Prognostic factors in ALS: a comparison between Germany and China

Abstract

Objective

Several independent prognostic factors, such as age of onset, type of onset, body mass index (BMI), and progression rate have been identified for amyotrophic lateral sclerosis (ALS) in Caucasians. The aim of this study was to identify such factors in Chinese patients and to compare their impact with German patients.

Methods

Comparison of prognostic factors was based on two hospital-based registries. The registry of the German Network for Motor Neuron Diseases contains 3100 patients with ALS. The Chinese registry comprises 2101 patients who were collected between 2003 and 2015 in the metropolitan area of Beijing.

Results

Disease progression was slower in China [median loss of 0.50 points (IQR 0.26–0.87 points) versus 0.55 points (IQR 0.28–1.00 points) of ALS functional rating scale revised (ALS-FRS-R) score per month; p < 0.0001]. Survival of patients with ALS was similar in Germany and China (p > 0.05). We found that younger age of onset (p < 0.0001), spinal onset (p < 0.0001), high BMI (p < 0.0001) and low progression rate (p < 0.0001) were positive prognostic factors in China as well as in Germany.

Interpretation

Prognostic factors, which are known to modify the course of disease in Caucasians, apply to Chinese patients as well. The results indicate that despite the apparent differences regarding genotype and clinical phenotype, findings from interventional studies in Caucasians aiming at disease-modifying prognostic factors (such as body weight) may be transferred to Chinese patients.

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Acknowledgements

The German network for motoneuron diseases was funded by Bundesministerium für Bildung und Forschung (BMBF; 01GM1103A). Dr. Lu Chen has received funding from the National Natural Science Foundation of China (81701248). Prof. Dongsheng Fan has received funding from the National Natural Science Foundation of China (81873784).

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Correspondence to Johannes Dorst.

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Conflicts of interest

The German network for motoneuron diseases was funded by Bundesministerium für Bildung und Forschung (BMBF; 01GM1103A). Dr. Lu Chen has received funding from the National Natural Science Foundation of China (81701248). Prof. Dongsheng Fan has received funding from the National Natural Science Foundation of China (81873784). JDo, LC, AR, JS, AH, JDr, TM, UW, AH, JHW, JK, JW, TG, TH, PL, JCK, AS, JG, MM, JW, ASW, TK, MB, SJ, AS, BS, DZ, XL, LT, DSF, and ACL declare that they have no conflict of interest. SP reports honoraria as speaker/consultant from Biogen Idec, Novartis, Cytokinetics, TEVA Pharmaceuticals, Desitin. BG reports honoraria by Grifols, Bayer, DGN. Funding by DFG (GE 2249/1–3) and BMBF (01GM1511A).

Human participants and/or animals

The research involved human participants. The study has been approved by the local ethics committees of all participating centers and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

All patients gave their written informed consent for data collection and analysis.

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Dorst, J., Chen, L., Rosenbohm, A. et al. Prognostic factors in ALS: a comparison between Germany and China. J Neurol 266, 1516–1525 (2019). https://doi.org/10.1007/s00415-019-09290-4

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Keywords

  • Amyotrophic lateral sclerosis
  • Motor neuron disease
  • Prognostic factors
  • Survival
  • Germany
  • China