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The primary objectives of the study are to estimate and rank-order the longitudinal standardized mean changes over 6 months and over 12 months, for a set of outcome measures administered to participants with amyotrophic lateral sclerosis (ALS), in order to identify measures that are more sensitive to disease progression than Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R). The secondary objectives of this study are: To evaluate the test-retest reproducibility of each outcome measure; To determine correlations between 6 and 12-month changes in all exploratory measures with 18 and 24-month changes in ALSFRS-R and survival; To assess correlations between/among the various measures; To obtain biological samples in order to identify molecular correlates to the clinical measures and to further characterize previously identified and novel molecular biomarkers of disease progression for incorporation into future clinical studies.
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| Measure | Description | Time Frame |
|---|---|---|
| Longitudinal standardized mean change in electrophysiological measures as assessed by electrical impedance myography (EIM) | EIM is an electrophysiological technique in which current is applied to a muscle of interest and resultant voltage and impedance are measured. These measured parameters reflect the conductivity of underlying tissue and presumably the pathologic state of denervated muscle in an ALS participant | Baseline to Month 6 and Baseline to Month 12 |
| Longitudinal standardized mean change in electrophysiological measures as assessed by compound muscle action potential (CMAP) | CMAP is a standard electrophysiological measure generated by maximally stimulating a nerve such that all muscle fibers innervated by the respective nerve are depolarized. Reduction of CMAP amplitude reflects loss of motor axons and, therefore, is directly relevant to ALS. | Baseline to Month 6 and Baseline to Month 12 |
| Longitudinal standardized mean change in electrophysiological measures as assessed by motor unit number estimation (MUNE) | Optional, to be administered at each site's Investigator's discretion. MUNE is used to estimate the number of functioning motor units. | Baseline to Month 6 and Baseline to Month 12 |
| Longitudinal standardized mean change in electrophysiological measures as assessed by motor unit number index (MUNIX) | MUNIX estimates functioning motor units within a muscle. CMAP and surface electromyography potentials (surface interference patterns) are obtained at various levels of voluntary effort, and MUNIX is estimated using power and area of CMAP and surface interference patterns. | Baseline to Month 6 and Baseline to Month 12 |
| Longitudinal standardized mean change in muscle strength measures as assessed by hand-held dynamometry (HHD) |
| Measure | Description | Time Frame |
|---|---|---|
| Within-participant test-retest reliability between the 2 repeated measurements occurring on Day 1 and Day 7 for EIM | Day 1 and Day 7 | |
| Within-participant test-retest reliability between the 2 repeated measurements for CMAP | Day 1 and Day 7 |
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Key Inclusion Criteria:
Key Exclusion Criteria:
NOTE: Other protocol defined Inclusion/ Exclusion criteria may apply
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Participants suffering from ALS are recruited by participating physicians in a standard clinical practice setting.
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| Name | Affiliation | Role |
|---|---|---|
| Medical Director | Biogen | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of California San Diego Medical Center | San Diego | California | 92103 | United States | ||
| California Pacific Medical Center |
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HHD tests isometric strength of multiple muscles using standard participant positioning. Approximately 10 muscle groups will be examined (per each side) in both upper and lower extremities.
| Baseline to Month 6 and Baseline to Month 12 |
| Longitudinal standardized mean change in respiratory measures as assessed by slow vital capacity (SVC) | Vital capacity will be measured by means of an SVC test, administered in the upright position. Upright SVC will be determined by performing 3 to 5 measures, in accordance with criteria established by the American Thoracic Society and the European Respiratory Society. | Baseline to Month 6 and Baseline to Month 12 |
| Longitudinal standardized mean change in functional measures as assessed by Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) | The ALSFRS-R has been demonstrated to predict survival. The ALSFRS-R measures 4 functional domains, including respiratory, bulbar function, gross motor skills, and fine motor skills. There are a total of 12 questions, each scored from 0 to 4 for a total possible score of 48 [Cedarbaum 1999], with higher scores representing better function. | Baseline to Month 6 and Baseline to Month 12 |
| Within-participant test-retest reliability between the 2 repeated measurements for MUNE | Day 1 and Day 7 |
| Within-participant test-retest reliability between the 2 repeated measurements for MUNIX | Day 1 and Day 7 |
| Within-participant test-retest reliability between the 2 repeated measurements for HHD | Day 1 and Day 7 |
| Within-participant test-retest reliability between the 2 repeated measurements for SVC | Day 1 and Day 7 |
| Within-participant test-retest reliability between the 2 repeated measurements for ALSFRS-R | Day 1 and Day 7 |
| Comparison between 6 and 12-month changes in exploratory measures with 18 and 24-month changes in ALSFRS-R and survival | Baseline to Month 24 |
| Comparison between 6-month changes for muscle electrophysiological measures | Baseline to Month 12 |
| Comparison between 6-month changes for muscle strength measures | Baseline to Month 12 |
| Comparison between 6-month changes for functional measures | Baseline to Month 12 |
| Comparison of molecular biomarkers with disease progression | Baseline to Month 12 |
| San Francisco |
| California |
| 94115 |
| United States |
| University of South Florida | Tampa | Florida | 33612 | United States |
| The Emory Clinic | Atlanta | Georgia | 30322 | United States |
| Johns Hopkins Hospital | Baltimore | Maryland | 21287 | United States |
| Massachusetts General Hospital, MA | Charlestown | Massachusetts | 2129 | United States |
| Washington University School of Medicine | St Louis | Missouri | 63110 | United States |
| Penn State Milton S. Hershey Medical Center | Hershey | Pennsylvania | EC037 | United States |
| UZ Leuven | Leuven | 3000 | Belgium |
| Sunnybrook Health Sciences Centre | Toronto | Ontario | M4N 3M5 | Canada |
| Montreal Neurological Institute Clinical Research Unit | Montreal | Quebec | H3A 2B4 | Canada |
| Hopital Gui de Chauliac, Service de Neurologie | Montpellier | Hérault | 34295 | France |
| Groupe Hospitalier Pitie-Salpetriere | Paris | Paris | 75013 | France |
| Charite - Campus Virchow-Klinikum | Berlin | 13125 | Germany |
| Medizinische Hochschule Hannover | Hanover | 30625 | Germany |
| Universitaetsklinikum Jena | Jena | 07743 | Germany |
| Universitaetsklinikum Ulm | Ulm | 89081 | Germany |
| Beaumont Hospital | Dublin | Dublin 9 | Ireland |
| UMC Utrecht | Utrecht | CX | 3584 | Netherlands |
| Kantonsspital St. Gallen | Sankt Gallen | 9007 | Switzerland |
| Royal Hallamshire Hospital | Sheffield | West Midlands | S102JF | United Kingdom |
| ID | Term |
|---|---|
| D000690 | Amyotrophic Lateral Sclerosis |
| ID | Term |
|---|---|
| D013118 | Spinal Cord Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D016472 | Motor Neuron Disease |
| D019636 | Neurodegenerative Diseases |
| D057177 | TDP-43 Proteinopathies |
| D009468 | Neuromuscular Diseases |
| D057165 | Proteostasis Deficiencies |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
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