ADVANCED FSHD-COM: New Clinical Outcome Measures to Evaluate Non-ambulant FSHD Patients, a Pilot Study
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 入组人数
- 30
- 试验地点
- 2
- 主要终点
- Change of the Motor Function Measure-32 (MFM-32) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)
研究概览
简要总结
Facioscapulohumeral muscular dystrophy (FSHD) is one of the most common adult muscular dystrophy with an estimated prevalence range of 2-7 per 100,000. The disease is characterized by slowly progressive, asymmetric muscle weakness that starts with the face and scapular muscles. It causes significant lifetime morbidity, with up to 20% of patients eventually requiring full-time wheelchair use. However, there is a large degree of clinical variability in both disease progression and severity. This makes predicting an individual's disease course difficult and has made clinical trial design challenging.
The disease is caused by the aberrant expression of a normally silenced gene, DUX4, which causes disease by a toxic gain-of-function. The establishment of a unifying model for the cause of FSHD made it possible to develop disease-specific targeted treatments. Pharmaceutical companies are actively investigating therapeutic approaches in order to knockdown or silence DUX4, including the use of antisense RNA oligonucleotides which is already investigated for spinal muscular atrophy, Duchenne muscular dystrophy, and myotonic dystrophy. The drug development pipeline for FSHD over the next 5 years looks promising but meetings with industry, advocacy groups, and FSHD scientific experts have identified several gaps that need to be addressed to accelerate efficient drug development. As drugs move from preclinical testing into human trials, it is essential to validate clinical trial tools and methodologies to facilitate drug development. There is a strong need for clinical outcome measures (COMs) including biomarkers, strength outcomes, functional measures and patient reported outcomes to follow disease progression and to evaluate treatment efficacy.
A large international multicenter study is currently ongoing in order to validate COMs in ambulant FSHD patients (ReSolve, NCT03458832). Additionally, Nice University Hospital is conducting an ancillary study (CTRL FSHD France, NCT04038138) to evaluate muscle MRI, an additional emerging biomarker, to follow disease progression in the same patient population. To limit patient heterogeneity, only ambulant FSHD patients are included in these 2 ongoing studies. It is therefore important to generate data in severely affected non-ambulant FSHD patients, in order to validate COMs that are adapted to this specific subgroup of patients for future therapeutic trials.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Other
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Genetically confirmed FSHD1 or clinical diagnosis of FSHD with characteristic findings on exam and an affected parent or offspring
- •Age 18-75 years
- •Symptomatic limb weakness
- •FSHD patients who use the wheelchair daily and are able to stand or to walk at most 30 meters with assistance, and wheelchair-bound patients who are unable to walk.
- •Clinical severity score (CSS) ≥ 8
- •Patient affiliated to the social security system
- •Patient giving written consent after written and oral information.
- •If taking over the counter supplements, willing to remain consistent with supplement regimen throughout the course of the study
排除标准
- •Patients with comorbidity not related to the disease that can modify the natural evolution of the disease or would interfere with safe testing in the opinion of the Investigator
- •Regular use of available muscle anabolic/catabolic agents such as corticosteroids, oral testosterone or derivatives, or oral beta agonists
- •Use of an experimental drug in an FSHD clinical trial within the past 30 days
- •Pregnancy
- •Vulnerable person (person deprived of their administrative and legal liberty, hospitalized person for other purposes than research)
结局指标
主要结局
Change of the Motor Function Measure-32 (MFM-32) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)
时间窗: at baseline, 6, 12 and 24 months
Within MFM-32, 32 terms will be evaluated to describe patient's motor functions and grouped into 3 sub-scores at baseline, 6, 12 and 24 months: D1: standing position and transfer D2: axial and proximal motor function D3: distal motor function The MFM-32 ratings rely on the use of a 4-point Likert scale based on the subject's maximal abilities without assistance (0: cannot initiate the task or maintain the starting position; 1: performs the task partially; 2: performs the task incompletely or imperfectly; 3: performs the task fully and normally.)
Change of the Manual Muscle Testing (MMT) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)
时间窗: at baseline, 6, 12 and 24 months
The Manual Muscle Testing is a modified Medical Research Council 13-point and is used with standardized positions for each grade and each muscle following the recommendations of the FSH-DY Group. Shoulder abduction and flexion, elbow flexion and extension, wrist flexion and extension, fingers flexion and extension, hip flexion and abd/adduction, knee flexion and extension, ankle plantarflexion and dorsiflexion strength will be measured bilaterally
Change of the Pinch and Grip test from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)
时间窗: at baseline, 6, 12 and 24 months
The purpose of those tests is to measure the maximum isometric strength of the hand and forearm muscles when doing a grasping or a pinching action. The equipment required for the grip and the pinch tests is a calibrate dynamometer. The subject should be strongly encouraged to give a maximum effort. We record three trials for each hand, alternating hands with at least 30 seconds recovery between each effort. We keep the best result.
Change of the Hand-Held dynamometry (HHD) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)
时间窗: at baseline, 6, 12 and 24 months
Hand-Held dynamometry (HHD) assess the isometric muscle strength in both the upper and lower limbs bilaterally (global shoulder abduction and flexion, elbow flexion and extension, hip abduction, knee extension, ankle dorsiflexion isometric strength). The required equipment is a calibrated hand-held dynamometer (MicroFet). The patient has to push against the hand-held dynamometer 3 times as hard as he can for 3-5 seconds. The maximal value will be kept for further analysis.
次要结局
- Change of the Fatigue Severity Scale (FSS) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)(at baseline, 6, 12 and 24 months)
- Change of the Stand Up test (SaUT) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)(at baseline, 6, 12 and 24 months)
- Change of the optimized Timed Up and Go test (classic TUG) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)(at baseline, 6, 12 and 24 months)
- Change of the Neck Flexion Fatigability Test (NFFT) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)(at baseline, 6, 12 and 24 months)
- Change of the Bend Over Test (BOT) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)(at baseline, 6, 12 and 24 months)
- Change of the repeated Stand Up test (r-SaUT) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)(at baseline, 6, 12 and 24 months)
- Change of the Swallowing Quality of Life questionnaire (SWAL-QOL) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)(at baseline, 6, 12 and 24 months)
- Change of the Sydney Swallow Questionnaire (SSQ) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)(at baseline, 6, 12 and 24 months)
- Change of the Upper Extremity Functional Index 15 (UEFI15) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)(at baseline, 6, 12 and 24 months)
- Change of the repeated 9-Hole Peg test (r9-HPT) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)(at baseline, 6, 12 and 24 months)
- Change of the classic Timed Up and Go test (classic TUG) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)(at baseline, 6, 12 and 24 months)
- Change of the repeated Sit Up test (r-SiUT) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)(at baseline, 6, 12 and 24 months)
- Change of the repeated Bend Over Test (r-BOT) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)(at baseline, 6, 12 and 24 months)
- Change of the Facial Disability Index (FDI) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)(at baseline, 6, 12 and 24 months)
- Change of the 9-Hole Peg test (9-HPT) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)(at baseline, 6, 12 and 24 months)
- Change of the Sit Up test (SiUT) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)(at baseline, 6, 12 and 24 months)
- Change of the muscle mass from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)(at baseline, 6, 12 and 24 months)
- Change of the respiratory function (sitting and bedside spirometry) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)(at baseline, 6, 12 and 24 months)
- Change of the Patient-Reported Outcomes Measurement Information System 57 (PROMIS57) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)(at baseline, 6, 12 and 24 months)
- Change of the Multidimensional Dyspnea Profile (MDP) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)(at baseline, 6, 12 and 24 months)
- Change of the Speech Handicap Index (SHI) from Baseline (T0) to 6 months (T6), 12 months (T12) and 24 months (M24)(at baseline, 6, 12 and 24 months)