Consensus Recommendations for Clinical Outcome Assessments and Registry Development in Ataxias: Ataxia Global Initiative (AGI) Working Group Expert Guidance

To accelerate and facilitate clinical trials, the Ataxia Global Initiative (AGI) was established as a worldwide research platform for trial readiness in ataxias. One of AGI’s major goals is the harmonization and standardization of outcome assessments. Clinical outcome assessments (COAs) that describe or reflect how a patient feels or functions are indispensable for clinical trials, but similarly important for observational studies and in routine patient care. The AGI working group on COAs has defined a set of data including a graded catalog of COAs that are recommended as a standard for future assessment and sharing of clinical data and joint clinical studies. Two datasets were defined: a mandatory dataset (minimal dataset) that can ideally be obtained during a routine clinical consultation and a more demanding extended dataset that is useful for research purposes. In the future, the currently most widely used clinician-reported outcome measure (ClinRO) in ataxia, the scale for the assessment and rating of ataxia (SARA), should be developed into a generally accepted instrument that can be used in upcoming clinical trials. Furthermore, there is an urgent need (i) to obtain more data on ataxia-specific, patient-reported outcome measures (PROs), (ii) to demonstrate and optimize sensitivity to change of many COAs, and (iii) to establish methods and evidence of anchoring change in COAs in patient meaningfulness, e.g., by determining patient-derived minimally meaningful thresholds of change

Orthogonal HPLC methods for quantitating related substances and degradation products of pramlintide

Pramlintide is a 37-amino acid peptide that is being evaluated as a drug candidate for treating people with type 1 and insulin-using type 2 diabetes. Two high-performance liquid chromatography (HPLC) methods were developed for quantitating related substance impurities in pramlintide drug substance as well as degradation products of pramlintide formulated for parenteral administration. The methods differ with respect to separation mode and therefore provide orthogonal information concerning related substances and degradation products. One method uses a reverse phase (RP) separation mode, and the other involves a strong cation exchange (SCX) separation. Method performance testing showed that the RP- and SCX-HPLC methods both afford a high degree of selectivity, accuracy, precision, and sensitivity. The limit of quantitation for determining spiked authentic samples of degradation products was shown to be approximately 0.1% (relative to intact pramlintide) for both methods. Relative retention times for known pramlintide degradation products were determined for both the RP- and SCX-HPLC methods, demonstrating the selectivities of the 2 methods as well as the orthogonality of the information. The methods were also shown to be diastereospecific with respect to separating pramlintide from authentic samples of D-isomers at Ala5, Ala8, Ala5-Ala8, and Leu12. The methods did not resolve pramlintide, however, from diastereomers with D-isomers near the C- and N-termini, namely Lys1,Cys2, and Tyr37

The role of myocardial perfusion scanning, heart rate variability and D-dimers in predicting the risk of perioperative cardiac complications after peripheral vascular surgery

Objectives: to study the value of a number of proposed prog-nos tic factors in prediction of the risk of perioperative cardiac events after vascular surgery. Design and Methods: two hundred and ninety-seven patients undergoing peripheral vascular surgery were prospectively studied. Patients underwent preoperative 24 h ambulatory electrocardiography, measurement of haemostatic variables, myocardial assessment of perfusion by dipyridamole-thallium scintigraphy and radionuclide ventriculography, The primary endpoint was cardiac death or nonfatal myocardial infarction within 30 days of surgery. A combined endpoint included the primary endpoint plus occurrence of cardiac failure, unstable angina or serious arrhythmias, Results: the primary endpoint occurred in 21 (7 %), and the combined endpoint in 41 (14 %) of patients. On multivariate analysis, increased age, previous myocardial infarction, aortic surgery, impaired heart rate variability and a positive thallium scan were independent predictors of primary end- points. Preoperative atrial fibrillation and increased fibrin D-dimer were additional predictors of the combined endpoint. Construction of receiver-operator characteristic curves to examine the incremental value of predictive models showed that sensitivity and specificity of clinical data alone for primary endpoints was 71 % and 72 % respectively, while for the full model (incorporating heart rate variability and thallium data) this rose to 84 % and 80 % (P = 0.0001). Conclusions: preliminary screening using clinical data has limited value in risk assessment prior - to vascular surgery but preoperative heart rate variability, D-dimers and thallium scanning provide modest incremental predictive value