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Leyens L, Batchelor J, De Beuckelaer E, Langel K, Hartog B. Unlocking the full potential of digital endpoints for decision making: a novel modular evidence concept enabling re-use and advancing collaboration. Expert Rev Pharmacoecon Outcomes Res 2024; 24:731-741. [PMID: 38747565 DOI: 10.1080/14737167.2024.2334347] [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: 08/30/2023] [Accepted: 03/20/2024] [Indexed: 06/17/2024]
Abstract
INTRODUCTION Over the last decade increasing examples indicate opportunities to measure patient functioning and its relevance for clinical and regulatory decision making via endpoints collected through digital health technologies. More recently, we have seen such measures support primary study endpoints and enable smaller trials. The field is advancing fast: validation requirements have been proposed in the literature and regulators are releasing new guidances to review these endpoints. Pharmaceutical companies are embracing collaborations to develop them and working with academia and patient organizations in their development. However, the road to validation and regulatory acceptance is lengthy. The full value of digital endpoints cannot be unlocked until better collaboration and modular evidence frameworks are developed enabling re-use of evidence and repurposing of digital endpoints. AREAS COVERED This paper proposes a solution by presenting a novel modular evidence framework -the Digital Evidence Ecosystem and Protocols (DEEP)- enabling repurposing of measurement solutions, re-use of evidence, application of standards and also facilitates collaboration with health technology assessment bodies. EXPERT OPINION The integration of digital endpoints in healthcare, essential for personalized and remote care, requires harmonization and transparency. The proposed novel stack model offers a modular approach, fostering collaboration and expediting the adoption in patient care.
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Affiliation(s)
- Lada Leyens
- Regulatory Science, DEEP Measures Oy, Helsinki, Finland
- Product Development Regulatory, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | | | - Kai Langel
- Regulatory, Janssen Cilag S.A, Madrid, Spain
| | - Bert Hartog
- Clinical Operations and Innovation, Janssen-Cilag B.V, DS Breda, The Netherlands
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Rabbia M, Guridi Ormazabal M, Staunton H, Veenstra K, Eggenspieler D, Annoussamy M, Servais L, Strijbos P. Stride Velocity 95th Centile Detects Decline in Ambulatory Function Over Shorter Intervals than the 6-Minute Walk Test or North Star Ambulatory Assessment in Duchenne Muscular Dystrophy. J Neuromuscul Dis 2024; 11:701-714. [PMID: 38640165 PMCID: PMC11091611 DOI: 10.3233/jnd-230188] [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] [Accepted: 03/17/2024] [Indexed: 04/21/2024]
Abstract
Background Stride Velocity 95th Centile (SV95C) is the first wearable device-derived clinical outcome assessment (COA) to receive European Medicines Agency (EMA) qualification as a primary endpoint in ambulant patients with Duchenne muscular dystrophy (DMD) aged ≥4 years. Objective To compare SV95C-in its first-ever clinical trial application as a secondary endpoint-with established motor function COAs used in the trial (Four-Stair Climb [4SC] velocity, North Star Ambulatory Assessment [NSAA], and Six-Minute Walk Distance [6MWD]). Methods SV95C was a secondary endpoint in a subset (n = 47) of participants in the SPITFIRE/WN40227 trial of taldefgrobep alfa, which was discontinued due to lack of clinical benefit. Participants in the ≤48-week SV95C sub-study were 6-11 years old and received corticosteroids for ≥6 months pre-treatment. Pearson correlations were used to compare SV95C with the other COAs. Responsiveness and changes over time were respectively assessed via standardized response means (SRMs) based on absolute changes and mixed models for repeated measures. Results SV95C change at Week 24 was -0.07 m/s, with limited variability (standard deviation: 0.16, n = 27). The SRM for SV95C indicated moderate responsiveness to clinical change at the earliest timepoint (Week 12, n = 46), while those of the other COAs did not indicate moderate responsiveness until Week 36 (6MWD, n = 33) or Week 48 (4SC velocity, n = 20; NSAA total score, n = 20). Baseline correlations between SV95C and other COAs were strong (r = 0.611-0.695). Correlations between SV95C change from baseline to Week 48 and changes in other COAs were moderate to strong (r = 0.443-0.678).∥. Conclusions Overall, SV95C demonstrated sensitivity to ambulatory decline over short intervals, low variability, and correlation with established COAs. Although the negative trial precluded demonstration of SV95C's sensitivity to drug effect, these findings support the continued use of SV95C in DMD clinical trials.
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Affiliation(s)
| | | | - Hannah Staunton
- Roche Products Ltd, Hexagon Place, Shire Park, 6 Falcon Way, Welwyn Garden City, UK
| | - Klaas Veenstra
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Basel, Switzerland
| | | | | | - Laurent Servais
- MDUK Oxford Neuromuscular Centre and NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Department of Pediatrics, Division of Child Neurology, Centre de Référence des Maladies Neuromusculaires, University Hospital Liège and University of Liège, Avenue de l’Hôpital 1, Liege, Belgium
| | - Paul Strijbos
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Basel, Switzerland
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Hamy V, Llop C, Yee CW, Garcia-Gancedo L, Maxwell A, Chen WH, Tomlinson R, Bobbili P, Bendelac J, Landry J, DerSarkissian M, Yenikomshian M, Mody EA, Duh MS, Williams R. Patient-centric assessment of rheumatoid arthritis using a smartwatch and bespoke mobile app in a clinical setting. Sci Rep 2023; 13:18311. [PMID: 37880288 PMCID: PMC10600111 DOI: 10.1038/s41598-023-45387-7] [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: 12/06/2022] [Accepted: 10/19/2023] [Indexed: 10/27/2023] Open
Abstract
Rheumatoid arthritis (RA) is a fluctuating progressive disease requiring frequent symptom assessment for appropriate management. Continuous tracking using digital technologies may provide greater insights of a patient's experience. This prospective study assessed the feasibility, reliability, and clinical utility of using novel digital technologies to remotely monitor participants with RA. Participants with moderate to severe RA and non-RA controls were monitored continuously for 14 days using an iPhone with an integrated bespoke application and an Apple Watch. Participants completed patient-reported outcome measures and objective guided tests designed to assess disease-related impact on physical function. The study was completed by 28 participants with RA, 28 matched controls, and 2 unmatched controls. Completion rates for all assessments were > 97% and were reproducible over time. Several guided tests distinguished between RA and control cohorts (e.g., mean lie-to-stand time [seconds]: RA: 4.77, control: 3.25; P < 0.001). Participants with RA reporting greater stiffness, pain, and fatigue had worse guided test performances (e.g., wrist movement [P < 0.001] and sit-to-stand transition time [P = 0.009]) compared with those reporting lower stiffness, pain, and fatigue. This study demonstrates that digital technologies can be used in a well-controlled, remote clinical setting to assess the daily impact of RA.
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Affiliation(s)
- Valentin Hamy
- Value Evidence and Outcomes, GSK, Brentford, TW8 9GS, UK.
| | | | | | | | - Aoife Maxwell
- Value Evidence and Outcomes, GSK, Brentford, TW8 9GS, UK
| | | | | | | | | | | | | | | | - Elinor A Mody
- Rheumatology Department, Reliant Medical Group, Auburn, USA
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Poleur M, Markati T, Servais L. The use of digital outcome measures in clinical trials in rare neurological diseases: a systematic literature review. Orphanet J Rare Dis 2023; 18:224. [PMID: 37533072 PMCID: PMC10398976 DOI: 10.1186/s13023-023-02813-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/07/2023] [Indexed: 08/04/2023] Open
Abstract
Developing drugs for rare diseases is challenging, and the precision and objectivity of outcome measures is critical to this process. In recent years, a number of technologies have increasingly been used for remote monitoring of patient health. We report a systematic literature review that aims to summarize the current state of progress with regard to the use of digital outcome measures for real-life motor function assessment of patients with rare neurological diseases. Our search of published literature identified 3826 records, of which 139 were included across 27 different diseases. This review shows that use of digital outcome measures for motor function outside a clinical setting is feasible and employed in a broad range of diseases, although we found few outcome measures that have been robustly validated and adopted as endpoints in clinical trials. Future research should focus on validation of devices, variables, and algorithms to allow for regulatory qualification and widespread adoption.
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Affiliation(s)
- Margaux Poleur
- Department of Neurology, Liege University Hospital Center, Liège, Belgium.
- Neuromuscular Reference Center, Division of Paediatrics University, Hospital University of Liège, Liège, Belgium.
- Centre de Référence des Maladies Neuromusculaires, Centre Hospitalier Régional de la Citadelle, Boulevard du 12eme de Ligne 1, 4000, Liège, Belgium.
| | - Theodora Markati
- MDUK Oxford Neuromuscular Centre and NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Laurent Servais
- MDUK Oxford Neuromuscular Centre and NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Neuromuscular Reference Center, Division of Paediatrics University, Hospital University of Liège, Liège, Belgium
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Audhya I, Rogula B, Szabo SM, Feeny D, Bolatova T, Gooch K. Exploring the relationship between North Star Ambulatory Assessment and Health Utilities Index scores in Duchenne muscular dystrophy. Health Qual Life Outcomes 2023; 21:76. [PMID: 37468890 PMCID: PMC10355009 DOI: 10.1186/s12955-023-02160-8] [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: 03/31/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The North Star Ambulatory Assessment (NSAA) documents motor performance in ambulatory individuals with Duchenne muscular dystrophy (DMD). Health Utilities Index (HUI) scores, reflecting preferences for health-related quality-of-life (HRQoL) implications of health states, are commonly estimated within trials. This study sought to characterize the relationship between the NSAA score and utility in DMD. METHODS Family members serving as proxy respondents for placebo-treated ambulatory individuals with DMD (NCT01254019; BioMarin Pharmaceuticals Inc) completed the HUI and the NSAA (score range, 0-34). Mean change over time on these measures was estimated, and the correlation between changes in NSAA score and a) HUI utility; b) HUI3 ambulation and HUI2 mobility attribute scores, over 48 weeks was calculated. RESULTS Baseline mean (range) age was 8.0 years (5-16; n = 61) and mean (standard deviation [SD]) scores were 0.87 (0.13; HUI2), 0.82 (0.19; HUI3), and 21.0 (8.1; NSAA). Mean (SD) change over 48 weeks was -0.05 (0.14; HUI2), -0.06 (0.19; HUI3), and -2.9 (4.7; NSAA). Weak positive correlations were observed between baseline NSAA score and HUI utility (HUI2: r = 0.29; HUI3: r = 0.17) and for change over 48 weeks (HUI2: r = 0.16; HUI3: r = 0.15). Stronger correlations were observed between change in NSAA score and the HUI3 ambulation (r = 0.41) and HUI2 mobility (r = 0.41) attributes. CONCLUSIONS Among ambulatory individuals with DMD, NSAA score is weakly correlated with HUI utility, suggesting that motor performance alone does not fully explain HRQoL. Stronger relationships were observed between HUI ambulation and mobility attributes, and NSAA. Although unidimensional measures like the NSAA are informative for documenting disease-specific health impacts, they may not correlate well with measures of overall health status; requiring use in conjunction with other patient-reported and preference-based outcomes.
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Affiliation(s)
| | - Basia Rogula
- Broadstreet HEOR, 201 - 343 Railway St, Vancouver, BC, V6A 1A6, Canada
| | - Shelagh M Szabo
- Broadstreet HEOR, 201 - 343 Railway St, Vancouver, BC, V6A 1A6, Canada.
| | - David Feeny
- McMaster University and Health Utilities Inc, Hamilton, ON, Canada
| | - Talshyn Bolatova
- Broadstreet HEOR, 201 - 343 Railway St, Vancouver, BC, V6A 1A6, Canada
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Ghosal R, Varma VR, Volfson D, Hillel I, Urbanek J, Hausdorff JM, Watts A, Zipunnikov V. Distributional data analysis via quantile functions and its application to modeling digital biomarkers of gait in Alzheimer's Disease. Biostatistics 2023; 24:539-561. [PMID: 36519565 PMCID: PMC10544806 DOI: 10.1093/biostatistics/kxab041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/10/2021] [Accepted: 10/19/2021] [Indexed: 07/20/2023] Open
Abstract
With the advent of continuous health monitoring with wearable devices, users now generate their unique streams of continuous data such as minute-level step counts or heartbeats. Summarizing these streams via scalar summaries often ignores the distributional nature of wearable data and almost unavoidably leads to the loss of critical information. We propose to capture the distributional nature of wearable data via user-specific quantile functions (QF) and use these QFs as predictors in scalar-on-quantile-function-regression (SOQFR). As an alternative approach, we also propose to represent QFs via user-specific L-moments, robust rank-based analogs of traditional moments, and use L-moments as predictors in SOQFR (SOQFR-L). These two approaches provide two mutually consistent interpretations: in terms of quantile levels by SOQFR and in terms of L-moments by SOQFR-L. We also demonstrate how to deal with multi-modal distributional data via Joint and Individual Variation Explained using L-moments. The proposed methods are illustrated in a study of association of digital gait biomarkers with cognitive function in Alzheimers disease. Our analysis shows that the proposed methods demonstrate higher predictive performance and attain much stronger associations with clinical cognitive scales compared to simple distributional summaries.
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Affiliation(s)
- Rahul Ghosal
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vijay R Varma
- National Institute on Aging (NIA), National Institutes of Health (NIH), Baltimore, MD, USA
| | - Dmitri Volfson
- Neuroscience Analytics, Computational Biology, Takeda, Cambridge, MA, USA
| | - Inbar Hillel
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jacek Urbanek
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, Department of Physical Therapy, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel, and Rush Alzheimer’s Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Amber Watts
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - Vadim Zipunnikov
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Izmailova ES, Demanuele C, McCarthy M. Digital health technology derived measures: Biomarkers or clinical outcome assessments? Clin Transl Sci 2023; 16:1113-1120. [PMID: 37118983 PMCID: PMC10339690 DOI: 10.1111/cts.13529] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/22/2023] [Accepted: 03/25/2023] [Indexed: 04/30/2023] Open
Abstract
Digital health technologies (DHTs) present unique opportunities for clinical evidence generation but pose certain challenges. These challenges stem, in part, from existing definitions of drug development tools, which were not created with DHT-derived measures in mind. DHT-derived measures can be leveraged as either clinical outcome assessments (COAs) or as biomarkers since they share properties with both categories of drug development tools. Examples from the literature indicate a variety of applications for DHT-derived data, including capturing disease physiology, symptom tracking, or response to therapies. The distinction between the categorization of DHT-derived measures as COAs or as biomarkers can be very fine, with terminology variability among regulatory authorities. This has significant implications for integration of DHT-derived measures in clinical trials, leading to confusion regarding the evidence required to support these tools' use in drug development. There is a need to amend definitions and create clear evidentiary requirements to support broad adoption of these new and innovative tools. The biopharma industry, the technology sector, consulting businesses, academic researchers, and regulators need a dialogue via multi-stakeholder collaborations to clarify questions around DHT-derived measures, to unify definitions, and to create the foundations for evidentiary package requirements, providing a path forward to predictable results.
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Mc Carthy M, Burrows K, Griffiths P, Black PM, Demanuele C, Karlsson N, Buenconsejo J, Patel N, Chen WH, Cappelleri JC. From Meaningful Outcomes to Meaningful Change Thresholds: A Path to Progress for Establishing Digital Endpoints. Ther Innov Regul Sci 2023; 57:629-645. [PMID: 37020160 DOI: 10.1007/s43441-023-00502-8] [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: 07/05/2022] [Accepted: 02/24/2023] [Indexed: 04/07/2023]
Abstract
This paper examines the use of digital endpoints (DEs) derived from digital health technologies (DHTs), focusing primarily on the specific considerations regarding the determination of meaningful change thresholds (MCT). Using DHTs in drug development is becoming more commonplace. There is general acceptance of the value of DHTs supporting patient-centric trial design, capturing data outside the traditional clinical trial setting, and generating DEs with the potential to be more sensitive to change than conventional assessments. However, the transition from exploratory endpoints to primary and secondary endpoints capable of supporting labeling claims requires these endpoints to be substantive with reproducible population-specific values. Meaningful change represents the amount of change in an endpoint measure perceived as important to patients and should be determined for each digital endpoint and given population under consideration. This paper examines existing approaches to determine meaningful change thresholds and explores examples of these methodologies and their use as part of DE development: emphasizing the importance of determining what aspects of health are important to patients and ensuring the DE captures these concepts of interest and aligns with the overarching endpoint strategy. Examples are drawn from published DE qualification documentation and responses to qualification submissions under review by the various regulatory authorities. It is the hope that these insights will inform and strengthen the development and validation of DEs as drug development tools, particularly for those new to the approaches to determine MCTs.
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Colloud S, Metcalfe T, Askin S, Belachew S, Ammann J, Bos E, Kilchenmann T, Strijbos P, Eggenspieler D, Servais L, Garay C, Konstantakopoulos A, Ritzhaupt A, Vetter T, Vincenzi C, Cerreta F. Evolving regulatory perspectives on digital health technologies for medicinal product development. NPJ Digit Med 2023; 6:56. [PMID: 36991116 DOI: 10.1038/s41746-023-00790-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/05/2023] [Indexed: 03/31/2023] Open
Abstract
Digital health technology tools (DHTTs) present real opportunities for accelerating innovation, improving patient care, reducing clinical trial duration and minimising risk in medicines development. This review is comprised of four case studies of DHTTs used throughout the lifecycle of medicinal products, starting from their development. These cases illustrate how the regulatory requirements of DHTTs used in medicines development are based on two European regulatory frameworks (medical device and the medicinal product regulations) and highlight the need for increased collaboration between various stakeholders, including regulators (medicines regulators and device bodies), pharmaceutical sponsors, manufacturers of devices and software, and academia. As illustrated in the examples, the complexity of the interactions is further increased by unique challenges related to DHTTs. These case studies are the main examples of DHTTs with a regulatory assessment thus far, providing an insight into the applicable current regulatory approach; they were selected by a group of authors, including regulatory specialists from pharmaceutical sponsors, technology experts, academic researchers and employees of the European Medicines Agency. For each case study, the challenges faced by sponsors and proposed potential solutions are discussed, and the benefit of a structured interaction among the different stakeholders is also highlighted.
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Affiliation(s)
| | | | | | | | | | - Ernst Bos
- F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | | | | | | | - Laurent Servais
- Muscular Dystrophy UK Oxford Neuromuscular Centre, Department of Paediatrics, University of Oxford, Oxford, UK
- Division of Child Neurology, Centre de Références des Maladies Neuromusculaires, Department of Paediatrics, University Hospital Liège and University of Liège, Liège, Belgium
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Alfano LN, James MK, Ramdharry GM, Lowes LP. 266th ENMC International Workshop: Remote delivery of clinical care and validation of remote clinical outcome assessments in neuromuscular disorders: A response to COVID-19 and proactive planning for the future. Hoofddorp, The Netherlands, 1-3 April 2022. Neuromuscul Disord 2023; 33:339-348. [PMID: 36965197 DOI: 10.1016/j.nmd.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 03/07/2023]
Affiliation(s)
- Lindsay N Alfano
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Center for Gene Therapy, Columbus, OH, United States; The Ohio State University College of Medicine, Department of Pediatrics, Columbus, OH, United States.
| | - Meredith K James
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Gita M Ramdharry
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, United Kingdom; Department of Neuromuscular Diseases, UCL Institute of Neurology, London, United Kingdom
| | - Linda P Lowes
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Center for Gene Therapy, Columbus, OH, United States; The Ohio State University College of Medicine, Department of Pediatrics, Columbus, OH, United States
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Lyden K, Abraham N, Boucher R, Wei G, Gonce V, Carle J, Hartsell SE, Christensen J, Beddhu S. Predicting hospitalization from real-world measures in patients with chronic kidney disease: A proof-of-principle study. Digit Health 2023; 9:20552076231181234. [PMID: 37361437 PMCID: PMC10286549 DOI: 10.1177/20552076231181234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Objective To investigate if in-clinic measures of physical function and real-world measures of physical behavior and mobility effort are associated with one another and to determine if they predict future hospitalization in participants with chronic kidney disease (CKD). Methods In this secondary analysis, novel real-world measures of physical behavior and mobility effort, including the best 6-minute step count (B6SC), were derived from passively collected data from a thigh worn actigraphy sensor and compared to traditional in-clinic measures of physical function (e.g. 6-minute walk test (6MWT). Hospitalization status during 2 years of follow-up was determined from electronic health records. Correlation analyses were used to compare measures and Cox Regression analysis was used to compare measures with hospitalization. Results One hundred and six participants were studied (69 ± 13 years, 43% women). Mean ± SD baseline measures for 6MWT was 386 ± 66 m and B6SC was 524 ± 125 steps. Forty-four hospitalization events over 224 years of total follow-up occurred. Good separation was achieved for tertiles of 6MWT, B6SC and steps/day for hospitalization events. This pattern persisted in models adjusted for demographics (6MWT: HR = 0.63 95% CI 0.43-0.93, B6SC: HR = 0.75, 95% CI 0.56-1.02 and steps/day: HR = 0.75, 95% CI 0.50-1.13) and further adjusted for morbidities (6MWT: HR = 0.54, 95% CI 0.35-0.84, B6SC: HR = 0.70, 95% CI 0.49-1.00 and steps/day: HR = 0.69, 95% CI 0.43-1.09). Conclusion Digital health technologies can be deployed remotely, passively, and continuously to collect real-world measures of physical behavior and mobility effort that differentiate risk of hospitalization in patients with CKD.
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Affiliation(s)
- Kate Lyden
- Department of Kinesiology, University of Massachusetts, Amherst, MA, USA
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Nikita Abraham
- Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Robert Boucher
- Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Guo Wei
- Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, UT, USA
- Division of Biostatistics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Victoria Gonce
- Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Judy Carle
- Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sydney E. Hartsell
- Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jesse Christensen
- Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Srinivasan Beddhu
- Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, UT, USA
- Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
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Clay I, Peerenboom N, Connors DE, Bourke S, Keogh A, Wac K, Gur-Arie T, Baker J, Bull C, Cereatti A, Cormack F, Eggenspieler D, Foschini L, Ganea R, Groenen PM, Gusset N, Izmailova E, Kanzler CM, Leyens L, Lyden K, Mueller A, Nam J, Ng WF, Nobbs D, Orfaniotou F, Perumal TM, Piwko W, Ries A, Scotland A, Taptiklis N, Torous J, Vereijken B, Xu S, Baltzer L, Vetter T, Goldhahn J, Hoffmann SC. Reverse Engineering of Digital Measures: Inviting Patients to the Conversation. Digit Biomark 2023; 7:28-44. [PMID: 37206894 PMCID: PMC10189241 DOI: 10.1159/000530413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/07/2023] [Indexed: 05/21/2023] Open
Abstract
Background Digital measures offer an unparalleled opportunity to create a more holistic picture of how people who are patients behave in their real-world environments, thereby establishing a better connection between patients, caregivers, and the clinical evidence used to drive drug development and disease management. Reaching this vision will require achieving a new level of co-creation between the stakeholders who design, develop, use, and make decisions using evidence from digital measures. Summary In September 2022, the second in a series of meetings hosted by the Swiss Federal Institute of Technology in Zürich, the Foundation for the National Institutes of Health Biomarkers Consortium, and sponsored by Wellcome Trust, entitled "Reverse Engineering of Digital Measures," was held in Zurich, Switzerland, with a broad range of stakeholders sharing their experience across four case studies to examine how patient centricity is essential in shaping development and validation of digital evidence generation tools. Key Messages In this paper, we discuss progress and the remaining barriers to widespread use of digital measures for evidence generation in clinical development and care delivery. We also present key discussion points and takeaways in order to continue discourse and provide a basis for dissemination and outreach to the wider community and other stakeholders. The work presented here shows us a blueprint for how and why the patient voice can be thoughtfully integrated into digital measure development and that continued multistakeholder engagement is critical for further progress.
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Affiliation(s)
| | | | | | | | - Alison Keogh
- Insight Centre for Data Analytics, UC Dublin, Dublin, Ireland
- Mobilise-D, Newcastle University, Newcastle upon Tyne, UK
| | - Katarzyna Wac
- Quality of Life Lab, University of Geneva, Geneva, Switzerland
| | - Tova Gur-Arie
- Mobilise-D, Newcastle University, Newcastle upon Tyne, UK
| | | | - Christopher Bull
- Newcastle University, Newcastle, UK
- IDEA-FAST, Newcastle University, Newcastle upon Tyne, UK
| | - Andrea Cereatti
- Mobilise-D, Newcastle University, Newcastle upon Tyne, UK
- Polytechnic University of Torino, Torino, Italy
| | - Francesca Cormack
- IDEA-FAST, Newcastle University, Newcastle upon Tyne, UK
- Cambridge Cognition Ltd, Cambridge, UK
| | | | | | | | | | | | | | | | | | | | - Arne Mueller
- Mobilise-D, Newcastle University, Newcastle upon Tyne, UK
- Novartis, Basel, Switzerland
| | - Julian Nam
- F. Hoffmann-La Roche, Basel, Switzerland
| | - Wan-Fai Ng
- Newcastle University, Newcastle, UK
- IDEA-FAST, Newcastle University, Newcastle upon Tyne, UK
| | - David Nobbs
- IDEA-FAST, Newcastle University, Newcastle upon Tyne, UK
- F. Hoffmann-La Roche, Basel, Switzerland
| | | | | | - Wojciech Piwko
- Takeda Pharmaceuticals International, Zurich, Switzerland
| | - Anja Ries
- F. Hoffmann-La Roche, Basel, Switzerland
| | - Alf Scotland
- Biogen Digital Health International GmbH, Baar, Switzerland
| | - Nick Taptiklis
- IDEA-FAST, Newcastle University, Newcastle upon Tyne, UK
- Cambridge Cognition Ltd, Cambridge, UK
| | | | - Beatrix Vereijken
- Mobilise-D, Newcastle University, Newcastle upon Tyne, UK
- Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | | | - Jörg Goldhahn
- Swiss Federal Institute of Technology, Zurich, Switzerland
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13
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Ricotti V, Kadirvelu B, Selby V, Festenstein R, Mercuri E, Voit T, Faisal AA. Wearable full-body motion tracking of activities of daily living predicts disease trajectory in Duchenne muscular dystrophy. Nat Med 2023; 29:95-103. [PMID: 36658421 PMCID: PMC9873561 DOI: 10.1038/s41591-022-02045-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/14/2022] [Indexed: 01/21/2023]
Abstract
Artificial intelligence has the potential to revolutionize healthcare, yet clinical trials in neurological diseases continue to rely on subjective, semiquantitative and motivation-dependent endpoints for drug development. To overcome this limitation, we collected a digital readout of whole-body movement behavior of patients with Duchenne muscular dystrophy (DMD) (n = 21) and age-matched controls (n = 17). Movement behavior was assessed while the participant engaged in everyday activities using a 17-sensor bodysuit during three clinical visits over the course of 12 months. We first defined new movement behavioral fingerprints capable of distinguishing DMD from controls. Then, we used machine learning algorithms that combined the behavioral fingerprints to make cross-sectional and longitudinal disease course predictions, which outperformed predictions derived from currently used clinical assessments. Finally, using Bayesian optimization, we constructed a behavioral biomarker, termed the KineDMD ethomic biomarker, which is derived from daily-life behavioral data and whose value progresses with age in an S-shaped sigmoid curve form. The biomarker developed in this study, derived from digital readouts of daily-life movement behavior, can predict disease progression in patients with muscular dystrophy and can potentially track the response to therapy.
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Affiliation(s)
- Valeria Ricotti
- National Institute for Health and Care Research Great Ormond Street Hospital Biomedical Research Centre/University College London Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Balasundaram Kadirvelu
- Brain & Behaviour Lab, Department of Bioengineering, Imperial College London, London, UK
- Brain & Behaviour Lab, Department of Computing, Imperial College London, London, UK
- Behaviour Analytics Lab, Data Science Institute, Imperial College London, London, UK
| | - Victoria Selby
- National Institute for Health and Care Research Great Ormond Street Hospital Biomedical Research Centre/University College London Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Richard Festenstein
- Gene Control Mechanisms & Disease Group Department of Brain Sciences, Imperial College London, London, UK
- Institute of Neurology, University College London, National Hospital for Neurology and Neurosurgery (University College London Hospitals), London, UK
- Medical Research Council London Institute of Medical Sciences, London, UK
| | - Eugenio Mercuri
- Università Cattolica del Sacro Cuore, Rome, Italy
- Policlinico Universitario Agostino Gemelli University Hospital, Rome, Italy
| | - Thomas Voit
- National Institute for Health and Care Research Great Ormond Street Hospital Biomedical Research Centre/University College London Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - A Aldo Faisal
- Brain & Behaviour Lab, Department of Bioengineering, Imperial College London, London, UK.
- Brain & Behaviour Lab, Department of Computing, Imperial College London, London, UK.
- Behaviour Analytics Lab, Data Science Institute, Imperial College London, London, UK.
- Medical Research Council London Institute of Medical Sciences, London, UK.
- Chair in Digital Health, Faculty of Life Sciences, University of Bayreuth, Bayreuth, Germany.
- Brain & Behaviour Lab, Institute of Artificial & Human Intelligence, University of Bayreuth, Bayreuth, Germany.
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14
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Milne SC, Kim SH, Murphy A, Larkindale J, Farmer J, Malapira R, Danoudis M, Shaw J, Ramakrishnan T, Rasouli F, Yiu EM, Georgiou-Karistianis N, Tai G, Zesiewicz T, Delatycki MB, Corben LA. The Responsiveness of Gait and Balance Outcomes to Disease Progression in Friedreich Ataxia. CEREBELLUM (LONDON, ENGLAND) 2022; 21:963-975. [PMID: 34855135 DOI: 10.1007/s12311-021-01348-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 06/13/2023]
Abstract
To identify gait and balance measures that are responsive to change during the timeline of a clinical trial in Friedreich ataxia (FRDA), we administered a battery of potential measures three times over a 12-month period. Sixty-one ambulant individuals with FRDA underwent assessment of gait and balance at baseline, 6 months and 12 months. Outcomes included GAITRite® spatiotemporal gait parameters; Biodex Balance System Postural Stability Test (PST) and Limits of Stability; Berg Balance Scale (BBS); Timed 25-Foot Walk Test; Dynamic Gait Index (DGI); SenseWear MF Armband step and energy activity; and the Friedreich Ataxia Rating Scale Upright Stability Subscale (FARS USS). The standardised response mean (SRM) or correlation coefficients were reported as effect size indices for comparison of internal responsiveness. Internal responsiveness was also analysed in subgroups. SenseWear Armband daily step count had the largest effect size of all the variables over 6 months (SRM = -0.615), while the PST medial-lateral index had the largest effect size (SRM = 0.829) over 12 months. The FARS USS (SRM = 0.824) and BBS (SRM = -0.720) were the only outcomes able to detect change over 12 months in all subgroups. The DGI was the most responsive outcome in children, detecting a mean change of -2.59 (95% CI -3.52 to -1.66, p < 0.001, SRM = -1.429). In conclusion, the FARS USS and BBS are highly responsive and can detect change in a wide range of ambulant individuals with FRDA. However, therapeutic effects in children may be best measured by the DGI.
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Affiliation(s)
- Sarah C Milne
- Bruce Lefroy Centre, Murdoch Children's Research Institute, Melbourne,, Australia.
- Physiotherapy Department, Monash Health, Melbourne, Australia.
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia.
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia.
| | | | - Anna Murphy
- MonARC, Monash Health, Melbourne, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | | | | | | | - Mary Danoudis
- MonARC, Monash Health, Melbourne, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | | | | | | | - Eppie M Yiu
- Bruce Lefroy Centre, Murdoch Children's Research Institute, Melbourne,, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of Neurology, The Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Nellie Georgiou-Karistianis
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Geneieve Tai
- Bruce Lefroy Centre, Murdoch Children's Research Institute, Melbourne,, Australia
| | | | - Martin B Delatycki
- Bruce Lefroy Centre, Murdoch Children's Research Institute, Melbourne,, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Victorian Clinical Genetics Services, Melbourne, Australia
| | - Louise A Corben
- Bruce Lefroy Centre, Murdoch Children's Research Institute, Melbourne,, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
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15
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Hendrikse NM, Llinares Garcia J, Vetter T, Humphreys AJ, Ehmann F. Biomarkers in Medicines Development-From Discovery to Regulatory Qualification and Beyond. Front Med (Lausanne) 2022; 9:878942. [PMID: 35559349 PMCID: PMC9086587 DOI: 10.3389/fmed.2022.878942] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Biomarkers are important tools in medicines development and clinical practice. Besides their use in clinical trials, such as for enrichment of patients, monitoring safety or response to treatment, biomarkers are a cornerstone of precision medicine. The European Medicines Agency (EMA) emphasised the importance of the discovery, qualification, and use of biomarkers in their Regulatory Science Strategy to 2025, which included the recommendation to enhance early engagement with biomarker developers to facilitate regulatory qualification. This study explores the journey of biomarkers through the EU regulatory system and beyond, based on a review of interactions between developers and the EMA from 2008 to 2020, as well as the use of qualified biomarkers in clinical trials. Of applicants that used early interaction platforms such as the Innovation Task Force, less than half engaged in fee-related follow-up procedures. Results showed that, as compared to companies, consortia were more likely to opt for the Qualification of Novel Methodologies procedure and engage in follow-up procedures. Our results highlight the importance of early engagement with regulators for achieving biomarker qualification, including pre-submission discussions in the context of the qualification procedure. A review of clinical trials showed that all qualified biomarkers are used in practice, although not always according to the endorsed context of use. Overall, this study highlights important aspects of biomarker qualification, including opportunities to improve the seamless support for developers by EMA. The use of qualified biomarkers in clinical trials underlines the importance of regulatory qualification, which will further enable precision medicine for the benefit of patients.
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Affiliation(s)
- Natalie M Hendrikse
- Regulatory Science and Innovation Task Force, European Medicines Agency, Amsterdam, Netherlands
| | - Jordi Llinares Garcia
- Regulatory Science and Innovation Task Force, European Medicines Agency, Amsterdam, Netherlands
| | - Thorsten Vetter
- Scientific Advice Office, European Medicines Agency, Amsterdam, Netherlands
| | - Anthony J Humphreys
- Regulatory Science and Innovation Task Force, European Medicines Agency, Amsterdam, Netherlands
| | - Falk Ehmann
- Regulatory Science and Innovation Task Force, European Medicines Agency, Amsterdam, Netherlands
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16
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Stephenson D, Ollivier C, Brinton R, Barrett J. Can Innovative Trial Designs in Orphan Diseases Drive Advancement of Treatments for Common Neurological Diseases? Clin Pharmacol Ther 2022; 111:799-806. [PMID: 35034352 PMCID: PMC9305159 DOI: 10.1002/cpt.2528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 12/27/2021] [Indexed: 11/10/2022]
Abstract
Global regulatory agencies have transformed their approach to approvals in their processes for formal review of the safety and efficacy of new drugs. Opportunities for innovation have expanded because of the COVID-19 pandemic. Several regulatory-led initiatives have progressed rapidly during the past year including patient-focused drug development, model-informed drug development, Real World Evidence, and complex innovative trial designs. Collectively, these initiatives have accelerated the rate of approvals. Despite demands to focus on urgent needs imposed by the COVID-19 pandemic, the number of new drug approvals over the past year, particularly for rare diseases, has outpaced expectations. Advancing therapeutics for nervous system disorders requires adaptive strategies that align with rapid developments in the field. Three relentlessly progressive diseases, Amyotrophic Lateral Sclerosis (ALS), Duchenne Muscular Dystrophy (DMD), and Parkinson's disease are in urgent need of new treatments. Herein, we propose new regulatory initiatives including innovative trial designs and patient-focused drug development that accelerate clinical trial conduct while meeting critical regulatory requirements for therapeutic approval.
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Affiliation(s)
| | | | - Roberta Brinton
- University of Arizona Health Sciences, Center for Innovation in Brain Sciences
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17
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Page A, Yung N, Auinger P, Venuto C, Glidden A, Macklin E, Omberg L, Schwarzschild MA, Dorsey ER. A Smartphone Application as an Exploratory Endpoint in a Phase 3 Parkinson's Disease Clinical Trial: A Pilot Study. Digit Biomark 2022; 6:1-8. [PMID: 35224425 PMCID: PMC8832247 DOI: 10.1159/000521232] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/30/2021] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Smartphones can generate objective measures of Parkinson's disease (PD) and supplement traditional in-person rating scales. However, smartphone use in clinical trials has been limited. OBJECTIVE This study aimed to determine the feasibility of introducing a smartphone research application into a PD clinical trial and to evaluate the resulting measures. METHODS A smartphone application was introduced part-way into a phase 3 randomized clinical trial of inosine. The application included finger tapping, gait, and cognition tests, and participants were asked to complete an assessment battery at home and in clinic alongside the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). RESULTS Of 236 eligible participants in the parent study, 88 (37%) consented to participate, and 59 (27 randomized to inosine and 32 to placebo) completed a baseline smartphone assessment. These 59 participants collectively completed 1,292 batteries of assessments. The proportion of participants who completed at least one smartphone assessment was 61% at 3, 54% at 6, and 35% at 12 months. Finger tapping speed correlated weakly with the part III motor portion (r = -0.16, left hand; r = -0.04, right hand) and total (r = -0.14) MDS-UPDRS. Gait speed correlated better with the same measures (r = -0.25, part III motor; r = -0.34, total). Over 6 months, finger tapping speed, gait speed, and memory scores did not differ between those randomized to active drug or placebo. CONCLUSIONS Introducing a smartphone application midway into a phase 3 clinical trial was challenging. Measures of bradykinesia and gait speed correlated modestly with traditional outcomes and were consistent with the study's overall findings, which found no benefit of the active drug.
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Affiliation(s)
- Alex Page
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Norman Yung
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Peggy Auinger
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Charles Venuto
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Alistair Glidden
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Eric Macklin
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - E. Ray Dorsey
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
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18
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Bortolani S, Brusa C, Rolle E, Monforte M, De Arcangelis V, Ricci E, Mongini TE, Tasca G. Technology-outcome measures in neuromuscular disorders: a systematic review. Eur J Neurol 2021; 29:1266-1278. [PMID: 34962693 DOI: 10.1111/ene.15235] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Portable and wearable devices can monitor a number of physical performances and have been lately applied to patients with neuromuscular disorders (NMD). METHODS We performed a systematic search of literature databases following PRISMA principles, including all studies reporting the use of technological devices for motor function assessment in NMDs from 2000 to 2021. We also summarized the evidence on measurement properties (validity, reliability, responsiveness) of the analyzed technological outcome measures. RESULTS One-hundred studies fulfilled the selection criteria, most of them published in the last ten years. We defined four categories that gathered similar technologies: gait analysis tools, for clinical assessment of pace and posture; continuous monitoring of physical activity with inertial sensors, that allow "unsupervised" activity assessment; upper limb evaluation tools, including Kinect-based outcome measures to assess the reachable workspace; and new muscle strength assessment tools, such as Myotools. Inertial sensors have the evident advantage of being applied in the "in-home" setting, which has become especially appealing with the Covid-19 pandemic, although poor evidence from psychometric property assessment and results of the analyzed studies may limit their research application. Both Kinect-based outcome measures and Myotools have been already validated in multicenter studies and different NMDs, showing excellent characteristics for application in clinical trials. CONCLUSION This overview is intended to raise awareness on the potential of the different TOMs in the neuromuscular field and be an informative source for the design of future clinical trials, particularly in the era of telemedicine.
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Affiliation(s)
- Sara Bortolani
- Department of Neuroscience, Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy.,Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Chiara Brusa
- Department of Neuroscience, Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Enrica Rolle
- Department of Neuroscience, Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Mauro Monforte
- Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valeria De Arcangelis
- Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enzo Ricci
- Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tiziana Enrica Mongini
- Department of Neuroscience, Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Giorgio Tasca
- Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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19
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Di J, Demanuele C, Kettermann A, Karahanoglu FI, Cappelleri JC, Potter A, Bury D, Cedarbaum JM, Byrom B. Considerations to address missing data when deriving clinical trial endpoints from digital health technologies. Contemp Clin Trials 2021; 113:106661. [PMID: 34954098 DOI: 10.1016/j.cct.2021.106661] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/23/2021] [Accepted: 12/18/2021] [Indexed: 11/25/2022]
Abstract
Digital health technologies (DHTs) enable us to measure human physiology and behavior remotely, objectively and continuously. With the accelerated adoption of DHTs in clinical trials, there is an unmet need to identify statistical approaches to address missing data to ensure that the derived endpoints are valid, accurate, and reliable. It is not obvious how commonly used statistical methods to handle missing data in clinical trials can be directly applied to the complex data collected by DHTs. Meanwhile, current approaches used to address missing data from DHTs are of limited sophistication and focus on the exclusion of data where the quantity of missing data exceeds a given threshold. High-frequency time series data collected by DHTs are often summarized to derive epoch-level data, which are then processed to compute daily summary measures. In this article, we discuss characteristics of missing data collected by DHT, review emerging statistical approaches for addressing missingness in epoch-level data including within-patient imputations across common time periods, functional data analysis, and deep learning methods, as well as imputation approaches and robust modeling appropriate for handling missing data in daily summary measures. We discuss strategies for minimizing missing data by optimizing DHT deployment and by including the patients' perspective in the study design. We believe that these approaches provide more insight into preventing missing data when deriving digital endpoints. We hope this article can serve as a starting point for further discussion among clinical trial stakeholders.
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Affiliation(s)
- Junrui Di
- Pfizer Inc., United States of America.
| | | | | | | | | | | | | | - Jesse M Cedarbaum
- Yale University School of Medicine, United States of America; Coeruleus Clinical Sciences LLC, United States of America
| | - Bill Byrom
- Signant Health, United States of America
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20
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Servais L, Yen K, Guridi M, Lukawy J, Vissière D, Strijbos P. Stride Velocity 95th Centile: Insights into Gaining Regulatory Qualification of the First Wearable-Derived Digital Endpoint for use in Duchenne Muscular Dystrophy Trials. J Neuromuscul Dis 2021; 9:335-346. [PMID: 34958044 PMCID: PMC9028650 DOI: 10.3233/jnd-210743] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In 2019, stride velocity 95th centile (SV95C) became the first wearable-derived digital clinical outcome assessment (COA) qualified by the European Medicines Agency (EMA) for use as a secondary endpoint in trials for Duchenne muscular dystrophy. SV95C was approved via the EMA’s qualification pathway for novel methodologies for medicine development, which is a voluntary procedure for assessing the regulatory acceptability of innovative methods used in pharmaceutical research and development. SV95C is an objective, real-world digital ambulation measure of peak performance, representing the speed of the fastest strides taken by the wearer over a recording period of 180 hours. SV95C is correlated with traditional clinic-based assessments of motor function and has greater sensitivity to clinical change over 6 months than other wearable-derived stride variables, for example, median stride length or velocity. SV95C overcomes many limitations of episodic, clinic-based motor function testing, allowing the assessment of ambulation ability between clinic visits and under free-living conditions. Here we highlight considerations and challenges in developing SV95C using evidence generated by a high-performance wearable sensor. We also provide a commentary of the device’s technical capabilities, which were a determining factor in the regulatory approval of SV95C. This article aims to provide insights into the methods employed, and the challenges faced, during the regulatory approval process for researchers developing new digital tools for patients with diseases that affect motor function.
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Affiliation(s)
- Laurent Servais
- Division of Child Neurology, Centre de Références des Maladies Neuromusculaires, Department of Pediatrics, University Hospital Liège and University of Liège, Liège, Belgium.,Muscular Dystrophy UK Oxford Neuromuscular Centre, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Karl Yen
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
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21
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Servais L, Camino E, Clement A, McDonald CM, Lukawy J, Lowes LP, Eggenspieler D, Cerreta F, Strijbos P. First Regulatory Qualification of a Novel Digital Endpoint in Duchenne Muscular Dystrophy: A Multi-Stakeholder Perspective on the Impact for Patients and for Drug Development in Neuromuscular Diseases. Digit Biomark 2021; 5:183-190. [PMID: 34723071 DOI: 10.1159/000517411] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/24/2021] [Indexed: 12/12/2022] Open
Abstract
Background Functional outcome measures used to assess efficacy in clinical trials of investigational treatments for rare neuromuscular diseases like Duchenne muscular dystrophy (DMD) are performance-based tasks completed by the patient during hospital visits. These are prone to bias and may not reflect motor abilities in real-world settings. Digital tools, such as wearable devices and other remote sensors, provide the opportunity for continuous, objective, and sensitive measurements of functional ability during daily life. Maintaining ambulation is of key importance to individuals with DMD. Stride velocity 95th centile (SV95C) is the first wearable acquired digital endpoint to receive qualification from the European Medicines Agency (EMA) to quantify the ambulation ability of ambulant DMD patients aged ≥5 years in drug therapeutic studies; it is also currently under review for the US Food and Drug Administration (FDA) qualification. Summary Focusing on SV95C as a key example, we describe perspectives of multiple stakeholders on the promise of novel digital endpoints in neuromuscular disease drug development.
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Affiliation(s)
- Laurent Servais
- MDUK Oxford Neuromuscular Centre, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,Division of Child Neurology, Centre de Référence des Maladies Neuromusculaires, Department of Pediatrics, University Hospital Liège and University of Liège, Liege, Belgium
| | - Eric Camino
- Parent Project Muscular Dystrophy, Hackensack, New Jersey, USA
| | | | - Craig M McDonald
- University of California Davis Health, Sacramento, California, USA
| | | | - Linda P Lowes
- Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
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22
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Markati T, De Waele L, Schara-Schmidt U, Servais L. Lessons Learned from Discontinued Clinical Developments in Duchenne Muscular Dystrophy. Front Pharmacol 2021; 12:735912. [PMID: 34790118 PMCID: PMC8591262 DOI: 10.3389/fphar.2021.735912] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 10/12/2021] [Indexed: 02/04/2023] Open
Abstract
Duchenne muscular dystrophy (DMD) is an X-linked condition caused by a deficiency of functional dystrophin protein. Patients experience progressive muscle weakness, cardiomyopathy and have a decreased life expectancy. Standards of care, including treatment with steroids, and multidisciplinary approaches have extended the life expectancy and improved the quality of life of patients. In the last 30 years, several compounds have been assessed in preclinical and clinical studies for their ability to restore functional dystrophin levels or to modify pathways involved in DMD pathophysiology. However, there is still an unmet need with regards to a disease-modifying treatment for DMD and the attrition rate between early-phase and late-phase clinical development remains high. Currently, there are 40 compounds in clinical development for DMD, including gene therapy and antisense oligonucleotides for exon skipping. Only five of them have received conditional approval in one jurisdiction subject to further proof of efficacy. In this review, we present data of another 16 compounds that failed to complete clinical development, despite positive results in early phases of development in some cases. We examine the reasons for the high attrition rate and we suggest solutions to avoid similar mistakes in the future.
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Affiliation(s)
- Theodora Markati
- MDUK Oxford Neuromuscular Center, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Liesbeth De Waele
- KU Leuven Department of Development and Regeneration, Leuven, Belgium
- Department of Paediatric Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Urlike Schara-Schmidt
- Department of Pediatric Neurology, Center for Neuromuscular Diseases, Center for Translational Neuro- and Behavioral Sciences, University Duisburg-Essen, Essen, Germany
| | - Laurent Servais
- MDUK Oxford Neuromuscular Center, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- Division of Child Neurology, Reference Center for Neuromuscular Disease, Centre Hospitalier Régional de Références des Maladies Neuromusculaires, Department of Pediatrics, University Hospital Liège, Liège, Belgium
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23
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Landers M, Dorsey R, Saria S. Digital Endpoints: Definition, Benefits, and Current Barriers in Accelerating Development and Adoption. Digit Biomark 2021; 5:216-223. [PMID: 34703976 DOI: 10.1159/000517885] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/08/2021] [Indexed: 11/19/2022] Open
Abstract
The assessment of health and disease requires a set of criteria to define health status and progression. These health measures are referred to as "endpoints." A "digital endpoint" is defined by its use of sensor-generated data often collected outside of a clinical setting such as in a patient's free-living environment. Applicable sensors exist in an array of devices and can be applied in a diverse set of contexts. For example, a smartphone's microphone might be used to diagnose or predict mild cognitive impairment due to Alzheimer's disease or a wrist-worn activity monitor (such as those found in smartwatches) may be used to measure a drug's effect on the nocturnal activity of patients with sickle cell disease. Digital endpoints are generating considerable excitement because they permit a more authentic assessment of the patient's experience, reveal formerly untold realities of disease burden, and can cut drug discovery costs in half. However, before these benefits can be realized, effort must be applied not only to the technical creation of digital endpoints but also to the environment that allows for their development and application. The future of digital endpoints rests on meaningful interdisciplinary collaboration, sufficient evidence that digital endpoints can realize their promise, and the development of an ecosystem in which the vast quantities of data that digital endpoints generate can be analyzed. The fundamental nature of health care is changing. With coronavirus disease 2019 serving as a catalyst, there has been a rapid expansion of home care models, telehealth, and remote patient monitoring. The increasing adoption of these health-care innovations will expedite the requirement for a digital characterization of clinical status as current assessment tools often rely upon direct interaction with patients and thus are not fit for purpose to be administered remotely. With the ubiquity of relatively inexpensive sensors, digital endpoints are positioned to drive this consequential change. It is therefore not surprising that regulators, physicians, researchers, and consultants have each offered their assessment of these novel tools. However, as we further describe later, the broad adoption of digital endpoints will require a cooperative effort. In this article, we present an analysis of the current state of digital endpoints. We also attempt to unify the perspectives of the parties involved in the development and deployment of these tools. We conclude with an interdependent list of challenges that must be collaboratively addressed before these endpoints are widely adopted.
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Affiliation(s)
- Matthew Landers
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ray Dorsey
- Center for Health + Technology, University of Rochester, Rochester, New York, USA
| | - Suchi Saria
- Departments of Computer Science and Statistics, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Bayesian Health, New York, New York, USA
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Gidaro T, Gasnier E, Annoussamy M, Vissing J, Attarian S, Mozaffar T, Iyadurai S, Wagner KR, Vissière D, Walker G, Shukla SS, Servais L. Home-based gait analysis as an exploratory endpoint during a multicenter phase 1 trial in limb girdle muscular dystrophy type R2 and facioscapulohumeral muscular dystrophy. Muscle Nerve 2021; 65:237-242. [PMID: 34687225 DOI: 10.1002/mus.27446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 01/20/2023]
Abstract
INTRODUCTION/AIMS Limb girdle muscular dystrophy type 2B (LGMDR2) and facioscapulohumeral muscular dystrophy (FSHD) are genetic muscular dystrophies with an increasing number of potential therapeutic approaches. The aim of this study is to report the data of exploratory digital outcomes extracted from wearable magneto-inertial sensors used in a non-controlled environment for ambulant patients with FSHD and LGMDR2 in a short-term, multicenter clinical study. METHODS Digital outcomes (stride length, stride speed, and walk parameters in a non-controlled environment) were used as exploratory outcomes in the open-label study ATYR1940-C-004 in ambulant patients during the 3 mo of ATYR1940 treatment and 1 mo of follow-up. Activity and gait variables were calculated from the data recorded in 30-day sub-periods using the sensors. For each sub-period, activity and gait parameters were compared between FSHD and LGMDR2 patients. Change from baseline over the 4-mo study period was assessed. RESULTS Ten patients (5 FSHD, 5 LGMDR2) were ambulant and compliant for analysis. Gait parameters, but not activity variables, were significantly lower in LGMDR2 compared to FSHD patients at baseline. Longitudinal analyses showed a slight but significant decrease in stride speed at month 4 for all subjects. Activity variables such as total number of strides per day were highly variable from month to month in individual patients, and no visit effects were found for this variable. DISCUSSION The present study suggests that home-recorded stride speed constitutes a precise and sensitive outcome in ambulant patients with FSHD and LGMDR2.
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Affiliation(s)
| | | | | | - John Vissing
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Shahram Attarian
- Reference Center for Neuromuscular Disorders and ALS CHU la Timon, Marseille, France
| | | | - Stanley Iyadurai
- Department of Neurology, Johns Hopkins All Children's Hospital, Saint-Pétersbourg, Florida, USA
| | - Kathryn R Wagner
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | | | | | - Laurent Servais
- I-Motion, Institute of Myology, Paris, France.,Division of Child Neurology, Reference Center for Neuromuscular Diseases, Department of Paediatrics, University Hospital Liège & University of Liège, Liège, Belgium.,MDUK Oxford Neuromuscular Centre, University of Oxford, Oxford, UK
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25
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Multimodal biometric monitoring technologies drive the development of clinical assessments in the home environment. Maturitas 2021; 151:41-47. [PMID: 34446278 DOI: 10.1016/j.maturitas.2021.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 01/23/2023]
Abstract
Biometric monitoring technologies (BioMeTs) have attracted the attention of the health care community because of their user-friendly form factor and multi-sensor data-collection capabilities. The potential benefits of remote monitoring for collecting comprehensive, longitudinal, and contextual datasets span therapeutic areas, and both chronic and acute disease settings. Importantly, multimodal BioMeTs unlock the ability to generate rich contextual data to augment digital measures. Currently, the availability of devices is no longer the main factor limiting adoption but rather the ability to integrate fit-for-purpose BioMeTs reliably and safely into clinical care. We provide a critical review of the state of art for multimodal BioMeTs in clinical care and identify three unmet clinical needs: 1) expand the abilities of existing ambulatory unimodal BioMeTs; 2) adapt standardized clinical test protocols ("spot checks'') for use under free living conditions; and 3) develop novel applications to manage rehabilitation and chronic diseases. As the field is still in an early and quickly evolving state, we make practical recommendations: 1) to select appropriate BioMeTs; 2) to develop composite digital measures; and 3) to design interoperable software to ingest, process, delegate, and visualize the data when deploying novel clinical applications. Multimodal BioMeTs will drive the evolution from in-clinic assessments to at-home data collection with a focus on prevention, personalization, and long-term outcomes by empowering health care providers with knowledge, delivering convenience, and an improved standard of care to patients.
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Mueller A, Paterson E, McIntosh A, Praestgaard J, Bylo M, Hoefling H, Wells M, Lynch DR, Rummey C, Krishnan ML, Schultz M, Malanga CJ. Digital endpoints for self-administered home-based functional assessment in pediatric Friedreich's ataxia. Ann Clin Transl Neurol 2021; 8:1845-1856. [PMID: 34355532 PMCID: PMC8419399 DOI: 10.1002/acn3.51438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 01/18/2023] Open
Abstract
Background Friedreich’s ataxia is an inherited, progressive, neurodegenerative disease that typically begins in childhood. Disease severity is commonly assessed with rating scales, such as the modified Friedreich’s Ataxia Rating Scale, which are usually administered in the clinic by a neurology specialist. Objective This study evaluated the utility of home‐based, self‐administered digital endpoints in children with Friedreich’s ataxia and unaffected controls and their relationship to standard clinical rating scales. Methods In a cross‐sectional study with 25 participants (13 with Friedreich’s ataxia and 12 unaffected controls, aged 6–15 years), home‐based digital endpoints that reflect activities of daily living were recorded over 1 week. Domains analyzed were hand motor function with a digitized drawing, automated analysis of speech with a recorded oral diadochokinesis test, and gait and balance with wearable sensors. Results Hand‐drawing and speech tests were easy to conduct and generated high‐quality data. The sensor‐based gait and balance tests suffered from technical limitations in this study setup. Several parameters discriminated between groups or correlated strongly with modified Friedreich’s Ataxia Rating Scale total score and activities of daily living total score in the Friedreich’s ataxia group. Hand‐drawing parameters also strongly correlated with standard 9‐hole peg test scores. Interpretation Deploying digital endpoints in home settings is feasible in this population, results in meaningful and robust data collection, and may allow for frequent sampling over longer periods of time to track disease progression. Care must be taken when training participants, and investigators should consider the complexity of the tasks and equipment used.
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Affiliation(s)
- Arne Mueller
- Translational Medicine, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Elaine Paterson
- Translational Medicine, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
| | | | | | - Mary Bylo
- Translational Medicine, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
| | - Holger Hoefling
- NIBR Informatics, Novartis Institute of Biomedical Research, Basel, Switzerland
| | - McKenzie Wells
- Division of Neurology, Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - David R Lynch
- Division of Neurology, Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Michelle L Krishnan
- Translational Medicine, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Meredith Schultz
- Translational Medicine, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
| | - C J Malanga
- Translational Medicine, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
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Pini J, Siciliano G, Lahaut P, Braun S, Segovia-Kueny S, Kole A, Hérnando I, Selb J, Schirinzi E, Duong T, Hogrel JY, Olmedo JJS, Vissing J, Servais L, Vincent-Genod D, Vuillerot C, Bannwarth S, Eggenspieler D, Vicart S, Diaz-Manera J, Lochmüller H, Sacconi S. E-Health & Innovation to Overcome Barriers in Neuromuscular Diseases. Report from the 1st eNMD Congress: Nice, France, March 22-23, 2019. J Neuromuscul Dis 2021; 8:743-754. [PMID: 33843694 PMCID: PMC8385527 DOI: 10.3233/jnd-210655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
By definition, neuromuscular diseases are rare and fluctuating in terms of symptoms; patients are often lately diagnosed, do not have enough information to understand their condition and be proactive in their management. Usually, insufficient resources or services are available, leading to patients' social burden. From a medical perspective, the rarity of such diseases leads to the unfamiliarity of the medical staff and caregiver and an absence of consensus in disease assessment, treatment, and management. Innovations have to be developed in response to patients' and physicians' unmet needs.It is vital to improve several aspects of patients' quality of life with a better comprehension of their disease, simplify their management and follow-up, help their caregiver, and reduce the social and economic burden for living with a rare debilitating disease. Database construction regrouping patients' data and symptoms according to specific country registration on data privacy will be critical in establishing a clear consensus on neuromuscular disease treatment.Clinicians also need technological innovations to help them recognize neuromuscular diseases, find the best therapeutic approach based on medical consensus, and tools to follow patients' states regularly. Diagnosis also has to be improved by implementing automated systems to analyze a considerable amount of data, representing a significant step forward to accelerate the diagnosis and the patients' follow up. Further, the development of new tools able to precisely measure specific outcomes reliably is of the matter of importance in clinical trials to assess the efficacy of a newly developed compound.In this context, creation of an expert community is essential to communicate and share ideas. To this end, 97 clinicians, healthcare professionals, researchers, and representatives of private companies from 9 different countries met to discuss the new perspective and challenges to develop and implement innovative tools in the field of neuromuscular diseases.
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Affiliation(s)
- Jonathan Pini
- Université Côte d'Azur (UCA), Centre Hospitalier Universitaire de Nice, Peripheral Nervous System and Muscle Department, Rare Neuromuscular Disease Reference Center, ERN-Euro-NMD, Nice, France
| | - Gabriele Siciliano
- Neurological Clinic, Department of Clinical and Experimental Medicine, Ospedale Santa Chiara, University of Pisa, Pisa, Italy
| | - Pauline Lahaut
- Université Côte d'Azur (UCA), Centre Hospitalier Universitaire de Nice, Peripheral Nervous System and Muscle Department, Rare Neuromuscular Disease Reference Center, ERN-Euro-NMD, Nice, France
| | | | | | - Anna Kole
- Public Health Policy Director Rare 2030 Lead EURORDIS
| | | | - Julij Selb
- University Clinic Golnik, Golnik, Slovenia -Medical consultant Parsek, Vienna, Austria
| | - Erika Schirinzi
- Neurological Clinic, Department of Clinical and Experimental Medicine, Ospedale Santa Chiara, University of Pisa, Pisa, Italy
| | - Tina Duong
- Department of Neurology Stanford University, Palo Alto, CA, USA
| | - Jean-Yves Hogrel
- Neuromuscular Physiology and Evaluation Lab, Neuromuscular Investigation Centre, Institute of Myology, Paris, France
| | - José Javier Serrano Olmedo
- Laboratory of Bioinstrumentation and Nanomedicine, Center for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain.,Networking Center for Biomedical Research on Bioengineering, Biomaterials and Nanomedicine, Madrid, Spain.,Escuela Técnica Superior de Ingenieros de Telecomunicación, Madrid, Spain
| | - John Vissing
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Laurent Servais
- MDUK Oxford Neuromuscular Center Department of Pediatrics University of Oxford, Oxford, UK.,Division of Child Neurology Reference Center for Neuromuscular Disease, Centre Hospitalier Régional de Références des Maladies Neuromusculaires, Department of Paediatrics, University, Oxford, UK
| | | | - Carole Vuillerot
- Neuron Interaction Team, NeuroMyogène Institute, Lyon University, Lyon, France
| | - Sylvie Bannwarth
- Department of Medical Genetics, National Center for Mitochondrial Diseases, Nice University Hospital, Nice, France.,Institute for Research on Cancer and Aging of Nice (IRCAN), Faculty of Medicine, Université Côte D'Azur (UCA), Nice, France
| | | | - Savine Vicart
- Channelopahies Reference Center, Service of Neuro-Myology, University Hospital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jordi Diaz-Manera
- John Walton Muscular Dystrophy Research Center, Newcastle University, Newcastle, UK.,Neurology department. Hospital de la Santa Creu I Sant Pau, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Spain
| | | | - Hanns Lochmüller
- Childrens Hospital of Eastern Ontario Research Institute; Division of Neurology, Department of Medicine, The Ottawa Hospital; and Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada.,Department of Neuropediatrics and Muscle Disorders, Medical Center -University of Freiburg, Faculty of Medicine, Freiburg, Germany.,Centro Nacional de Análisis Genómico (CNAG-CRG), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Catalonia, Spain
| | - Sabrina Sacconi
- Université Côte d'Azur (UCA), Centre Hospitalier Universitaire de Nice, Peripheral Nervous System and Muscle Department, Rare Neuromuscular Disease Reference Center, ERN-Euro-NMD, Nice, France.,Institute for Research on Cancer and Aging of Nice (IRCAN), Faculty of Medicine, Université Côte D'Azur (UCA), Nice, France.,Fédération Hospitalo-Universitaire Oncoage, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur (UCA), Nice, France
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Staunton H, Trennery C, Arbuckle R, Guridi M, Zhuravleva E, Furlong P, Fischer R, Hall R. Development of a Clinical Global Impression of Change (CGI-C) and a Caregiver Global Impression of Change (CaGI-C) measure for ambulant individuals with Duchenne muscular dystrophy. Health Qual Life Outcomes 2021; 19:184. [PMID: 34311756 PMCID: PMC8314490 DOI: 10.1186/s12955-021-01813-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 06/28/2021] [Indexed: 01/14/2023] Open
Abstract
Background In clinical trials for rare diseases, such as Duchenne muscular dystrophy, clinical outcome assessments (COA) used to assess treatment benefit are often generic and may not be sensitive enough to detect change in specific patient populations. Thus, there is a need for disease specific COAs that track meaningful change among individuals. When developing such measures, input from clinicians, caregivers and patients is critical for assessing clinically relevant concepts and ensuring validity of the measure. Method The aim of this study was to develop two Duchenne-specific global impression items for use in clinical trials. The development of the Duchenne Clinical Global Impression of Change (CGI-C) and Caregiver Global Impression of Change (CaGI-C) was informed by findings from concept elicitation (CE) interviews with clinicians, caregivers and individuals with Duchenne. Through cognitive debriefing (CD) interviews, clinicians and caregivers evaluated draft CGI-C and CaGI-C items to ensure relevance and understanding of the items and instructions. Suggestions made during the CD interviews were incorporated into the finalized CGI-C and CaGI-C measures. Results The symptoms most frequently reported by clinicians, caregivers and individuals with Duchenne were muscle weakness, fatigue, cardiac difficulties and pain. Regarding physical functioning, all three populations noted that small changes in functional ability were meaningful, particularly when independence was impacted. Caregivers and clinicians reported that changes in speed, endurance and quality of movement were important, as was improvement in the ability of individuals to keep up with their peers. A change in the ability to complete everyday activities was also significant to families. These results were used to create two global impression of change items and instruction documents for use by clinicians (CGI-C) and caregivers (CaGI-C). Overall, both items were well understood by participants. The descriptions and examples developed from the CE interviews were reported to be relevant and appropriate for illustrating different levels of meaningful change in patients with Duchenne. Modifications were made based on caregiver and clinician CD feedback . Conclusions As part of a holistic measurement strategy, such COA can be incorporated into the clinical trial setting to assess global changes in relevant symptoms and functional impacts associated with Duchenne. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-021-01813-w.
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Affiliation(s)
| | | | - Rob Arbuckle
- Adelphi Values, Patient-Centered Outcomes, Bollington, UK
| | | | | | - Pat Furlong
- Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | - Ryan Fischer
- Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | - Rebecca Hall
- Adelphi Values, Patient-Centered Outcomes, Bollington, UK
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Poleur M, Ulinici A, Daron A, Schneider O, Farra FD, Demonceau M, Annoussamy M, Vissière D, Eggenspieler D, Servais L. Normative data on spontaneous stride velocity, stride length, and walking activity in a non-controlled environment. Orphanet J Rare Dis 2021; 16:318. [PMID: 34281599 PMCID: PMC8287788 DOI: 10.1186/s13023-021-01956-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/11/2021] [Indexed: 01/14/2023] Open
Abstract
Background Normative data are necessary for validation of new outcome measures. Recently, the 95th centile of stride speed was qualified by the European Medicines Agency as a valid secondary outcome for clinical trials in subjects with Duchenne muscular dystrophy. This study aims to obtain normative data on spontaneous stride velocity and length in a non-controlled environment and their evolution after 12 months. Method Ninety-one healthy volunteers (50 females, 41 males), with a mean age of 16 years and 2 months, were recruited and assessed at baseline and 12 months later. The 4-stair climb, 6-min walk test, 10-m walk test and rise from floor assessments were performed. Stride length, stride velocity, and the distance walked per hour were studied in an everyday setting for one month after each evaluation. Results Of the 91 subjects assessed, 82 provided more than 50 h of recordings at baseline; and 73 subjects provided the same at the end of the year. We observed significant positive correlations of the stride length with age and height of participants, and a significant increase of the median stride length in children after the period. In this group, the 95th centile stride velocity was not correlated with age and was stable after one year. All measures but the 10MWT were stable in adults after a one-year period. Conclusion This study provides with data on the influence of age, height, and gender on stride velocity and length as well as accounting for natural changes after one year in controls.
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Affiliation(s)
- Margaux Poleur
- Centre de Référence des Maladies Neuromusculaires, Centre Hospitalier Régional de la Citadelle, Boulevard du 12eme de Ligne 1, 4000, Liège, Belgium
| | - Ana Ulinici
- Centre de Référence des Maladies Neuromusculaires, Centre Hospitalier Régional de la Citadelle, Boulevard du 12eme de Ligne 1, 4000, Liège, Belgium
| | - Aurore Daron
- Centre de Référence des Maladies Neuromusculaires, Centre Hospitalier Régional de la Citadelle, Boulevard du 12eme de Ligne 1, 4000, Liège, Belgium
| | - Olivier Schneider
- Centre de Référence des Maladies Neuromusculaires, Centre Hospitalier Régional de la Citadelle, Boulevard du 12eme de Ligne 1, 4000, Liège, Belgium
| | - Fabian Dal Farra
- Centre de Référence des Maladies Neuromusculaires, Centre Hospitalier Régional de la Citadelle, Boulevard du 12eme de Ligne 1, 4000, Liège, Belgium
| | - Marie Demonceau
- Centre de Référence des Maladies Neuromusculaires, Centre Hospitalier Régional de la Citadelle, Boulevard du 12eme de Ligne 1, 4000, Liège, Belgium
| | | | | | | | - Laurent Servais
- Centre de Référence des Maladies Neuromusculaires, Centre Hospitalier Régional de la Citadelle, Boulevard du 12eme de Ligne 1, 4000, Liège, Belgium. .,Department of Paediatrics, MDUK Oxford Neuromuscular Centre, University of Oxford, Oxford, UK.
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McErlane F, Davies EH, Ollivier C, Mayhew A, Anyanwu O, Harbottle V, Donald A. Wearable Technologies for Children with Chronic Illnesses: An Exploratory Approach. Ther Innov Regul Sci 2021; 55:799-806. [PMID: 33844190 DOI: 10.1007/s43441-021-00278-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the utility of wearable technologies in physical activity assessment in three paediatric diseases, namely, Niemann-Pick C (NP-C), Juvenile Idiopathic Arthritis (JIA) and Duchenne Muscular Dystrophy (DMD). DESIGN Exploratory study SETTING AND PATIENTS: Thirty children were recruited across three UK hospitals (Royal Manchester's Children Hospital, Great Ormond Street Children's Hospital, and the Great North Children's Hospital). Ten were diagnosed with NP-C, eight with DMD and twelve with JIA. INTERVENTION All participants completed the 6-min walk test (6MWT) at enrolment. Patients were provided with disease-specific smartphone apps paired with a wearable device via Bluetooth. Ambulation was recorded in 30-min epochs measuring average daily maximum (ADM), average daily steps (ADS) and average daily steps per 30-min epoch (ASE). RESULTS Median 6MWT results were 450 m, 325 m and 434.5 m for the NP-C, DMD and JIA cohorts, respectively. Wearable data capture was feasible in all three disease cohorts, although complete data capture was not sustained. A statistically significant between-cohort difference was identified for ADM, ADS and ASE. Statistically significant differences were found between DMD/JIA for ADM; NP-C/DMD for ADS and DMD/JIA for ASE. DISCUSSION Wearable sensor technologies have the potential to provide additional information for our understanding of ambulation in chronic paediatric disease. The wearable devices were easy to use and popular with patients although key features need to be addressed to appropriately meet study objectives. As the technology continues to evolve at a rapid pace, opportunities to implement child friendly solutions are already available.
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Affiliation(s)
- Flora McErlane
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle Upon Tyne, UK
- Institute of Cellular Medicine (Rheumatology), Medical School, Newcastle University, Newcastle Upon Tyne, UK
| | | | | | - Anna Mayhew
- The John Walton Muscular Dystrophy Research Centre at Newcastle, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Victoria Harbottle
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Aimee Donald
- Manchester Centre for Genomic Medicine, St Marys Hospital, Manchester, UK
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Digital health technologies in clinical trials for central nervous system drugs: an EU regulatory perspective. Nat Rev Drug Discov 2021; 20:83-84. [PMID: 32994577 DOI: 10.1038/d41573-020-00168-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Goldsack JC, Dowling AV, Samuelson D, Patrick-Lake B, Clay I. Evaluation, Acceptance, and Qualification of Digital Measures: From Proof of Concept to Endpoint. Digit Biomark 2021; 5:53-64. [PMID: 33977218 DOI: 10.1159/000514730] [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] [Received: 12/11/2020] [Accepted: 01/19/2021] [Indexed: 12/12/2022] Open
Abstract
To support the successful adoption of digital measures into internal decision making and evidence generation for medical product development, we present a unified lexicon to aid communication throughout this process, and highlight key concepts including the critical role of participant engagement in development of digital measures. We detail the steps of bringing a successful proof of concept to scale, focusing on key decisions in the development of a new digital measure: asking the right question, optimized approaches to evaluating new measures, and whether and how to pursue qualification or acceptance. Building on the V3 framework for establishing verification and analytical and clinical validation, we discuss strategic and practical considerations for collecting this evidence, illustrated with concrete examples of trailblazing digital measures in the field.
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Affiliation(s)
| | | | | | | | - Ieuan Clay
- Evidation Health Inc., San Mateo, California, USA
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Dockendorf MF, Hansen BJ, Bateman KP, Moyer M, Shah JK, Shipley LA. Digitally Enabled, Patient-Centric Clinical Trials: Shifting the Drug Development Paradigm. Clin Transl Sci 2021; 14:445-459. [PMID: 33048475 PMCID: PMC7993267 DOI: 10.1111/cts.12910] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 09/23/2020] [Indexed: 12/29/2022] Open
Abstract
The rapidly advancing field of digital health technologies provides a great opportunity to radically transform the way clinical trials are conducted and to shift the clinical trial paradigm from a site-centric to a patient-centric model. Merck's (Kenilworth, NJ) digitally enabled clinical trial initiative is focused on introduction of digital technologies into the clinical trial paradigm to reduce patient burden, improve drug adherence, provide a means of more closely engaging with the patient, and enable higher quality, faster, and more frequent data collection. This paper will describe the following four key areas of focus from Merck's digitally enabled clinical trials initiative, along with corresponding enabling technologies: (i) use of technologies that can monitor and improve drug adherence (smart dosing), (ii) collection of pharmacokinetic (PK), pharmacodynamic (PD), and biomarker samples in an outpatient setting (patient-centric sampling), (iii) use of digital devices to collect and measure physiological and behavioral data (digital biomarkers), and (iv) use of data platforms that integrate digital data streams, visualize data in real-time, and provide a means of greater patient engagement during the trial (digital platform). Furthermore, this paper will discuss the synergistic power in implementation of these approaches jointly within a trial to enable better understanding of adherence, safety, efficacy, PK, PD, and corresponding exposure-response relationships of investigational therapies as well as reduced patient burden for clinical trial participation. Obstacle and challenges to adoption and full realization of the vision of patient-centric, digitally enabled trials will also be discussed.
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Kruizinga MD, Stuurman FE, Exadaktylos V, Doll RJ, Stephenson DT, Groeneveld GJ, Driessen GJA, Cohen AF. Development of Novel, Value-Based, Digital Endpoints for Clinical Trials: A Structured Approach Toward Fit-for-Purpose Validation. Pharmacol Rev 2021; 72:899-909. [PMID: 32958524 DOI: 10.1124/pr.120.000028] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Novel digital endpoints gathered via wearables, small devices, or algorithms hold great promise for clinical trials. However, implementation has been slow because of a lack of guidelines regarding the validation process of these new measurements. In this paper, we propose a pragmatic approach toward selection and fit-for-purpose validation of digital endpoints. Measurements should be value-based, meaning the measurements should directly measure or be associated with meaningful outcomes for patients. Devices should be assessed regarding technological validity. Most importantly, a rigorous clinical validation process should appraise the tolerability, difference between patients and controls, repeatability, detection of clinical events, and correlation with traditional endpoints. When technically and clinically fit-for-purpose, case building in interventional clinical trials starts to generate evidence regarding the response to new or existing health-care interventions. This process may lead to the digital endpoint replacing traditional endpoints, such as clinical rating scales or questionnaires in clinical trials. We recommend initiating more data-sharing collaborations to prevent unnecessary duplication of research and integration of value-based measurements in clinical care to enhance acceptance by health-care professionals. Finally, we invite researchers and regulators to adopt this approach to ensure a timely implementation of digital measurements and value-based thinking in clinical trial design and health care. SIGNIFICANCE STATEMENT: Novel digital endpoints are often cited as promising for the clinical trial of the future. However, clear validation guidelines are lacking in the literature. This paper contains pragmatic criteria for the selection, technical validation, and clinical validation of novel digital endpoints and provides recommendations for future work and collaboration.
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Affiliation(s)
- M D Kruizinga
- Centre for Human Drug Research, Leiden, The Netherlands (M.D.K., F.E.S., V.E., R.J.D., G.J.G., A.F.C.); Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands (M.D.K., G.J.A.D.); Leiden University Medical Center, Leiden, The Netherlands (M.D.K., F.E.S., G.J.G., A.F.C.); and Critical Path for Parkinson's Consortium, Critical Path Institute, Tucson, Arizona (D.T.S.)
| | - F E Stuurman
- Centre for Human Drug Research, Leiden, The Netherlands (M.D.K., F.E.S., V.E., R.J.D., G.J.G., A.F.C.); Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands (M.D.K., G.J.A.D.); Leiden University Medical Center, Leiden, The Netherlands (M.D.K., F.E.S., G.J.G., A.F.C.); and Critical Path for Parkinson's Consortium, Critical Path Institute, Tucson, Arizona (D.T.S.)
| | - V Exadaktylos
- Centre for Human Drug Research, Leiden, The Netherlands (M.D.K., F.E.S., V.E., R.J.D., G.J.G., A.F.C.); Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands (M.D.K., G.J.A.D.); Leiden University Medical Center, Leiden, The Netherlands (M.D.K., F.E.S., G.J.G., A.F.C.); and Critical Path for Parkinson's Consortium, Critical Path Institute, Tucson, Arizona (D.T.S.)
| | - R J Doll
- Centre for Human Drug Research, Leiden, The Netherlands (M.D.K., F.E.S., V.E., R.J.D., G.J.G., A.F.C.); Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands (M.D.K., G.J.A.D.); Leiden University Medical Center, Leiden, The Netherlands (M.D.K., F.E.S., G.J.G., A.F.C.); and Critical Path for Parkinson's Consortium, Critical Path Institute, Tucson, Arizona (D.T.S.)
| | - D T Stephenson
- Centre for Human Drug Research, Leiden, The Netherlands (M.D.K., F.E.S., V.E., R.J.D., G.J.G., A.F.C.); Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands (M.D.K., G.J.A.D.); Leiden University Medical Center, Leiden, The Netherlands (M.D.K., F.E.S., G.J.G., A.F.C.); and Critical Path for Parkinson's Consortium, Critical Path Institute, Tucson, Arizona (D.T.S.)
| | - G J Groeneveld
- Centre for Human Drug Research, Leiden, The Netherlands (M.D.K., F.E.S., V.E., R.J.D., G.J.G., A.F.C.); Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands (M.D.K., G.J.A.D.); Leiden University Medical Center, Leiden, The Netherlands (M.D.K., F.E.S., G.J.G., A.F.C.); and Critical Path for Parkinson's Consortium, Critical Path Institute, Tucson, Arizona (D.T.S.)
| | - G J A Driessen
- Centre for Human Drug Research, Leiden, The Netherlands (M.D.K., F.E.S., V.E., R.J.D., G.J.G., A.F.C.); Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands (M.D.K., G.J.A.D.); Leiden University Medical Center, Leiden, The Netherlands (M.D.K., F.E.S., G.J.G., A.F.C.); and Critical Path for Parkinson's Consortium, Critical Path Institute, Tucson, Arizona (D.T.S.)
| | - A F Cohen
- Centre for Human Drug Research, Leiden, The Netherlands (M.D.K., F.E.S., V.E., R.J.D., G.J.G., A.F.C.); Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands (M.D.K., G.J.A.D.); Leiden University Medical Center, Leiden, The Netherlands (M.D.K., F.E.S., G.J.G., A.F.C.); and Critical Path for Parkinson's Consortium, Critical Path Institute, Tucson, Arizona (D.T.S.)
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Annoussamy M, Seferian AM, Daron A, Péréon Y, Cances C, Vuillerot C, De Waele L, Laugel V, Schara U, Gidaro T, Lilien C, Hogrel JY, Carlier P, Fournier E, Lowes L, Gorni K, Ly-Le Moal M, Hellbach N, Seabrook T, Czech C, Hermosilla R, Servais L. Natural history of Type 2 and 3 spinal muscular atrophy: 2-year NatHis-SMA study. Ann Clin Transl Neurol 2020; 8:359-373. [PMID: 33369268 PMCID: PMC7886049 DOI: 10.1002/acn3.51281] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 12/19/2022] Open
Abstract
Objective To characterize the natural history of spinal muscular atrophy (SMA) over 24 months using innovative measures such as wearable devices, and to provide evidence for the sensitivity of these measures to determine their suitability as endpoints in clinical trials. Methods Patients with Type 2 and 3 SMA (N = 81) with varied functional abilities (sitters, nonsitters, nonambulant, and ambulant) who were not receiving disease‐modifying treatment were assessed over 24 months: motor function (Motor Function Measure [MFM]), upper limb strength (MyoGrip, MyoPinch), upper limb activity (ActiMyo®), quantitative magnetic resonance imaging (fat fraction [FFT2] mapping and contractile cross‐sectional area [C‐CSA]), pulmonary function (forced vital capacity [FVC], peak cough flow, maximum expiratory pressure, maximum inspiratory pressure, and sniff nasal inspiratory pressure), and survival of motor neuron (SMN) protein levels. Results MFM32 scores declined significantly over 24 months, but not 12 months. Changes in upper limb activity could be detected over 6 months and continued to decrease significantly over 12 months, but not 24 months. Upper limb strength decreased significantly over 12 and 24 months. FVC declined significantly over 12 months, but not 24 months. FFT2 increased over 12 and 24 months, although not with statistical significance. A significant increase in C‐CSA was observed at 12 but not 24 months. Blood SMN protein levels were stable over 12 and 24 months. Interpretation These data demonstrate that the MFM32, MyoGrip, MyoPinch, and ActiMyo® enable the detection of a significant decline in patients with Type 2 and 3 SMA over 12 or 24 months.
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Affiliation(s)
- Mélanie Annoussamy
- Institute of Myology, GH Pitié Salpêtrière, Paris, France.,Sysnav, Vernon, France
| | | | - Aurore Daron
- Centre de Référence des Maladies Neuromusculaires, CHU de Liège, Liege, Belgium
| | - Yann Péréon
- Centre de Référence Maladies Neuromusculaires Atlantique-Occitanie-Caraïbes, Hôpital Hôtel-Dieu, Nantes, France
| | - Claude Cances
- Centre de Référence des Maladies, Neuromusculaires, Hôpital des Enfants, Toulouse, France.,Unité de Neurologie Pédiatrique, Hôpital des Enfants, Toulouse, France
| | - Carole Vuillerot
- Service de rééducation pédiatrique infantile L'Escale, Hôpital Mère Enfant, CHU-Lyon, Bron, France.,Neuromyogen Institute, CNRS, UMR 5310 INSERM U1217, Université de Lyon, Lyon, France
| | - Liesbeth De Waele
- Department of Pediatric Neurology, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven Kulak Kortrijk, Kortrijk, Belgium
| | - Vincent Laugel
- Neuropédiatrie, INSERM CIC 1434, CHU Strasbourg Hautepierre, Strasbourg, France
| | - Ulrike Schara
- Paediatric neurology and Neuromuscular Center, University of Essen, Essen, Germany
| | - Teresa Gidaro
- Institute of Myology, GH Pitié Salpêtrière, Paris, France
| | - Charlotte Lilien
- Institute of Myology, GH Pitié Salpêtrière, Paris, France.,Department of Paediatrics, MDUK Oxford Neuromuscular Centre, University of Oxford, Oxford, UK
| | | | - Pierre Carlier
- Institute of Myology, GH Pitié Salpêtrière, Paris, France
| | | | - Linda Lowes
- Center for Gene Therapy, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Ksenija Gorni
- PDMA Neuroscience and Rare Disease, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | | | - Nicole Hellbach
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center, Basel, Switzerland
| | - Timothy Seabrook
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center, Basel, Switzerland
| | - Christian Czech
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center, Basel, Switzerland.,Rare Disease Research Unit, Pfizer, Nice, France
| | - Ricardo Hermosilla
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center, Basel, Switzerland
| | - Laurent Servais
- Institute of Myology, GH Pitié Salpêtrière, Paris, France.,Department of Paediatrics, MDUK Oxford Neuromuscular Centre, University of Oxford, Oxford, UK.,Division of Child Neurology, Centre de Références des Maladies Neuromusculaires, Department of Pediatrics, University Hospital Liège & University of Liège, Liège, Belgium
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36
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Houts CR, Patrick-Lake B, Clay I, Wirth RJ. The Path Forward for Digital Measures: Suppressing the Desire to Compare Apples and Pineapples. Digit Biomark 2020; 4:3-12. [PMID: 33442577 DOI: 10.1159/000511586] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/14/2020] [Indexed: 01/08/2023] Open
Abstract
Digital measures are becoming more prevalent in clinical development. Methods for robust evaluation are increasingly well defined, yet the primary barrier for digital measures to transition beyond exploratory usage often relies on a comparison to the existing standards. This article focuses on how researchers should approach the complex issue of comparing across assessment modalities. We discuss comparisons of subjective versus objective assessments, or performance-based versus behavioral measures, and we pay particular attention to the situation where the expected association may be poor or nonlinear. We propose that, rather than seeking to replace the standard, research should focus on a structured understanding of how the new measure augments established assessments, with the ultimate goal of developing a more complete understanding of what is meaningful to patients.
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Affiliation(s)
- Carrie R Houts
- Vector Psychometric Group, LLC, Chapel Hill, North Carolina, USA
| | | | - Ieuan Clay
- Evidation Health, Inc., San Mateo, California, USA
| | - R J Wirth
- Vector Psychometric Group, LLC, Chapel Hill, North Carolina, USA
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Stephenson D, Alexander R, Aggarwal V, Badawy R, Bain L, Bhatnagar R, Bloem BR, Boroojerdi B, Burton J, Cedarbaum JM, Cosman J, Dexter DT, Dockendorf M, Dorsey ER, Dowling AV, Evers LJW, Fisher K, Frasier M, Garcia-Gancedo L, Goldsack JC, Hill D, Hitchcock J, Hu MT, Lawton MP, Lee SJ, Lindemann M, Marek K, Mehrotra N, Meinders MJ, Minchik M, Oliva L, Romero K, Roussos G, Rubens R, Sadar S, Scheeren J, Sengoku E, Simuni T, Stebbins G, Taylor KI, Yang B, Zach N. Precompetitive Consensus Building to Facilitate the Use of Digital Health Technologies to Support Parkinson Disease Drug Development through Regulatory Science. Digit Biomark 2020; 4:28-49. [PMID: 33442579 PMCID: PMC7768153 DOI: 10.1159/000512500] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/23/2020] [Indexed: 12/22/2022] Open
Abstract
Innovative tools are urgently needed to accelerate the evaluation and subsequent approval of novel treatments that may slow, halt, or reverse the relentless progression of Parkinson disease (PD). Therapies that intervene early in the disease continuum are a priority for the many candidates in the drug development pipeline. There is a paucity of sensitive and objective, yet clinically interpretable, measures that can capture meaningful aspects of the disease. This poses a major challenge for the development of new therapies and is compounded by the considerable heterogeneity in clinical manifestations across patients and the fluctuating nature of many signs and symptoms of PD. Digital health technologies (DHT), such as smartphone applications, wearable sensors, and digital diaries, have the potential to address many of these gaps by enabling the objective, remote, and frequent measurement of PD signs and symptoms in natural living environments. The current climate of the COVID-19 pandemic creates a heightened sense of urgency for effective implementation of such strategies. In order for these technologies to be adopted in drug development studies, a regulatory-aligned consensus on best practices in implementing appropriate technologies, including the collection, processing, and interpretation of digital sensor data, is required. A growing number of collaborative initiatives are being launched to identify effective ways to advance the use of DHT in PD clinical trials. The Critical Path for Parkinson's Consortium of the Critical Path Institute is highlighted as a case example where stakeholders collectively engaged regulatory agencies on the effective use of DHT in PD clinical trials. Global regulatory agencies, including the US Food and Drug Administration and the European Medicines Agency, are encouraging the efficiencies of data-driven engagements through multistakeholder consortia. To this end, we review how the advancement of DHT can be most effectively achieved by aligning knowledge, expertise, and data sharing in ways that maximize efficiencies.
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Affiliation(s)
| | | | | | - Reham Badawy
- University of Birmingham, Birmingham, United Kingdom
| | - Lisa Bain
- Independent Medical Writer, Philadelphia, Pennsylvania, USA
| | | | - Bastiaan R. Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, The Netherlands
| | | | | | - Jesse M. Cedarbaum
- Critical Path Institute, Tucson, Arizona, USA
- Coeruleus Clinical Sciences LLC, Woodbridge, Connecticut, USA
| | - Josh Cosman
- Biogen, Cambridge, Massachusetts, USA
- AbbVie, Chicago, Illinois, USA
| | | | | | | | | | - Luc J. W. Evers
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, The Netherlands
| | | | - Mark Frasier
- Michael J. Fox Foundation, New York, New York, USA
| | | | | | - Derek Hill
- Critical Path Institute, Tucson, Arizona, USA
| | | | - Michele T. Hu
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | | | | | | | - Ken Marek
- Institute of Neurodegenerative Diseases, New Haven, Connecticut, USA
| | | | - Marjan J. Meinders
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, The Netherlands
| | | | | | | | - George Roussos
- Critical Path Institute, Tucson, Arizona, USA
- Birbeck College, University of London, London, United Kingdom
| | | | | | | | | | - Tanya Simuni
- Northwestern University, Evanston, Illinois, USA
| | | | - Kirsten I. Taylor
- F. Hoffmann-La Roche Ltd., Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Neta Zach
- Takeda, Cambridge, Massachusetts, USA
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38
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Karas M, Marinsek N, Goldhahn J, Foschini L, Ramirez E, Clay I. Predicting Subjective Recovery from Lower Limb Surgery Using Consumer Wearables. Digit Biomark 2020; 4:73-86. [PMID: 33442582 DOI: 10.1159/000511531] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/11/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction A major challenge in the monitoring of rehabilitation is the lack of long-term individual baseline data which would enable accurate and objective assessment of functional recovery. Consumer-grade wearable devices enable the tracking of individual everyday functioning prior to illness or other medical events which necessitate the monitoring of recovery trajectories. Methods For 1,324 individuals who underwent surgery on a lower limb, we collected their Fitbit device data of steps, heart rate, and sleep from 26 weeks before to 26 weeks after the self-reported surgery date. We identified subgroups of individuals who self-reported surgeries for bone fracture repair (n = 355), tendon or ligament repair/reconstruction (n = 773), and knee or hip joint replacement (n = 196). We used linear mixed models to estimate the average effect of time relative to surgery on daily activity measurements while adjusting for gender, age, and the participant-specific activity baseline. We used a sub-cohort of 127 individuals with dense wearable data who underwent tendon/ligament surgery and employed XGBoost to predict the self-reported recovery time. Results The 1,324 study individuals were all US residents, predominantly female (84%), white or Caucasian (85%), and young to middle-aged (mean age 36.2 years). We showed that 12 weeks pre- and 26 weeks post-surgery trajectories of daily behavioral measurements (steps sum, heart rate, sleep efficiency score) can capture activity changes relative to an individual's baseline. We demonstrated that the trajectories differ across surgery types, recapitulate the documented effect of age on functional recovery, and highlight differences in relative activity change across self-reported recovery time groups. Finally, using a sub-cohort of 127 individuals, we showed that long-term recovery can be accurately predicted, on an individual level, only 1 month after surgery (AUROC 0.734, AUPRC 0.8). Furthermore, we showed that predictions are most accurate when long-term, individual baseline data are available. Discussion Leveraging long-term, passively collected wearable data promises to enable relative assessment of individual recovery and is a first step towards data-driven intervention for individuals.
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Affiliation(s)
- Marta Karas
- Evidation Health Inc., San Mateo, California, USA.,Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Jörg Goldhahn
- Institute of Translational Medicine, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule (ETH), Zurich, Switzerland
| | | | | | - Ieuan Clay
- Evidation Health Inc., San Mateo, California, USA
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Bourke AK, Scotland A, Lipsmeier F, Gossens C, Lindemann M. Gait Characteristics Harvested During a Smartphone-Based Self-Administered 2-Minute Walk Test in People with Multiple Sclerosis: Test-Retest Reliability and Minimum Detectable Change. SENSORS 2020; 20:s20205906. [PMID: 33086734 PMCID: PMC7589972 DOI: 10.3390/s20205906] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 01/26/2023]
Abstract
The measurement of gait characteristics during a self-administered 2-minute walk test (2MWT), in persons with multiple sclerosis (PwMS), using a single body-worn device, has the potential to provide high-density longitudinal information on disease progression, beyond what is currently measured in the clinician-administered 2MWT. The purpose of this study is to determine the test-retest reliability, standard error of measurement (SEM) and minimum detectable change (MDC) of features calculated on gait characteristics, harvested during a self-administered 2MWT in a home environment, in 51 PwMS and 11 healthy control (HC) subjects over 24 weeks, using a single waist-worn inertial sensor-based smartphone. Excellent, or good to excellent test-retest reliability were observed in 58 of the 92 temporal, spatial and spatiotemporal gait features in PwMS. However, these were less reliable for HCs. Low SEM% and MDC% values were observed for most of the distribution measures for all gait characteristics for PwMS and HCs. This study demonstrates the inter-session test-retest reliability and provides an indication of clinically important change estimates, for interpreting the outcomes of gait characteristics measured using a body-worn smartphone, during a self-administered 2MWT. This system thus provides a reliable measure of gait characteristics in PwMS, supporting its application for the longitudinal assessment of gait deficits in this population.
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Affiliation(s)
- Alan K. Bourke
- Roche Pharma Research and Early Development, pRED Informatics, Roche Innovation Center Basel, F Hoffmann–La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland; (A.K.B.); (F.L.); (M.L.)
| | - Alf Scotland
- Inovigate, Aeschenvorstadt 55, 4051 Basel, Switzerland;
| | - Florian Lipsmeier
- Roche Pharma Research and Early Development, pRED Informatics, Roche Innovation Center Basel, F Hoffmann–La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland; (A.K.B.); (F.L.); (M.L.)
| | - Christian Gossens
- Roche Pharma Research and Early Development, pRED Informatics, Roche Innovation Center Basel, F Hoffmann–La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland; (A.K.B.); (F.L.); (M.L.)
- Correspondence: ; Tel.: +41-61-687-5113
| | - Michael Lindemann
- Roche Pharma Research and Early Development, pRED Informatics, Roche Innovation Center Basel, F Hoffmann–La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland; (A.K.B.); (F.L.); (M.L.)
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40
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Neuhaus SB, Wallgren-Pettersson C, Bönnemann CG, Schara U, Servais L. 250th ENMC International Workshop: Clinical trial readiness in nemaline myopathy 6-8 September 2019, Hoofdorp, the Netherlands. Neuromuscul Disord 2020; 30:866-875. [PMID: 32919842 DOI: 10.1016/j.nmd.2020.08.356] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Sarah B Neuhaus
- Neuromuscular and Neurogenetic Disorders of Childhood Section, Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, 20892, U.S.A
| | - Carina Wallgren-Pettersson
- The Folkhälsan Institute of Genetics and the Department of Medical and Clinical Genetics, Medicum, University of Helsinki, Helsinki, Finland
| | - Carsten G Bönnemann
- Neuromuscular and Neurogenetic Disorders of Childhood Section, Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, 20892, U.S.A
| | - Ulrike Schara
- Department of Pediatric Neurology, Centre for Neuromuscular Disorders in Children and Adolecents, University Hospital Essen, University of Duisburg-Essen, Germany
| | - Laurent Servais
- Division of Child Neurology, Centre de Références des Maladies Neuromusculaires, Department of Pediatrics, University Hospital Liège & University of Liège, Liège, Belgium; MDUK Neuromuscular Centre, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.
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41
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Dorsey ER, Kluger B, Lipset CH. The New Normal in Clinical Trials: Decentralized Studies. Ann Neurol 2020; 88:863-866. [PMID: 32869367 DOI: 10.1002/ana.25892] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/14/2020] [Accepted: 08/23/2020] [Indexed: 12/11/2022]
Affiliation(s)
- E Ray Dorsey
- Center for Health and Technology (CHeT) and Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Benzi Kluger
- Center for Health and Technology (CHeT) and Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Craig H Lipset
- Clinical Innovation Partners LLC, Basking Ridge, NJ, USA
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Izmailova ES, Wagner JA, Ammour N, Amondikar N, Bell‐Vlasov A, Berman S, Bloomfield D, Brady LS, Cai X, Calle RA, Campbell M, Cerreta F, Clay I, Foschini L, Furlong P, Goldel R, Goldsack JS, Groenen PM, Folarin A, Heemskerk J, Honig P, Hotopf M, Kamphaus T, Karlin DR, Leptak C, Liu Q, Manji H, Mather RJ, Menetski JP, Narayan VA, Papadopoulos E, Patel B, Patrick‐Lake B, Podichetty JT, Pratap A, Servais L, Stephenson D, Tenaerts P, Tromberg BJ, Usdin S, Vasudevan S, Zipunnikov V, Hoffmann SC. Remote Digital Monitoring for Medical Product Development. Clin Transl Sci 2020. [PMCID: PMC7877824 DOI: 10.1111/cts.12851] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The use of digital health products has gained considerable interest as a new way to improve therapeutic research and development. Although these products are being adopted by various industries and stakeholders, their incorporation in clinical trials has been slow due to a disconnect between the promises of digital products and potential risks in using these new technologies in the absence of regulatory support. The Foundation for the National Institutes of Health (FNIH) Biomarkers Consortium hosted a public workshop to address challenges and opportunities in this field. Important characteristics of tool development were addressed in a series of presentations, case studies, and open panel sessions. The workshop participants endorsed the usefulness of an evidentiary criteria framework, highlighted the importance of early patient engagement, and emphasized the potential impact of digital monitoring tools and precompetitive collaborations. Concerns were expressed about the lack of real‐life validation examples and the limitations of legacy standards used as a benchmark for novel tool development and validation. Participants recognized the need for novel analytical and statistical approaches to accommodate analyses of these novel data types. Future directions are to harmonize definitions to build common methodologies and foster multidisciplinary collaborations; to develop approaches toward integrating digital monitoring data with the totality of the data in clinical trials, and to continue an open dialog in the community. There was a consensus that all these efforts combined may create a paradigm shift of how clinical trials are planned, conducted, and results brought to regulatory reviews.
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Affiliation(s)
| | | | - Nadir Ammour
- Sanofi Research & Development Chilly‐Mazarin France
| | - Ninad Amondikar
- The Michael J. Fox Foundation for Parkinson's Research New York New York USA
| | - Andrea Bell‐Vlasov
- Center for Devices and Radiological Health, US Food and Drug Administration Silver Spring Maryland USA
| | - Steven Berman
- Center for Drug Evaluation and Research, US Food and Drug Administration Silver Spring Maryland USA
| | | | - Linda S. Brady
- National Institute of Mental Health National Institutes of Health Bethesda Maryland USA
| | | | | | - Michelle Campbell
- Center for Drug Evaluation and Research, US Food and Drug Administration Silver Spring Maryland USA
| | | | - Ieuan Clay
- Evidation Health San Mateo California USA
| | | | - Pat Furlong
- Parent Project Muscular Dystrophy Hackensack New Jersey USA
| | - Rob Goldel
- Center for Devices and Radiological Health, US Food and Drug Administration Silver Spring Maryland USA
| | | | | | | | - Jill Heemskerk
- National Institute of Biomedical Imaging and Bioengineering National Institutes of Health Bethesda Maryland USA
| | | | | | - Tania Kamphaus
- Foundation for the National Institutes of Health North Bethesda Maryland USA
| | | | - Christopher Leptak
- Center for Drug Evaluation and Research, US Food and Drug Administration Silver Spring Maryland USA
| | - Qi Liu
- Center for Drug Evaluation and Research, US Food and Drug Administration Silver Spring Maryland USA
| | - Husseini Manji
- Janssen Research and Development LLC Titusville New Jersey USA
| | | | - Joseph P. Menetski
- Foundation for the National Institutes of Health North Bethesda Maryland USA
| | | | - Elektra Papadopoulos
- Center for Drug Evaluation and Research, US Food and Drug Administration Silver Spring Maryland USA
| | - Bakul Patel
- Center for Devices and Radiological Health, US Food and Drug Administration Silver Spring Maryland USA
| | | | | | | | - Laurent Servais
- University of Liège Neuromuscular Reference Center Disease Liege Belgium
- MDUK Neuromuscular Center University of Oxford Oxford UK
| | | | - Pam Tenaerts
- Clinical Trials Transformation Initiative Durham North Carolina USA
| | - Bruce J. Tromberg
- National Institute of Biomedical Imaging and Bioengineering National Institutes of Health Bethesda Maryland USA
| | - Steve Usdin
- BioCentury Publications Washington District of Columbia USA
| | - Srikanth Vasudevan
- Center for Devices and Radiological Health, US Food and Drug Administration Silver Spring Maryland USA
| | - Vadim Zipunnikov
- Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Steven C. Hoffmann
- Foundation for the National Institutes of Health North Bethesda Maryland USA
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Arteaga D, Donnelly T, Crum K, Markham L, Killian M, Burnette WB, Soslow J, Buchowski MS. Assessing Physical Activity Using Accelerometers in Youth with Duchenne Muscular Dystrophy. J Neuromuscul Dis 2020; 7:331-342. [PMID: 32417792 PMCID: PMC7369107 DOI: 10.3233/jnd-200478] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Physical activity, assessed by accelerometers, has been proposed as a quantitative outcome measure for patients with DMD, but research is limitedObjective:To assess the total amount and patterns of physical activity in patients with DMD using accelerometers. METHODS Physical activity was assessed in patients with DMD (n = 49, 13.6±4.0-year-old) and age- and sex-matched healthy controls (n = 15, 14.0±2.3-year-old) using wrist- and ankle-worn accelerometers. To assess the amount of activity, accelerometer recordings were converted into acceleration estimates (counts/min). Patterns of activity were assessed as the time that participants spent in sedentary, low-intensity, and moderate-to-vigorous physical activity categories. The sedentary category was divided into three (sedentary -1, -2, and -3) and the low-intensity into two (low-intensity-1, and -2) subcategories. RESULTS Physical activity across intensity categories differed between study groups (p < 0.001). Patients with DMD spent on average 98.8% of their daytime in the sedentary and low-intensity categories. Compared to non-ambulatory, ambulatory patients spent more time in sedentary-3 and low-intensity-2 subcategories (p < 0.001). Amount of activity was lower in all patients than controls (p < 0.05) and in non-ambulatory than ambulatory patients and controls (p < 0.001), but similar between ambulatory patients and controls. Activity measures in patients were significantly affected by age and ambulation status (p < 0.05) but not corticosteroid use. CONCLUSION Patients with DMD spent most of their daytime in sedentary and low-intensity activities. Dividing these intensities into three and two subcategories, respectively, allows better characterization of activity patterns in DMD. Ambulation status and age but not corticosteroid use affected activity measures in patients with DMD.
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Affiliation(s)
- David Arteaga
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Thomas Donnelly
- Energy Balance Laboratory, Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Diabetes Research and Training Center, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kimberly Crum
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Larry Markham
- Division of Cardiology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Mary Killian
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - W Bryan Burnette
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan Soslow
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Maciej S Buchowski
- Energy Balance Laboratory, Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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