Abstract:
:Amyotrophic lateral sclerosis (ALS) is a debilitating neurodegenerative disorder with complex biology and significant clinical heterogeneity. Many preclinical and early phase ALS clinical trials have yielded promising results that could not be replicated in larger phase 3 confirmatory trials. One reason for the lack of reproducibility may be ALS biological and clinical heterogeneity. Therefore, in this review, we explore sources of ALS heterogeneity that may reduce statistical power to evaluate efficacy in ALS trials. We also review efforts to manage clinical heterogeneity, including use of validated disease outcome measures, predictive biomarkers of disease progression, and individual clinical risk stratification. We propose that personalized prognostic models with use of predictive biomarkers may identify patients with ALS for whom a specific therapeutic strategy may be expected to be more successful. Finally, the rapid application of emerging clinical and biomarker strategies may reduce heterogeneity, increase trial efficiency, and, in turn, accelerate ALS drug development.
journal_name
Muscle Nervejournal_title
Muscle & nerveauthors
Goyal NA,Berry JD,Windebank A,Staff NP,Maragakis NJ,van den Berg LH,Genge A,Miller R,Baloh RH,Kern R,Gothelf Y,Lebovits C,Cudkowicz Mdoi
10.1002/mus.26801subject
Has Abstractpub_date
2020-08-01 00:00:00pages
156-166issue
2eissn
0148-639Xissn
1097-4598journal_volume
62pub_type
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