Factors Associated With Early Motor Function Trajectories in DMD After Glucocorticoid Initiation: Post Hoc Analysis of the FOR-DMD Trial.

BACKGROUND AND OBJECTIVES: Clinical trials in Duchenne muscular dystrophy (DMD) require 3-6 months of stable glucocorticoids, and the primary outcome is explored at 48-52 weeks. The factors that influence the clinical outcome assessment (COA) trajectories soon after glucocorticoid initiation are relevant for the design and analysis of clinical trials of novel drugs. We describe early COA trajectories, associated factors, and the time from glucocorticoid initiation to COA peak. METHODS: This was a prospective 18-month analysis of the Finding the Optimum Corticosteroid Regimen for Duchenne Muscular Dystrophy study. Four COAs were investigated: rise from supine velocity (RFV), 10-meter walk/run velocity (10MWRV), North Star Ambulatory Assessment (NSAA) total score, and 6-minute walk test distance (6MWT). The relationships of baseline age (4-5 vs 6-7 years), COA baseline performance, genotype, and glucocorticoid regimen (daily vs intermittent) with the COA trajectories were evaluated using linear mixed-effects models. RESULTS: One hundred ninety-six glucocorticoid-naïve boys with DMD aged 4-7 years were enrolled. The mean age at baseline was 5.9 ± 1.0 years, 66% (n = 130) were on daily regimens, 55% (n = 107) showed a 6MWT distance >330 metres; 41% (n = 78) showed RFV >0.2 rise/s; 76% (n = 149) showed 10MWRV >0.142 10m/s, and 41.0% (n = 79) showed NSAA total score >22 points. Mean COA trajectories differed by age at glucocorticoid initiation (p < 0.01 for RFV, 10MWRV, and NSAA; p < 0.05 for 6MWT) and regimen (p < 0.01 for RFV, 10MWRV, and NSAA). Boys younger than 6 years reached their peak performance 12-18 months after glucocorticoid initiation. Boys aged 6 years or older on a daily regimen peaked between months 9 and 12 and those on an intermittent regimen by 9 months. The baseline COA performance was associated with the NSAA (p < 0.01) and the 6MWT trajectory in boys younger than 6 years on a daily regimen (p < 0.01). Differences in the mean trajectories by genotype were not significant. DISCUSSION: Glucocorticoid regimen, age, duration of glucocorticoid exposure, and baseline COA performance need to be considered in the design and analysis of clinical trials in young boys with DMD.

The iQID camera: An ionizing-radiation quantum imaging detector.

We have developed and tested a novel, ionizing-radiation Quantum Imaging Detector (iQID). This scintillation-based detector was originally developed as a high-resolution gamma-ray imager, called BazookaSPECT, for use in single-photon emission computed tomography (SPECT). Recently, we have investigated the detector's response and imaging potential with other forms of ionizing radiation including alpha, neutron, beta, and fission fragment particles. The confirmed response to this broad range of ionizing radiation has prompted its new title. The principle operation of the iQID camera involves coupling a scintillator to an image intensifier. The scintillation light generated by particle interactions is optically amplified by the intensifier and then re-imaged onto a CCD/CMOS camera sensor. The intensifier provides sufficient optical gain that practically any CCD/CMOS camera can be used to image ionizing radiation. The spatial location and energy of individual particles are estimated on an event-by-event basis in real time using image analysis algorithms on high-performance graphics processing hardware. Distinguishing features of the iQID camera include portability, large active areas, excellent detection efficiency for charged particles, and high spatial resolution (tens of microns). Although modest, iQID has energy resolution that is sufficient to discriminate between particles. Additionally, spatial features of individual events can be used for particle discrimination. An important iQID imaging application that has recently been developed is real-time, single-particle digital autoradiography. We present the latest results and discuss potential applications.