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Venema A, Peeks F, Rossi A, Jager EA, Derks TGJ. Towards values-based healthcare for inherited metabolic disorders: An overview of current practices for persons with liver glycogen storage disease and fatty acid oxidation disorders. J Inherit Metab Dis 2022; 45:1018-1027. [PMID: 36088581 PMCID: PMC9828459 DOI: 10.1002/jimd.12555] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 01/12/2023]
Abstract
Value-based healthcare (VBHC) intends to achieve better outcomes for patients, to improve quality of patient care, with reduced costs. Four dimensions define a model of intimately related value-pillars: personal value, allocative value, technical value, and societal value. VBHC is mostly applied in common diseases, and there are fundamental challenges in applying VBHC strategies to low volume, high complex healthcare situations, such as rare diseases, including inherited metabolic disorders. This article summarizes current practices at various academical domains (i.e., research, healthcare, education, and training) that (aim to) increase values at various value-pillars for persons with liver glycogen storage diseases or fatty acid oxidation disorders and their families. Future perspectives may include facilitating virtual networks to function as integrated practice units, improving measurement of outcomes, and creating information technology platforms to overcome the ethical, legal, societal, and technical challenges of data sharing for healthcare and research purposes.
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Affiliation(s)
- Annieke Venema
- Department of Metabolic Diseases, Beatrix Children's Hospital, University Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
| | - Fabian Peeks
- Department of Metabolic Diseases, Beatrix Children's Hospital, University Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
| | - Alessandro Rossi
- Department of Metabolic Diseases, Beatrix Children's Hospital, University Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
- Department of Translational Medicine, Section of PediatricsUniversity of Naples “Federico II”NaplesItaly
| | - Emmalie A. Jager
- Department of Metabolic Diseases, Beatrix Children's Hospital, University Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
| | - Terry G. J. Derks
- Department of Metabolic Diseases, Beatrix Children's Hospital, University Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
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2
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Mason E, Hindmarch CCT, Dunham‐Snary KJ. Medium-chain Acyl-COA dehydrogenase deficiency: Pathogenesis, diagnosis, and treatment. Endocrinol Diabetes Metab 2022; 6:e385. [PMID: 36300606 PMCID: PMC9836253 DOI: 10.1002/edm2.385] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/09/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Medium-Chain Acyl-CoA Dehydrogenase Deficiency (MCADD) is the most common inherited metabolic disorder of β-oxidation. Patients with MCADD present with hypoketotic hypoglycemia, which may quickly progress to lethargy, coma, and death. Prognosis for MCADD patients is highly promising once a diagnosis has been established, though management strategies may vary depending on the severity of illness and the presence of comorbidities. METHODS AND RESULTS Given the rapid developments in the world of gene therapy and implementation of newborn screening for inherited metabolic disorders, the provision of concise and contemporary knowledge of MCADD is essential for clinicians to effectively manage patients. Thus, this review aims to consolidate current information for physicians on the pathogenesis, diagnostic tools, and treatment options for MCADD patients. CONCLUSION MCADD is a commonly inherited metabolic disease with serious implications for health outcomes, particularly in children, that may be successfully managed with proper intervention.
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Affiliation(s)
- Emily Mason
- Department of Biomedical and Molecular SciencesQueen's UniversityKingstonOntarioCanada
| | | | - Kimberly J. Dunham‐Snary
- Department of Biomedical and Molecular SciencesQueen's UniversityKingstonOntarioCanada,Department of MedicineQueen's UniversityKingstonOntarioCanada
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3
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Howie AH, Tingley K, Inbar-Feigenberg M, Mitchell JJ, Butcher NJ, Offringa M, Smith M, Angel K, Gentle J, Wyatt A, Campeau PM, Chan A, Chakraborty P, El Turk F, Mamak E, Mhanni A, Skidmore B, Sparkes R, Stockler S, Potter BK. Establishing a core outcome set for mucopolysaccharidoses (MPS) in children: study protocol for a rapid literature review, candidate outcomes survey, and Delphi surveys. Trials 2021; 22:816. [PMID: 34789302 PMCID: PMC8600749 DOI: 10.1186/s13063-021-05791-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/03/2021] [Indexed: 11/17/2022] Open
Abstract
Background Mucopolysaccharidoses (MPS) are a group of inherited metabolic diseases characterized by chronic, progressive multi-system manifestations with varying degrees of severity. Disease-modifying therapies exist to treat some types of MPS; however, they are not curative, underscoring the need to identify and evaluate co-interventions that optimize functioning, participation in preferred activities, and quality of life. A Canadian pediatric MPS registry is under development and may serve as a platform to launch randomized controlled trials to evaluate such interventions. To promote the standardized collection of patient/family-reported and clinical outcomes considered important to patients/families, health care providers (HCPs), and policymakers, the choice of outcomes to include in the registry will be informed by a core outcome set (COS). We aim to establish a patient-oriented COS for pediatric MPS using a multi-stakeholder approach. Methods In step 1 of the six-step process to develop the COS, we will identify relevant outcomes through a rapid literature review and candidate outcomes survey. A two-phase screening approach will be implemented to identify eligible publications, followed by extraction of outcomes and other pre-specified data elements. Simultaneously, we will conduct a candidate outcomes survey with children with MPS and their families to identify outcomes most important to them. In step 2, HCPs experienced in treating patients with MPS will be invited to review the list of outcomes generated in step 1 and identify additional clinically relevant outcomes. We will then ask patients/families, HCPs, and policymakers to rate the outcomes in a set of Delphi Surveys (step 3), and to participate in a subsequent consensus meeting to finalize the COS (step 4). Step 5 involves establishing a set of outcome measurement instruments for the COS. Finally, we will disseminate the COS to knowledge users (step 6). Discussion The proposed COS will inform the choice of outcomes to include in the MPS registry and, more broadly, promote the standardized collection of patient-oriented outcomes for pediatric MPS research. By involving patients/families from the earliest stage of the research, we will ensure that the COS will be relevant to those who will ultimately benefit from the research. Trial registration PROSPERO CRD42021267531, COMET Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05791-8.
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Affiliation(s)
- Alison H Howie
- School of Epidemiology and Public Health, University of Ottawa, Room 101, 600 Peter Morand Crescent, Ottawa ON, Canada, Ottawa, ON, K1G 5Z3, Canada
| | - Kylie Tingley
- School of Epidemiology and Public Health, University of Ottawa, Room 101, 600 Peter Morand Crescent, Ottawa ON, Canada, Ottawa, ON, K1G 5Z3, Canada
| | | | | | - Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Martin Offringa
- The Hospital for Sick Children, Toronto, ON, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Maureen Smith
- Patient Partner, Canadian Organization for Rare Disorders, Ottawa, ON, Canada
| | - Kim Angel
- Canadian MPS Society, Vancouver, BC, Canada
| | | | | | - Philippe M Campeau
- Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, Montreal, QC, Canada
| | - Alicia Chan
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
| | - Pranesh Chakraborty
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Farah El Turk
- McGill University Health Centre, Montreal, QC, Canada.,Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, Montreal, QC, Canada
| | - Eva Mamak
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Aizeddin Mhanni
- Department of Pediatrics and Child Health, and Department of Biochemistry and Medical Genetics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Rebecca Sparkes
- Department of Medical Genetics and Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Sylvia Stockler
- Biochemical Diseases, BC Children's Hospital, Vancouver, BC, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, Room 101, 600 Peter Morand Crescent, Ottawa ON, Canada, Ottawa, ON, K1G 5Z3, Canada.
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4
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Vanderhout SM, Smith M, Pallone N, Tingley K, Pugliese M, Chakraborty P, Stockler S, Offringa M, Butcher N, Nicholls SG, Potter BK. Patient and family engagement in the development of core outcome sets for two rare chronic diseases in children. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:66. [PMID: 34521478 PMCID: PMC8439069 DOI: 10.1186/s40900-021-00304-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/12/2021] [Indexed: 05/29/2023]
Abstract
BACKGROUND Core outcome sets (COS) are lists of consensus-determined outcomes to be measured and reported in all clinical research studies within a disease area. While including patients and families in COS development to improve their relevance and applicability to patient values is key, there is limited literature documenting practical barriers and facilitators to successful patient engagement in COS development. In this paper, as researchers and patient partners, we provide a resource for COS developers to meaningfully and effectively engage patients and families. MAIN BODY To establish a consensus-based COS for children with two inherited metabolic diseases (medium-chain acyl-CoA dehydrogenase deficiency and phenylketonuria), we conducted an evidence review, Delphi survey, and workshop. Two adult patient partner co-investigators co-developed the study protocol, co-designed strategies to address challenges with incorporating patient perspectives, and led all patient engagement activities, including communication with a group of family advisors. Seven adult family advisors received training about COS development and subsequently contributed to Delphi survey development, outcome definitions, the consensus workshop, and selection of outcome measurement instruments. Patient partner co-investigators and family advisors were essential to the successful design, conduct, and completion of the two COS. Patient partner co-investigators supported the understanding, inclusion and engagement of family advisors, and helped develop accessible tools to determine patient-oriented outcome measurement instruments. Patient partner co-investigators and family advisors collaborated with the study team to co-develop surveys, modify technical language, and recruit participants to the study. Together, we addressed challenges to patient engagement in COS development such as unfamiliarity with study methods, comprehensibility of materials and ongoing engagement, and power imbalances between team members. CONCLUSION Our approach to patient and family engagement in COS development for two rare conditions for children was feasible and considered valuable by all study team members, including patients and family members, in improving the relevance of the deliverable to patients. This approach to patient engagement in developing COS can be applied to other paediatric disease contexts, allowing patient and family perspectives to influence the direction of future studies to develop COS.
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Affiliation(s)
- Shelley M Vanderhout
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON, K1G 5Z3, Canada
| | - Maureen Smith
- Patient Partner, Canadian Organization for Rare Disorders, Toronto, ON, Canada
| | - Nicole Pallone
- Patient Partner, Director of CanPKU and Parent of a Child with an Inherited Metabolic Disease, Toronto, ON, Canada
| | - Kylie Tingley
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON, K1G 5Z3, Canada
| | - Michael Pugliese
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON, K1G 5Z3, Canada
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 415 Smyth Road, Ottawa, ON, K1H 8M8, Canada
| | - Sylvia Stockler
- Division of Biochemical Genetics, BC Children's Hospital, Department of Pediatrics, University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
| | - Martin Offringa
- The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, 11th Floor, South 16, Toronto, ON, M5G 0A4, Canada
| | - Nancy Butcher
- The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, 11th Floor, South 16, Toronto, ON, M5G 0A4, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College St, 8th Floor, Toronto, ON, M5T 1R8, Canada
| | - Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON, K1G 5Z3, Canada.
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5
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Pugliese M, Tingley K, Chow A, Pallone N, Smith M, Chakraborty P, Geraghty MT, Irwin JK, Mitchell JJ, Stockler S, Nicholls SG, Offringa M, Rahman A, Tessier LA, Butcher NJ, Iverson R, Lamoureux M, Clifford TJ, Hutton B, Paik K, Tao J, Skidmore B, Coyle D, Duddy K, Dyack S, Greenberg CR, Jain Ghai S, Karp N, Korngut L, Kronick J, MacKenzie A, MacKenzie J, Maranda B, Potter M, Prasad C, Schulze A, Sparkes R, Taljaard M, Trakadis Y, Walia J, Potter BK. Core Outcome Sets for Medium-Chain Acyl-CoA Dehydrogenase Deficiency and Phenylketonuria. Pediatrics 2021; 148:peds.2020-037747. [PMID: 34266901 DOI: 10.1542/peds.2020-037747] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Evidence to guide treatment of pediatric medium-chain acyl-coenzyme A dehydrogenase (MCAD) deficiency and phenylketonuria (PKU) is fragmented because of large variability in outcome selection and measurement. Our goal was to develop core outcome sets (COSs) for these diseases to facilitate meaningful future evidence generation and enhance the capacity to compare and synthesize findings across studies. METHODS Parents and/or caregivers, health professionals, and health policy advisors completed a Delphi survey and participated in a consensus workshop to select core outcomes from candidate lists of outcomes for MCAD deficiency and PKU. Delphi participants rated the importance of outcomes on a nine-point scale (1-3: not important, 4-6: important but not critical, 7-9: critical). Candidate outcomes were progressively narrowed down over 3 survey rounds. At the workshop, participants evaluated the remaining candidate outcomes using an adapted nominal technique, open discussion, and voting. After the workshop, we finalized the COSs and recommended measurement instruments for each outcome. RESULTS There were 85, 61, and 53 participants across 3 Delphi rounds, respectively. The candidate core outcome lists were narrowed down to 20 outcomes per disease to be discussed at the consensus workshop. Voting by 18 workshop participants led to COSs composed of 8 and 9 outcomes for MCAD deficiency and PKU, respectively, with measurement recommendations. CONCLUSIONS These are the first known pediatric COSs for MCAD deficiency and PKU. Adoption in future studies will help to ensure best use of limited research resources to ultimately improve care for children with these rare diseases.
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Affiliation(s)
- Michael Pugliese
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Kylie Tingley
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Andrea Chow
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Nicole Pallone
- Patient partner, Canadian Organization for Rare Disorders, Toronto, Canada
| | | | - Pranesh Chakraborty
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada.,Divisions of Medical Genetics and Pediatric Endocrinology, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Michael T Geraghty
- Divisions of Medical Genetics and Pediatric Endocrinology, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Julie K Irwin
- Biochemical Diseases, British Columbia Children's Hospital, Vancouver, Canada
| | - John J Mitchell
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sylvia Stockler
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Stuart G Nicholls
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Martin Offringa
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Alvi Rahman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Laure A Tessier
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Nancy J Butcher
- Department of Pediatrics, Dalhousie University, Halifax, Canada.,Patient partner, Canadian Phenylketonuria & Allied Disorders Inc, Toronto, Canada
| | - Ryan Iverson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Monica Lamoureux
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Tammy J Clifford
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Brian Hutton
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Karen Paik
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Jessica Tao
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Becky Skidmore
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Kathleen Duddy
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Sarah Dyack
- Department of Medical Genetics, University of Alberta, Edmonton, Canada
| | | | - Shailly Jain Ghai
- Departments of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Natalya Karp
- Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Canada
| | - Lawrence Korngut
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Jonathan Kronick
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Alex MacKenzie
- Division of Metabolics, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Bruno Maranda
- Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Murray Potter
- Department of Pediatrics, Université de Sherbrooke, Sherbrooke, Canada
| | - Chitra Prasad
- Departments of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Andreas Schulze
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Rebecca Sparkes
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Yannis Trakadis
- Medical Genetics, and Pediatrics, University of Calgary, Calgary, Canada
| | - Jagdeep Walia
- Department of Human Genetics, McGill University, Montreal, Canada
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Stockler‐Ipsiroglu S, Potter BK, Yuskiv N, Tingley K, Patterson M, van Karnebeek C. Developments in evidence creation for treatments of inborn errors of metabolism. J Inherit Metab Dis 2021; 44:88-98. [PMID: 32944978 PMCID: PMC7891579 DOI: 10.1002/jimd.12315] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022]
Abstract
Inborn errors of metabolism (IEM) represent the first group of genetic disorders, amenable to causal therapies. In addition to traditional medical diet and cofactor treatments, new treatment strategies such as enzyme replacement and small molecule therapies, solid organ transplantation, and cell-and gene-based therapies have become available. Inherent to the rare nature of the single conditions, generating high-quality evidence for these treatments in clinical trials and under real-world conditions has been challenging. Guidelines developed with standardized methodologies have contributed to improve the practice of care and long-term clinical outcomes. Adaptive trial designs allow for changes in sample size, group allocation and trial duration as the trial proceeds. n-of-1 studies may be used in small sample sized when participants are clinically heterogeneous. Multicenter observational and registry-based clinical trials are promoted via international research networks. Core outcome and standard data element sets will enhance comparative analysis of clinical trials and observational studies. Patient-centered outcome-research as well as patient-led research initiatives will further accelerate the development of therapies for IEM.
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Affiliation(s)
- Sylvia Stockler‐Ipsiroglu
- Division of Biochemical Genetics, Department of Pediatrics, and BC Children's Hospital Research InstituteUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Beth K. Potter
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Nataliya Yuskiv
- Division of Biochemical Genetics, Department of Pediatrics, and BC Children's Hospital Research InstituteUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Kylie Tingley
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Marc Patterson
- Division of Child and Adolescent Neurology, Departments of Neurology Pediatrics and Medical GeneticsMayo Clinic Children's CenterRochesterMinnesotaUSA
| | - Clara van Karnebeek
- Departments of Pediatrics and Clinical GeneticsAmsterdam University Medical CentresAmsterdamThe Netherlands
- Department of PediatricsRadboud University Medical CentreNijmegenThe Netherlands
- Department of PediatricsBC Children's Hospital Research Institute, Centre for Molecular Medicine and TherapeuticsVancouverBritish ColumbiaCanada
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7
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Manta-Vogli PD, Schulpis KH, Dotsikas Y, Loukas YL. Nutrition and medical support during pregnancy and lactation in women with inborn errors of intermediary metabolism disorders (IEMDs). J Pediatr Endocrinol Metab 2020; 33:5-20. [PMID: 31804959 DOI: 10.1515/jpem-2019-0048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 09/20/2019] [Indexed: 12/25/2022]
Abstract
The establishment of expanded newborn screening (NBS) not only results in the early diagnosis and treatment of neonates with inborn errors of intermediary metabolism disorders (IEMDs) but also helps the affected females to reach the reproductive age under medical and dietetic support, as well as to give birth to normal infants. In this review, we aimed to focus on laboratory investigation tests, dietetic management and medical support for most known IEMD pregnant and lactating women, such as those suffering from aminoacidopathies, carbohydrate metabolic diseases and fatty acid (FAO) oxidation disorders.
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Affiliation(s)
- Penelope D Manta-Vogli
- Department of Clinical Nutrition and Dietetics, Agia Sofia Children's Hospital, Athens, Greece
| | | | - Yannis Dotsikas
- Laboratory of Pharm. Analysis, Department of Pharmacy, National and Kapodestrian University of Athens, Panepistimiopolis Zographou, GR-157 71, Athens, Greece, Phone: +30 210 7274696, Fax: +30 210 7274039
| | - Yannis L Loukas
- Laboratory of Pharm. Analysis, Department of Pharmacy, National and Kapodestrian University of Athens, Panepistimiopolis Zographou, GR-157 71, Athens, Greece, Phone: +30 210 7274224, Fax: +30 211 1826131
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8
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Pugliese M, Tingley K, Chow A, Pallone N, Smith M, Rahman A, Chakraborty P, Geraghty MT, Irwin J, Tessier L, Nicholls SG, Offringa M, Butcher NJ, Iverson R, Clifford TJ, Stockler S, Hutton B, Paik K, Tao J, Skidmore B, Coyle D, Duddy K, Dyack S, Greenberg CR, Ghai SJ, Karp N, Korngut L, Kronick J, MacKenzie A, MacKenzie J, Maranda B, Mitchell JJ, Potter M, Prasad C, Schulze A, Sparkes R, Taljaard M, Trakadis Y, Walia J, Potter BK. Outcomes in pediatric studies of medium-chain acyl-coA dehydrogenase (MCAD) deficiency and phenylketonuria (PKU): a review. Orphanet J Rare Dis 2020; 15:12. [PMID: 31937333 PMCID: PMC6961328 DOI: 10.1186/s13023-019-1276-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inherited metabolic diseases (IMDs) are a group of individually rare single-gene diseases. For many IMDs, there is a paucity of high-quality evidence that evaluates the effectiveness of clinical interventions. Clinical effectiveness trials of IMD interventions could be supported through the development of core outcome sets (COSs), a recommended minimum set of standardized, high-quality outcomes and associated outcome measurement instruments to be incorporated by all trials in an area of study. We began the process of establishing pediatric COSs for two IMDs, medium-chain acyl-CoA dehydrogenase (MCAD) deficiency and phenylketonuria (PKU), by reviewing published literature to describe outcomes reported by authors, identify heterogeneity in outcomes across studies, and assemble a candidate list of outcomes. METHODS We used a comprehensive search strategy to identify primary studies and guidelines relevant to children with MCAD deficiency and PKU, extracting study characteristics and outcome information from eligible studies including outcome measurement instruments for select outcomes. Informed by an established framework and a previously published pediatric COS, outcomes were grouped into five, mutually-exclusive, a priori core areas: growth and development, life impact, pathophysiological manifestations, resource use, and death. RESULTS For MCAD deficiency, we identified 83 outcomes from 52 articles. The most frequently represented core area was pathophysiological manifestations, with 33 outcomes reported in 29/52 articles (56%). Death was the most frequently reported outcome. One-third of outcomes were reported by a single study. The most diversely measured outcome was cognition and intelligence/IQ for which eight unique measurement instruments were reported among 14 articles. For PKU, we identified 97 outcomes from 343 articles. The most frequently represented core area was pathophysiological manifestations with 31 outcomes reported in 281/343 articles (82%). Phenylalanine concentration was the most frequently reported outcome. Sixteen percent of outcomes were reported by a single study. Similar to MCAD deficiency, the most diversely measured PKU outcome was cognition and intelligence/IQ with 39 different instruments reported among 82 articles. CONCLUSIONS Heterogeneity of reported outcomes and outcome measurement instruments across published studies for both MCAD deficiency and PKU highlights the need for COSs for these diseases, to promote the use of meaningful outcomes and facilitate comparisons across studies.
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Affiliation(s)
- Michael Pugliese
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Kylie Tingley
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrea Chow
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Maureen Smith
- Canadian Organization for Rare Disorders, Ottawa, Canada
| | - Alvi Rahman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Michael T Geraghty
- Division of Metabolics and Newborn Screening, Pediatrics, Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Julie Irwin
- Ambulatory Care, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Laure Tessier
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Martin Offringa
- Department of Pediatrics, University of Toronto, Toronto, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Ryan Iverson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Tammy J Clifford
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Sylvia Stockler
- Biochemical Diseases, BC Children's Hospital, Vancouver, Canada
| | - Brian Hutton
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Karen Paik
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jessica Tao
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Becky Skidmore
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathleen Duddy
- Biochemical Diseases, BC Children's Hospital, Vancouver, Canada
| | - Sarah Dyack
- Division of Medical Genetics, IWK Health Centre, Halifax, Canada
| | - Cheryl R Greenberg
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Shailly Jain Ghai
- Department of Medical Genetics, University of Alberta, Edmonton, Canada
| | - Natalya Karp
- Department of Pediatrics, Western University, London, Canada
| | - Lawrence Korngut
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Jonathan Kronick
- Department of Pediatrics, University of Toronto, Toronto, Canada.,Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Canada
| | - Alex MacKenzie
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | | | - Bruno Maranda
- Department of Pediatrics, Université de Sherbrooke, Sherbrooke, Canada
| | - John J Mitchell
- Human Genetics and Pediatrics, McGill University, Montreal, Canada
| | - Murray Potter
- Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Chitra Prasad
- Department of Pediatrics, Western University, London, Canada
| | - Andreas Schulze
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Rebecca Sparkes
- Medical Genetics and Pediatrics, University of Calgary, Calgary, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Yannis Trakadis
- Human Genetics and Medical Genetics, McGill University Health Centre, Montreal, Canada
| | - Jagdeep Walia
- Department of Pediatrics, Queen's University, Kingston, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
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