTERPRETATION dEMG provided reliable, noninvasive measure of MUAP amplitude size and firing rate and revealed divergent patterns across disease severity in adults with SMA. Firing rate enhancement, as seen in milder SMA, may provide a therapeutic avenue for improving function in more severe SMA, where firing rates appear preserved. MUAP amplitude size and firing rate, quantified with dEMG, may be promising monitoring biomarker candidates for noninvasive assessment of SMA.
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Affiliation(s)
- Kristina Marie Kelly
- Department of Physical Medicine & RehabilitationUniversity of MissouriColumbiaMOUSA
- NextGen Precision HealthUniversity of MissouriColumbiaMOUSA
| | - Jordan Mizell
- College of MedicineThe Ohio State UniversityColumbusOHUSA
| | - Ladan Bigdeli
- College of MedicineThe Ohio State UniversityColumbusOHUSA
| | - Samuel Paul
- College of MedicineThe Ohio State UniversityColumbusOHUSA
| | - Marco Antonio Tellez
- Department of NeurologyThe Ohio State University Wexner Medical CenterColumbusOHUSA
| | - Amy Bartlett
- Center for Clinical and Translational ScienceThe Ohio State University Wexner Medical CenterColumbusOHUSA
| | - Sarah Heintzman
- Department of NeurologyThe Ohio State University Wexner Medical CenterColumbusOHUSA
| | | | - Gary Brent Sterling
- Department of NeurologyThe Ohio State University Wexner Medical CenterColumbusOHUSA
| | | | - Stephen James Kolb
- Department of NeurologyThe Ohio State University Wexner Medical CenterColumbusOHUSA
| | - Bakri Elsheikh
- Department of NeurologyThe Ohio State University Wexner Medical CenterColumbusOHUSA
| | - William David Arnold
- Department of Physical Medicine & RehabilitationUniversity of MissouriColumbiaMOUSA
- NextGen Precision HealthUniversity of MissouriColumbiaMOUSA
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13
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Sprenger-Svačina A, Haensch J, Weiss K, Große Hokamp N, Maintz D, Schlamann M, Fink GR, Schloss N, Laukamp K, Wunderlich G, Lehmann HC, Lichtenstein T. MRI correlates of motoneuron loss in SMA. J Neurol 2023; 270:503-510. [PMID: 36180649 PMCID: PMC9813025 DOI: 10.1007/s00415-022-11326-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is currently explored as supplemental tool to monitor disease progression and treatment response in various neuromuscular disorders. We here assessed the utility of a multi-parametric magnetic resonance imaging (MRI) protocol including quantitative water T2 mapping, Dixon-based proton density fat fraction (PDFF) estimation and diffusion tensor imaging (DTI) to detect loss of spinal motor neurons and subsequent muscle damage in adult SMA patients. METHODS Sixteen SMA patients and 13 age-matched controls were enrolled in this prospective, longitudinal study. All participants underwent MRI imaging including measurements of Dixon-based PDFF and DTI of the sciatic nerve. SMA patients furthermore underwent measurements of muscle water T2 (T2w) of the biceps femoris muscle (BFM) and quadriceps femoris muscle (QFM). Ten participants returned for a second scan six months later. MRI parameter were correlated with clinical data. All patients were on nusinersen treatment. RESULTS There were significantly higher intramuscular fat fractions in the BFM and QFM of SMA patients compared to healthy controls at baseline and after 6 months. Furthermore, T2 values significantly correlated positively with intramuscular fat fractions. The Hammersmith functional motor scale significantly correlated with the QFM's intramuscular fat fractions. DTI scans of the sciatic nerve were not significantly different between the two groups. CONCLUSION This study demonstrates that, water T2 mapping and Dixon-based PDFF estimation may distinguish between adult SMA patients and controls, due to massive intramuscular fat accumulation in SMA. More extensive long-term studies are warranted to further evaluate these two modalities as surrogate markers in SMA patients during treatment.
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Affiliation(s)
- Alina Sprenger-Svačina
- Department of Neurology, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Johannes Haensch
- Department of Neurology, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Kilian Weiss
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Philips GmbH Market DACH, Hamburg, Germany
| | - Nils Große Hokamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marc Schlamann
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, Juelich, Germany
| | - Natalie Schloss
- Department of Neurology, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Kai Laukamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gilbert Wunderlich
- Department of Neurology, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Helmar C Lehmann
- Department of Neurology, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Thorsten Lichtenstein
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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14
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Scheijmans FEV, Cuppen I, van Eijk RPA, Wijngaarde CA, Schoenmakers MAGC, van der Woude DR, Bartels B, Veldhoen ES, Oude Lansink ILB, Groen EJN, Asselman FL, Wadman RI, van der Pol WL. Population-based assessment of nusinersen efficacy in children with spinal muscular atrophy: a 3-year follow-up study. Brain Commun 2022; 4:fcac269. [PMID: 36382221 PMCID: PMC9651026 DOI: 10.1093/braincomms/fcac269] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 08/17/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022] Open
Abstract
Nusinersen (Spinraza®) improves survival of infants with hereditary proximal spinal muscular atrophy and motor function in children up to 12 years. Population-based assessments of treatment efficacy are limited and confined to select cohorts of patients. We performed a nationwide, population-based, single-centre cohort study in children with spinal muscular atrophy younger than 9.5 years at start of treatment in line with reimbursement criteria in the Netherlands. We assessed age-relevant motor function scores, the need for tube feeding, hours of ventilatory support and documented adverse events. We used linear mixed modelling to assess treatment effects. We compared motor function during treatment with natural history data and to individual trajectories of muscle strength and motor function before the start of treatment. We included 71 out of 72 Dutch children who were treated (median age 54 months; range 0–117) and followed them for a median of 38 months (range 5–52). We observed improvement of motor function in 72% and stabilization in another 18% of the symptomatic children, which differed from the natural disease course in a matched cohort of which we had previously collected natural history data. Longitudinal analysis showed that motor function improved up to a median of 24 months (range 12–30) of treatment after which it stabilized. Shorter disease duration at start of treatment resulted in better treatment efficacy (P < 0.01). Sixteen children (23%) achieved new motor milestones. Bulbar and respiratory function did not improve significantly during treatment. In 15 patients from whom treatment-naïve data were available, the pre-treatment trajectory of motor function decline changed to stabilization or improvement after the start of treatment. We documented 82 adverse events after 934 injections (9%) in 45 patients. None of the adverse events led to treatment discontinuation. Intrathecal nusinersen treatment is safe and improves or stabilizes motor function in 90% of young children with spinal muscular atrophy types 1c–3a. We did not observe improvement of respiratory and bulbar functions.
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Affiliation(s)
- Féline E V Scheijmans
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX, Utrecht , The Netherlands
| | - Inge Cuppen
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX, Utrecht , The Netherlands
| | - Ruben P A van Eijk
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX, Utrecht , The Netherlands
- Biostatistics and Research Support, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht , 3584 CX, Utrecht , The Netherlands
| | - Camiel A Wijngaarde
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX, Utrecht , The Netherlands
| | - Marja A G C Schoenmakers
- Child Development and Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, 3584 CX, Utrecht , The Netherlands
| | - Danny R van der Woude
- Child Development and Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, 3584 CX, Utrecht , The Netherlands
| | - Bart Bartels
- Child Development and Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, 3584 CX, Utrecht , The Netherlands
| | - Esther S Veldhoen
- Pediatric Intensive Care Unit, Wilhelmina Children’s Hospital , 3584 EA, Utrecht , The Netherlands
| | - Irene L B Oude Lansink
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht , 3584 CX, Utrecht , The Netherlands
| | - Ewout J N Groen
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX, Utrecht , The Netherlands
| | - Fay-Lynn Asselman
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX, Utrecht , The Netherlands
| | - Renske I Wadman
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX, Utrecht , The Netherlands
| | - W Ludo van der Pol
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX, Utrecht , The Netherlands
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15
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Krosschell KJ, Dunaway Young S, Peterson I, Curry M, Mazzella A, Jarecki J, Cruz R. Clinical and Research Readiness for Spinal Muscular Atrophy: The Time Is Now for Knowledge Translation. Phys Ther 2022; 102:6651754. [PMID: 35904447 DOI: 10.1093/ptj/pzac108] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 03/05/2022] [Accepted: 06/08/2022] [Indexed: 11/12/2022]
Abstract
UNLABELLED Disease-modifying therapies for spinal muscular atrophy (SMA) are rapidly changing the outlook for many individuals by substantially altering the clinical course, phenotypic expression, and functional outcomes. Physical therapists have played critical roles in the effective conduct and execution of clinical trials leading to the approval of these therapies. Given the treatment landscape, educating practicing clinicians to understand best practice is of great importance, and a timely call to action to facilitate knowledge translation from SMA researchers to clinicians is necessary. The SMA Clinical Trial Readiness Program engaged clinical and research centers, identified physical therapy knowledge gaps related to evaluation and outcomes assessment, and provided educational resources, including the development of a SMA Best Practices Clinical Evaluator Toolkit. Toolkit content synthesizes evidence and covers a breadth of issues relevant to practice, including background on SMA and the drug pipeline; therapist roles and responsibilities related to research; clinical and research evaluation; and useful materials and resources for additional education, training, and professional development. Surveys and telephone interviews were conducted with physical therapists managing individuals with SMA to determine their SMA practice experience and educational needs. Their recommendations, along with synthesized SMA research evidence, provided input into toolkit content development and assisted in identifying gaps important to address. Impact was assessed over time via utilization feedback surveys downloaded by clinicians across various settings. Open-ended feedback supported beneficial use of the toolkit for clinicians and researchers working with individuals with SMA. Next steps should include timely dissemination to bring this resource and others into practice in a systematic, efficacious, and engaging manner. As the treatment landscape for SMA evolves, the therapist's role in multidisciplinary care and research is of great importance, and a call to action for the development, implementation, evaluation and reporting of informed knowledge using evidence-based knowledge translation strategies is critical. IMPACT Partnership among patient advocacy groups, industry collaborators, and key opinion leaders/experts can optimize essential resource development to address the knowledge gap for best practices in physical therapy. This partnership model can be replicated for other diseases, providing an efficient way to support clinical trial readiness and target early development of evidence-based content and resources related to both research and best practice clinical evaluation for physical therapist researchers, clinicians, and patients. While identifying knowledge gaps and resource development are initial steps toward change in SMA practice, a rapidly changing rehabilitation outlook warrants a call to action for enhanced efforts aimed at improving rehabilitation evaluation, assessment, and care for this population. It is critical to forge a timely path forward for development, implementation, and sustainability of effective knowledge translation to practice for SMA.
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Affiliation(s)
- Kristin J Krosschell
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sally Dunaway Young
- Department of Neurology, Stanford University School of Medicine, Stanford, California, USA
| | - Ilse Peterson
- Faegre Drinker Biddle and Reath LLP, Washington, DC, USA
| | - Mary Curry
- Cure SMA, Elk Grove Village, Illinois, USA
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16
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Bonanno S, Giossi R, Zanin R, Porcelli V, Iannacone C, Baranello G, Ingenito G, Iyadurai S, Stevic Z, Peric S, Maggi L. Amifampridine safety and efficacy in spinal muscular atrophy ambulatory patients: a randomized, placebo-controlled, crossover phase 2 trial. J Neurol 2022; 269:5858-5867. [PMID: 35763114 PMCID: PMC9243784 DOI: 10.1007/s00415-022-11231-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 12/01/2022]
Abstract
Background Spinal muscular atrophy (SMA) is an autosomal recessive disease where a deficient amount of SMN protein leads to progressive lower motor neuron degeneration. SMN-enhancing therapies are now available. Yet, fatigue and signs of impaired neuromuscular junction (NMJ) transmission could contribute to SMA phenotype. Amifampridine prolongs presynaptic NMJ terminal depolarization, enhancing neuromuscular transmission. Methods SMA-001 was a phase 2, 1:1 randomized, double-blind, placebo-controlled crossover study. Ambulatory (walking unaided at least 30 m) SMA Type 3 patients, untreated with SMN-enhancing medications, entered a run-in phase where amifampridine was titrated up to an optimized stable dose. Patients achieving at least three points improvement in Hammersmith Functional Motor Score Expanded (HFMSE) were randomized to amifampridine or placebo, alternatively, in the 28-day double-blind crossover phase. Safety was evaluated by adverse events (AE) collection. Primary efficacy measure was the HFMSE change from randomization. Secondary outcomes included timed tests and quality of life assessment. Descriptive analyses and a mixed effects linear model were used for statistics. Results From 14 January 2019, 13 patients, mean age 34.5 years (range 18–53), with 5/13 (38.5%) females, were included. No serious AE were reported. Transient paresthesia (33.3%) was the only amifampridine-related AE. Six patients for each treatment sequence were randomized. Amifampridine treatment led to a statistically significant improvement in HFMSE (mean difference 0.792; 95% CI from 0.22 to 1.37; p = 0.0083), compared to placebo, but not in secondary outcomes. Discussion SMA-001 study provided Class II evidence that amifampridine was safe and effective in treating ambulatory SMA type 3 patients. Clinical Trial Registration: NCT03781479; EUDRACT 2017-004,600-22. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11231-7.
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Affiliation(s)
- Silvia Bonanno
- Neuroimmunology and Neuromuscular Disease Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Riccardo Giossi
- Neuroimmunology and Neuromuscular Disease Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.,Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, Milan, Italy
| | - Riccardo Zanin
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Valentina Porcelli
- Department of Clinical Research and Innovation, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Giovanni Baranello
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Developmental Neuroscience Research and Teaching Department, Faculty of Population Health Sciences, Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | | | - Stanley Iyadurai
- Catalyst Pharmaceuticals, Inc., Coral Gables, USA.,Johns Hopkins All Children's Hospital, St Petersburg, FL, 33701, USA
| | - Zorica Stevic
- Faculty of Medicine, Neurology Clinic, University Clinical Center of Serbia, University of Belgrade, Dr Subotica 6, 11000, Belgrade, Serbia
| | - Stojan Peric
- Faculty of Medicine, Neurology Clinic, University Clinical Center of Serbia, University of Belgrade, Dr Subotica 6, 11000, Belgrade, Serbia
| | - Lorenzo Maggi
- Neuroimmunology and Neuromuscular Disease Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
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17
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Wu JW, Pepler L, Maturi B, Afonso ACF, Sarmiento J, Haldenby R. Systematic Review of Motor Function Scales and Patient-Reported Outcomes in Spinal Muscular Atrophy. Am J Phys Med Rehabil 2022; 101:590-608. [PMID: 34483260 DOI: 10.1097/phm.0000000000001869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Spinal muscular atrophy is a heterogeneous disease that results in loss of motor function. In an evolving treatment landscape, establishing the suitability and limitations of existing motor function scales and patient-reported outcomes used to monitor patients with this disease is important. A systematic review was conducted to examine utility of motor function scales and patient-reported outcomes in evaluating patients with spinal muscular atrophy. Published literature was reviewed up to June 2021 with no start date restriction. Of the reports screened, 122 were deemed appropriate for inclusion and are discussed in this review (including 24 validation studies for motor function scales or patient-reported outcomes). Fifteen motor function scales and patient-reported outcomes were identified to be commonly used (≥5 studies), of which 11 had available validation assessments. Each instrument has its strengths and limitations. It is imperative that the patient population (e.g., age, mobility), goals of treatment, and outcomes or endpoints of interest be considered when selecting the appropriate motor function scales and patient-reported outcomes for clinical studies.
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Affiliation(s)
- Jennifer W Wu
- From the Hoffmann-La Roche Limited, Mississauga, Ontario, Canada (JWW, LP, BM, RH); and Synapse Medical Communications, Inc, Oakville, Ontario, Canada (ACFA, JS)
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18
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Rad N, Cai H, Weiss MD. Management of Spinal Muscular Atrophy in the Adult Population. Muscle Nerve 2022; 65:498-507. [PMID: 35218574 DOI: 10.1002/mus.27519] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 01/30/2022] [Accepted: 02/06/2022] [Indexed: 12/14/2022]
Abstract
Spinal muscular atrophy (SMA) is a group of neurodegenerative disorders resulting from the loss of spinal motor neurons. 95% of patients share a pathogenic mechanism of loss of survival motor neuron (SMN) 1 protein expression due to homozygous deletions or other mutations of the SMN1 gene, with the different phenotypes influenced by variable copy numbers of the SMN2 gene. Advances in supportive care, disease modifying treatment and novel gene therapies have led to an increase in the prevalence of SMA, with a third of SMA patients now represented by adults. Despite the growing number of adult patients, consensus on the management of SMA has focused primarily on the pediatric population. As the disease burden is vastly different in adult SMA, an approach to treatment must be tailored to their unique needs. This review will focus on the management of the adult SMA patient as they age and will discuss proper transition of care from a pediatric to adult center, including the need for continued monitoring for osteoporosis, scoliosis, malnutrition, and declining mobility and functioning. As in the pediatric population, multidisciplinary care remains the best approach to the management of adult SMA. Novel and emerging therapies such as nusinersen and risdiplam provide hope for these patients, though these medications are of uncertain efficacy in this population and require additional study.
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Affiliation(s)
- Nassim Rad
- Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, Washington, USA
| | - Haibi Cai
- Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, Washington, USA
| | - Michael D Weiss
- Department of Neurology, University of Washington, Seattle, Washington, USA
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19
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Sutherland CS, Hudson P, Mitchell S, Paracha N. Systematic Literature Review to Identify Utility Values in Patients with Spinal Muscular Atrophy (SMA) and Their Caregivers. PHARMACOECONOMICS 2022; 40:39-67. [PMID: 34907515 PMCID: PMC8994729 DOI: 10.1007/s40273-021-01115-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND Spinal muscular atrophy (SMA) is a progressive neuromuscular disorder that has a substantial impact on health-related quality of life for patients with SMA and their caregivers. Utility values ('utilities') are used in health economic analyses to incorporate individual or societal perspectives regarding the desirability of health outcomes such as a certain health state or change in health states over time. OBJECTIVES The primary objective of this systematic literature review (SLR) was to identify published utilities associated with patients with SMA and their caregivers and to determine the extent to which Health Technology Assessment (HTA) requirements of methods used to generate utilities are met. A secondary objective was to broaden the scope to identify utilities associated with other (non-SMA) neuromuscular disorders. METHODS A comprehensive search to capture published utilities associated with patients with SMA and their caregivers was performed in 2019 and updated in 2021 using several electronic databases in addition to supplementary sources. As we anticipated that few published utilities associated with SMA would be identified, the search also captured utilities for other (non-SMA) neuromuscular disorders that may serve as useful surrogate values for studies of SMA and other rare diseases. Electronic searches were performed in Embase, MEDLINE, Evidence-Based Medicine Reviews, and EconLit via the Ovid platform and were supplemented by searches of the grey literature (reference lists, conference proceedings, global HTA body websites, and other relevant sources). Study eligibility criteria were based on the population, interventions, comparators, and outcomes (PICO) framework. The quality of the full-text publications was assessed using a checklist based on UK National Institute for Health and Care Excellence technical support documents. RESULTS In total, 14 publications that reported SMA-related patient or caregiver utilities or disutilities met the eligibility criteria to be included in the SLR; the included studies demonstrate the substantial health-related quality-of-life burden of SMA on both patients with SMA and their caregivers. A variety of preference-based measures were used to derive utilities for patients with SMA and their caregivers. Different methods for collecting utility data included patient and proxy assessment of health states using questionnaires, vignette methodologies, structured forms of expert elicitation, and mapped data from results of clinical trials. A range of utilities was reported from both patient- and proxy-reported data, which reflects the degree of disability associated with early- and later-onset SMA. Methods for deriving utilities were assessed with respect to three reference cases from HTA bodies in the UK, the USA, and Canada. None of the 14 publications met the requirements of all three HTA bodies because of differing tariff requirements between countries; one study met the requirements of HTA bodies in Canada and the UK. Also, six studies did not report the method of valuation, which precluded analysis with respect to the HTA reference cases. CONCLUSIONS This SLR provides a comprehensive repository of the currently available utilities relevant to patients with SMA and their caregivers. This SLR provides recommendations for establishing consensus on the approach to generating utility values for the SMA patient population and their caregivers for health economic decisions.
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Affiliation(s)
- C Simone Sutherland
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124 Building 001/OG13, CH 4070, Basel, Switzerland.
| | | | | | - Noman Paracha
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124 Building 001/OG13, CH 4070, Basel, Switzerland
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20
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Fainmesser Y, Drory VE, Ben-Shushan S, Lavon A, Spector L, Abramovich B, Abraham A. Longer-term follow-up of nusinersen efficacy and safety in adult patients with spinal muscular atrophy types 2 and 3. Neuromuscul Disord 2022; 32:451-459. [DOI: 10.1016/j.nmd.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 03/12/2022] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
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21
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Duong T, Staunton H, Braid J, Barriere A, Trzaskoma B, Gao L, Willgoss T, Cruz R, Gusset N, Gorni K, Randhawa S, Yang L, Vuillerot C. A Patient-Centered Evaluation of Meaningful Change on the 32-Item Motor Function Measure in Spinal Muscular Atrophy Using Qualitative and Quantitative Data. Front Neurol 2022; 12:770423. [PMID: 35111124 PMCID: PMC8802297 DOI: 10.3389/fneur.2021.770423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/06/2021] [Indexed: 12/02/2022] Open
Abstract
The 32-item Motor Function Measure (MFM32) is an assessment of motor function used to evaluate fine and gross motor ability in patients with neuromuscular disorders, including spinal muscular atrophy (SMA). Reliability and validity of the MFM32 have been documented in individuals with SMA. Through semi-structured qualitative interviews (N = 40) and an online survey in eight countries (N = 217) with individuals with Types 2 and 3 SMA aged 2–59 years old and caregivers, the meaning of changes on a patient-friendly version of the MFM32 was explored. In an independent analysis of clinical trial data, anchor- and distribution-based analyses were conducted in a sample of individuals with Type 2 and non-ambulant Type 3 SMA to estimate patient-centered quantitative MFM32 meaningful change thresholds. The results from this study demonstrate that, based on patient and caregiver insights, maintaining functional ability as assessed by a patient-friendly version of the MFM32 is an important outcome. Quantitative analyses using multiple anchors (median age range of 5–8 years old across anchor groups) indicated that an ~3-point improvement in MFM32 total score represents meaningful change at the individual patient level. Overall, the qualitative and quantitative findings from this study support the importance of examining a range of meaningful change thresholds on the MFM32 including ≥0 points change reflecting stabilization or improvement and ≥3 points change reflecting a higher threshold of improvement. Future research is needed to explore quantitative differences in meaningful change on the MFM32 based on age and functional subgroups.
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Affiliation(s)
- Tina Duong
- Department of Neurology, Stanford University, Stanford, CA, United States
| | - Hannah Staunton
- Roche Products Limited, Welwyn Garden City, United Kingdom
- *Correspondence: Hannah Staunton
| | - Jessica Braid
- Roche Products Limited, Welwyn Garden City, United Kingdom
| | - Aurelie Barriere
- Department of Pediatric Physical Medicine and Rehabilitation, Hôpital Mère Enfant, Centre Hospitalier Universitaire (CHU)-Lyon, Lyon University, Lyon, France
| | - Ben Trzaskoma
- Genentech Inc., South San Francisco, CA, United States
| | - Ling Gao
- Analystat Corporation, Point Roberts, WA, United States
| | - Tom Willgoss
- Roche Products Limited, Welwyn Garden City, United Kingdom
| | | | - Nicole Gusset
- SMA Europe, Freiburg, Germany
- SMA Schweiz, Swiss Patient Organisation for Spinal Muscular Atrophy, Heimberg, Switzerland
| | - Ksenija Gorni
- Product Development Medical Affairs, Neuroscience and Rare Disease, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Sharan Randhawa
- Adelphi Values, Patient-Centered Outcomes, Adelphi Mill, Bollington, United Kingdom
| | - Lida Yang
- Charles River Associates Inc., Zurich, Switzerland
| | - Carole Vuillerot
- Neuromyogen Institute, CNRS UMR 5310 INSERM U1217, Université de Lyon, Lyon, France
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22
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Stimpson G, Chesshyre M, Baranello G, Muntoni F. Lessons Learned From Translational Research in Neuromuscular Diseases: Impact on Study Design, Outcome Measures and Managing Expectation. Front Genet 2021; 12:759994. [PMID: 36687260 PMCID: PMC9855753 DOI: 10.3389/fgene.2021.759994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/09/2021] [Indexed: 01/25/2023] Open
Abstract
Spinal Muscular Atrophy (SMA) and Duchenne Muscular Dystrophy (DMD), two of the most common, child onset, rare neuromuscular disorders, present a case study for the translation of preclinical research into clinical work. Over the past decade, well-designed clinical trials and innovative methods have led to the approval of several novel therapies for SMA and DMD, with many more in the pipeline. This review discusses several features that must be considered during trial design for neuromuscular diseases, as well as other rare diseases, to maximise the possibility of trial success using historic examples. These features include well-defined inclusion criteria, matching criteria, alternatives to placebo-controlled trials and the selection of trial endpoints. These features will be particularly important in the coming years as the investigation into innovative therapy approaches for neuromuscular diseases continues.
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Affiliation(s)
- Georgia Stimpson
- Developmental Neuroscience Research and Training Department, Dubowitz Neuromuscular Centre, Faculty of Population Health Sciences, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Mary Chesshyre
- Developmental Neuroscience Research and Training Department, Dubowitz Neuromuscular Centre, Faculty of Population Health Sciences, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom,NIHR Great Ormond Street Hospital Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Giovanni Baranello
- Developmental Neuroscience Research and Training Department, Dubowitz Neuromuscular Centre, Faculty of Population Health Sciences, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom,NIHR Great Ormond Street Hospital Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Francesco Muntoni
- Developmental Neuroscience Research and Training Department, Dubowitz Neuromuscular Centre, Faculty of Population Health Sciences, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom,NIHR Great Ormond Street Hospital Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom,*Correspondence: Francesco Muntoni,
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23
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Vázquez-Costa JF, Hervás D. Minimal detectable change and minimal clinically important difference in spinal muscular atrophy patients. Eur J Neurol 2021; 28:e40-e41. [PMID: 33604967 DOI: 10.1111/ene.14780] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Juan F Vázquez-Costa
- Neuromuscular Research Unit, Instituto de Investigación Sanitaria la Fe, Valencia, Spain.,Motor Neuron Disease Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain.,Department of Medicine, University of Valencia, Valencia, Spain
| | - David Hervás
- Department of Applied Statistics and Operational Research and Quality, Universitat Politècnica de València, Valencia, Spain
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