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Bravetti C, Coratti G, Pera MC, Gadaleta G, Mongini T, Coccia M, Ferrero A, Costantini EM, Longo A, Cumbo F, Catteruccia M, D'Amico A, Morando S, Brolatti N, Bruno C, Verriello L, Pessa ME, Antonaci L, Faini C, Liguori R, Vacchiano V, Ruggiero L, Zoppi D, Russo A, Torri F, Ricci G, Chiappini R, Siciliano G, Trabacca A, Agosto C, Benedetti F, Pane M, Mercuri E, ITASMAC working group. Italian validation of the SMA independence scale-upper limb module. Eur J Pediatr 2025; 184:410. [PMID: 40490594 DOI: 10.1007/s00431-025-06207-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Collaborators] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2025] [Revised: 05/07/2025] [Accepted: 05/16/2025] [Indexed: 06/11/2025]
Abstract
Spinal muscular atrophy (SMA) is a progressive disorder caused by SMN1 mutations. While therapies have changed its course, current motor scales often miss aspects. This study aimed to validate the Italian SMA Independence Scale (SMAIS-ULM) for reliability, applicability, and expansion across diverse SMA phenotypes. Patients with genetically confirmed 5qSMA were recruited from 12 Italian centers. Analyses included Intraclass Correlation Coefficients (ICCs) for test-retest reliability, the Kruskal-Wallis for group comparisons, and the Spearman correlations with functional measures. Ceiling/floor effects were defined as ≥ 85% of a group reaching the maximum or minimum score. The study analyzed 472 completed questionnaires: 263 from caregivers (mean age 26.4 ± 17.6; 29 SMA I, 123 SMA II, 104 SMA III, 7 presymptomatic) and 209 from patients (mean age 33.1 ± 16.4; 3 SMA I, 101 SMA II, 104 SMA III; 1 SMA IV), including 195 matched caregiver-patient pairs. ICC was conducted in 29 caregivers and 31 patients; values ranged from 0.97 to 1.00. SMAIS-ULM scores differed by SMA type, with SMA III/presymptomatic subjects scoring higher than SMA I/II (p < 0.001) and walkers scoring higher than sitters/non-sitters (p < 0.001). Floor effects were found in 18.9% of non-sitters and 50% of walkers, with comparable patterns in patient responses. Strong correlations with functional measures were found, with no significant differences between caregiver and patient reports. Conclusion: The findings confirm the reliability and validity of the SMAIS-ULM as an effective tool for measuring functional independence in individuals with SMA, both from the caregiver and patient perspectives.
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Affiliation(s)
- Chiara Bravetti
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giorgia Coratti
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Carmela Pera
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Child Neuropsychiatry Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giulio Gadaleta
- Neuromuscular Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Tiziana Mongini
- Neuromuscular Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Michela Coccia
- NeMO Clinical Center Ancona - Azienda Ospedaliero-Universitaria Delle Marche, Ancona, Italy
| | - Amanda Ferrero
- NeMO Clinical Center Ancona - Azienda Ospedaliero-Universitaria Delle Marche, Ancona, Italy
| | | | - Antonella Longo
- Unit of Muscular and Neurodegenerative Diseases, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Cumbo
- Unit of Muscular and Neurodegenerative Diseases, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Michela Catteruccia
- Unit of Muscular and Neurodegenerative Diseases, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Adele D'Amico
- Unit of Muscular and Neurodegenerative Diseases, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Simone Morando
- Center of Translational and Experimental Myology, Department of Neuroscience, Rehabilitation, Ophthalmology Genetics, Maternal and Child Health, IRCCS Istituto Giannina Gaslini and University of Genoa, Genoa, Italy
| | - Noemi Brolatti
- Center of Translational and Experimental Myology, Department of Neuroscience, Rehabilitation, Ophthalmology Genetics, Maternal and Child Health, IRCCS Istituto Giannina Gaslini and University of Genoa, Genoa, Italy
| | - Claudio Bruno
- Center of Translational and Experimental Myology, Department of Neuroscience, Rehabilitation, Ophthalmology Genetics, Maternal and Child Health, IRCCS Istituto Giannina Gaslini and University of Genoa, Genoa, Italy
| | - Lorenzo Verriello
- Neurology Unit, "Head, Neck and Neurosciences" Department, University Hospital of Udine, 33100, Udine, Italy
| | - Maria Elena Pessa
- Neurology Unit, "Head, Neck and Neurosciences" Department, University Hospital of Udine, 33100, Udine, Italy
| | - Laura Antonaci
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudia Faini
- Dipartimento Di Scienze Biomediche E Neuromotorie, Università Di Bologna, 40139, Bologna, Italy
| | - Rocco Liguori
- UOC Clinica Neurologica, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, 40139, Bologna, Italy
- Dipartimento Di Scienze Biomediche E Neuromotorie, Università Di Bologna, 40139, Bologna, Italy
- Centro Clinico NeMO, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, 40139, Bologna, Italy
| | - Veria Vacchiano
- UOC Clinica Neurologica, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, 40139, Bologna, Italy
- Centro Clinico NeMO, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, 40139, Bologna, Italy
| | - Lucia Ruggiero
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Dario Zoppi
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Anna Russo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Francesca Torri
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy
| | - Giulia Ricci
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy
| | - Roberto Chiappini
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy
| | - Antonio Trabacca
- Scientific Institute IRCCS "E. Medea", Scientific Direction, Via Don L. Monza 20, 23842, Bosisio Parini, LC, Italy
| | - Caterina Agosto
- Pediatric Pain and Palliative Care Service, Department of Women's and Children's Health, University Hospital, Padua, Italy
| | - Francesca Benedetti
- Pediatric Pain and Palliative Care Service, Department of Women's and Children's Health, University Hospital, Padua, Italy
| | - Marika Pane
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eugenio Mercuri
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy.
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Collaborators
Anna Capasso, Chiara Arpaia, Gianpaolo Cicala, Sophia Paolucci, Chiara Cutrì, Marianna Villa, Simona Sestito, Agnese Polo, Anna Falco, Azzurra Rausa, Marianna Moro, Chiara Porto, Alessia De Gioia, Elena De Rosa, Elisa Rolleri, Federica Ascione, Federica Giammartino, Giorgia Petracca, Lucia Esposito, Maddalena Bianchetti, Giuseppe Marsella, Martina Malaspina, Irene Dainesi, Sara Mannucci, Martina De Maria, Giacomo De Luca, Irene Mizzoni, Adelina Carlesi,
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Peterson IS, Chitale R, Curry MA, Belter LT. SMA Community Priorities for Future Drug Therapies: Cross-Sectional Survey Findings Representing 410 Adults with SMA. Neurol Ther 2025; 14:1083-1092. [PMID: 40317455 PMCID: PMC12089628 DOI: 10.1007/s40120-025-00753-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2025] [Accepted: 04/11/2025] [Indexed: 05/07/2025] Open
Abstract
INTRODUCTION Despite advances in the therapeutic landscape for spinal muscular atrophy (SMA), unmet needs for those with this condition persist. This study seeks to characterize unmet needs that adults with SMA hope future therapies will address and explores associations between reported needs and health status and demographic characteristics. METHODS Close-ended questions from 2021 to 2023 Cure SMA Community Update Survey data were used to assess the importance of needs related to muscle and motor function, lung function and bulbar function, and general functioning. Data was stratified by SMA type and mobility status, and Fisher's exact tests were used to assess for statistically significant differences based on these characteristics. Variations in reported needs were further explored with regressions controlling for sex, education, maximum mobility, and drug treatment status. RESULTS The sample included 410 adults who answered questions on unmet needs. Most had type 2 or type 3 SMA (48% and 45%, respectively). Gaining muscle strength was the most frequently reported unmet need, and followed by improving daily functioning, achieving new motor function, and stabilizing motor function. Stratifications and regressions identified statistically significant differences in treatment needs based on health status and demographic characteristics (p < 0.05). Most notably, people with more severe types of SMA and lower mobility were more likely to report items related to lung function and bulbar function as important. CONCLUSION This research highlights treatment priorities for adults with SMA.
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Affiliation(s)
| | - Ramaa Chitale
- Contractor to Faegre Drinker Consulting, Washington, DC, USA
| | - Mary A Curry
- Cure SMA, 925 Busse Road, Elk Grove Village, IL, 60007, USA
| | - Lisa T Belter
- Cure SMA, 925 Busse Road, Elk Grove Village, IL, 60007, USA.
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O'Connell C, Rodrigue X, Hodgkinson V, Henley K, Slayter J, Aleman A, Drost D, Izenberg A, Knowles B, Lochmüller H, Nury M, O'Ferrall E, Osman H, Schellenberg K, Shoesmith C, Stables C, Vander Wyk S, Westbury G. Thinking outside the box: A re-evaluation of Canadian recommended outcome measures in adult spinal muscular atrophy - report of a national consensus workshop. J Neuromuscul Dis 2025:22143602251336076. [PMID: 40356341 DOI: 10.1177/22143602251336076] [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: 05/15/2025]
Abstract
BackgroundDisease-modifying therapies for persons with spinal muscular atrophy (SMA) has led to greater need and demand for relevant outcomes assessments. Such tools help monitor disease progression, assess treatment response, and inform clinical management. Canadian SMA clinicians participated in a Delphi process to achieve a 2021 national consensus on recommended outcomes, recognizing future reassessment would be essential given the evolving field and gaps in patient-reported and bulbar measures.ObjectiveDerive updated Canadian consensus of recommended outcome measures for adults with SMA.MethodsA national consensus workshop was held with SMA clinicians, patient/family representatives, research leaders, national registry and advocacy organizations. Clinics and registry experience and data were presented and discussed, utility of current and additional outcomes reviewed. Long and short lists of measures were generated, with voting to derive consensus.ResultsPractical implementation, value of data, and relevance to persons with SMA were key considerations. Consensus was achieved to 'think outside the box', recognizing a spectrum of function and need to choose the right outcome measure for the right patient at the right time. Measures with greater acceptance for adults were selected, and bulbar measures introduced. Eight outcome measures are recommended; 4 motor, 2 respiratory and 2 patient reported domains, with use based on the individuals level of function. The Revised Upper Limb Module was deemed to have broadest applicability except in the strongest and weakest adults. Additional measures are included as optional and exploratory.ConclusionsEmploying measures meaningful for clinicians, researchers, and persons living with SMA is essential to ensuring quality data collection and an engaged patient-centred clinical team. Clinicians should select measures based on the person's functional ability and goals. Building a national community of practice to support clinical and research practice, including standardized outcome measure training, will be a key next step in dissemination and advocacy.
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Affiliation(s)
- Colleen O'Connell
- Division of Physical Medicine & Rehabilitation, Department of Medicine, Dalhousie University, Halifax, Canada
- Stan Cassidy Centre for Rehabilitation, Horizon Health Network, Fredericton, Canada
| | - Xavier Rodrigue
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Institut de réadaptation en déficience physique de Québec, Département de médecine, Université Laval, Québec, Canada
| | - Victoria Hodgkinson
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Katie Henley
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Jeremy Slayter
- Division of Physical Medicine & Rehabilitation, Department of Medicine, Dalhousie University, Halifax, Canada
| | - Alberto Aleman
- Children's Hospital of Eastern Ontario Research Institute, Division of Neurology, Department of Pediatrics, Ottawa, Canada
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Canada
- Brain and Mind Research Institute, Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Dorothy Drost
- Stan Cassidy Centre for Rehabilitation, Horizon Health Network, Fredericton, Canada
| | - Aaron Izenberg
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Beth Knowles
- Stan Cassidy Centre for Rehabilitation, Horizon Health Network, Fredericton, Canada
| | - Hanns Lochmüller
- Children's Hospital of Eastern Ontario Research Institute, Division of Neurology, Department of Pediatrics, Ottawa, Canada
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Canada
- Brain and Mind Research Institute, Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Marianne Nury
- Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Erin O'Ferrall
- Departments of Neurology, Neurosurgery and Pathology, Montreal Neurological Institute and McGill University, Montreal, Canada
| | | | | | | | - Christine Stables
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Grace Westbury
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
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Chen S, Wang Q, Fu J, Wei Q, Ou R, Lai X, Chen X, Shang H. Serum creatinine to cystatin C ratio as monitoring biomarker in Chinese adult spinal muscular atrophy: a prospective cohort study. Orphanet J Rare Dis 2025; 20:209. [PMID: 40317045 PMCID: PMC12046850 DOI: 10.1186/s13023-025-03730-3] [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: 12/14/2024] [Accepted: 04/10/2025] [Indexed: 05/04/2025] Open
Abstract
BACKGROUND The creatinine to cystatin C ratio (CCR) can be used as a biomarker of muscle mass and strength, but no studies have evaluated whether it can be used as a biomarker to monitor the efficacy of treatment with nusinersen in Chinese adults with 5q-associated spinal muscular atrophy (SMA). METHODS In this prospective observational study, 28 adult SMA patients were followed for 18 months. Data on motor function and daily activities were collected using the Hammersmith Functional Motor Scale Expanded (HFMSE), Revised Upper Limb Module (RULM), 6-Minute Walking Test (6WMT), and Barthel Index (BI). Serum levels of creatinine (Cr), creatine kinase (CK), and CCR were measured. Spearman correlation and linear mixed models analyzed the relationships between functional scores and laboratory indicators. RESULTS HFMSE scores showed significant improvement at Visit 5 (V5) [+ 1.04 points, p = 0.016), V6 (+ 1.61, p = 0.012), V7 (+ 1.93, p < 0.001), and V8 (+ 1.89, p < 0.001)], while RULM scores improved significantly at V5 (+ 2.00 points, p = 0.024), V7 (+ 2.00, p = 0.032), and V8 (+ 2.00, p < 0.001). The BI also exhibited significant improvement at V7 (+ 5.00, p < 0.001) and V8 (+ 2.50, p < 0.001). The 6MWT did not show significant improvement (p > 0.05). Serum CCR levels were significantly higher than baseline at V5 (+ 4.35 points, p < 0.001), V7 (+ 5.12, p < 0.001), and V8 (+ 6.59, p < 0.001). Cr levels were significantly higher than baseline at V5 (+ 2.39 points, p < 0.001) and V7 (+ 0.90, p < 0.001), while log10 CK levels remained unchanged (p > 0.05). Spearman correlation analysis revealed CCR showed the strongest correlation with functional scores, followed by Cr and log10 CK. Further linear mixed-effect model indicated that after adjusting for covariates, only CCR showed a dynamic positive correlation with HFMSE scores (β = 0.280; 95% CI 0.023-0.537, p = 0.033), while other serum indicators had no correlation with functional scores. CONCLUSION Long-term use of nusinersen effectively improves motor function and quality of life in adult SMA patients, and CCR may be a better indicator to reflect changes in motor function during treatment compared to other blood biomarkers.
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Affiliation(s)
- Sihui Chen
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Qiong Wang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jiajia Fu
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Qianqian Wei
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Ruwei Ou
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Xiaohui Lai
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Xueping Chen
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China.
| | - Huifang Shang
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China.
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Jiang L, Yan Y, Yu Y, Huang S, Feng Y, Gao F, Mao S. Impact of Nusinersen Treatment on the Independence and Mental Health of School-Aged Patients With Spinal Muscular Atrophy. Pediatr Neurol 2025; 168:100-104. [PMID: 40408826 DOI: 10.1016/j.pediatrneurol.2025.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 08/21/2024] [Accepted: 04/23/2025] [Indexed: 05/25/2025]
Abstract
BACKGROUND Emerging disease-modifying therapies for spinal muscular atrophy (SMA) have altered patients' mental health and daily functioning. This longitudinal study evaluated nusinersen's effects on independence and mental health in school-age SMA patients. METHODS Thirty-one SMA type 2/3 patients from a pediatric hospital were assessed using the SMA Independence Scale-Upper Limb Module (SMAIS-ULM), Screen for Child Anxiety-Related Emotional Disorders (SCARED), and Depression Self-Rating Scale for Children (DSRSC). Motor function was measured via Hammersmith Functional Motor Scale-Expanded (HFMSE) and Revised Upper Limb Module (RULM), with correlations analyzed. RESULTS Median treatment initiation age was 9.19 (8.73-11.90) years. After 14 months, SMAIS-ULM scores improved significantly (P < 0.01), while anxiety/depression rates declined (P < 0.01). Higher HFMSE scores correlated with better independence (P < 0.01) and reduced anxiety/depression (P < 0.01). Similarly, higher RULM scores predicted greater independence (P < 0.01) and lower anxiety (P < 0.05). CONCLUSIONS Nusinersen therapy enhances independence and mental health in school-age SMA patients, supported by patient-reported outcomes. These findings underscore its multifaceted therapeutic benefits.
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Affiliation(s)
- Liya Jiang
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Yue Yan
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Yicheng Yu
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Siyi Huang
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Yijie Feng
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Feng Gao
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Shanshan Mao
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China.
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Muni-Lofra R, Coratti G, Duong T, Medina-Cantillo J, Civitello M, Mayhew A, Finkel R, Mercuri E, Marini-Bettolo C, Muntoni F. Assessing disease progression in spinal muscular atrophy, current gaps, and opportunities: a narrative review. Neuromuscul Disord 2025; 49:105341. [PMID: 40120531 DOI: 10.1016/j.nmd.2025.105341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Revised: 02/23/2025] [Accepted: 03/10/2025] [Indexed: 03/25/2025]
Abstract
Spinal Muscular Atrophy is a genetic disorder causing muscle atrophy and progressive weakness. People living with the condition can have a significant heterogenous phenotype ranging from arrest of motor development to mild impairment. Assessing disease severity has been done using a range of outcome measures that can be classified by body structure or function, by activities or by participation. Functional outocome measures can be generic measures, used to compare individuals or populations against general norms, or disease-specific measures designed to fit disease characteristics. Outcome measures assessing participation are primarily used to capture patients' perceptions of health-related quality of life, daily activity abilities, caregiver burden, and the impact of physical symptoms like fatigue or pain. When assessing disease progression, often the focus on functional abilities has served as an overall indicator of change. With the appearance of disease modifying therapies and the need to evaluate the impact that they had in the course of the disease, new requirements for the existing assessments measure had appeared. The current available toolkit is able to capture a significant spectrum of both, natural history and effect of new treatments but the increased survival, changes in fatigue, bulbar function and others will benefit from further assessment.
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Affiliation(s)
- R Muni-Lofra
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 3BZ, UK.
| | - G Coratti
- Pediatric Neurology Unit, Catholic University of Sacred Heart, 00135 Rome, Italy; Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - T Duong
- Department of Neurology, Stanford University, Stanford, CA, United States
| | - J Medina-Cantillo
- Neuromuscular Unit, Rehabilitation Department, Hospital Universitari Sant Joan de Deu, Barcelona, Spain
| | - M Civitello
- Center for Experimental Neurotherapeutics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - A Mayhew
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 3BZ, UK
| | - R Finkel
- Neuromuscular Unit, Rehabilitation Department, Hospital Universitari Sant Joan de Deu, Barcelona, Spain
| | - E Mercuri
- Pediatric Neurology Unit, Catholic University of Sacred Heart, 00135 Rome, Italy; Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - C Marini-Bettolo
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 3BZ, UK
| | - F Muntoni
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London WC1N1EH, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
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7
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Huang S, Jiang L, Zhou D, Yan Y, Feng Y, Yu Y, Yao M, Gao F, Mao S. Longitudinal Efficacy of Nusinersen Treatment on Health-Related Quality of Life and Independence in Children With Later-Onset Spinal Muscular Atrophy. Muscle Nerve 2025; 71:368-376. [PMID: 39718202 PMCID: PMC11799406 DOI: 10.1002/mus.28311] [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: 04/23/2024] [Revised: 11/23/2024] [Accepted: 11/24/2024] [Indexed: 12/25/2024]
Abstract
INTRODUCTION/AIMS The rising use of disease-modifying therapy is progressively impacting the health-related quality of life (HRQoL) of patients with spinal muscular atrophy (SMA) in their daily lives. This study aimed to evaluate the changes in HRQoL and independence in children with later-onset SMA receiving longitudinal treatment with nusinersen. METHODS Forty-nine pediatric patients with later-onset SMA (symptom onset after 6 months of age) and their caregivers were enrolled. The HRQoL of patients evaluated by the proxy-reported Pediatric Quality of Life Inventory 3.0 Neuromuscular Module (PedsQL NMM) and the independence level determined by the SMA Independence Scale-Upper Limb Module (SMAIS-ULM) were assessed. Caregiver HRQoL was assessed using the Pediatric Quality of Life Inventory Family Impact Module (PedsQL FIM). Motor function was recorded using the Hammersmith Functional Motor Scale Expanded (HFMSE) and the Revised Upper Limb Module (RULM), with subsequent analysis of the correlation between motor function, HRQoL, and independence scores. RESULTS A significant difference was observed across all domains of the proxy-reported PedsQL NMM and in the independence assessment over the 18-month follow-up period (p < 0.001). A positive correlation was identified between RULM and total PedsQL NMM scores (Pearson-r = 0.539, p < 0.001), as well as SMAIS-ULM scores (Spearman-rho = 0.507, p < 0.001). Scores in all modules of the PedsQL FIM improved over time (p < 0.001). DISCUSSION This study demonstrates the longitudinal effects of nusinersen treatment on multifaceted aspects of SMA patients, as captured by patient-reported outcome measures (PROMs). The inclusion of PROMs should be considered as part of the SMA multidisciplinary assessment.
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Affiliation(s)
- Siyi Huang
- Department of NeurologyChildren's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
| | - Liya Jiang
- Department of NeurologyChildren's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
| | - Dongming Zhou
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
| | - Yue Yan
- Department of NeurologyChildren's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
| | - Yijie Feng
- Department of NeurologyChildren's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
| | - Yicheng Yu
- Department of NeurologyChildren's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
| | - Mei Yao
- Department of Infectious DiseasesChildren's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
| | - Feng Gao
- Department of NeurologyChildren's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
| | - Shanshan Mao
- Department of NeurologyChildren's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
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Mandarakas M, Farrar M. Measuring Broad and Meaningful Impacts With Patient-Reported Outcomes in Spinal Muscular Atrophy as a Framework for Neuromuscular Disorders. Muscle Nerve 2025; 71:287-289. [PMID: 39731330 DOI: 10.1002/mus.28335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 12/19/2024] [Accepted: 12/20/2024] [Indexed: 12/29/2024]
Affiliation(s)
- Melissa Mandarakas
- Department of Neurology, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, Sydney, New South Wales, Australia
| | - Michelle Farrar
- Department of Neurology, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, Sydney, New South Wales, Australia
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Slayter J, Casey L, McCullum S, Drost D, Banks A, O'Connell C. An exploratory qualitative assessment of patient and clinician perspectives on patient-reported outcome measures and disease-modifying therapies in adults with spinal muscular atrophy. J Rehabil Med 2025; 57:jrm41254. [PMID: 39810476 PMCID: PMC11748171 DOI: 10.2340/jrm.v57.41254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 12/16/2024] [Indexed: 01/16/2025] Open
Abstract
OBJECTIVE To understand patient, caregiver, and clinician perspectives on patient-reported outcome measures, critical functional domains, and disease-modifying therapies in adult spinal muscular atrophy. DESIGN An exploratory qualitative single-site study. PATIENTS Ten adults with spinal muscular atrophy and two clinicians participated in semi-structured interviews. METHODS Semi-structured interviews were conducted virtually or in person with participants after they completed outcome measures at a routine clinic visit. Two researchers analysed transcripts concurrently using a thematic approach to determine themes. RESULTS Ten themes were identified among partici-pants. Patient-reported outcome measure preference varied between functional groups and was under-responsive, although it captured meaningful data. Motor stability was most frequently expected with disease-modifying therapy, but participants also reported improved fatigue and respiratory status. CONCLUSION After considering patient goals, functional status, and preferences, patient-reported outcome measures represent a valuable adjunct to standard clinical and research tools. Optimal selection of patient-reported outcome measures requires careful consideration of multiple patient factors. Collaborative development of modified patient-reported outcome measures may yield a responsive, meaningful, and acceptable tool that can be used across a broad functional spectrum.
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Affiliation(s)
- Jeremy Slayter
- Division of Physical Medicine & Rehabilitation, Dalhousie University, Halifax, Nova Scotia, Canada; Stan Cassidy Centre for Rehabilitation, Horizon Health Network, Fredericton, New Brunswick, Canada.
| | - Lauren Casey
- Stan Cassidy Centre for Rehabilitation, Horizon Health Network, Fredericton, New Brunswick, Canada
| | - Shane McCullum
- Stan Cassidy Centre for Rehabilitation, Horizon Health Network, Fredericton, New Brunswick, Canada
| | - Dorothy Drost
- Stan Cassidy Centre for Rehabilitation, Horizon Health Network, Fredericton, New Brunswick, Canada
| | - Allison Banks
- Stan Cassidy Centre for Rehabilitation, Horizon Health Network, Fredericton, New Brunswick, Canada
| | - Colleen O'Connell
- Stan Cassidy Centre for Rehabilitation, Horizon Health Network, Fredericton, New Brunswick, Canada; Dalhousie Medicine New Brunswick, Dalhousie University, Saint John, New Brunswick, Canada
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Servais L, Lair LL, Connolly AM, Byrne BJ, Chen KS, Coric V, Qureshi I, Durham S, Campbell DJ, Maclaine G, Marin J, Bechtold C. Taldefgrobep Alfa and the Phase 3 RESILIENT Trial in Spinal Muscular Atrophy. Int J Mol Sci 2024; 25:10273. [PMID: 39408601 PMCID: PMC11477173 DOI: 10.3390/ijms251910273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 09/19/2024] [Accepted: 09/20/2024] [Indexed: 10/19/2024] Open
Abstract
Spinal muscular atrophy (SMA) is a rare, genetic neurodegenerative disorder caused by insufficient production of survival motor neuron (SMN) protein. Diminished SMN protein levels lead to motor neuron loss, causing muscle atrophy and weakness that impairs daily functioning and reduces quality of life. SMN upregulators offer clinical improvements and increased survival in SMA patients, although significant unmet needs remain. Myostatin, a TGF-β superfamily signaling molecule that binds to the activin II receptor, negatively regulates muscle growth; myostatin inhibition is a promising therapeutic strategy for enhancing muscle. Combining myostatin inhibition with SMN upregulation, a comprehensive therapeutic strategy targeting the whole motor unit, offers promise in SMA. Taldefgrobep alfa is a novel, fully human recombinant protein that selectively binds to myostatin and competitively inhibits other ligands that signal through the activin II receptor. Given a robust scientific and clinical rationale and the favorable safety profile of taldefgrobep in patients with neuromuscular disease, the RESILIENT phase 3, randomized, placebo-controlled trial is investigating taldefgrobep as an adjunct to SMN upregulators in SMA (NCT05337553). This manuscript reviews the role of myostatin in muscle, explores the preclinical and clinical development of taldefgrobep and introduces the phase 3 RESILIENT trial of taldefgrobep in SMA.
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Affiliation(s)
- Laurent Servais
- Department of Pediatrics, University of Oxford, Oxford OX3 9DU, UK
- Division of Child Neurology, Department of Paediatrics, Centre de Référence des Maladies Neuromusculaires, University Hospital of Liège, University of Liège, Boulevard Du 12e De Ligne, 4000 Liege, Belgium
| | | | | | - Barry J. Byrne
- Department of Pediatrics, University of Florida, Gainesville, FL 32611, USA
| | - Karen S. Chen
- Spinal Muscular Atrophy Foundation, 970 W Broadway STE E, PMB 140, Jackson, WY 83001, USA
| | - Vlad Coric
- Biohaven Pharmaceuticals Inc., New Haven, CT 06510, USA
| | - Irfan Qureshi
- Biohaven Pharmaceuticals Inc., New Haven, CT 06510, USA
| | - Susan Durham
- Biohaven Pharmaceuticals Inc., New Haven, CT 06510, USA
| | | | | | - Jackie Marin
- Biohaven Pharmaceuticals Inc., New Haven, CT 06510, USA
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Xu RH, Zhao Z, Mao Z, Wang S, Xiong H, Dong D. Measurement properties of the EQ-5D-Y-3L, PedsQL 4.0, and PROMIS-25 Profile v2.0 in pediatric patients with spinal muscular atrophy. Health Qual Life Outcomes 2024; 22:50. [PMID: 38937825 PMCID: PMC11210123 DOI: 10.1186/s12955-024-02264-9] [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: 01/02/2024] [Accepted: 05/31/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVE The objective of this study was to examine the psychometric properties of the EQ-5D-Y-3 L, Patient Reported Outcomes Measurement System 25-item version profile v2.0 (PROMIS-25), and Pediatric Quality of Life Inventory™ version 4.0 Generic Core Scale (PedsQL 4.0) in Chinese pediatric patients with spinal muscular atrophy (SMA). METHODS The data used in this study were obtained via a web-based cross-sectional survey. Parents of pediatric patients with SMA completed the proxy-reported EQ-5D-Y-3 L, PedsQL 4.0, and PROMIS-25 measures. Information about socioeconomic and health status was also obtained. The ceiling and floor effects, factorial structure, convergent validity, and known-group validity of the three measures were assessed. RESULTS Three hundred and sixty-three parents of children aged from 5 to 12 completed the questionnaires. Strong floor effects were observed for the physical function components of the PROMIS-25 (41.3%) and PedsQL 4.0 (67.8%). For EQ-5D-Y-3 L, 84.6% of the respondents reported having "a lot of" problems with the dimensions "walking" and "looking after myself." Minimal ceiling or floor effects were observed for the EQ-5D-Y-3 L index value. The confirmatory factor analysis supported a six-factor structure for the PROMIS-25, but did not support a four-factor structure for the PedsQL 4.0. All hypothesized correlations of the dimensions among the three measures were confirmed, with coefficients ranging from 0.28 to 0.68. Analysis of variance showed that EQ-5D-Y-3 L demonstrated better known-group validity than the other two measures in 14 out of 16 comparisons. CONCLUSIONS The EQ-5D-Y-3 L showed better discriminant power than the other two measures. The physical health dimensions of all three measures showed the significant floor effects. These findings provide valuable insights into the effectiveness of these measures at capturing and quantifying the impact of SMA on patients' health-related quality of life.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Zuyi Zhao
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Zhuxin Mao
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Antwerp, Belgium
| | - Shengfeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Hui Xiong
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Dong Dong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
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12
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Braid J. Letter to the Editor Regarding "Validation of a Set of Instruments to Assess Patient- and Caregiver-Oriented Measurements in Spinal Muscular Atrophy: Results of the SMA-TOOL Study". Neurol Ther 2024; 13:251-254. [PMID: 37924479 PMCID: PMC10787713 DOI: 10.1007/s40120-023-00560-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/17/2023] [Indexed: 11/06/2023] Open
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Rebollo P, García-López S, Povedano M, Cattinari MG, Martínez-Moreno M, Terrancle Á, Cabello-Moruno R, Vázquez-Costa JF. Design and Validation of a Clinical Outcome Measure for Adolescents and Adult Patients with Spinal Muscular Atrophy: SMA Life Study Protocol. Neurol Ther 2024; 13:233-249. [PMID: 38180726 PMCID: PMC10787721 DOI: 10.1007/s40120-023-00571-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/22/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION The objective of this study is to develop a clinical tool for the evaluation and follow-up of adolescent and adult patients with 5q spinal muscular atrophy (SMA) and to design its validation. METHODS This prospective, non-interventional study will be carried out at five centres in Spain and will include patients aged 16 years or older with a confirmed diagnosis of 5q SMA (biallelic mutation of the survival motor neuron 1 [SMN1] gene). A panel of experts made up of neurologists, physiatrists and Spanish patients' association (FundAME), participated in the design of the clinical tool. Physicians will administer the tool at three time points (baseline, 12 months and 24 months). Additionally, data from other questionnaires and scales will be collected. Once recruitment is achieved, an interim statistical analysis will be performed to assess its psychometric properties by applying Rasch analysis and classical statistical tests. RESULTS The tool will consist of up to 53 items to assess functional status from a clinical perspective in seven key dimensions (bulbar, respiratory, axial, lower, upper, fatigability and other symptoms), which will be collected together with objective clinical measures (body mass index, forced vital capacity, pinch strength and 6-minute walk test). CONCLUSIONS The validation of this tool will facilitate the clinical evaluation of adult and adolescent patients with SMA and the quantification of their response to new treatments in both clinical practice and research.
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Affiliation(s)
| | | | - Mónica Povedano
- Unidad Funcional de Motoneurona (UFMN), Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Mercedes Martínez-Moreno
- Sección de Rehabilitación Infantil, Servicio de Medicina Física y Rehabilitación, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Juan F Vázquez-Costa
- Department of Medicine, University of Valencia, Valencia, Spain.
- ALS Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain.
- Neuromuscular Research Unit, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain.
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Xu RH, Ma B, Xin H, Zhang H, Zeng Y, Luo N, Dong D. Measurement properties of the EQ-5D-5L and PROPr in patients with spinal muscular atrophy. Health Qual Life Outcomes 2023; 21:123. [PMID: 37968716 PMCID: PMC10647137 DOI: 10.1186/s12955-023-02204-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVES Spinal muscular atrophy (SMA) is a rare monogenic neuromuscular disorder caused by loss of function mutations. Measuring health-related quality of life to support economic evaluations in this population is encouraged. However, empirical evidence on the performance of preference-based measures (PBMs) in individuals with SMA is limited. This study aimed to assess the psychometric properties of the EQ-5D-5L and the Patient-Reported Outcomes Measure Information System Preference measure (PROPr) in individuals with SMA. METHODS The data used in this study were obtained via a web-based, cross-sectional survey. All participants completed the self-reporting EQ-5D-5L and PROMIS-29 questionnaires. Information about their socioeconomic and health status was also obtained. Ceiling and floor effects, convergent and divergent validity, known-group validity, and the agreement between the two measures were assessed. RESULTS Strong ceiling and floor effects were observed for four dimensions of the EQ-5D-5L and three subscales, including pain intensity, pain interference, and physical function, of the PROMIS-29. All hypothesized associations between EQ-5D-5L/PROMIS-29 and other neuromuscular questions were confirmed, supporting good convergent validity. Moreover, both EQ-5D-5L and PROPr scores differentiated between impaired functional groups, demonstrating good discriminative ability. Poor agreement between the EQ-5D-5L and PROPr utility scores was observed. CONCLUSIONS The EQ-5D-5L and PROPr both appear to be valid PBMs for individuals with SMA. However, PROPr yielded considerably lower utility scores than EQ-5D-5L and their agreement was poor. Therefore, these two PBMs may not be used interchangeably in economic evaluations of SMA-related interventions.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Bin Ma
- Meier Advocacy & Support Center for SMA, Beijing, China
| | - Huanping Xin
- Meier Advocacy & Support Center for SMA, Beijing, China
| | - Huanyu Zhang
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Yan Zeng
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Dong Dong
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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Perumal TM, Wolf D, Berchtold D, Pointeau G, Zhang YP, Cheng WY, Lipsmeier F, Sprengel J, Czech C, Chiriboga CA, Lindemann M. Digital measures of respiratory and upper limb function in spinal muscular atrophy: design, feasibility, reliability, and preliminary validity of a smartphone sensor-based assessment suite. Neuromuscul Disord 2023; 33:845-855. [PMID: 37722988 DOI: 10.1016/j.nmd.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/14/2023] [Accepted: 07/26/2023] [Indexed: 09/20/2023]
Abstract
Spinal muscular atrophy (SMA) is characterized by progressive muscle weakness and paralysis. Motor function is monitored in the clinical setting using assessments including the 32-item Motor Function Measure (MFM-32), but changes in disease severity between clinical visits may be missed. Digital health technologies may assist evaluation of disease severity by bridging gaps between clinical visits. We developed a smartphone sensor-based assessment suite, comprising nine tasks, to assess motor and muscle function in people with SMA. We used data from the risdiplam phase 2 JEWELFISH trial to assess the test-retest reliability and convergent validity of each task. In the first 6 weeks, 116 eligible participants completed assessments on a median of 6.3 days per week. Eight of the nine tasks demonstrated good or excellent test-retest reliability (intraclass correlation coefficients >0.75 and >0.9, respectively). Seven tasks showed a significant association (P < 0.05) with related clinical measures of motor function (individual items from the MFM-32 or Revised Upper Limb Module scales) and seven showed significant association (P < 0.05) with disease severity measured using the MFM-32 total score. This cross-sectional study supports the feasibility, reliability, and validity of using smartphone-based digital assessments to measure function in people living with SMA.
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Affiliation(s)
- Thanneer Malai Perumal
- F. Hoffmann-La Roche Ltd, Roche Innovation Center Basel, Grenzacherstrasse 124, Basel 4070, Switzerland.
| | - Detlef Wolf
- F. Hoffmann-La Roche Ltd, Roche Innovation Center Basel, Grenzacherstrasse 124, Basel 4070, Switzerland
| | - Doris Berchtold
- F. Hoffmann-La Roche Ltd, Roche Innovation Center Basel, Grenzacherstrasse 124, Basel 4070, Switzerland
| | - Grégoire Pointeau
- F. Hoffmann-La Roche Ltd, Roche Innovation Center Basel, Grenzacherstrasse 124, Basel 4070, Switzerland
| | - Yan-Ping Zhang
- F. Hoffmann-La Roche Ltd, Roche Innovation Center Basel, Grenzacherstrasse 124, Basel 4070, Switzerland
| | - Wei-Yi Cheng
- F. Hoffmann-La Roche Ltd, Roche Innovation Center Basel, Grenzacherstrasse 124, Basel 4070, Switzerland
| | - Florian Lipsmeier
- F. Hoffmann-La Roche Ltd, Roche Innovation Center Basel, Grenzacherstrasse 124, Basel 4070, Switzerland
| | - Jörg Sprengel
- F. Hoffmann-La Roche Ltd, Roche Innovation Center Basel, Grenzacherstrasse 124, Basel 4070, Switzerland
| | - Christian Czech
- F. Hoffmann-La Roche Ltd, Roche Innovation Center Basel, Grenzacherstrasse 124, Basel 4070, Switzerland
| | | | - Michael Lindemann
- F. Hoffmann-La Roche Ltd, Roche Innovation Center Basel, Grenzacherstrasse 124, Basel 4070, Switzerland
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Qiao Y, Chi Y, Gu J, Ma Y. Safety and Efficacy of Nusinersen and Risdiplam for Spinal Muscular Atrophy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Brain Sci 2023; 13:1419. [PMID: 37891788 PMCID: PMC10605531 DOI: 10.3390/brainsci13101419] [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: 09/10/2023] [Revised: 09/25/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE We performed a systematic review and meta-analysis of the efficacy and safety of nusinersen and risdiplam in the treatment of spinal muscular disease (SMA). METHODS We screened the literature published in Pubmed, Web of Science, Embase, and Cochrane before July 2023 to conduct randomized controlled trials to test the treatment of SMA patients with nusinersen and risdiplam. The data were analyzed using Review Manager 5.4 software and Stata version 15.0 software. RESULTS A total of six randomized controlled trials were included, involving 728 SMA patients, to synthesize evidence. It is reported that nusinersen treatment was beneficial for increasing the score of the Hammersmith Functional Motor Scale-Expanded (HFMSE) (WMD: 4.90; 95% CI: 3.17, 6.63; p < 0.00001), Revised Upper Limb Module (RULM) (WMD: 3.70; 95% CI: 3.30, 4.10; p < 0.00001), and Hammersmith Infant Neurological Evaluation Section 2 (HINE-2) (WMD: 5.21; 95% CI: 4.83, 5.60; p < 0.00001). In addition, the risdiplam treatment group also showed statistically significant improvements in the HFMSE score (WMD:0.87; 95% CI: 0.05, 1.68; p = 0.04), the 32-item Motor Function Measure (MFM32) (WMD:1.48; 95% CI: 0.58, 2.38; p = 0.001), and (WMD: 1.29; 95% CI: 0.57, 2.01; p = 0.0005). Nusinersen and risdiplam did not cause a statistically significant increase in the RULM score for adverse events (OR: 0.93; 95% CI: 0.51, 1.7; p = 0.82) and for severe adverse events (OR: 0.77; 95% CI: 0.47, 1.27; p = 0.31). CONCLUSION Our analysis found that nusinersen and risdiplam treatment showed clinically meaningful improvement in motor function and a similar incidence rate of adverse events compared with the placebo. Further research should be carried out to provide a direct comparison between the two drugs in terms of safety and efficacy.
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Affiliation(s)
| | | | | | - Ying Ma
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang 110055, China
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Oskoui M, Day JW, Deconinck N, Mazzone ES, Nascimento A, Saito K, Vuillerot C, Baranello G, Goemans N, Kirschner J, Kostera-Pruszczyk A, Servais L, Papp G, Gorni K, Kletzl H, Martin C, McIver T, Scalco RS, Staunton H, Yeung WY, Fontoura P, Mercuri E. Two-year efficacy and safety of risdiplam in patients with type 2 or non-ambulant type 3 spinal muscular atrophy (SMA). J Neurol 2023; 270:2531-2546. [PMID: 36735057 PMCID: PMC9897618 DOI: 10.1007/s00415-023-11560-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/06/2023] [Accepted: 01/08/2023] [Indexed: 02/04/2023]
Abstract
Risdiplam is an oral, survival of motor neuron 2 (SMN2) pre-mRNA splicing modifier approved for the treatment of spinal muscular atrophy (SMA). SUNFISH (NCT02908685) Part 2, a Phase 3, randomized, double-blind, placebo-controlled study, investigated the efficacy and safety of risdiplam in type 2 and non‑ambulant type 3 SMA. The primary endpoint was met: a significantly greater change from baseline in 32-item Motor Function Measure (MFM32) total score was observed with risdiplam compared with placebo at month 12. After 12 months, all participants received risdiplam while preserving initial treatment blinding. We report 24-month efficacy and safety results in this population. Month 24 exploratory endpoints included change from baseline in MFM32 and safety. MFM‑derived results were compared with an external comparator. At month 24 of risdiplam treatment, 32% of patients demonstrated improvement (a change of ≥ 3) from baseline in MFM32 total score; 58% showed stabilization (a change of ≥ 0). Compared with an external comparator, a treatment difference of 3.12 (95% confidence interval [CI] 1.67-4.57) in favor of risdiplam was observed in MFM-derived scores. Overall, gains in motor function at month 12 were maintained or improved upon at month 24. In patients initially receiving placebo, MFM32 remained stable compared with baseline (0.31 [95% CI - 0.65 to 1.28]) after 12 months of risdiplam; 16% of patients improved their score and 59% exhibited stabilization. The safety profile after 24 months was consistent with that observed after 12 months. Risdiplam over 24 months resulted in further improvement or stabilization in motor function, confirming the benefit of longer-term treatment.
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Affiliation(s)
- Maryam Oskoui
- Departments of Pediatrics and Neurology and Neurosurgery, McGill University, Montreal, Canada.
| | - John W Day
- Department of Neurology, Stanford University, Palo Alto, CA, USA
| | - Nicolas Deconinck
- Neuromuscular Reference Center, UZ Gent, Ghent, Belgium
- Centre de Référence des Maladies Neuromusculaires et Service de Neurologie Pédiatrique, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles, ULB, Brussels, Belgium
| | - Elena S Mazzone
- Pediatric Neurology Institute, Catholic University and Nemo Pediatrico, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Andres Nascimento
- Neuromuscular Unit, Neuropaediatrics Department, Hospital Sant Joan de Déu, Fundacion Sant Joan de Deu, CIBERER-ISC III, Barcelona, Spain
| | - Kayoko Saito
- Institute of Medical Genetics, Tokyo Women's Medical University, Tokyo, Japan
| | - Carole Vuillerot
- Department of Pediatric Physical Medicine and Rehabilitation, Hôpital Mère Enfant, CHU-Lyon, Lyon, France
- Neuromyogen Institute, CNRS UMR 5310-INSERM U1217, Université de Lyon, Lyon, France
| | - Giovanni Baranello
- The Dubowitz Neuromuscular Centre, NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, University College London and Great Ormond Street Hospital Trust, London, UK
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Nathalie Goemans
- Neuromuscular Reference Centre, Department of Paediatrics and Child Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Janbernd Kirschner
- Department of Neuropediatrics and Muscle Disorders, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | | | - Laurent Servais
- I-Motion-Hôpital Armand Trousseau, Paris, France
- MDUK Oxford Neuromuscular Centre, Department of Paediatrics, University of Oxford, Oxford, UK
- Division of Child Neurology, Centre de Références des Maladies Neuromusculaires, University Hospital Liège and University of Liège, Liège, Belgium
| | - Gergely Papp
- Pharma Development, Safety, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Ksenija Gorni
- PDMA Neuroscience and Rare Disease, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Heidemarie Kletzl
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | | | | | - Renata S Scalco
- Pharma Development Neurology, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | | | - Paulo Fontoura
- PDMA Neuroscience and Rare Disease, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Eugenio Mercuri
- Pediatric Neurology Institute, Catholic University and Nemo Pediatrico, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
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Vázquez-Costa JF, Branas-Pampillón M, Medina-Cantillo J, Povedano M, Pitarch-Castellano I, López-Lobato M, Fernández-Ramos JA, Lafuente-Hidalgo M, Rojas-García R, Caballero-Caballero JM, Málaga I, Eirís-Puñal J, De Lemus M, Cattinari MG, Cabello-Moruno R, Díaz-Abós P, Sánchez-Menéndez V, Rebollo P, Maurino J, Madruga-Garrido M. Validation of a Set of Instruments to Assess Patient- and Caregiver-Oriented Measurements in Spinal Muscular Atrophy: Results of the SMA-TOOL Study. Neurol Ther 2023; 12:89-105. [PMID: 36269538 PMCID: PMC9837344 DOI: 10.1007/s40120-022-00411-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/04/2022] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Outcome measures traditionally used in spinal muscular atrophy (SMA) clinical trials are inadequate to assess the full range of disease severity. The aim of this study was to assess the psychometric properties of a set of existing questionnaires and new items, gathering information on the impact of SMA from the patient and caregiver perspectives. METHODS This was a multicenter, prospective, noninterventional study including patients with a confirmed diagnosis of 5q-autosomal-recessive SMA aged 8 years and above, or their parents (if aged between 2 and 8 years). The set of outcome measurements included the SMA Independence Scale (SMAIS) patient and caregiver versions, the Neuro-QoL Fatigue Computer Adaptive Test (CAT), the Neuro-QoL Pain Short Form-Pediatric Pain, the PROMIS adult Pain Interference CAT, and new items developed by Fundación Atrofia Muscular España: perceived fatigability, breathing and voice, sleep and rest, and vulnerability. Reliability, construct validity, discriminant validity, and sensitivity to change (4 months from baseline) were measured. RESULTS A total of 113 patients were included (59.3% 2-17 years old, 59.3% male, and 50.4% with SMA type II). Patients required moderate assistance [mean patient and caregiver SMAIS (SD) scores were 31.1 (12.8) and 7.6 (11.1), respectively]. Perceived fatigability was the most impacted domain, followed by vulnerability. Cronbach's alpha coefficient for perceived fatigability, breathing and voice, and vulnerability total scores were 0.92, 0.88, and 0.85, respectively. The exploratory factor analysis identified the main factors considered in the design, except in the sleep and rest domain. All questionnaires were able to discriminate between the Clinical Global Impression-Severity scores and SMA types. Sensitivity to change was only found for the SMAIS caregiver version and vulnerability items. CONCLUSIONS This set of outcome measures showed adequate reliability, construct validity, and discriminant validity and may constitute a valuable option to measure symptom severity in patients with SMA.
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Affiliation(s)
- Juan F Vázquez-Costa
- Neuromuscular Unit, Department of Neurology, Hospital Universitari I Politècnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | | | - Julita Medina-Cantillo
- Rehabilitation and Physical Unit Department, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Mónica Povedano
- Department of Neurology, IDIBELL, Hospital de Bellvitge, Barcelona, Spain
| | | | - Mercedes López-Lobato
- Neuromuscular Research Unit, Department of Pediatric Neurology, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain
| | | | - Miguel Lafuente-Hidalgo
- Child Neurology Unit, Department of Pediatrics, Hospital Universitario Miguel Servet, Saragossa, Spain
| | - Ricard Rojas-García
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | | | - Ignacio Málaga
- Child Neurology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Jesús Eirís-Puñal
- Department of Pediatric Neurology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Mencía De Lemus
- Fundacion Atrofia Muscular Espinal España (FundAME), Madrid, Spain
| | | | - Rosana Cabello-Moruno
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain
| | - Paola Díaz-Abós
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain
| | | | | | - Jorge Maurino
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain
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Staunton H, Cleanthous S, Teodoro V, Barrett L, Braid J, Ewens B, Cano S, Baranello G, Kirschner J, Belter L, Mayhew A. A Mixed-method Approach to Develop an Ambulatory Module of the SMA Independence Scale. J Neuromuscul Dis 2023; 10:1093-1109. [PMID: 37742658 PMCID: PMC10657657 DOI: 10.3233/jnd-230096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Limited qualitative data exist on the symptoms and impacts of spinal muscular atrophy (SMA) experienced by ambulant individuals. An ambulant module of the SMA Independence Scale (SMAIS) was developed to quantify the assistance required to perform everyday mobility-related activities. OBJECTIVE The objective of this study was to develop a patient-centered module that provides key insights into what constitutes independence for ambulant and near-ambulant individuals with SMA. METHODS A stepwise, mixed-method approach was used. Semi-structured interviews were conducted in three waves with individuals with SMA and caregivers of children with SMA who were ambulant or near-ambulant (can walk ≥5 steps with support). Wave 1 interviews (n = 20) focused on concept elicitation. Wave 2 and 3 interviews (n = 15, both) involved completion and cognitive debriefing of items generated based on Wave 1 interviews. Therapeutic area experts were consulted throughout all key steps of the study. In particular, feedback was provided for item refinement and response option decisions. A macro-level preliminary, exploratory analysis, using Rasch Measurement Theory (RMT), provided insight on measurement properties. RESULTS Wave 1 resulted in 42 mobility and 11 instrumental activity of daily living (iADL) items. During Wave 2, participants defined independence as completing a task with supportive aids but without help from another person, leading to item refinement and modifications to the response scale. Lack of conceptual relevance and ceiling effects led to the removal of all iADL items after Wave 2, and 41 mobility items were tested in Wave 3. Final exploratory RMT and item refinement to reduce overlap led to a 27-item set related to mobility tasks. CONCLUSIONS Our study provides preliminary support for using the 27-item SMAIS-Ambulatory Module for ambulant or near-ambulant individuals with SMA. Larger-scale analyses to further assess the psychometric properties of the scale are warranted.
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Affiliation(s)
- Hannah Staunton
- Roche Products Ltd, Hexagon Place, 6 Falcon Way, Shire Park, Welwyn Garden City, AL7 1TW, UK
| | - Sophie Cleanthous
- Modus Outcomes, 4th Floor St. James House, St. James Square, Cheltenham, GL50 3PR, UK
| | - Vanda Teodoro
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Louise Barrett
- Modus Outcomes, 4th Floor St. James House, St. James Square, Cheltenham, GL50 3PR, UK
| | - Jessica Braid
- Roche Products Ltd, Hexagon Place, 6 Falcon Way, Shire Park, Welwyn Garden City, AL7 1TW, UK
| | - Bethany Ewens
- Modus Outcomes, 4th Floor St. James House, St. James Square, Cheltenham, GL50 3PR, UK
| | - Stefan Cano
- Modus Outcomes, 4th Floor St. James House, St. James Square, Cheltenham, GL50 3PR, UK
| | - Giovanni Baranello
- The Dubowitz Neuromuscular Centre, NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College London, & Great Ormond Street Hospital Trust, London, WC1N 3JH, UK
| | - Janbernd Kirschner
- Department of Neuropediatrics and Muscle Disorders, University of Freiburg, Faculty of Medicine, 79106, Freiburg, Germany
| | | | - Anna Mayhew
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle Upon Tyne, NE1 3BZ, UK
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Markati T, Fisher G, Ramdas S, Servais L. Risdiplam: an investigational motor neuron-2 (SMN-2) splicing modifier for spinal muscular atrophy (SMA). Expert Opin Investig Drugs 2022; 31:451-461. [PMID: 35316106 DOI: 10.1080/13543784.2022.2056836] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Spinal muscular atrophy (SMA) is a rare autosomal recessive neuromuscular disease which is characterized by muscle atrophy and early death in most patients. Risdiplam is the third overall and first oral drug approved for SMA with disease-modifying potential. Risdiplam acts as a survival motor neuron 2 (SMN2) pre-mRNA splicing modifier with satisfactory safety and efficacy profile. This review aims to critically appraise the place of risdiplam in the map of SMA therapeutics. AREAS COVERED This review gives an overview of the current market for SMA and presents the mechanism of action and the pharmacological properties of risdiplam. It also outlines the development of risdiplam from early preclinical stages through to the most recently published results from phase 2/3 clinical trials. Risdiplam has proved its efficacy in pivotal trials for SMA Types 1, 2, and 3 with a satisfactory safety profile. EXPERT OPINION In the absence of comparative data with the other two approved drugs, the role of risdiplam in the treatment algorithm of affected individuals is examined in three different patient populations based on the age and diagnosis method (newborn screening or clinical, symptom-driven diagnosis). Long-term data and real-world data will play a fundamental role in its future.
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Affiliation(s)
- Theodora Markati
- MDUK Oxford Neuromuscular Center, Department of Paediatrics, University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gemma Fisher
- MDUK Oxford Neuromuscular Center, Department of Paediatrics, University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sithara Ramdas
- MDUK Oxford Neuromuscular Center, Department of Paediatrics, University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Laurent Servais
- MDUK Oxford Neuromuscular Center, Department of Paediatrics, University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Division of Child Neurology, Centre de Références des Maladies Neuromusculaires, Department of Pediatrics, University Hospital Liège & University of Liège, Belgium
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21
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Duong T, Staunton H, Braid J, Barriere A, Trzaskoma B, Gao L, Willgoss T, Cruz R, Gusset N, Gorni K, Randhawa S, Yang L, Vuillerot C. A Patient-Centered Evaluation of Meaningful Change on the 32-Item Motor Function Measure in Spinal Muscular Atrophy Using Qualitative and Quantitative Data. Front Neurol 2022; 12:770423. [PMID: 35111124 PMCID: PMC8802297 DOI: 10.3389/fneur.2021.770423] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/06/2021] [Indexed: 12/02/2022] Open
Abstract
The 32-item Motor Function Measure (MFM32) is an assessment of motor function used to evaluate fine and gross motor ability in patients with neuromuscular disorders, including spinal muscular atrophy (SMA). Reliability and validity of the MFM32 have been documented in individuals with SMA. Through semi-structured qualitative interviews (N = 40) and an online survey in eight countries (N = 217) with individuals with Types 2 and 3 SMA aged 2–59 years old and caregivers, the meaning of changes on a patient-friendly version of the MFM32 was explored. In an independent analysis of clinical trial data, anchor- and distribution-based analyses were conducted in a sample of individuals with Type 2 and non-ambulant Type 3 SMA to estimate patient-centered quantitative MFM32 meaningful change thresholds. The results from this study demonstrate that, based on patient and caregiver insights, maintaining functional ability as assessed by a patient-friendly version of the MFM32 is an important outcome. Quantitative analyses using multiple anchors (median age range of 5–8 years old across anchor groups) indicated that an ~3-point improvement in MFM32 total score represents meaningful change at the individual patient level. Overall, the qualitative and quantitative findings from this study support the importance of examining a range of meaningful change thresholds on the MFM32 including ≥0 points change reflecting stabilization or improvement and ≥3 points change reflecting a higher threshold of improvement. Future research is needed to explore quantitative differences in meaningful change on the MFM32 based on age and functional subgroups.
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Affiliation(s)
- Tina Duong
- Department of Neurology, Stanford University, Stanford, CA, United States
| | - Hannah Staunton
- Roche Products Limited, Welwyn Garden City, United Kingdom
- *Correspondence: Hannah Staunton
| | - Jessica Braid
- Roche Products Limited, Welwyn Garden City, United Kingdom
| | - Aurelie Barriere
- Department of Pediatric Physical Medicine and Rehabilitation, Hôpital Mère Enfant, Centre Hospitalier Universitaire (CHU)-Lyon, Lyon University, Lyon, France
| | - Ben Trzaskoma
- Genentech Inc., South San Francisco, CA, United States
| | - Ling Gao
- Analystat Corporation, Point Roberts, WA, United States
| | - Tom Willgoss
- Roche Products Limited, Welwyn Garden City, United Kingdom
| | | | - Nicole Gusset
- SMA Europe, Freiburg, Germany
- SMA Schweiz, Swiss Patient Organisation for Spinal Muscular Atrophy, Heimberg, Switzerland
| | - Ksenija Gorni
- Product Development Medical Affairs, Neuroscience and Rare Disease, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Sharan Randhawa
- Adelphi Values, Patient-Centered Outcomes, Adelphi Mill, Bollington, United Kingdom
| | - Lida Yang
- Charles River Associates Inc., Zurich, Switzerland
| | - Carole Vuillerot
- Neuromyogen Institute, CNRS UMR 5310 INSERM U1217, Université de Lyon, Lyon, France
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