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Kliest T, Van Eijk RPA, Al-Chalabi A, Albanese A, Andersen PM, Amador MDM, BrÅthen G, Brunaud-Danel V, Brylev L, Camu W, De Carvalho M, Cereda C, Cetin H, Chaverri D, Chiò A, Corcia P, Couratier P, De Marchi F, Desnuelle C, Van Es MA, Esteban J, Filosto M, GarcÍa Redondo A, Grosskreutz J, Hanemann CO, HolmØy T, HØyer H, Ingre C, Koritnik B, Kuzma-Kozakiewicz M, Lambert T, Leigh PN, Lunetta C, Mandrioli J, Mcdermott CJ, Meyer T, Mora JS, Petri S, Povedano MÓ, Reviers E, Riva N, Roes KCB, Rubio MÁ, Salachas F, Sarafov S, SorarÙ G, Stevic Z, Svenstrup K, MØller AT, Turner MR, Van Damme P, Van Leeuwen LAG, Varona L, VÁzquez Costa JF, Weber M, Hardiman O, Van Den Berg LH. Clinical trials in pediatric ALS: a TRICALS feasibility study. Amyotroph Lateral Scler Frontotemporal Degener 2022; 23:481-488. [PMID: 35172656 PMCID: PMC9662181 DOI: 10.1080/21678421.2021.2024856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Pediatric investigation plans (PIPs) describe how adult drugs can be studied in children. In 2015, PIPs for Amyotrophic Lateral Sclerosis (ALS) became mandatory for European marketing-authorization of adult treatments, unless a waiver is granted by the European Medicines Agency (EMA). Objective: To assess the feasibility of clinical studies on the effect of therapy in children (<18 years) with ALS in Europe. Methods: The EMA database was searched for submitted PIPs in ALS. A questionnaire was sent to 58 European ALS centers to collect the prevalence of pediatric ALS during the past ten years, the recruitment potential for future pediatric trials, and opinions of ALS experts concerning a waiver for ALS. Results: Four PIPs were identified; two were waived and two are planned for the future. In total, 49 (84.5%) centers responded to the questionnaire. The diagnosis of 44,858 patients with ALS was reported by 46 sites; 39 of the patients had an onset < 18 years (prevalence of 0.008 cases per 100,000 or 0.087% of all diagnosed patients). The estimated recruitment potential (47 sites) was 26 pediatric patients within five years. A majority of ALS experts (75.5%) recommend a waiver should apply for ALS due to the low prevalence of pediatric ALS. Conclusions: ALS with an onset before 18 years is extremely rare and may be a distinct entity from adult ALS. Conducting studies on the effect of disease-modifying therapy in pediatric ALS may involve lengthy recruitment periods, high costs, ethical/legal implications, challenges in trial design and limited information.
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Affiliation(s)
- Tessa Kliest
- Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Ruben P A Van Eijk
- Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, the Netherlands.,Biostatistics & Research Support, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, King's College London, Maurice Wohl Clinical Neuroscience Institute, London, UK.,Department of Neurology, King's College Hospital, London, UK
| | | | - Peter M Andersen
- Department of Clinical Sciences, Neurosciences, Umeå University, Umeå, Sweden
| | - Maria Del Mar Amador
- Département de Neurologie, Centre de référence SLA Ile de France.,Hôpital de la Pitié Salpêtrière, AP-HP, Paris, France
| | - Geir BrÅthen
- Department of Neurology, University Hospital of Trondheim, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Lev Brylev
- Bujanov Moscow City Clinical Hospital, Moscow, Russian Federation.,Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russian Federation
| | - William Camu
- ALS Centre CHU Gui de Chauliac, University of Montpellier, Montpellier, France
| | - Mamede De Carvalho
- Institute of Physiology-Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Department of Neurosciences and Mental Health, H Santa Maria-CHLN, Lisbon, Portugal
| | - Cristina Cereda
- Regional Newborn Screening Laboratory, Vittore Buzzi Children's Hospital-University of Milan, Italy
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Delia Chaverri
- Neurology Service, Hospital Universitario La Paz, Madrid, Spain
| | - Adriano Chiò
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Centre, University of Torino, Turin, Italy.,Azienda Ospedaliera Città della Salute e della Scienza, Turin, Italy
| | - Philippe Corcia
- Centre Constitutif SLA, CHRU de Tours - Fédération des centres SLA Tours-Limoges, LitORALS, Tours, France
| | - Philippe Couratier
- Centre Constitutif de reference SLA-Fédération Tours-Limoges, CHU de Limoges, Limoges, France
| | | | | | - Michael A Van Es
- Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - JesÚs Esteban
- ALS Research Lab - ALS Unit, Instituto de Investigación Sanitaria Hospital 12 de Octubre "i + 12", CIBERER, Madrid, Spain
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia; NeMO-Brescia Clinical Center for Neuromuscular Diseases, Brescia, Italy
| | - Alberto GarcÍa Redondo
- ALS Research Lab - ALS Unit, Instituto de Investigación Sanitaria Hospital 12 de Octubre "i + 12", CIBERER, Madrid, Spain
| | - Julian Grosskreutz
- Precision Neurology, Dept. of Neurology, Lübeck University Hospital, Lübeck, Germany
| | - Clemens O Hanemann
- University of Plymouth, Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Trygve HolmØy
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helle HØyer
- Department of Medical Genetics, Telemark Hospital, Skien, Norway
| | - Caroline Ingre
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Blaz Koritnik
- Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Thomas Lambert
- Department of Neurology, Royal Stoke University Hospital, Stoke, United Kingdom
| | - Peter N Leigh
- Department of Neuroscience, Brighton and Sussex Medical School, Trafford Centre for Biomedical Research, University of Sussex, Brighton, UK
| | - Christian Lunetta
- NEMO Clinical Center, Serena Onlus Foundation, Milan, Italy.,NEMO LAB, Milan, Italy
| | - Jessica Mandrioli
- Department of Biomedical, Metabolic and Neural Sciences, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy.,Department of Neuroscience, St. Agostino Estense Hospital, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Christopher J Mcdermott
- Department of Neuroscience, University of Sheffield, Sheffield Institute for Translational Neuroscience, Sheffield, United Kingdom
| | - Thomas Meyer
- ALS Outpatient Department, Charité - Universitatsmedizin Berlin, Berlin, Germany
| | - Jesus S Mora
- ALS Unit/Neurology, Hospital San Rafael, Madrid, Spain
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - MÓnica Povedano
- Functional Unit of Amyotrophic Lateral Sclerosis (UFELA), Service of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Evy Reviers
- European Organization for Professionals and Patients with ALS (EUpALS) & ALS Liga Belgium, Leuven, Belgium
| | - Nilo Riva
- Department of Neurology, Experimental Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Kit C B Roes
- Department of Health Evidence, Section Biostatistics, Radboud University Medical Centre Nijmegen, Nijmegen, the Netherlands
| | - Miguel Á Rubio
- Neuromuscular Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain.,Instituto Hospital del Mar de Investivaciones Médicas (IMIM), Barcelona, Spain
| | - FranÇois Salachas
- Département de Neurologie, Centre de référence SLA Ile de France.,Hôpital de la Pitié Salpêtrière, AP-HP, Paris, France
| | - Stayko Sarafov
- Clinic of General Neurology, Medical University Sofia, University Hospital Alexandrovska, Sofia, Bulgaria
| | - Gianni SorarÙ
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Zorica Stevic
- Clinic of Neurology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Kirsten Svenstrup
- Department of Neurology, Bispebjerg-Frederiksberg Hospital and Rigshospitalet, University Hospital of Copenhagen, Denmark
| | | | - Martin R Turner
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Philip Van Damme
- Department of Neurosciences, Laboratory for Neurobiology, KU Leuven and Centre for Brain & Disease Research, VIB, Leuven Brain Institute, Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Lucie A G Van Leeuwen
- Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Luis Varona
- Department of Neurology, Basurto University Hospital, Vizcaya, Spain
| | - Juan F VÁzquez Costa
- ALS Unit and Neuromuscular Disease Unit, Department of Neurology, Hospital La Fe, Valencia, Spain
| | - Markus Weber
- Neuromoscular Disease Unit/ALS Clinic, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Orla Hardiman
- Academic Unit of Neurology Trinity College Dublin Ireland, Dublin, Ireland
| | - Leonard H Van Den Berg
- Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
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