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Efficacy and safety of leuprorelin acetate for subjects with spinal and bulbar muscular atrophy: pooled analyses of two randomized-controlled trials

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Abstract

Background

Spinal and bulbar muscular atrophy (SBMA) is an adult-onset, hereditary neuromuscular disease characterized by muscle atrophy, weakness, contraction fasciculation, and bulbar involvement. Although the causative gene, androgen receptor, has been identified, the development of novel therapeutics for SBMA is incomplete. In this study, the efficacy and safety of leuprorelin acetate administration for patients with SBMA, using the pooled data of two randomized-controlled trials, was studied.

Methods

Two randomized double-blinded studies (JASMITT-06DB and JASMITT-11DB) were done as multicentric, investigator-initiated clinical trials in Japan. In both studies, eligible patients were randomly assigned 1:1 to receive leuprorelin acetate administration once per 12 weeks for 48 weeks. The primary endpoint was the longitudinal change of pharyngeal barium residues from the baseline data measured with videofluorographic swallowing analyses. The pooled analysis plan was decided upon after the 06B study was finished and before the 11DB study began.

Results

The primary endpoint difference between the leuprorelin group and the placebo group was pharyngeal barium residue after initial swallowing, − 4.12% (95% CI, − 8.40–0.15; p = 0.058). The primary endpoint of this study does not reach significant results, although inter-group differences of pharyngeal barium residues after the initial swallowing indicated that leuprorelin acetate may be effective at each assessment point in both study groups.

Conclusions

The efficacy of leuprorelin acetate for patients with SBMA was statistically similar in two randomized-controlled trials, and suggested that leuprorelin acetate may be effective and safe. Further investigations are needed to clarify the promising efficacy of the drug.

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Acknowledgements

This study is funded by Large Scale Clinical Trial Network Project, which is subsidised by the Japan Ministry of Health, Labour and Welfare and supported by Health and Labour Sciences Research Grants, Japan. Study drugs were provided by Takeda Pharmaceuticals. We thank all patients and their families for participating in this study. JASMITT study group: Principle investigator in 06 DB trial, H Sasaki, M Aoki, I Nakano, S Ito, H Mizusawa, To Yamamoto, K Hasegawa, H Miyajima, G Sobue, N Kanda, K Nakajima, A tsujino, M Uchino, Principle investigator in 11DB trial, M Morita, K Kanai, Ta Yamamoto, H Mizusawa, To Yamamoto, and G Sobue.

Author information

Authors and Affiliations

  1. Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, showa-ku, Nagoya, Aichi, 466-8550, Japan

    Atsushi Hashizume, Masahisa Katsuno, Keisuke Suzuki, Haruhiko Banno, Yu Takeuchi, Motoshi Kawashima, Noriaki Suga, Tomoo Mano, Amane Araki, Yasuhiro Hijikata & Gen Sobue

  2. Department of Clinical Research, Innovation Center for Clinical Research, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan

    Keisuke Suzuki

  3. Department of Biostatistics and bioinformatics, The University of Tokyo, Graduate school of Medicine, Tokyo, Japan

    Akihiro Hirakawa

  4. Research Division of Dementia and Neurodegenerative Disease, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, showa-ku, Nagoya, 466-8550, Japan

    Gen Sobue

Authors
  1. Atsushi Hashizume
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  2. Masahisa Katsuno
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  3. Keisuke Suzuki
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  4. Haruhiko Banno
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  5. Yu Takeuchi
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  6. Motoshi Kawashima
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  7. Noriaki Suga
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  8. Tomoo Mano
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  9. Amane Araki
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  10. Yasuhiro Hijikata
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  11. Akihiro Hirakawa
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  12. Gen Sobue
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Consortia

JASMITT study group

  • H. Sasaki
  • , M. Aoki
  • , I. Nakano
  • , S. Ito
  • , H. Mizusawa
  • , To Yamamoto
  • , K. Hasegawa
  • , H. Miyajima
  • , G. Sobue
  • , N. Kanda
  • , K. Nakajima
  • , A. Tsujino
  • , M. Uchino
  • , M. Morita
  • , K. Kanai
  • , Ta Yamamoto
  • , H. Mizusawa
  • , To Yamamoto
  •  & G. Sobue

Contributions

AH drafting/revising the manuscript, analysis/interpretation of the data, research project execution, data acquisition, statistical analysis, and study design and concept. MK research project organization, research project execution, revising the manuscript, interpretation of the data, statistical analysis, study design and concept. KS acquisition of data, research project execution, and study design and concept. HB acquisition of data, research project execution, and study design and concept. YT, MK, NS, TM, AA, and YH: acquisition of data and research project execution. GS: research project organization, research project execution, revising the manuscript, interpretation of the data, statistical analysis, and study design and concept.

Corresponding authors

Correspondence to Masahisa Katsuno or Gen Sobue.

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Conflicts of interest

MK and GS have received honoraria from Takeda Pharmaceuticals. All other authors have no conflicts of interest.

Additional information

Members of the group “JASMITT study group” are listed in Acknowledgements section.

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Hashizume, A., Katsuno, M., Suzuki, K. et al. Efficacy and safety of leuprorelin acetate for subjects with spinal and bulbar muscular atrophy: pooled analyses of two randomized-controlled trials. J Neurol 266, 1211–1221 (2019). https://doi.org/10.1007/s00415-019-09251-x

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  • DOI: https://doi.org/10.1007/s00415-019-09251-x

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