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Benemei S, Gatto F, Boni L, Pane M. "If you cannot measure it, you cannot improve it". Outcome measures in Duchenne Muscular Dystrophy: current and future perspectives. Acta Neurol Belg 2024:10.1007/s13760-024-02600-2. [PMID: 39080230 DOI: 10.1007/s13760-024-02600-2] [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: 04/23/2024] [Accepted: 07/11/2024] [Indexed: 09/04/2024]
Abstract
Duchenne Muscular Dystrophy (DMD) is an X-linked recessive neuromuscular disorder primarily affecting males, caused by mutations in the dystrophin gene. The absence of dystrophin protein leads to progressive skeletal muscle degeneration. Recent advances in the therapeutic landscape underscore the need to identify appropriate outcome measures to assess treatment efficacy in ambulant and non-ambulant DMD patients, across clinical and research settings. This is essential for accurately evaluating new treatments and attributing therapeutic benefits.It is crucial to establish a robust correlation between outcome scores and disease progression patterns. This task is challenging since functional test performance may be influenced by different patient's characteristics, including the physiological evolution of the neurodevelopment together with the disease progression. While widely used DMD outcomes such as the North Star Ambulatory Assessment, the 6-Minute Walking Test, the 4 stairs climbed, and the Performance of the Upper Limb exhibit reliability and validity, their clinical significance is influenced by the wide phenotype and progression variability of the disease.We present and discuss the features (relevance, quantifiability, validity, objectivity, reliability, sensitivity, specificity, precision) of available DMD outcome measures, including new potential measures that may be provided by digital tools and artificial intelligence.
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Affiliation(s)
| | | | - Luca Boni
- U.O. Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marika Pane
- Nemo Clinical Centre, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
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Peay HL, Do BT, Khosla N, Paramsothy P, Erickson SW, Lamb MM, Whitehead N, Fox DJ, Pandya S, Kinnett K, Wolff J, Howard JF. Role Attainment in Emerging Adulthood: Subjective Evaluation by Male Adolescents and Adults with Duchenne and Becker Muscular Dystrophy. J Neuromuscul Dis 2022; 9:447-456. [PMID: 35275556 PMCID: PMC9126318 DOI: 10.3233/jnd-210709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Youth with Duchenne and Becker muscular dystrophy (DBMD) experience challenges in attaining adult roles, which may impact quality of life. New interventions and treatments may facilitate adult role attainment through improved function. Historical data on adult role attainment is important to assess the impact of new interventions on teens and young adults with DBMD. This study assesses medical knowledge, independence and employment, and relationships among adolescents and young adults with DBMD. METHODS This study uses data from a 2013 Muscular Dystrophy Surveillance, Tracking, and Research Network (MD STARnet) survey on adult transition. Males with DBMD aged 16-30 years were included. RESULTS Sixty-five of 258 eligible males participated; we report results on 60 participants with an MD STARnet case definition of DMD or BMD. Individuals with BMD reported higher rates than those with DMD of frequently staying home without supervision (50% BMD; 14% DMD), independently performing daily physical needs (93% BMD; 7% DMD) and being employed full or part time (33% BMD; 4% DMD). Most participants understood medication and physical therapy goals; less than half indicated being often or always responsible for scheduling DMBD-related management and refilling medications. Most had not been in a romantic relationship but reported desiring such relationships. CONCLUSIONS Our data reinforce the impact of DMD (and to a lesser extent, BMD) on transition to adult roles. These results provide an important historical comparator for teen and adult patients who are trying new interventions and therapies. Such data are important for assessing the quality-of-life impact of new treatments and to inform support and training programs for people with DBMD as they transition to new adult roles and responsibilities.
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Affiliation(s)
- Holly L Peay
- Genomics, Bioinformatics, and Translational Research Center, RTI International, Research Triangle Park NC
| | - Barbara T. Do
- Clinical Research Network Center, RTI International, Research Triangle Park NC
| | - Neil Khosla
- Oak Ridge Institute for Science and Education (ORISE) Fellow, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Pangaja Paramsothy
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Stephen W Erickson
- Genomics in Public Health & Medicine Center RTI International, Research Triangle Park NC
| | - Molly M. Lamb
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Nedra Whitehead
- Genomics in Public Health & Medicine Center, RTI International, Research Triangle Park NC
| | | | - Shree Pandya
- School of Medicine and Dentistry, University of Rochester, Rochester, NY
| | | | - Jodi Wolff
- Santhera Pharmaceuticals, Burlington, MA, Stride Bio, Research Triangle Park, NC
| | - James F Howard
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Lazovic M, Nikolic D, Boyer FC, Borg K, Ceravolo MG, Zampolini M, Kiekens C. Evidence based position paper on Physical and Rehabilitation Medicine practice for people with muscular dystrophies. Eur J Phys Rehabil Med 2021; 57:1036-1044. [PMID: 34823337 DOI: 10.23736/s1973-9087.21.07121-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Muscular dystrophies present a group of inherited degenerative disorder that are characterized by progressive muscular weakness. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section. The aim of the paper is to evaluate the role of the physical and rehabilitation medicine (PRM) physician and PRM practice for people with muscular dystrophies. A systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with thirty-three recommendations resulting from the Delphi procedure. The role of the PRM physician is to assess the functional status of persons with muscular dystrophy and to plan, monitor and lead PRM program in an interdisciplinary setting within a multiprofessional team.
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Affiliation(s)
- Milica Lazovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia - .,Institute for Rehabilitation, Belgrade, Serbia -
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Physical Medicine and Rehabilitation, University Children's Hospital, Belgrade, Serbia
| | - François C Boyer
- PRM Department, Sebastopol Hospital, Reims Champagne Ardenne University, Reims, France
| | - Kristian Borg
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Maria G Ceravolo
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, University Hospital of Ancona, Politecnica delle Marche University, Ancona, Italy
| | - Mauro Zampolini
- Department of Rehabilitation, San Giovanni Battista Hospital, Foligno, Perugia, Italy
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[Expert recommendation: treatment of nonambulatory patients with Duchenne muscular dystrophy]. DER NERVENARZT 2020; 92:359-366. [PMID: 33215271 PMCID: PMC8026471 DOI: 10.1007/s00115-020-01019-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) is the most frequent genetic neuromuscular disease in childhood with loss of ambulation usually occurring around the age of 9-11 years. OBJECTIVE, MATERIAL AND METHODS Based on current guidelines and clinical trials, neuropediatric and neurological experts developed recommendations for the treatment of nonambulatory DMD patients focusing on drug treatment of adults. This advisory board was sponsored by PTC Therapeutics, the distributers of the substance ataluren. RESULTS AND CONCLUSION Loss of ambulation is heterogeneously defined across clinical trials. Among others, the need of a wheelchair, ambulation without mobility aids or maximum walking distance can be suitable parameters for assessment. Treatment of DMD patients at any stage of the disease is based on supportive and symptomatic measures, which should be continued after loss of ambulation. In addition, disease-modifying drugs are available for the treatment of DMD and glucocorticoids are the usual standard of care treatment even beyond the loss of ambulation. Ataluren, a potentially dystrophin restorative, disease-modifying treatment, has been approved for patients with DMD due to a nonsense mutation (nmDMD), which applies to approximately 13% of DMD patients and is usually combined with steroids. Clinical data from the STRIDE registry demonstrated a delayed disease progression even after loss of ambulation. Currently, no reliable data are available for exon skipping approaches in adult DMD patients. The antioxidant idebenone could be an option in nonambulant adolescent patients not treated with glucocorticoids and without other therapeutic options. A combination treatment of idebenone and glucocorticoids is currently being investigated in a clinical trial. Add-on treatment with idebenone in addition to ataluren may be considered for nonambulant nmDMD patients. Some of the discussed treatment options are still in clinical trials or there are not enough data for older DMD patients; therefore, these expert recommendations correspond to evidence class IV.
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Conway KM, Eichinger K, Trout C, Romitti PA, Mathews KD, Pandya SK. Needs management in families affected by childhood-onset dystrophinopathies. SAGE Open Med 2019; 7:2050312119834470. [PMID: 30854202 PMCID: PMC6399767 DOI: 10.1177/2050312119834470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/05/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose To collect information about the needs of families affected by childhood-onset dystrophinopathies residing in the United States. Methods Individuals with an eligible dystrophinopathy were identified by the Muscular Dystrophy Surveillance, Tracking, and Research network. Between September 2008 and December 2012, 272 caregivers completed a 48-item survey about needs related to information, healthcare services, psychosocial issues, finances, caregiver demographics, and the individual's functioning. Results Overall, at least 80% of the survey items were identified as needs for more than one-half of caregivers. Among the needs identified, physical health and access to information were currently managed for most caregivers. Items identified as needed but managed less consistently were funding for needs not covered by insurance and psychosocial support. Conclusions Healthcare providers, public health practitioners, and policymakers should be aware of the many needs reported by caregivers, and focus on addressing gaps in provision of needed financial and psychosocial services.
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Affiliation(s)
- Kristin M Conway
- Department of Epidemiology, The University of Iowa, Iowa City, IA, USA
| | - Katy Eichinger
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Christina Trout
- Department of Pediatrics, The University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Paul A Romitti
- Department of Epidemiology, The University of Iowa, Iowa City, IA, USA
| | - Katherine D Mathews
- Department of Neurology, School of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Shree K Pandya
- Department of Neurology, University of Rochester, Rochester, NY, USA
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