Optimizing INITIation of Non-invasive Ventilation in ALS Patients

Study Overview
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Brief Summary
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Objective: The primary objective in this study is to identify which (pheno)type of ALS patient has the most benefit from NIV in improving quality of life. Study population: Adult patients with ALS, PLS (Primary Lateral Sclerosis) of PSMA (Progressive Spinal Muscular Atrophy) in the Netherlands. Patients will be included during their first visit to one of the HMV centres in the Netherlands. Main study parameters/endpoints: The main study parameter is change in Quality of Life (QoL) defined as change in ALS Assessment Questionnaire (ALSAQ-40) in patients with ALS after initiation of NIV. Design: Multi-centre prospective cohort study consisting of 2 non-randomized cohorts, i.e. ALS patients who start NIV and ALS patients who do not start NIV at the time of inclusion in the present study. Duration: The total duration of the study: 3,5 years. Inclusion period: 30 months. Follow up time after initiation of NIV: 9 months. Thereafter, 6 months will be used for data analysis. Setting: Involvement of all (4) HMV centres in the Netherlands (Groningen, Maastricht, Rotterdam, Utrecht). Procedure: 250 ALS patients will be included. During the first regular visit to the HMV centre patients will be asked to participate in the study. Data will be recorded during regular visits to the HMV centre.

Detailed Description
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First visit: After informed consent the following data which are gathered as parts of usual care will be recorded in the case report form (CRF): Pulmonary function: FVC ( % predicted) upright and supine capillary blood gas analysis, room air (pH, pCO2, HCO3-, pO2) anamnestic questions (Borg scale 0-4) Gender Age Percutaneous Endoscopic Gastrostomy (PEG)/ Percutaneous Radiological Gastrostomy (PRG) tube: yes/no Medication Weight/ BMI Living situation Civil status The following clinical characteristics from their medical record (from neurologist or rehabilitation specialist): Date of diagnosis Type of ALS at onset ALSFRS-R at the time of diagnosis Pulmonary function at the time of diagnosis Cognitive status (ECAS, ALS-FTD-Q) Medical history Validated questionnaires (online): Quality of life questionnaires (SF 36, ALSAQ-40) Respiratory insufficiency questionnaire (SRI) ALS FRS R (patient version) Bulbar symptoms questionnaire (CNS BFS) After the first visit patients will participate in one of the two cohorts (non-randomized): Cohort 1: patients who start NIV in the first two months after the first visit to the HMV Cohort 2: patients who do not start NIV in the first two months after the first visit to the HMV. Cohort 1: Data will be recorded at the moment of initiation of NIV and 3, 6 and 9 months after initiation. Data will be recorded during regular visits (to the HMV centre or at the patients home). Pulmonary function: capillary blood gas, room air (pH, pCO2 (kPa/ mmHg), HCO3- (mmol/l), SaO2 (%)) anamnestic questions (Borg scale 0-4) Nocturnal gas exchange by transcutaneous measurement, at the patients home - Mean tcpCO2 (kPa), Maximal tcpCO2 (kPa), mean oxygen saturation (%), lowest oxygen saturation (%) Data from NIV equipment (compliance, modus, IPPA, EPAP, freq, mask type) Use of NIV hours a day/night In case of no use: why not? PEG/ PRG tube: yes/no Survival Tracheostomy or not Weight Validated online questionnaires: Quality of life questionnaires (SF 36, ALSAQ-40) Respiratory insufficiency questionnaire (SRI) ALS FRS R (patient version) Bulbar symptoms questionnaire (CNS BFS) Nocturnal gas exchange, transcutaneous, at the patients home Cohort 2: Data will be recorded every 3 months until initiation of NIV or death or max 1,5 years after the first visit to the HMV. Data will be recorded during regular visits (to the HMV centre or at the patients home). Pulmonary function: Capillary blood gas (pH, pCO2 (kPa/ mmHg), HCO3- (mmol/l), SaO2 (%)) anamnestic questions (Borg scale 0-4) Nocturnal gas exchange by transcutaneous measurement, at the patients home - tcpCO2 (kPa), Maximal tcpCO2 (kPa), oxygen saturation (%), lowest oxygen saturation (%) PEG/ PRG tube: yes/no Survival Tracheostomy or not Weight Cognitive status (from medical record) Reason for not starting NIV Validated online questionnaires: Quality of life questionnaires (SF 36, ALSAQ-40) Respiratory insufficiency questionnaire (SRI) ALS FRS R (patient version) Bulbar symptoms questionnaire (CNS BFS) Nocturnal gas exchange, transcutaneous, at the patients home If a patient in cohort 2 will start with NIV, the patient will be transferred to cohort 1.

Official Title
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Optimizing INITIation of Non-invasive Ventilation in ALS Patients

Conditions
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Amyotrophic Lateral Sclerosis

Intervention / Treatment
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* Other: Standard care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age > 18 years Diagnosis of ALS, PLS or PSMA Ability to give informed consent. Ability to fill in the questionnaires independently or with assistance of a caregiver. Exclusion Criteria: Use of NIV or invasive ventilation (tracheostomy) at time of first visit to a HMV centre. Pregnancy

Ages Eligible for Study
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Minimum Age: 18 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 |
| --- | --- |
| Cohort 1<br>Patients who start NIV in the first two months after the first visit to the HMV | Other: Standard care<br>* Both groups: standard care+ questionnaires<br>|
| Cohort 2<br>Patients who do not start NIV in the first two months after the first visit to the HMV. | Other: Standard care<br>* Both groups: standard care+ questionnaires<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Health related Quality of Life in patients with ALS | Assessed by Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ-40) Min score: 0 Max score: 160 Higher scores mean a worse outcome | 15 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Survival | Determine the effect of NIV on survival in patients with different ALS phenotypes. | 15 months | 
| Overall function | Overall function decline based on the ALS Functional Rating Scale Revised (ALS-FRS-R). Min score: 0 Max score: 48 Higher scores mean a worse outcome | 15 months | 
| Forced vital capacity | Pulmonary function based on FVC Min score: 0% Max score: 100% Lower scores mean a worse outcome | 15 months | 
| Carbondioxide | Pulmonary function based on carbondioxide pCO2 in capillary bloodgas Min score: 4 kPa Max score: 9 kPa Higher score means a worse outcome | 15 months | 
| Anamnestic questions | Pulmonary function based on anamnestic questions, Borg scale Min score: 0 Max score: 40 Higher score means a worse outcome | 15 months | 
| Bulbar function | Bulbar function based on questionnaire Center for Neurological Study Bulbar Functional Scale (CNS BFS). Min score: 21 Max score: 105 Higher scores means a worse outcome | 15 months | 
| Weight | Weight in kg Min score: 40 Max score 130 Lower scores mean a worse outcome | 15 months | 
| General health Quality of Life in patients with severe respiratory insufficiency | Assessed by severe respiratory insufficiency questionnaire (SRI) Min score: 49 Max score: 245 Higher scores mean worse outcome | 15 months | 
| General health Quality of Life | Assessed by in Short Form Health Survey (SF-36) Min score: 45 Max score: 198 Higher score means a worse outcome | 15 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Noninvasive ventilation, Quality of life