Article (Scientific journals)
Real-world and natural history data for drug evaluation in Duchenne muscular dystrophy: suitability of the North Star Ambulatory Assessment for comparisons with external controls.
Muntoni, Francesco; Signorovitch, James; Sajeev, Gautam et al.
2022In Neuromuscular Disorders, 32 (4), p. 271-283
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Keywords :
Clinical trials; Drug evaluation; Duchenne muscular dystrophy; External controls; Natural history data; Real-world data; Pediatrics, Perinatology and Child Health; Neurology; Neurology (clinical); Genetics (clinical)
Abstract :
[en] Using external controls based on real-world or natural history data (RWD/NHD) for drug evaluations in Duchenne muscular dystrophy (DMD) is appealing given the challenges of enrolling placebo-controlled trials, especially for multi-year trials. Comparisons to external controls, however, face risks of bias due to differences in outcomes between trial and RWD/NHD settings. To assess this bias empirically, we conducted a multi-institution study comparing mean 48-week changes in North Star Ambulatory Assessment (NSAA) total score between trial placebo arms and RWD/NHD sources, with and without adjustment for baseline prognostic factors. Analyses used data from three placebo arms (235 48-week intervals, N = 235 patients) and three RWD/NHD sources (348 intervals, N = 202 patients). Differences in mean ΔNSAA between placebo arms and RWD/NHD sources were small before adjustment (-1.2 units, 95% CI: [-2.0 -0.5]) and were attenuated and no longer statistically significant after adjustment (0.1 units (95% CI: [-0.6, 0.8]). Results were similar whether adjusting using multivariable regression or propensity score matching. This consistency in ΔNSAA between trial placebo arms and RWD/NHD sources accords with prior findings for the six-minute walk distance, provides a well-validated framework for baseline adjustment of prognostic factors, and supports the suitability of RWD/NHD external controls for drug evaluations in ambulatory DMD.
Disciplines :
Neurology
Pediatrics
Author, co-author :
Muntoni, Francesco;  Dubowitz Neuromuscular Centre, NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, London, UK
Signorovitch, James;  Analysis Group, Inc., Boston, Massachusetts, USA, The Collaborative Trajectory Analysis Project, Cambridge, Massachusetts, USA. Electronic address: James.signorovitch@analysisgroup.com
Sajeev, Gautam;  Analysis Group, Inc., Boston, Massachusetts, USA
Goemans, Nathalie;  University Hospitals Leuven, Child Neurology, Leuven, Belgium
Wong, Brenda;  Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
Tian, Cuixia;  Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio & College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
Mercuri, Eugenio;  Department of Pediatric Neurology, Fondazione Policlinico Gemelli IRCCS, Catholic University, Rome, Italy
Done, Nicolae;  Analysis Group, Inc., Boston, Massachusetts, USA
Wong, Hallee;  Analysis Group, Inc., Boston, Massachusetts, USA
Moss, Jackson;  Analysis Group, Inc., Boston, Massachusetts, USA
Yao, Zhiwen;  Analysis Group, Inc., Boston, Massachusetts, USA
Ward, Susan J;  The Collaborative Trajectory Analysis Project, Cambridge, Massachusetts, USA
Manzur, Adnan;  Dubowitz Neuromuscular Centre, NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, London, UK
Servais, Laurent ;  Centre Hospitalier Universitaire de Liège - CHU > > Service de pédiatrie ; University of Oxford > Department of Paediatrics > UK Oxford Neuromuscular Center
Niks, Erik H;  Leiden University Medical Centre, Leiden, the Netherlands
Straub, Volker;  John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle, UK
de Groot, Imelda Jm;  Radboud University Nijmegen Medical Center, Donders Centre of Neuroscience, Department of Rehabilitation, Nijmegen, the Netherlands
McDonald, Craig;  Department of Physical Medicine and Rehabilitation, and Pediatrics, University of California, Davis, Sacramento, California, USA
North Star Clinical Network, PRO-DMD-01 Study, The Association Française contre les Myopathies (AFM), The DMD Italian Group, and The Collaborative Trajectory Analysis Project (cTAP)
More authors (9 more) Less
Language :
English
Title :
Real-world and natural history data for drug evaluation in Duchenne muscular dystrophy: suitability of the North Star Ambulatory Assessment for comparisons with external controls.
Publication date :
25 February 2022
Journal title :
Neuromuscular Disorders
ISSN :
0960-8966
eISSN :
1873-2364
Publisher :
Elsevier Ltd, England
Volume :
32
Issue :
4
Pages :
271-283
Peer reviewed :
Peer Reviewed verified by ORBi
Funding text :
Francesco Muntoni is a member of the Rare Disease Scientific Advisory Group for Pfizer and of Dyne Therapeutics SAB, and has participated to SAB meetings for PTC, Sarepta, Santhera, Wave Therapeutics. UCL and Great Ormond Street Hospital are recipient of grants from Pfizer, Italfarmaco, Wave, Santhera, Sarepta regarding clinical trials. James Signorovitch co-founded the collaborative Trajectory Analysis Project (cTAP) and is an employee of Analysis Group, Inc., a consulting firm that received funding from the membership of cTAP to conduct this study. Gautam Sajeev, Nicolae Done, Hallee Wong, Jackson Moss, and Zhiwen Yao are employees of Analysis Group, Inc., a consulting firm that received funding from the membership of cTAP to conduct this study. Nathalie Goemans has received compensation for consultancy services from Eli Lilly, Italfarmaco, PTC Therapeutics, BioMarin Pharmaceutical, Pfizer, Avidity, Daiichi Sankyo, Wave, Santhera and has served as site investigator for GlaxoSmithKline, Prosensa, BioMarin Pharmaceutical, Italfarmaco, Eli Lilly, Wave, and Sarepta. Brenda Wong has participated in advisory committee meetings for Prosensa and Biomarin and has received compensation for consultancy services for Gilead Sciences, Pfizer and GSK. Cuixia Tian has served as the site investigator for trials sponsored by PTC Therapeutics, Eli Lilly, GSK, Prosensa/Biomarin, Bristol Myers Squibb, Roche, Pfizer. Santhera, Sarepta, Fibrogen, Capricor, Pfizer, Avexis, and Catabasis. Eugenio Mercuri has served on clinical steering committees and/or as a consultant for Eli Lilly, Italfarmaco, PTC Therapeutics, Sarepta, Santhera, and Pfizer; has served as PI for GlaxoSmithKline, Prosensa, BioMarin Pharmaceutical, Italfarmaco, Roche, PTC, Pfizer, Sarepta, Santhera, Wave, NS and Eli Lilly. Susan J. Ward co-founded and manages the collaborative Trajectory Analysis Project and has received funding from the membership of cTAP to facilitate this study. Adnan Manzur has no disclosures. Laurent Servais is member of the SAB or has performed consultancy for Sarepta, Dynacure, Santhera, Avexis, Biogen, Cytokinetics and Roche, Audentes Therapeutics and Affinia Therapeutics; Laurent Servais has given lectures and has served as a consultant for Roche, Biogen, Avexis, and Cytokinetics. Laurent Servais is the project leader of the newborn screening in Southern Belgium funded by Avexis, Roche, and Biogen. Erik H. Niks is a member of the European Reference Network for Rare Neuromuscular Diseases (ERN EURO‐NMD). Erik H. Niks reports grants from Duchenne Parent Project, ZonMW and AFM, consultancies for BioMarin and Summit, and worked as local investigator of clinical trials of BioMarin, GSK, Lilly, Santhera, Givinostat, and Roche outside the submitted work. E.H.N. reports ad hoc consultancies for WAVE, Santhera, Regenxbio, and PTC, and he worked as investigator of clinical trials of Italfarmaco, NS Pharma, Reveragen, Roche, WAVE, and Sarepta outside the submitted work. Volker Straub has participated in advisory boards for Audentes Therapeutics, Biogen, Exonics Therapeutics, Italfarmaco S.p.A., Roche, Sanofi Genzyme, Sarepta Therapeutics, Summit Therapeutics, UCB, and Wave Therapeutics. He has research collaborations with Ultragenyx and Sanofi Genzyme. Imelda JM de Groot has no disclosures. Craig McDonald has served as a consultant for PTC Therapeutics, BioMarin Pharmaceutical, Sarepta Therapeutics, Eli Lilly, Pfizer Inc, Santhera Pharmaceuticals, Cardero Therapeutics, Inc, Catabasis Pharmaceuticals, Capricor Therapeutics, Astellas Pharma (Mitobridge), and FibroGen, Inc; serves on external advisory boards related to DMD for PTC Therapeutics, Sarepta Therapeutics, Santhera Pharmaceuticals, and Capricor Therapeutics; and reports grants from US Department of Education/National Institute on Disability and Rehabilitation Research, the National Institute on Disability, Independent Living, and Rehabilitation Research, US NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH/National Institute of Neurologic Disorders and Stroke, US Department of Defense, and Parent Project Muscular Dystrophy US.The authors are grateful to patients for participating in the clinical assessments and agreeing to make their data available for research. The authors also thank Eli Lilly for contributing placebo arm data from the tadalafil DMD trial. Gloria DeWalt, PhD, an employee of Analysis Group, Inc., assisted with the development of this manuscript. The authors would like to acknowledge investigators and staff from each of the RWD/NHD sources included in this study. The iMDEX study is funded by the Association Française contre les Myopathies (AFM), while the UK North Star is funded by Muscular Dystrophy UK. Francesco Muntoni is partially supported by the National Institute for Health Research (NIHR) Biomedical Research centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London.This study was conducted within the collaborative Trajectory Analysis Project (cTAP), a pre-competitive coalition of academic clinicians, drug developers, and patient foundations formed in 2015 to overcome the challenges of high variation in clinical trials in DMD. cTAP has received sponsorship from Astellas (Mitobridge), BioMarin Pharmaceutical, Bristol Meyers Squibb, Catabasis, Edgewise Therapeutics, FibroGen, Italfarmaco SpA, Marathon Pharmaceuticals, NS Pharma, Pfizer, PTC Therapeutics, Roche, Sarepta Therapeutics, Shire, Solid Biosciences, Summit Therapeutics, Vertex Pharmaceuticals, Parent Project Muscular Dystrophy, Charley's Fund, and CureDuchenne, a founding patient advocacy partner and provider of initial seed funding to cTAP. Physical function testing at Universitaire Ziekenhuizen Leuven was funded by Fonds Spierzieke Kinderen. The PRO-DMD-01 study was sponsored by BioMarin Pharmaceuticals and data were provided to cTAP by CureDuchenne.Francesco Muntoni is a member of the Rare Disease Scientific Advisory Group for Pfizer and of Dyne Therapeutics SAB, and has participated to SAB meetings for PTC, Sarepta, Santhera, Wave Therapeutics. UCL and Great Ormond Street Hospital are recipient of grants from Pfizer, Italfarmaco, Wave, Santhera, Sarepta regarding clinical trials. James Signorovitch co-founded the collaborative Trajectory Analysis Project (cTAP) and is an employee of Analysis Group, Inc., a consulting firm that received funding from the membership of cTAP to conduct this study. Gautam Sajeev, Nicolae Done, Hallee Wong, Jackson Moss, and Zhiwen Yao are employees of Analysis Group, Inc., a consulting firm that received funding from the membership of cTAP to conduct this study. Nathalie Goemans has received compensation for consultancy services from Eli Lilly, Italfarmaco, PTC Therapeutics, BioMarin Pharmaceutical, Pfizer, Avidity, Daiichi Sankyo, Wave, Santhera and has served as site investigator for GlaxoSmithKline, Prosensa, BioMarin Pharmaceutical, Italfarmaco, Eli Lilly, Wave, and Sarepta. Brenda Wong has participated in advisory committee meetings for Prosensa and Biomarin and has received compensation for consultancy services for Gilead Sciences, Pfizer and GSK. Cuixia Tian has served as the site investigator for trials sponsored by PTC Therapeutics, Eli Lilly, GSK, Prosensa/Biomarin, Bristol Myers Squibb, Roche, Pfizer. Santhera, Sarepta, Fibrogen, Capricor, Pfizer, Avexis, and Catabasis. Eugenio Mercuri has served on clinical steering committees and/or as a consultant for Eli Lilly, Italfarmaco, PTC Therapeutics, Sarepta, Santhera, and Pfizer; has served as PI for GlaxoSmithKline, Prosensa, BioMarin Pharmaceutical, Italfarmaco, Roche, PTC, Pfizer, Sarepta, Santhera, Wave, NS and Eli Lilly. Susan J. Ward co-founded and manages the collaborative Trajectory Analysis Project and has received funding from the membership of cTAP to facilitate this study. Adnan Manzur has no disclosures. Laurent Servais is member of the SAB or has performed consultancy for Sarepta, Dynacure, Santhera, Avexis, Biogen, Cytokinetics and Roche, Audentes Therapeutics and Affinia Therapeutics; Laurent Servais has given lectures and has served as a consultant for Roche, Biogen, Avexis, and Cytokinetics. Laurent Servais is the project leader of the newborn screening in Southern Belgium funded by Avexis, Roche, and Biogen. Erik H. Niks is a member of the European Reference Network for Rare Neuromuscular Diseases (ERN EURO?NMD). Erik H. Niks reports grants from Duchenne Parent Project, ZonMW and AFM, consultancies for BioMarin and Summit, and worked as local investigator of clinical trials of BioMarin, GSK, Lilly, Santhera, Givinostat, and Roche outside the submitted work. E.H.N. reports ad hoc consultancies for WAVE, Santhera, Regenxbio, and PTC, and he worked as investigator of clinical trials of Italfarmaco, NS Pharma, Reveragen, Roche, WAVE, and Sarepta outside the submitted work. Volker Straub has participated in advisory boards for Audentes Therapeutics, Biogen, Exonics Therapeutics, Italfarmaco S.p.A., Roche, Sanofi Genzyme, Sarepta Therapeutics, Summit Therapeutics, UCB, and Wave Therapeutics. He has research collaborations with Ultragenyx and Sanofi Genzyme. Imelda JM de Groot has no disclosures. Craig McDonald has served as a consultant for PTC Therapeutics, BioMarin Pharmaceutical, Sarepta Therapeutics, Eli Lilly, Pfizer Inc, Santhera Pharmaceuticals, Cardero Therapeutics, Inc, Catabasis Pharmaceuticals, Capricor Therapeutics, Astellas Pharma (Mitobridge), and FibroGen, Inc; serves on external advisory boards related to DMD for PTC Therapeutics, Sarepta Therapeutics, Santhera Pharmaceuticals, and Capricor Therapeutics; and reports grants from US Department of Education/National Institute on Disability and Rehabilitation Research, the National Institute on Disability, Independent Living, and Rehabilitation Research, US NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH/National Institute of Neurologic Disorders and Stroke, US Department of Defense, and Parent Project Muscular Dystrophy US.The authors are grateful to patients for participating in the clinical assessments and agreeing to make their data available for research. The authors also thank Eli Lilly for contributing placebo arm data from the tadalafil DMD trial. Gloria DeWalt, PhD, an employee of Analysis Group, Inc. assisted with the development of this manuscript. The authors would like to acknowledge investigators and staff from each of the RWD/NHD sources included in this study. The iMDEX study is funded by the Association Fran?aise contre les Myopathies (AFM), while the UK North Star is funded by Muscular Dystrophy UK. Francesco Muntoni is partially supported by the National Institute for Health Research (NIHR) Biomedical Research centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London. M. Van den Hauwe, N. Goemans, N. Deconicnk, M. Tulinius, E. Niks, I. de Groot, K. Flanigan, E. Henricson, B. Wong, M. Bernadete Dutra de Resende, G. Vita, U. Schara, J. Kirschner, E. Mercuri, H. Topaloglu, D. Monges, M. Soledad, C. Cances, V. Selby, D. Ridout, V. Decostre, A. Mayhew, M. Guglieri, M. Van der Holst, M. Jansen, J.J.G.M. Verschuuren, I.J.M. de Groot, E.H. Niks, L. Servais, V. Straub, J.Y. Hogrel, F. Muntoni, F. Muntoni, A.Y. Manzur, S. Robb, R. Quinlivan, A. Sarkozy, P. Munot, M. Main, L.E. Abbot, H. Patel, S. Samsuddin, V. Ayyar-Gupta, K. Bushby, V. Straub, M. Guglieri, C. Bertolli, A. Mayhew, R. Muni-Lofra, M. James, D. Moat, J. Sodhi, H. Roper, D. Parasuraman, H. McMurchie, R.M. Rabb, A. Childs, K. Pysden, L. Pallant, S. Spinty, G. Peachey, R. Madhu, A.J. Shillington, E. Wraige, H. Jungbluth, V. Gowda, J. Sheehan, R. Spahr, I. Hughes, E. Bateman, C. Cammiss, T. Willis, L. Groves, N. Emery, P. Baxter, M.T. Ong, N. Goulborne, M. Senior, E. Scott, L. Hartley, L.B. Parsons, A. Majumdar, K. Vijaykumar, F.F. Mason, L. Jenkins, B. Toms, C.H. Frimpong-Ansah, K. Naismith, J. Dalgleish, A. Keddie, I. Horrocks, M. Di Marco, J. Dunne, G.C.S. Chow, A. Miah, C. de Goede, A. Selley, N. Thomas, M. Illingworth, M. Geary, J. Palmer, C.P. White, K. Greenfield, S. Tiraputhi, S. MacAuley, N. Hussain, H. Robbins, M. Iqbal, G. Ambegaonkar, D. Krishnakumar, C. Ward, J. Taylor, A. O'Hara, J. Tewnion, S.R. Chandratre, S. Ramdas, M. White, H. Ramjattan, A. Baxter, J. Yirrel, Neuromuscular providers (B. Wong, C. Tian, I. Rybalsky, K. Shellenbarger) and physical therapists (A. McCormick, M. McGuire, K. Bonnarrigo, A. Fowler, M. Kiefer) and research support (J. Bange, S. Hu), E. Mercuri, M. Pane, E. Mazzone, S. Messina, G.L. Vita, M.P. Sormani, A. D'Amico, E. Bertini, A. Berardinelli, F. Magri, G. Pietro Comi, G. Baranello, T. Mongini, A. Pini, R. Battini, E. Pegoraro, C. Bruno, L. Politano, S. Previtali, This study was conducted within the collaborative Trajectory Analysis Project (cTAP), a pre-competitive coalition of academic clinicians, drug developers, and patient foundations formed in 2015 to overcome the challenges of high variation in clinical trials in DMD. cTAP has received sponsorship from Astellas (Mitobridge), BioMarin Pharmaceutical, Bristol Meyers Squibb, Catabasis, Edgewise Therapeutics, FibroGen, Italfarmaco SpA, Marathon Pharmaceuticals, NS Pharma, Pfizer, PTC Therapeutics, Roche, Sarepta Therapeutics, Shire, Solid Biosciences, Summit Therapeutics, Vertex Pharmaceuticals, Parent Project Muscular Dystrophy, Charley's Fund, and CureDuchenne, a founding patient advocacy partner and provider of initial seed funding to cTAP. Physical function testing at Universitaire Ziekenhuizen Leuven was funded by Fonds Spierzieke Kinderen. The PRO-DMD-01 study was sponsored by BioMarin Pharmaceuticals and data were provided to cTAP by CureDuchenne.
Commentary :
Online ahead of print.
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since 26 April 2022

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