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Sample enrichment for clinical trials to show delay of onset in huntington disease
- Source :
- Movement Disorders. 34:274-280
- Publication Year :
- 2019
- Publisher :
- Wiley, 2019.
-
Abstract
- BACKGROUND Disease-modifying clinical trials in persons without symptoms are often limited in methods to assess the impact associated with experimental therapeutics. This study suggests sample enrichment approaches to facilitate preventive trials to delay disease onset in individuals with the dominant gene for Huntington disease. METHODS Using published onset prediction indexes, we conducted the receiver operating curve analysis for diagnosis within a 3-year clinical trial time frame. We determined optimal cut points on the indexes for participant recruitment and then conducted sample size and power calculations to detect varying effect sizes for treatment efficacy in reducing 3-year rates of disease onset (or diagnosis). RESULTS Area under the curve for 3 onset prediction indexes all demonstrated excellent value in sample enrichment methodology, with the best-performing index being the multivariate risk score (MRS). CONCLUSIONS This study showed that conducting an intervention trial in premanifest and prodromal individuals with the gene expansion for Huntington disease is highly feasible using sample enrichment recruitment methods. Ongoing natural history studies are highly likely to indicate additional markers of disease prior to diagnosis. Statistical modeling of identified markers can facilitate participant enrichment to increase the likelihood of detecting a difference between treatment arms in a cost-effective and efficient manner. Such variations may expedite translation of emerging therapies to persons in an earlier phase of the disease. TRIAL REGISTRATION PREDICT-HD is registered with www.clinicaltrials.gov, number NCT00051324. © 2019 International Parkinson and Movement Disorder Society.
- Subjects :
- 0301 basic medicine
medicine.medical_specialty
Multivariate statistics
Framingham Risk Score
Movement disorders
Receiver operating characteristic
business.industry
Area under the curve
Disease
Clinical trial
03 medical and health sciences
030104 developmental biology
0302 clinical medicine
Neurology
Sample size determination
Internal medicine
medicine
Neurology (clinical)
medicine.symptom
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 15318257 and 08853185
- Volume :
- 34
- Database :
- OpenAIRE
- Journal :
- Movement Disorders
- Accession number :
- edsair.doi...........6554b877510de1eff539685e71068da2