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Gaboli M, López Lobato M, Valverde Fernández J, Ferrand Ferri P, Rubio Pérez E, Andrade Ruiz HA, López-Puerta González JM, Madruga-Garrido M. Effect of Nusinersen on Respiratory and Bulbar Function in Children with Spinal Muscular Atrophy: Real-World Experience from a Single Center. Neuropediatrics 2024. [PMID: 39102865 DOI: 10.1055/a-2379-7069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
BACKGROUND Due to the limited data from clinical trials and real-world settings in the realm of nusinersen, there is a need for further evidence. This study seeks to assess the impact of nusinersen, when combined with standard care, on bulbar function, respiratory function, and the necessity for respiratory support among pediatric patients with spinal muscular atrophy (SMA). METHODS Prospective observational study, involving pediatric SMA patients (Types 1-3) undergoing nusinersen treatment at the Hospital Universitario Virgen del Rocío in Spain over at least 24 months. The cohort included 11 SMA type 1 patients, comprising 6 type 1b and 5 type 1c, 12 SMA type 2 patients, and 5 SMA type 3 patients. RESULTS Twenty-eight pediatric patients were enrolled with the majority being male (n = 20). Patients with type 1 were diagnosed and received treatment significantly earlier than those with types 2 and 3 (p < 0.001). Additionally, there was a longer period between diagnosis and the start of treatment in types 2 and 3 (p = 0.002). Follow-up revealed statistically improved functional and respiratory outcomes associated with earlier initiation of nusinersen treatment at 6, 12, and 24 months in all phenotypes. The ability to swallow and feed correctly remained unchanged throughout the study, with SMA type 1c patients maintaining oral feeding in contrast to patients with SMA type 1b. Notably, no deaths were recorded. CONCLUSIONS This study provides important insights into the real-world clinical progress of pediatric SMA patients and their response to nusinersen treatment, highlighting the significance of early intervention for better functional and respiratory outcomes.
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Affiliation(s)
- Mirella Gaboli
- Paediatric Pulmonology Unit, Department of Paediatrics, Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Mercedes López Lobato
- Paediatric Neurology Unit, Department of Paediatrics, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Justo Valverde Fernández
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Department of Paediatrics, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Patricia Ferrand Ferri
- Paediatric Physical Medicine and Rehabilitation Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Eloisa Rubio Pérez
- Methodological and Statistical Management Unit, Fundación para la Gestión de la Investigación en Salud de Sevilla (FISEVI), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Henry A Andrade Ruiz
- Methodological and Statistical Management Unit, Fundación para la Gestión de la Investigación en Salud de Sevilla (FISEVI), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - José María López-Puerta González
- Spine Surgery, Department of Orthopaedic Surgery and Traumatology, Universitary Hospital Virgen del Rocío, Networking Biomedical Research Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Sevilla, Spain
| | - Marcos Madruga-Garrido
- Neurología Pediátrica, Hospital Viamed Santa Angela de la Cruz and Neurolinkia, Sevilla, Spain
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O'Brien K, Nguo K, Yiu EM, Woodcock IR, Billich N, Davidson ZE. Nutrition outcomes of disease modifying therapies in spinal muscular atrophy: A systematic review. Muscle Nerve 2024. [PMID: 39129236 DOI: 10.1002/mus.28224] [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: 03/06/2024] [Revised: 07/17/2024] [Accepted: 07/19/2024] [Indexed: 08/13/2024]
Abstract
The nutritional implications of spinal muscular atrophy (SMA) are profound. Disease modifying therapies (DMT) have improved clinical outcomes. This review describes the impact of DMT on nutrition outcomes. A systematic search strategy was applied across seven databases until May 2023. Eligible studies measured nutrition outcomes in individuals with SMA on DMT (nusinersen, risdiplam or onasemnogene abeparvovec [OA]) compared to untreated comparators. Nutrition outcomes included anthropometry, feeding route, swallowing dysfunction, dietary intake, dietetic intervention, nutritional biochemistry, metabolism, gastrointestinal issues and energy expenditure. Articles retrieved were screened in duplicate, data were extracted and appraised systematically. Sixty three articles from 54 studies were included; 41% (n = 22) investigated nusinersen in pediatric participants with SMA type 1. Anthropometry (n = 18), feeding route (n = 39), and swallowing dysfunction (n = 18) were the most commonly reported outcomes. In combined pediatric and adult cohorts, BMI z-score remained stable post nusinersen therapy. The proportion of children with SMA requiring enteral nutrition was stable post nusinersen therapy. Ability to thrive at age 1.5 years was higher in children treated in early infancy with OA compared to historical controls. Significant heterogeneity existed across study population characteristics and outcome measures. Nusinersen may prevent deterioration in some nutrition outcomes; and OA in early infancy may be associated with improved nutrition outcomes. Timing of DMT initiation is an important consideration for future nutrition research. Studies investigating nutrition as a primary outcome of DMT, using consistent outcome measures are required for nutritional management strategies for this cohort to be appropriately tailored.
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Affiliation(s)
- Katie O'Brien
- Department of Nutrition, Dietetics and Food, Monash University, Faculty of Medicine Nursing and Health Sciences, Melbourne, Australia
- Department of Nutrition and Food Services, Royal Children's Hospital, Melbourne, Australia
| | - Kay Nguo
- Department of Nutrition, Dietetics and Food, Monash University, Faculty of Medicine Nursing and Health Sciences, Melbourne, Australia
| | - Eppie M Yiu
- Department of Neurology, Royal Children's Hospital, Melbourne, Australia
- Neurosciences Research, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Ian R Woodcock
- Department of Neurology, Royal Children's Hospital, Melbourne, Australia
- Neurosciences Research, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Natassja Billich
- Molecular Therapies Research, Murdoch Children's Research Institute, Melbourne, Australia
- The University of Queensland School of Human Movement and Nutrition Sciences, St Lucia, Australia
| | - Zoe E Davidson
- Department of Nutrition, Dietetics and Food, Monash University, Faculty of Medicine Nursing and Health Sciences, Melbourne, Australia
- Department of Neurology, Royal Children's Hospital, Melbourne, Australia
- Neurosciences Research, Murdoch Children's Research Institute, Melbourne, Australia
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Al-Taie A, Köseoğlu A. Evaluation of the therapeutic efficacy and tolerability of current drug treatments on the clinical outcomes of paediatric spinal muscular atrophy type 1: A systematic review. Paediatr Respir Rev 2023; 48:65-71. [PMID: 37563072 DOI: 10.1016/j.prrv.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/12/2023] [Indexed: 08/12/2023]
Abstract
Spinal muscular atrophy (SMA) is a severe hereditary lower motor neuron disorder characterised by degeneration of alpha motor neurons in the spinal cord, resulting in progressive weakness and paralysis of proximal muscles. A systematic literature search was carried out by using PRISMA guidelines and searching through different databases that could provide findings of evidence on the health outcomes of the approved therapies for the management of paediatric SMA type 1 regarding efficacy with follow-up in terms of motor and respiratory functions and the tolerability and incidence of adverse drug reactions (ADRs) post-treatment from real-world publications. Half of the publications (50%) had a prospective observational design. Eight studies (66.7%) assessed nusinersen, and three studies (25%) assessed onasemnogene abeparvovec with a duration of follow-up ranging from 6 months to 3 years to evaluate the motor and respiratory functions using different assessment tools, hospitalisation rates, and the tolerability and incidence of ADRs post-treatment. The three currently approved treatments for SMA type 1 provided good support and health outcomes in terms of motor function, respiratory outcomes, reduction of hospitalisations, and improvement of survival. Nevertheless, uncertainties regarding continued improvement after long-term illness and the generalizability of results are still unknown.
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Affiliation(s)
- Anmar Al-Taie
- Clinical Pharmacy Department, Faculty of Pharmacy, Istinye University, Istanbul, Türkiye.
| | - Aygül Köseoğlu
- Istanbul Medipol University, Graduate School of Health Sciences, Istanbul, Türkiye
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Shin HJ, Na JH, Lee H, Lee YM. Nusinersen for Spinal Muscular Atrophy Type I with Chronic Respiratory Failure: A Retrospective Study in South Korea. Yonsei Med J 2023; 64:705-711. [PMID: 37992742 PMCID: PMC10681826 DOI: 10.3349/ymj.2023.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/12/2023] [Accepted: 08/21/2023] [Indexed: 11/24/2023] Open
Abstract
PURPOSE To analyze the efficacy and safety of nusinersen in patients with spinal muscular atrophy (SMA) type I with chronic respiratory failure. MATERIALS AND METHODS We retrospectively reviewed seven patients diagnosed with SMA type I and chronic respiratory failure who were on permanent ventilation and treated with nusinersen at Gangnam Severance Hospital between January 2018 and July 2023. Patient demographics and clinical characteristics were recorded, and treatment progress was evaluated according to Hammersmith Infant Neurological Examination (HINE-2) and Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) scores. RESULTS Patients initially developed hypotonia at a mean age of 3.7 months. Mean age at start of nusinersen was 7.3 years; the mean duration of follow-up after starting nusinersen was 46.2 months. At 6-, 18-, 38-, 58-, and 74-month follow-up, the mean changes in CHOP-INTEND scores were 1.0, 2.9, 1.8, 1.5, and 1.5, respectively, and the proportions of patients who showed disease amelioration were 28.6%, 71.4%, 75.0%, 100%, and 100%, respectively. CONCLUSION Nusinersen is safe and effective in patients with SMA type I, even those with chronic respiratory failure and those on permanent ventilation. No significant adverse effects of nusinersen were observed.
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Affiliation(s)
- Hui Jin Shin
- Department of Pediatrics, Gangnam Severance Hospital, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji-Hoon Na
- Department of Pediatrics, Gangnam Severance Hospital, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyunjoo Lee
- Department of Pediatrics, Gangnam Severance Hospital, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Mock Lee
- Department of Pediatrics, Gangnam Severance Hospital, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Shin HJ, Na JH, Lee H, Lee YM. Nusinersen for spinal muscular atrophy types II and III: a retrospective single-center study in South Korea. World J Pediatr 2023; 19:450-459. [PMID: 36441395 DOI: 10.1007/s12519-022-00638-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study investigated the efficacy and safety of nusinersen, an antisense oligonucleotide, in patients with spinal muscular atrophy (SMA) types II (OMIM: 253,550) or III (OMIM: 253,400), including those with severe scoliosis or requiring respiratory support via mechanical ventilation. METHODS Data from 40 patients with genetically confirmed SMA who were treated with nusinersen at our institute from March 2019 to April 2022 were retrospectively analyzed. Of these, 30 patients with an age of onset < 3 years and not on permanent ventilation were selected. Clinical and genetic characteristics were investigated, and motor function was evaluated based on the Hammersmith Functional Motor Scale-Expanded (HFMSE) score. RESULTS The mean age of symptom onset was 1.2 years. Most patients were diagnosed with SMA type II (27/30, 90%). Nusinersen was administered via computed tomography-guided or direct intrathecal injection in 87% (26/30) and 13% (4/30) of the patients, respectively. At the 6-, 14-, 22-, and 26-month follow-ups, 72%, 71%, 88%, and 86% of patients showed motor improvement, respectively, with mean changes in HFMSE scores of 2.10, 2.88, 4.21, and 5.29, respectively. Multivariable analysis showed that the use of noninvasive ventilation was associated with poorer outcomes of motor function. CONCLUSIONS Patients with SMA type II or III who received nusinersen treatment showed significant improvement in motor function. A longer treatment duration led to a higher number of patients with improved motor function. No significant side effects of nusinersen were observed. Patients with SMA, even those with severe scoliosis or on respiratory support, can be safely treated using nusinersen.
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Affiliation(s)
- Hui Jin Shin
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul, 135-720, Korea
| | - Ji-Hoon Na
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul, 135-720, Korea
| | - Hyunjoo Lee
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul, 135-720, Korea
| | - Young-Mock Lee
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul, 135-720, Korea.
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Ergenekon AP, Gümüş Z, Yegit CY, Cenk M, Gulieva A, Kalyoncu M, Selcuk M, Karabulut S, Ozturk G, Eralp EE, Unver O, Karadag B, Gokdemir Y. Depression, anxiety, and sleep quality of caregivers of children with spinal muscular atrophy. Pediatr Pulmonol 2023; 58:1697-1702. [PMID: 36856268 DOI: 10.1002/ppul.26379] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 02/03/2023] [Accepted: 02/26/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the prevalence of anxiety, depression, sleep, and associated factors in caregivers of children with spinal muscular atrophy (SMA). MATERIALS AND METHODS Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory-State (STAI-S), the State-Trait Anxiety Inventory-Trait (STAI-T), and Pittsburgh Sleep Quality Index (PSQI) were used to assess the anxiety, depression, and sleep quality of the caregivers of children with SMA. Higher scores indicated worse outcome for all three questionnaires. RESULTS Fifty-six caregivers of children with SMA were included in the study. Median age of children was 6 (3.2-10) years and mean age of the caregivers was 37.0 ± 6.5 years. Median scores of the BDI, STAI-S, STAI-T, and PSQI were 12 (7.2-17), 35.5 (31-44), 40.5 (35-48), and 7.0 (5.0-10.0), respectively. There was a positive correlation between BDI and PSQI scores (p < 0.05). There was a negative correlation between the age of the caregivers and PSQI, BDI, STAI-T scores (p = 0.01, r = -0.341; p = 0.006, r = -0.364; p = 0.003, r = -0.395, respectively). There was a negative correlation between the age of the patients and the PSQI scores of the caregivers (p = 0.01, r = -0.33). There was a negative correlation between BDI scores and household income (p = 0.01, r = -0.34). CONCLUSION Caregivers of children with SMA had elevated depression and anxiety levels and they also had decreased sleep quality. Economic and social support resources are needed to help caregivers of those children.
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Affiliation(s)
- Almala Pinar Ergenekon
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Zeynep Gümüş
- Marmara University School of Medicine, Istanbul, Turkey
| | - Cansu Yilmaz Yegit
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Muruvvet Cenk
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Aynur Gulieva
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Mine Kalyoncu
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Merve Selcuk
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Seyda Karabulut
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Gulten Ozturk
- Division of Pediatric Neurology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Olcay Unver
- Division of Pediatric Neurology, Marmara University School of Medicine, Istanbul, Turkey
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
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Pan M, Shi J, Miao H, Zhang Q. Successful weaning from the invasive respiratory support after nusinersen treatment in a child with SMA type 1: A case report. Front Pediatr 2023; 11:1097063. [PMID: 36873628 PMCID: PMC9975261 DOI: 10.3389/fped.2023.1097063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/23/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Spinal muscular atrophy (SMA) is an autosomal recessive disease, which can be classified into 4 types according to the symptom onset age and the highest physical developmental milestone. Among them, type 1 SMA is the most severe form that affects infants younger than 6 months. Permanent assisted ventilation is usually needed for infants with type 1 SMA before the age of 2 years due to the rapid progression of disease. Nusinersen can improve the motor function of SMA patients, but its effect on respiratory function varies. In the present study, we reported a case of child with type 1 SMA who was successfully weaned from the invasive respiratory support after nusinersen treatment. CASE PRESENTATION A girl aged 6 years and 5 months was admitted for SMA in the Children's Hospital of Nanjing Medical University for 18 times. She received the first administration of nusinersen in November 2020 at the age of 5 years and 1 month. At the age of 6 years and 1 month following 6 loading doses, we tried to wean the child from the invasive ventilation for non-invasive respiratory support using a nasal mask. At present, the patient shows oxygen saturation (SpO2) above 95% without ventilator support during the daytime, and no signs of dyspnea. A non-invasive home ventilator was used at nighttime for the sake of safety. The CHOP INTEND score increased by 11 points from the first loading dose to the sixth. She can now move her limbs against gravity, take in food orally and perform partial vocal function. CONCLUSIONS We reported a child with type 1 SMA who was successfully weaned from the 2-years invasive ventilation after 6 loading doses, and now only need non-invasive ventilation 12 h per day. It is suggested that even a late nusinersen treatment can improve respiratory and motor function in SMA patients, and wean them from mechanical ventilation, thus improve the quality of life and reduce the medical cost.
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Affiliation(s)
- Meiling Pan
- Department of Emergency and Critical Care Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Shi
- Department of Emergency and Critical Care Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Hongjun Miao
- Department of Emergency and Critical Care Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Qin Zhang
- Department of Emergency and Critical Care Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
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