Longitudinal Study of the Natural History of Duchenne Muscular Dystrophy (DMD)

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Brief Title

Longitudinal Study of the Natural History of Duchenne Muscular Dystrophy (DMD)

Official Title

Longitudinal Study of the Relationship Between Impairment, Activity Limitation, Participation and Quality of Life in Persons With Confirmed Duchenne Muscular Dystrophy (DMD)

Brief Summary

      The purpose of this study is to establish the largest long-term assessment of people with
      Duchenne muscular dystrophy (DMD). In this study, the investigators associated with the
      Cooperative International Neuromuscular Research Group CINRG) will take a detailed look (for
      a minimum of eight years) at DMD participant's physical abilities, the medical problems they
      experience, and how they use health care services. Physical abilities will be compared to a
      group of healthy controls.

      The second purpose of this study is to find out whether small, normal differences in the
      genetic makeup of people with DMD (called "single nucleotide polymorphisms" or "SNPs") affect
      how their disease progresses and relates to muscle strength/size and steroid response.

      The third purpose of this study is to study genetic variations associated with DMD.

      The final purpose of this study is to determine whether certain biomarkers are present in
      people with DMD and not in healthy controls.
    

Detailed Description

      Phenotyping Study Aims

      Aim 1: Longitudinally assess body function and body structure (impairment) through the
      measurement of anthropometrics, muscle strength and pulmonary function in subjects with DMD
      through the multicenter CINRG network.

      Aim 2: Longitudinally assess activity limitations in subjects with DMD through CINRG with
      timed motor performance, burden of care, and functional status.

      Aim 3: Longitudinally assess secondary conditions in subjects with DMD, and relative risks of
      developing those conditions based on exposure to preventive interventions.

      Aim 4: Longitudinally assess participation, life satisfaction, service utilization and
      health-related quality of life in subjects with DMD.

      Aim 5: Determine appropriate outcome measurements for impairment, activities (activity
      limitations), participation and quality of life to determine the effect of prednisone and
      other therapeutic interventions on these factors.

      Aim 6: Using the most robust impairment, activity, participation and quality of life outcome
      measures, determine the sample size, power and statistical methods for the analysis of the
      effect size for future planned randomized-controlled rehabilitation interventions in DMD.

      Aim 7: Examine the associations between interventions and incidence and severity of secondary
      conditions, achievement of disease milestones and measures of motor function and mobility.

      Aim 8: To assess the validity and responsiveness of novel clinical outcome measures in DMD,
      including the 6-minute walk test (6MWT), the 9-hole peg test (9-HPT) Egen Klassification
      Scale(EK), the North Star Ambulatory Assessment (NSAA), and quantitative key and pinch grip
      strength testing.

      Aim 9: To assess the reliability, validity and responsiveness of novel patient-reported
      outcome(PRO) measures in DMD, including the NeuroQOL and PedsQL Neuromuscular Module.

      Aim 10: To assess the clinical meaningfulness of novel objective clinical outcome measures by
      assessing their ability to predict milestones of loss of ability to stand from supine, to
      stand from a seated position, to climb stairs, to ambulate independently and to raise a hand
      to the mouth.

      AIM 11: To determine the impact of development and growth on outcome measure performance,we
      will assess physical function on a group of healthy, typically developing male children and
      adults between 6 and 30 years of age for outcome measures of motor function and strength
      including the9-HPT, 6MWT, NSAA, timed function tests and quantitative muscle strength (QMT).
      Test results from this cohort will be used to develop initial percent predicted for age
      values for these assessments.

      SNP Genotyping Study Aim

      Our goal of the proposed study is to define polygenic modifiers of disease progression, and
      also response to treatment with glucocorticoids (prednisone and deflazacort). The most common
      type of human genetic variation is the single-nucleotide polymorphism (SNP, a base position
      at which two alternative bases occur at an appreciable frequency (>1%) in the population.
      SNPs are 90% of variation in the human genome. SNPs occur on the average of 1 per 1000 to
      2000 bp throughout the 3.2 billion bp of the human genome while coding region SNPs (cSNPs)
      occur on the average of 1 per 346 bp.

      Genome-wide Association Study Aim

      Our goal of the proposed study is to isolate genomic DNA and find possible correlations of
      clinical phenotypes with gene loci associated with mild vs. severe clinical presentation,
      progression, or response to steroids.

      Serum Biomarkers Study Aim

      Our goal is to discover and validate sensitive and specific serum biomarkers for DMD.
    


Study Type

Observational


Primary Outcome

Strength and function

Secondary Outcome

 Biomarkers and genetic modifiers

Condition

Duchenne Muscular Dystrophy


Study Arms / Comparison Groups

 Ongoing Duchenne Muscular Dystrophy (DMD) Cohort
Description:  340 patients currently enrolled participants with DMD.

Publications

* Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.

Recruitment Information



Estimated Enrollment

551

Start Date

December 2005

Completion Date

December 2019

Primary Completion Date

December 2019

Eligibility Criteria

        DMD Subject Inclusion Criteria

          -  Affected subjects must be male and between the ages of 2 and 30

          -  Affected subjects between the ages of 2 and 4 must have a diagnosis of DMD confirmed
             by at least one the following OR have an older male sibling that meet at least one of
             the following criteria:

               -  Dystrophin immunofluorescence and/or immunoblot showing complete dystrophin
                  deficiency, and clinical picture consistent with typical Duchenne dystrophy OR

               -  Gene deletion test positive (missing one or more exons) in the central rod domain
                  exons 25-60) of dystrophin, where reading frame can be predicted as
                  'out-of-frame',and clinical picture consistent with typical Duchenne dystrophy.

               -  Complete dystrophin gene sequencing showing an alteration (point mutation,
                  duplication, other) that is expected to preclude production of the dystrophin
                  protein(i.e. nonsense mutation, deletion/duplication leading to a downstream stop
                  codon),with a typical clinical picture of DMD.

          -  Affected subjects between the ages of 5 and 30 must either fulfill the above criteria
             OR show evidence of a dystrophinopathy and clinical picture consistent with Duchenne
             Muscular Dystrophy

               -  Participants who have documented clinical symptoms referable to a
                  dystrophinopathy and direct support of the diagnosis by either (1) a positive DNA
                  analysis for dystrophin mutation, (2) a muscle biopsy demonstrating abnormal
                  dystrophin, or (3) an elevated CK (>5X normal), and X-linked pedigree and an
                  affected family member who meets either criterion (1) or (2) as described above.

        NOTE: Determination of the appropriate clinical symptoms consistent with DMD will generally
        be the responsibility of the clinician. At a minimum this will include progressive loss of
        function, with additional consideration for other clinical features such as a
        characteristic gait, a positive Gower sign and calf pseudohypertrophy. When immunostaining
        of muscle biopsy is used to determining case definition, the clinical reviewer (site PI)
        should confirm that appropriate testing has ruled out a secondary deficiency of dystrophin.
        Affected subjects that do not exhibit the above symptoms consistent with DMD should be
        excluded.

        o Muscle weakness prevalent by 5 years of age

        - Non-affected adult subjects must be Parent(s) or legal guardian(s) of an eligible
        affected subject.

        DMD Serum Biomarker Inclusion Criteria

          -  Participants must meet eligibility criteria for the DMD phenotyping portion of this
             study

          -  For the GC-treatment response cohort, participants must initiate GC treatment within
             the first year of study participation (i.e. between their first study visit and their
             one year follow-up visit)

        DMD Subject Exclusion Criteria

        For those subjects that confirm DMD diagnosis through a clinical picture consistent with
        DMD

          -  Steroid-naïve subjects ambulating past the 13th birthday

          -  Steroid users ambulating past the 16th birthday

          -  Subjects/families who are unwilling or unable to comply with the protocol study
             procedures or visits

        Controls Subject Inclusion Criteria

          -  Male sex

          -  Age 6-30 years

          -  Able to comply with functional testing instructions

        Control Serum Biomarker Inclusion criteria

          -  Participants must be male

          -  Participants must be free of DMD, other neuromuscular disease, or other significant
             concomitant illness

          -  Participant must be free of glucocorticoid therapy

        Control Subject Exclusion Criteria

          -  Musculoskeletal disease

          -  Musculoskeletal injury within 6 months of enrollment

          -  Other concomitant illness that precludes functional testing in the judgment of the
             investigator or clinical evaluator

          -  Completion of enrollment for age cohort
      

Gender

Male

Ages

2 Years - 30 Years

Accepts Healthy Volunteers

Accepts Healthy Volunteers

Contacts

Craig McDonald, MD, , 

Location Countries

Argentina

Location Countries

Argentina

Administrative Informations


NCT ID

NCT00468832

Organization ID

UCD0305


Responsible Party

Sponsor

Study Sponsor

Cooperative International Neuromuscular Research Group

Collaborators

 U.S. Department of Education

Study Sponsor

Craig McDonald, MD, Study Chair, University of California, Davis


Verification Date

April 2016