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Manssen L, Krey I, Gburek-Augustat J, von Hagen C, Lemke JR, Merkenschlager A, Weigand H, Makowski C. Precision Medicine in Angelman Syndrome. Neuropediatrics 2024. [PMID: 39168152 DOI: 10.1055/a-2399-0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Angelman syndrome (AS) is a rare neurogenetic disorder caused by a loss of function of UBE3A on the maternal allele. Clinical features include severe neurodevelopmental delay, epilepsy, sleep disturbances, and behavioral disorders. Therapy currently evolves from conventional symptomatic, supportive, and antiseizure treatments toward alteration of mRNA expression, which is subject of several ongoing clinical trials.This article will provide an overview of clinical research and therapeutic approaches on AS.
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Affiliation(s)
- Lena Manssen
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Ilona Krey
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Janina Gburek-Augustat
- Division of Neuropediatrics, Hospital for Children and Adolescents, Department of Women and Child Health, University of Leipzig, Leipzig, Germany
| | - Cornelia von Hagen
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
- Kinderzentrum Munchen gemeinnutzige GmbH, kbo, Munich, Germany
| | - Johannes R Lemke
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
- Center for Rare Diseases, University of Leipzig Medical Center, Leipzig, Germany
| | - Andreas Merkenschlager
- Division of Neuropediatrics, Hospital for Children and Adolescents, Department of Women and Child Health, University of Leipzig, Leipzig, Germany
| | - Heike Weigand
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Christine Makowski
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
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Peters SU, Shelton AR, Malow BA, Neul JL. A clinical-translational review of sleep problems in neurodevelopmental disabilities. J Neurodev Disord 2024; 16:41. [PMID: 39033100 PMCID: PMC11265033 DOI: 10.1186/s11689-024-09559-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 07/05/2024] [Indexed: 07/23/2024] Open
Abstract
Sleep disorders are very common across neurodevelopmental disorders and place a large burden on affected children, adolescents, and their families. Sleep disturbances seem to involve a complex interplay of genetic, neurobiological, and medical/environmental factors in neurodevelopmental disorders. In this review, we discuss animal models of sleep problems and characterize their presence in two single gene disorders, Rett Syndrome, and Angelman Syndrome and two more commonly occurring neurodevelopmental disorders, Down Syndrome, and autism spectrum disorders. We then discuss strategies for novel methods of assessment using wearable sensors more broadly for neurodevelopmental disorders in general, including the importance of analytical validation. An increased understanding of the mechanistic contributions and potential biomarkers of disordered sleep may offer quantifiable targets for interventions that improve overall quality of life for affected individuals and their families.
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Affiliation(s)
- Sarika U Peters
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA.
- Vanderbilt Kennedy Center for Research on Human Development, One Magnolia Circle, Room 404B, Nashville, TN, 37203, USA.
| | - Althea Robinson Shelton
- Vanderbilt Kennedy Center for Research on Human Development, One Magnolia Circle, Room 404B, Nashville, TN, 37203, USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, USA
| | - Beth A Malow
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
- Vanderbilt Kennedy Center for Research on Human Development, One Magnolia Circle, Room 404B, Nashville, TN, 37203, USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, USA
| | - Jeffrey L Neul
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
- Vanderbilt Kennedy Center for Research on Human Development, One Magnolia Circle, Room 404B, Nashville, TN, 37203, USA
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Ventola P, Jaeger J, Keary CJ, Kolevzon A, Adams M, Keshavan B, Zinger-Salmun C, Ochoa-Lubinoff C. An adapted clinical global Impression of improvement for use in Angelman syndrome: Validation analyses utilizing data from the NEPTUNE study. Eur J Paediatr Neurol 2023; 47:35-40. [PMID: 37688937 DOI: 10.1016/j.ejpn.2023.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE Angelman Syndrome (AS) is a rare, severe neurogenetic disorder that causes symptoms such as intellectual disability and motor impairments and is typically diagnosed in early childhood. The complexity and heterogeneity of AS confound characterization of disease severity and pose unique challenges when determining an individual's response to treatment. There is therefore a substantial unmet need for rating scales specifically designed for complex conditions such as AS. To address this, the Clinical Global Impressions (CGI) scale, which has components for both symptom severity (CGI-S) and improvement (CGI-I) was specifically adapted to measure severity (CGI-S-AS) and improvement (CGI-I-AS) in AS. METHODS The modified CGI-S/I-AS was used in the NEPTUNE trial of gaboxadol for the treatment of AS. Here we report on the validation of the CGI-I-AS using data from NEPTUNE and discuss insights for its potential use in future trials. RESULTS Improvements in the CGI-I-AS rating tended to be consistent with changes on other relevant rating scales. Sleep-related symptoms were particularly well represented, while communication-related symptoms were not. CONCLUSIONS Our validation analysis of the CGI-I-AS demonstrates its usefulness along with possible areas of improvement. The CGI-I-AS is a potential tool for use in other trials of AS drug candidates, and the process for its development can serve as a road map for the development of assessment tools for other neuropsychiatric disorders with similar complexities and heterogeneity.
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Affiliation(s)
- Pamela Ventola
- Yale University Child Study Center, New Haven, CT, USA; Cogstate, New Haven, CT, USA.
| | - Judith Jaeger
- CognitionMetrics, LLC, DE, USA; Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christopher J Keary
- Angelman Syndrome Program, Massachusetts General Hospital for Children, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Alexander Kolevzon
- Seaver Autism Center for Research and Treatment, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maxwell Adams
- Formerly of Ovid Therapeutics, Inc, New York, NY, USA
| | - Bina Keshavan
- Formerly of Ovid Therapeutics, Inc, New York, NY, USA
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Keary C, Bird LM, de Wit MC, Hatti S, Heimer G, Heussler H, Kolevzon A, Mathews A, Ochoa-Lubinoff C, Tan WH, Yan Y, Adams M. Gaboxadol in angelman syndrome: A double-blind, parallel-group, randomized placebo-controlled phase 3 study. Eur J Paediatr Neurol 2023; 47:6-12. [PMID: 37639777 DOI: 10.1016/j.ejpn.2023.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE To evaluate efficacy and safety of gaboxadol for treatment of children with Angelman syndrome (AS). METHOD In this international, double-blind, phase 3 trial, we randomized children 4-12 years old with a molecular diagnosis of AS and a Clinical Global Impression (CGI)-severity score ≥3 to either daily administration of weight-based gaboxadol or matching placebo for 12 weeks. The primary endpoint was the CGI-Improvement-AS (CGI-I-AS) score at week 12. Secondary endpoints included the proportion of participants with CGI-I-AS response of ≤3 (i.e., at least "minimal improvement") and ≤2 (i.e., at least "much improvement") at week 12. Safety and tolerability were monitored throughout the study. Weight based dosing of study drug ranged from 0.125 mg/kg to 0.24 mg/kg depending on weight range. RESULTS Between August 2019 and November 2020, 104 participants were enrolled: participants 4-12 years old were randomly (1:1) assigned to gaboxadol (n = 47) or placebo (n = 50), and 7 other participants 2─3 years old who received gaboxadol and were assessed for safety only. All gaboxadol-treated participants and 48 of 50 placebo-treated participants completed treatment. There was no significant difference in CGI-I-AS between groups: at week 12, mean CGI-I-AS score was 3.3 (SD, 1.00) and 3.2 (SD, 1.05) in the gaboxadol and placebo groups, respectively, yielding a least squares mean difference of zero (p = 0.83). There were no between-group significant differences with respect to CGI-I-AS responses. Gaboxadol was well tolerated in all age groups of this study. CONCLUSIONS There was no significant difference in CGI-I-AS between gaboxadol and placebo after 12 weeks of study treatment in pediatric AS participants. CLINICALTRIALS GOV: NCT04106557.
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Affiliation(s)
| | - Lynne M Bird
- University of California, San Diego and Rady Children's Hospital, San Diego, California, USA
| | - Marie-Claire de Wit
- Department of Pediatric Neurology, ENCORE Expertise Center, ERN-Ithaca Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - Gali Heimer
- Sheba Medical Center, The Tel Aviv University, Ramat Gan, Israel
| | - Helen Heussler
- Centre for Children's Health Research, University of Queensland, Brisbane, Australia; Centre for Clinical Trials in Rare Neurodevelopmental Disorders, Queensland Children's Hospital, Brisbane, Australia
| | | | | | | | - Wen-Hann Tan
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ying Yan
- Ovid Therapeutics, Cambridge, MA, USA
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Müller AR, Luijten MAJ, Haverman L, de Ranitz-Greven WL, Janssens P, Rietman AB, Ten Hoopen LW, de Graaff LCG, de Wit MC, Jansen AC, Gipson T, Capal JK, de Vries PJ, van Eeghen AM. Understanding the impact of tuberous sclerosis complex: development and validation of the TSC-PROM. BMC Med 2023; 21:298. [PMID: 37553648 PMCID: PMC10408092 DOI: 10.1186/s12916-023-03012-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is a rare and complex genetic disorder, associated with tumor growth in various organ systems, epilepsy, and a range of neuropsychiatric manifestations including intellectual disability. With improving patient-centered care and targeted therapies, patient-reported outcome measures (PROMs) are needed to measure the impact of TSC manifestations on daily functioning. The aim of this study was to develop a TSC-specific PROM for adults that captures the impact of TSC on physical functions, mental functions, activity and participation, and the social support individuals with TSC receive, called the TSC-PROM. METHODS COSMIN methodology was used to develop a self-reported and proxy-reported version. Development and validation consisted of the following studies: PROM development, content validity, structural validity, internal consistency, and construct validity. The International Classification of Functioning and Disability was used as a framework. Content validity was examined by a multidisciplinary expert group and cognitive interview study. Structural and construct validity, and internal consistency were examined in a large cohort, using confirmatory factor analysis, hypotheses testing, and Cronbach's alpha. RESULTS The study resulted in an 82-item self version and 75-item proxy version of the TSC-PROM with four subscales (physical functions 18 and 19 items, mental functions 37 and 28 items, activities and participation 13 and 14 items, social support 13 items, for self version and proxy version respectively). Sufficient results were found for structural validity with sufficient unidimensionality for each subscale. With regard to construct validity, 82% of the hypotheses were met for the self version and 59% for the proxy version. The PROM showed good internal consistency (Cronbach's alpha 0.78-0.97). CONCLUSIONS We developed a PROM for adults with TSC, named TSC-PROM, showing sufficient evidence for reliability and validity that can be used in clinical and research settings to systematically gain insight into their experiences. It is the first PROM in TSC that addresses the impact of specific TSC manifestations on functioning, providing a valuable, patient-centered addition to the current clinical outcomes.
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Affiliation(s)
- Annelieke R Müller
- 's Heeren Loo, Amersfoort, The Netherlands
- Emma Center for Personalized Medicine, Department of Pediatrics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Methodology and Mental Health and Personalized Medicine, Amsterdam, The Netherlands
| | - Michiel A J Luijten
- Amsterdam Public Health Research Institute, Methodology and Mental Health and Personalized Medicine, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Child Development, Amsterdam, The Netherlands
| | - Lotte Haverman
- Amsterdam Public Health Research Institute, Methodology and Mental Health and Personalized Medicine, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Child Development, Amsterdam, The Netherlands
| | | | - Peter Janssens
- Department of Nephrology and Arterial Hypertension, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel, Brussels, Belgium
| | - André B Rietman
- Department of Child and Adolescent Psychiatry/Psychology and ENCORE Expertise Center, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Leontine W Ten Hoopen
- Department of Child and Adolescent Psychiatry/Psychology and ENCORE Expertise Center, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Laura C G de Graaff
- Center for Adults With Rare Genetic Syndromes, Division of Endocrinology, Department of Internal Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marie-Claire de Wit
- Department of Pediatric Neurology and ENCORE Expertise Center, Erasmus Medical Center Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anna C Jansen
- Neurogenetics Research Group, Reproduction Genetics and Regenerative Medicine Research Cluster, Vrije Universiteit Brussel, Brussels, Belgium
- Pediatric Neurology Unit, Department of Pediatrics, Antwerp University Hospital; Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - Tanjala Gipson
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN, USA
- Le Bonheur Children's Hospital and Boling Center for Developmental Disabilities, Memphis, TN, USA
| | - Jamie K Capal
- Department of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Petrus J de Vries
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Agnies M van Eeghen
- 's Heeren Loo, Amersfoort, The Netherlands.
- Emma Center for Personalized Medicine, Department of Pediatrics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Methodology and Mental Health and Personalized Medicine, Amsterdam, The Netherlands.
- Amsterdam Reproduction & Development, Child Development, Amsterdam, The Netherlands.
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Yoon IY, Ryu JH, Do SH, Min B, Koo CH. Etomidate versus Propofol for Electroconvulsive Therapy in Patients with Major Depressive Disorders in Terms of Clinical Responses to Treatment: A Retrospective Analysis. Brain Sci 2023; 13:1023. [PMID: 37508956 PMCID: PMC10377494 DOI: 10.3390/brainsci13071023] [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: 06/09/2023] [Revised: 06/25/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
General anesthetic agents may be associated with the clinical efficacy of electroconvulsive therapy (ECT), as they may influence seizure quality and duration. Hence, a retrospective study was conducted to compare the clinical effects and seizure variables of etomidate and propofol during ECT. Patients treated with ECT under anesthesia with etomidate (n = 43) or propofol (n = 12) were retrospectively analyzed. Seizure variables (seizure duration, intensity, and threshold) and hemodynamic changes during ECT were assessed and recorded. Clinical responses to treatment were evaluated using the Clinical Global Impression scale and mood at discharge after the course of ECT. Adverse effects were also recorded. The demographic characteristics were similar between the two groups. There were no significant differences in the Clinical Global Impression scale scores, mood at discharge, and adverse effects between the two groups (p > 0.05); however, etomidate was associated with a significantly longer motor (42.0 vs. 23.65 s, p < 0.001) and electroencephalogram (51.8 vs. 33.5 s, p < 0.001) seizure duration than propofol. In conclusion, etomidate showed more favorable seizure profiles than propofol during ECT; however, both agents (etomidate and propofol) were associated with similar clinical efficacy profiles at discharge.
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Affiliation(s)
- In-Young Yoon
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Jung-Hee Ryu
- Department of Anesthesia and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
- Department of Anesthesia and Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Sang-Hwan Do
- Department of Anesthesia and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
- Department of Anesthesia and Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Beomjun Min
- Chung Psychiatric Clinic, Seoul 06614, Republic of Korea
| | - Chang-Hoon Koo
- Department of Anesthesia and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
- Department of Anesthesia and Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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Duis J, Skinner A, Carson R, Gouelle A, Annoussamy M, Silverman JL, Apkon S, Servais L, Carollo J. Quantitative measures of motor development in Angelman syndrome. Am J Med Genet A 2023; 191:1711-1721. [PMID: 37019838 PMCID: PMC11068498 DOI: 10.1002/ajmg.a.63192] [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: 12/31/2022] [Revised: 02/10/2023] [Accepted: 03/10/2023] [Indexed: 04/07/2023]
Abstract
Angelman Syndrome is a rare neurodevelopmental disorder characterized by developmental delay, lack of speech, seizures, intellectual disability, characteristic behavior, and movement disorders. Clinical gait analysis provides the opportunity for movement quantification to investigate an observed maladaptive change in gait pattern and offers an objective outcome of change. Pressure-sensor-based technology, inertial and activity monitoring, and instrumented gait analysis (IGA) were employed to define motor abnormalities in Angelman syndrome. Temporal-spatial gait parameters of persons with Angelman Syndrome (pwAS) show deficiencies in gait performance through walking speed, step length, step width, and walk ratio. pwAS walk with reduced step lengths, increased step width, and greater variability. Three-dimensional motion kinematics showed increased anterior pelvic tilt, hip flexion, and knee flexion. PwAS have a walk ratio more than two standard deviations below controls. Dynamic electromyography showed prolonged activation of knee extensors, which was associated with a decreased range of motion and the presence of hip flexion contractures. Use of multiple gait tracking modalities revealed that pwAS exhibit a change in gait pattern to a flexed knee gait pattern. Cross-sectional studies of individuals with AS show a regression toward this maladaptive gait pattern over development in pwAS ages 4-11. PwAS unexpectedly did not have spasticity associated with change in gait pattern. Multiple quantitative measures of motor patterning may offer early biomarkers of gait decline consistent with critical periods of intervention, insight into appropriate management strategies, objective primary outcomes, and early indicators of adverse events.
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Affiliation(s)
- Jessica Duis
- Center for Gait & Movement Analysis (CGMA), Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Section of Genetics and Inherited Metabolic Disease, Department of Pediatrics, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Section of Pediatrics, Special Care Clinic, Department of Pediatrics, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Austin Skinner
- Center for Gait & Movement Analysis (CGMA), Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Robert Carson
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arnaud Gouelle
- Université de Reims Champagne-Ardenne, PSMS (Performance, Santé, Métrologie, Société), Reims, France
- Gait and Balance Academy, ProtoKinetics, Havertown, Pennsylvania, USA
| | | | - Jill L. Silverman
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California, USA
| | - Susan Apkon
- Department of Physical Medicine & Rehabilitation, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Laurent Servais
- Department of Paediatrics, Oxford University, Oxford, UK
- Division of Child Neurology, Centre de References des Maladies Neuromusculaires, Department of Pediatrics, University Hospital Liege & University of Liege, Liege, Belgium
| | - James Carollo
- Center for Gait & Movement Analysis (CGMA), Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Physical Medicine & Rehabilitation, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Connor-Ahmad S, Tjeertes J, Chladek M, Newton L, Symonds T, Clinch S, Vincenzi B, McDougall F. Developing Angelman syndrome-specific clinician-reported and caregiver-reported measures to support holistic, patient-centered drug development. Orphanet J Rare Dis 2023; 18:156. [PMID: 37349793 DOI: 10.1186/s13023-023-02729-y] [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: 10/10/2022] [Accepted: 05/14/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Angelman syndrome (AS) is a rare, heterogenous neurogenetic condition, which significantly impacts the lives of people with AS and their families. Valid and reliable measures reporting key symptoms and functional impairments of AS are required to support development of patient-centered therapies. We describe the development of clinician- and caregiver-reported, AS-specific Global Impression scales for incorporation into clinical trials. Best practice US Food and Drug Administration guidance for measure development was followed with input from expert clinicians, patient advocates, and caregivers during content generation and refinement. RESULTS Initial measurement domains for the Symptoms of AS-Clinician Global Impression (SAS-CGI) and the Caregiver-reported AS Scale (CASS) were identified from a conceptual disease model of AS symptoms and impacts, derived from interviews with caregivers and clinicians. Two rounds of cognitive debriefing (CD) interviews were performed; clinicians debriefed the SAS-CGI, with patient advocates and caregivers debriefing the CASS to ensure relevance and comprehension. Feedback was used to refine items and ensure wording was age-appropriate and captured AS-specific symptoms, as well as associated impacts and functional impairments. The SAS-CGI and CASS capture global assessments of seizures, sleep, maladaptive behaviors, expressive communication, fine and gross motor skills, cognition, and self-care, which were determined by clinicians, patient advocates, and caregivers to be the most challenging aspects of AS. Additionally, the measures include items for assessing overall AS symptoms and the meaningfulness of any change. In addition to ratings for severity, impact, and change, a notes field was included in the SAS-CGI to provide the rationale for the chosen rating. CD interviews confirmed the measures covered key concepts of AS from the perspective of clinicians and caregivers, and demonstrated that the measures' instructions, items, and response options were clear and appropriate. Interview feedback informed adjustments to the wording of the instructions and the items. CONCLUSIONS The SAS-CGI and CASS were designed to capture multiple AS symptoms, reflecting the heterogeneity and complexity of AS in children 1 to 12 years old. These clinical outcome assessments have been incorporated into AS clinical studies, which will allow for the evaluation of their psychometric properties and inform further refinements if needed.
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Affiliation(s)
| | | | | | | | - Tara Symonds
- Clinical Outcomes Solutions Ltd., Folkestone, UK
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Ours CA, Hodges MB, Oden N, Sapp JC, Biesecker LG. Development of the Clinical Gestalt Assessment: a visual clinical global impression scale for Proteus syndrome. Orphanet J Rare Dis 2022; 17:173. [PMID: 35461279 PMCID: PMC9034583 DOI: 10.1186/s13023-022-02325-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical outcome assessments are important tools for measuring the natural history of disease and efficacy of an intervention. The heterogenous phenotype and difficult to quantity features of Proteus syndrome present challenges to measuring clinical outcomes. To address these, we designed a global clinical assessment for Proteus syndrome, a rare mosaic overgrowth disorder. The Clinical Gestalt Assessment (CGA) aims to evaluate change over time in this phenotypically diverse disorder. RESULTS We gathered paired serial photographs and radiographs obtained at 12-to-36-month intervals from our natural history study of Proteus syndrome. The chronologic order of each set was blinded and presented to clinicians familiar with overgrowth disorders. They were asked to determine the chronologic order and, based on that response, rate global clinical change using a seven-point scale (Much Worse, Worse, Minimally Worse, No Change, Minimally Improved, Improved, Much Improved). Following a pilot, we tested the inter-rater reliability of the CGA using eight cases rated by eight clinicians. Raters identified the correct chronologic order in 53 of 64 (83%) of responses. There was low inter-rater variance and poor to moderate reliability with an intraclass correlation coefficient of 0.46 (95% CI 0.24-0.75). The overall estimate of global change was Minimally Worse over time, which is an accurate reflection of the natural history of Proteus syndrome. CONCLUSIONS The CGA is a tool to evaluate clinical change over time in Proteus syndrome and may be a useful adjunct to measure clinical outcomes in prospective therapeutic trials.
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Affiliation(s)
- Christopher A Ours
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, 10 Center Drive 8D47B, Bethesda, MD, 20892, USA.
| | - Mia B Hodges
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, 10 Center Drive 8D47B, Bethesda, MD, 20892, USA
| | - Neal Oden
- The EMMES Corporation, Rockville, MD, USA
| | - Julie C Sapp
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, 10 Center Drive 8D47B, Bethesda, MD, 20892, USA
| | - Leslie G Biesecker
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, 10 Center Drive 8D47B, Bethesda, MD, 20892, USA
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10
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Duis J. The Road to Personalized Therapies: Lessons Learned From Angelman Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 127:95-98. [PMID: 35180775 DOI: 10.1352/1944-7558-127.2.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Indexed: 06/14/2023]
Abstract
Angelman syndrome (AS) is a neurogenetic disorder characterized by delays including a severe expressive language delay, motor concerns, ataxia, epilepsy, sleep disturbances, gastrointestinal problems, and characteristic behaviors, including a happy demeanor, hyperactivity, and excitability. The syndrome is one of the first neurodevelopmental disorders with a clear trajectory towards meaningful treatment with approximately 20 companies actively developing targeted therapeutics for AS. Herein, we highlight the historical context of the road to therapeutics and some of the challenges in the field with the potential to impact the success of clinical trials for Angelman syndrome and also have relevance of other neurogenetic developmental disabilities.
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Busner J, Pandina G, Domingo S, Berger AK, Acosta MT, Fisseha N, Horrigan J, Ivkovic J, Jacobson W, Revicki D, Villalta-Gil V. Clinician- and Patient-reported Endpoints in CNS Orphan Drug Clinical Trials: ISCTM Position Paper on Best Practices for Endpoint Selection, Validation, Training, and Standardization. INNOVATIONS IN CLINICAL NEUROSCIENCE 2021; 18:15-22. [PMID: 35096477 PMCID: PMC8794479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The International Society of CNS Clinical Trials Methodology (ISCTM) Working Group on Rare Disease/Orphan Drug Development is dedicated to improving and streamlining trials to best develop new treatments for rare diseases. The rarity of these disorders requires a drug development strategy that differs from those of nonrare conditions. Rare disease drug development programs are challenged with small sample sizes, heterogeneous clinical presentations, and few, if any, off-the-shelf endpoints. When disease-specific clinical endpoints exist, they might not be validated and are typically not well known or broadly used in clinical practice. This paper aims to provide an overview of the special issues surrounding endpoints in rare disease drug development, with guidance, practical applications, and discussion. DISCUSSION The paper covers regulatory considerations in endpoint selection; identification of relevant measurement domains; methods of quantifying clinical meaningfulness; incorporation of patient- and clinician-reported outcomes; considerations for global clinician- and patient-rated clinical assessments; cognition assessment challenges in rare diseases; translation considerations; training, standardization, and calibration of assessors; and endpoint quality assurance. Additionally, it provides guidance and resources for those involved in drug development for rare diseases. CONCLUSION In keeping with the mission of ISCTM and the rare disease/orphan drug development working group, this article is designed to encourage thoughtful consideration and provide insight and guidance to promote and further efforts in in central nervous system (CNS) rare disease drug development efforts.
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Affiliation(s)
- Joan Busner
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Gahan Pandina
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - SilviaZaragoza Domingo
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Anna-Karin Berger
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Maria T Acosta
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Nahome Fisseha
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Joseph Horrigan
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Jelena Ivkovic
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - William Jacobson
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Dennis Revicki
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Victoria Villalta-Gil
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
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