Respiratory and upper limb function as outcome measures in ambulant and non-ambulant subjects with Duchenne muscular dystrophy: A prospective multicentre study

Ricotti, Valeria; Selby, V.; Ridout, Deborah; Domingos, Joana; Decostre, V.; Mayhew, Anna; Eagle, Michelle; Butler, J.; Guglieri, Michela; Holst, Menno van der; Jansen, M.; Verschuuren, Jan J.; Groot, I. de; Niks, Erik H.; Servais, Laurent; Straub, Volker; Voït, Thomas; Hogrel, Jean‐Yves; Muntoni, Francesco

doi:10.1016/j.nmd.2019.02.002

Cited by 35 publications

(47 citation statements)

References 39 publications

(51 reference statements)

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“…Estimating yearly rates of decline of PFTs is relevant for clinical management, as it allows to gauge the relative severity of individual decline trajectories, and for the design and interpretation of clinical trials. The FVC decline slope identified in the Italian cohort (−4.2%/year) is in line with previous reports 4,24,25 which estimated values of decline around 5%/year for both FVC and PEF. The decline of PEF, on the other hand, appeared somewhat slower in the Italian cohort (−2.9%/year).…”

Section: Discussionsupporting

confidence: 91%

Genetic modifiers of respiratory function in Duchenne muscular dystrophy

Bello

D'Angelo

Villa

et al. 2020

Ann Clin Transl Neurol

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Objective: Respiratory insufficiency is a major complication of Duchenne muscular dystrophy (DMD). Its progression shows considerable interindividual variability, which has been less thoroughly characterized and understood than in skeletal muscle. We collected pulmonary function testing (PFT) data from a large retrospective cohort followed at Centers collaborating in the Italian DMD Network. Furthermore, we analyzed PFT associations with different DMD mutation types, and with genetic variants in SPP1, LTBP4, CD40, and ACTN3, known to modify skeletal muscle weakness in DMD. Genetic association findings were independently validated in the Cooperative International Neuromuscular Research Group Duchenne Natural History Study (CINRG-DNHS). Methods and Results: Generalized estimating equation analysis of 1852 PFTs from 327 Italian DMD patients, over an average follow-up time of 4.5 years, 786 estimated that forced vital capacity (FVC) declined yearly by À4.2%, forced expiratory volume in 1 sec by À5.0%, and peak expiratory flow (PEF) by À2.9%. Glucocorticoid (GC) treatment was associated with higher values of all PFT measures (approximately + 15% across disease stages). Mutations situated 3' of DMD intron 44, thus predicted to alter the expression of short dystrophin isoforms, were associated with lower (approximately À6%) PFT values, a finding independently validated in the CINRG-DNHS. Deletions amenable to skipping of exon 51 and 53 were independently associated with worse PFT outcomes. A meta-analysis of the two cohorts identified detrimental effects of SPP1 rs28357094 and CD40 rs1883832 minor alleles on both FVC and PEF. Interpretation: These findings support GC efficacy in delaying respiratory insufficiency, and will be useful for the design and interpretation of clinical trials focused on respiratory endpoints in DMD.

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Section: Discussionsupporting

confidence: 91%

Genetic modifiers of respiratory function in Duchenne muscular dystrophy

Bello

D'Angelo

Villa

et al. 2020

Ann Clin Transl Neurol

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“…We explored the potential use of the Peak Expiratory Flow (PEF) as surrogate of expiratory muscle function in SMA type 2. In other neuromuscular disorders such as Duchenne muscular dystrophy PEF captured respiratory decline earlier than FVC% [28]. In patients with SMA, our novel findings showed that PEF%P declined consistently with FVC%P, confirming its potential utility as a measure of pulmonary function in SMA.…”

Section: A C C E P T E Dsupporting

confidence: 60%

Respiratory Trajectories in Type 2 and 3 Spinal Muscular Atrophy in the iSMAC Cohort Study

Trucco¹,

Ridout

Scoto

et al. 2021

Neurology

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Objective.To describe the respiratory trajectories and their correlation with motor function in an international paediatric cohort of patients with type 2 and non-ambulant type 3 spinal muscular atrophy (SMA).Methods.Eight-year retrospective observational study of patients in the iSMAc natural history study. We retrieved anthropometrics, forced vital capacity (FVC) absolute, FVC% predicted (FVC%P.), Non-Invasive ventilation (NIV) requirement. Hammersmith functional motor scale (HFMS) and Revised performance of upper limb (RULM) were correlated with respiratory function. We excluded patients in interventional clinical trials and on Nusinersen commercial therapy.Results.There were 437 patients with SMA: 348 type 2, 89 non-ambulant type 3. Mean age at first visit was 6.9(±4.4) and 11.1(±4) years. In SMA type 2 FVC%P declined by 4.2%/year from 5 to 13 years, followed by a slower decline (1.0%/year). In type 3 FVC%P declined by 6.3%/year between 8 and 13 years, followed by a slower decline (0.9%/year). 39% SMA type 2 and 9% type 3 required NIV at median age 5.0(1.8-16.6) and 15.1(13.8-16.3) years. 84% SMA type 2 and 80% type 3 had scoliosis, 54% and 46% required surgery, which did not significantly affect respiratory decline. FVC%P positively correlated with HFMS and RULM in both subtypes.Conclusions.In SMA type 2 and non-ambulant type 3 lung function declines differently, with a common levelling after age 13 years. Lung and motor function correlated in both subtypes. Our data further defines the milder SMA phenotypes and provides novel information to benchmark the long-term efficacy of new treatments for SMA.

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“…Several questions remain to be assessed to fully explore the therapeutic potential of idebenone in the treatment of DMD. A study in younger, predominantly ambulant patients would be useful to investigate the effect of idebenone on non-respiratory muscle, and more specifically on upper limb function which is the main function to preserve in patients with already established respiratory involvement [10] . The combined effect of idebenone and glucocorticoids on respiratory outcomes is currently under investigation in a large randomized, placebo-controlled study (SIDEROS, clinical trials.gov ID: NCT02814019).…”

Section: Discussionmentioning

confidence: 99%

“…Abnormal respiratory function, defined as PEF%p or FVC%p falling below 80% of normal, typically occurs at around 10-14 years of age and coincides with the time of loss of ambulation. Thereafter, and over the course of about 10 years both PEF%p and FVC%p follow a co-linear decline [6][7][8][9][10] (reviewed in [4 , 11] ).…”

Section: Introductionmentioning

confidence: 99%

Long-term data with idebenone on respiratory function outcomes in patients with Duchenne muscular dystrophy

Servais

Straathof

Schara

et al. 2020

Neuromuscular Disorders

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Decline in respiratory function in patients with DMD starts during early teenage years and leads to early morbidity and mortality. Published evidence of efficacy for idebenone on respiratory function outcomes is currently limited to 12 months of follow-up time. Here we report data collected as retrospective cohort study (SYROS) from 18 DMD patients not using glucocorticoids who were treated with idebenone (900 mg/day) under Expanded Access Programs (EAPs). The objective was to assess the long-term respiratory function evolution for periods On-Idebenone compared to periods Off-Idebenone in the same patients. The mean idebenone exposure in the EAPs was 4.2 (range 2.4-6.1) years. The primary endpoint was the annual change in forced vital capacity percent of predicted (FVC%p) compared between Off-Idebenone and On-Idebenone periods. The annual rate of decline in FVC%p was reduced by approximately 50% from −7.4% (95% CI: −9.1, −5.8) for the Off-Idebenone periods to −3.8% (95% CI: −4.8, −2.8) for the On-Idebenone periods (N = 11). Similarly, annual change in peak expiratory flow percent of predicted (PEF%p) was −5.9% (95% CI: −8.0, −3.9) for the Off-Idebenone periods (N = 9) and reduced to −1.9% (95% CI: −3.2, −0.7) for the On-Idebenone periods during the EAPs. The reduced rates of decline in FVC%p and PEF%p were maintained for several years with possible beneficial effects on the rate of bronchopulmonary adverse events, time to 10% decline in FVC%p and risk of hospitalization due to respiratory cause. These long-term data provide Class IV evidence to further support the disease modifying treatment effect of idebenone previously observed in randomized, controlled trials.

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Respiratory and upper limb function as outcome measures in ambulant and non-ambulant subjects with Duchenne muscular dystrophy: A prospective multicentre study

Cited by 35 publications

References 39 publications

Genetic modifiers of respiratory function in Duchenne muscular dystrophy

Genetic modifiers of respiratory function in Duchenne muscular dystrophy

Respiratory Trajectories in Type 2 and 3 Spinal Muscular Atrophy in the iSMAC Cohort Study

Long-term data with idebenone on respiratory function outcomes in patients with Duchenne muscular dystrophy

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