Clinical Trial Readiness to Solve Barriers to Drug Development in FSHD

Study Overview
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Brief Summary
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The primary cause of facioscapulohumeral muscular dystrophy (FSHD), a common adult-onset dystrophy, was recently discovered identifying targets for therapy. As multiple drug companies pursue treatments for FSHD, there is an urgent need to define the clinical trial strategies which will hasten drug development, including creating disease-relevant outcome measures and optimizing inclusion criteria. This proposal will develop two new outcome measures and optimize eligibility criteria by testing 160 patients in 7 sites over a period of 24 months.

Detailed Description
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The overall aim of this study is to hasten drug development for facioscapulohumeral muscular dystrophy (FSHD). Recent breakthroughs in FSHD research have identified the primary disease mechanism as the aberrant expression of a normally silenced gene, DUX4, resulting in a toxic gain-of-function. This disease mechanism is particularly amenable to knock-down of DUX4 using epigenetic strategies or RNA therapies, as well as to other interventions targeting the downstream effects of DUX4 expression. There are many drug companies actively working towards disease-targeted therapies, and two clinical trials either under way now, or planned to start in early Fall 2016. However, meetings with industry, advocacy groups, and FSHD researchers have identified several gaps in the clinical trial arsenal, and clinical trial planning as a major goal for the community. Consequently, there is an urgent need to establish the tools necessary for the conduct of currently planned and expected therapeutic trials in FSHD. To this end, the researchers propose to develop two novel clinical outcome assessments (COA), a composite functional outcome measure (FSH-COM) and skeletal muscle biomarker, electrical impedance myography (EIM). In addition there is broad consensus a better understanding of the relationship of genetic and demographic features to disease progression will be necessary for enumerating eligibility criteria. The specific aims are to: 1. Determine the multi-site validity of the COAs, 2. Compare the responsiveness of new COAs to other FSHD outcomes and determine the minimal clinically meaningful changes, and 3. establish FSHD cohort characteristics useful for determining clinical trial eligibility criteria. To achieve these aims, the researchers are conducting a multicenter, prospective, 24 months study of 160 subjects.

Official Title
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Clinical Trial Readiness to Solve Barriers to Drug Development in FSHD

Conditions
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Facioscapulohumeral Muscular Dystrophy

Intervention / Treatment
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* Diagnostic Test: FSHD-specific functional rating scale
* Device: Electrical Impedance Myography


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with genetically confirmed FSHD1 or clinical diagnosis of FSHD with characteristic findings on exam and an affected parent or offspring Patients with symptomatic limb weakness Patients must be able to walk 30 feet without the support of another person or assistance (canes, walking sticks, and braces allowed; no walker). If taking over the counter supplements, willing to remain consistent with supplement regimen throughout the course of the study Exclusion Criteria: Patients with cardiac or respiratory dysfunction (deemed clinically unstable, or would interfere with safe testing, in the opinion of the Investigator) Patients with orthopedic conditions that preclude safe testing of muscle function Patients that regularly use available muscle anabolic/catabolic agents such as corticosteroids, oral testosterone or derivatives, or oral beta agonists Patients that have used an experimental drug in an FSHD clinical trial within the past 30 days Patients that are pregnant

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| FSHD-COM<br>All participants will be asked to undergo FSHD-specific functional rating scale tests and procedures and Electrical Impedance Myography. | Diagnostic Test: FSHD-specific functional rating scale<br>* The FSHD-COM is composed of disease-relevant functional tasks such as leg function; shoulder and arm function; trunk function, hand function, and balance.<br>* Other names: FSHD-COM;Device: Electrical Impedance Myography<br>* EIM is a non-invasive, painless, and fast technique for obtaining information on how a patient's muscle structure is changing. EIM uses a small electrical current to measure the health of the underlying muscle. The patient will be asked to lie down and a trained clinical evaluator will perform testing on 16 total muscles (8 on each side) on your arms and legs.<br>* Other names: EIM;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Validate FSHD-COM as COA | The FSHD-COM is an 18-item evaluator-administered instrument comprised of individually validated functional motor tasks. The body regions represented match areas of importance identified by patients and include: leg function; shoulder and arm function; trunk function, hand function; and balance. Each item is scored on a 0-4 scale, with 0 representing unaffected/normal performance, and the divisions based on healthy population normative values, or the relative degree of ability to perform the functional task. The total scale has 72 points, with larger weight given to the two most frequently patient-cited areas of functional motor concern - leg function and shoulder and arm function. | 24 Months | 
| Validate EIM as COA |  | 24 Months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Motor Function Measure (MFM) Domain 1 | The MFM domain 1 is a validated evaluator administered functional measure for neuromuscular disorders, with 13 items related to standing and transfers. | 24 Months | 
| Facial Function | The Iowa Oral Performance Instrument (IOPI) is a means to quantify lip, tongue, and buccal strength using a validated tool with published ranges for normative data for lingual measurements. | 24 Months | 
| Reachable Workspace | Subjects are seated in front of a 3D camera and asked to perform a standardized upper extremity movement protocol under the supervision of a study clinical evaluator. | 24 Months | 
| Manual Muscle Testing | Strength testing will be performed using manual muscle testing (MMT) using a hand held force dynamometer. | 24 Months | 
| Respiratory Function | The researchers will obtain forced vital capacity and forced expiratory volume in 1 second using bedside spirometry. | 24 Months | 
| Whole body and regional lean muscle mass (LMM) | Whole body and regional lean muscle mass (LMM) will be measured via Dual Energy X-Ray Absorptiometry (DEXA). | 24 Months | 
| Severity Scores | A limited physical exam and strength testing will be used to derive two FSHD clinical severity scores. These severity scores both rank weakness in the face, shoulders, arms, distal, and proximal lower extremities on either a 10 or 15 point scale. | 24 Months | 
| FSHD-Health Inventory (HI) | The HI is a 15 domain questionnaire designed and based on patient interviews to measure total FSHD health-related quality-of-life, including both motor impairment and the social and emotional impact of FSHD. 116 questions are combined into a total score, the score is transformed onto a percentage scale, with 100 representing maximal disability, and lower scores representing decreasing disability. | 24 Months | 
| Patient-Reported Outcomes Measurement Information System-57 (PROMIS57) | The PROMIS57 is an instrument developed by the NIH which generates scores for physical function, and the impact of physical limitations on daily life. 57 questions are summed into a total score, which is transformed into a normalized t-score with 50 representing normal, and lower scores representing increasing disability. | 24 Months | 
| The Upper Extremity Functional Index | This index measures upper extremity dysfunction. 20 questions are combined into a total score, the score is transformed into a normalized score with 80 representing normal, and lower scores representing increasing disability. | 24 Months | 
| The Facial Disability Index (FDI) | The FDI is a short 5 item questionnaire. The five questions are summed into total score which transformed onto a percentage scale, with 100 representing normal, and lower scores representing increasing disability. | 24 Months | 
| Fall assessment | Fall assessment will be completed weekly for 3 months after the month 3 visit. | Total between Month 3 and Month 6 Visit | 
| Quantitative myometry | Force will be measured on digital myometer, in KG-force. | 24 Months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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muscular dystrophy., FSHD