“…6 Molecular treatment trials will need to consider that most ARCA patients available for recruitment in real-world settings will already be >10 years into their disease, with a substantial share of patients no longer walking independently (in particular from ARSACS, SYNE1, AOA2, or POLG). Also, some ARCAs show a fairly slow disease progression (ARSACS, RFC1, SPG7; for detailed analyses, see Traschütz et al 7 ), indicating the need for either large sample sizes, longer trial duration, and/or more sensitive nonclinical outcome measures in upcoming trials.…”