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Swoboda KJ, Scott CB, Crawford TO, Simard LR, Reyna SP, Krosschell KJ, Acsadi G, Elsheik B, Schroth MK, D'Anjou G, LaSalle B, Prior TW, Sorenson SL, Maczulski JA, Bromberg MB, Chan GM, Kissel JT. SMA CARNI-VAL trial part I: double-blind, randomized, placebo-controlled trial of L-carnitine and valproic acid in spinal muscular atrophy. PLoS One 2010; 5:e12140. [PMID: 20808854 PMCID: PMC2924376 DOI: 10.1371/journal.pone.0012140] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 07/13/2010] [Indexed: 01/21/2023] Open
Abstract
Background Valproic acid (VPA) has demonstrated potential as a therapeutic candidate for spinal muscular atrophy (SMA) in vitro and in vivo. Methods Two cohorts of subjects were enrolled in the SMA CARNIVAL TRIAL, a non-ambulatory group of “sitters” (cohort 1) and an ambulatory group of “walkers” (cohort 2). Here, we present results for cohort 1: a multicenter phase II randomized double-blind intention-to-treat protocol in non-ambulatory SMA subjects 2–8 years of age. Sixty-one subjects were randomized 1∶1 to placebo or treatment for the first six months; all received active treatment the subsequent six months. The primary outcome was change in the modified Hammersmith Functional Motor Scale (MHFMS) score following six months of treatment. Secondary outcomes included safety and adverse event data, and change in MHFMS score for twelve versus six months of active treatment, body composition, quantitative SMN mRNA levels, maximum ulnar CMAP amplitudes, myometry and PFT measures. Results At 6 months, there was no difference in change from the baseline MHFMS score between treatment and placebo groups (difference = 0.643, 95% CI = −1.22–2.51). Adverse events occurred in >80% of subjects and were more common in the treatment group. Excessive weight gain was the most frequent drug-related adverse event, and increased fat mass was negatively related to change in MHFMS values (p = 0.0409). Post-hoc analysis found that children ages two to three years that received 12 months treatment, when adjusted for baseline weight, had significantly improved MHFMS scores (p = 0.03) compared to those who received placebo the first six months. A linear regression analysis limited to the influence of age demonstrates young age as a significant factor in improved MHFMS scores (p = 0.007). Conclusions This study demonstrated no benefit from six months treatment with VPA and L-carnitine in a young non-ambulatory cohort of subjects with SMA. Weight gain, age and treatment duration were significant confounding variables that should be considered in the design of future trials. Trial Registry Clinicaltrials.gov NCT00227266
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Affiliation(s)
- Kathryn J. Swoboda
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- * E-mail:
| | - Charles B. Scott
- CBS Squared, Inc, Fort Washington, Pennsylvania, United States of America
| | - Thomas O. Crawford
- Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Louise R. Simard
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sandra P. Reyna
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Kristin J. Krosschell
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Gyula Acsadi
- Departments of Neurology and Pediatrics, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Bakri Elsheik
- Department of Neurology, Ohio State University Medical Center, Columbus, Ohio, United States of America
| | - Mary K. Schroth
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Guy D'Anjou
- Division of Pediatric Neurology, Ste-Justine Hospital, Montréal, Québec, Canada
| | - Bernard LaSalle
- General Clinical Research Center, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Thomas W. Prior
- Department of Molecular Pathology, Ohio State University, Columbus, Ohio, United States of America
| | - Susan L. Sorenson
- Primary Children's Medical Center, Salt Lake City, Utah, United States of America
| | - Jo Anne Maczulski
- Pediatric Occupational Therapy Services, Chicago, Illinois, United States of America
| | - Mark B. Bromberg
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Gary M. Chan
- Department of Pediatric Neonatology, University of Utah, Salt Lake City, Utah, United States of America
| | - John T. Kissel
- Department of Neurology, Ohio State University Medical Center, Columbus, Ohio, United States of America
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