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Can Selection of Rapidly Progressing Patients Shorten Clinical Trials in Amyotrophic Lateral Sclerosis?
Mamede de Carvalho, MD;
Michael Swash, MD
Arch Neurol. 2006;63:557-560.
Background The marked variability in progression of amyotrophic lateral sclerosis (ALS) requires large numbers of patients to detect a significant effect in current clinical trial designs.
Objective To test the utility of a lead-in period to assess rate of progression so that patients with rapidly progressive ALS can be selected for subsequent clinical trials.
Design Prospective study.
Setting The ALS Center, University of Lisbon, Lisbon, Portugal.
Patients Fifty-seven consecutively recruited patients assessed at diagnosis and 3 months later (end of lead-in period).
Interventions Change in ALS Functional Rating Scale (ALS-FRS) score was analyzed to establish a statistically significant cutoff point to define patients with rapid (group 1) or slow (group 2) progression. Patients from both groups were reexamined 1 and 3 months after the lead-in period.
Main Outcome Measures Changes in ALS-FRS score, motor unit number estimation, and neurophysiologic index, and resultant grouping of patients according to rate of progression at 1 and 3 months.
Results Both the 80th percentile and 2 SDs above the mean of the change in ALS-FRS score identified the same patients. Twelve patients showed rapid progression (group 1) and 45 showed slow progression (group 2). One month after the lead-in period there was a significant reduction in ALS-FRS score, motor unit number estimation, and neurophysiologic index in group 1, and after 3 months all these measurements changed significantly in both groups.
Conclusions This strategy of selecting patients with rapidly progressing ALS for inclusion in exploratory, short phase II clinical trials offers substantial savings in costs and time, and could accelerate the process of testing potentially useful drugs for the treatment of ALS.
Author Affiliations: Department of Neurology, Hospital de Santa Maria, Lisbon, Portugal (Dr de Carvalho); Institute of Neuroscience, Queen Mary School of Medicine and Dentistry, Queen Mary University of London, London, England (Dr Swash); Laboratory of Electromyography, Centro de Estudos Egas Moniz, Lisbon (Dr de Carvalho); Faculty of Medicine, Institute of Molecular Medicine, Lisbon (Dr de Carvalho); and Department of Neurology, Royal London Hospital (Dr Swash).
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