• Mamede de Carvalho and Michael Swash.
• Department of Neurology, Hospital de Santa Maria, Lisbon, Portugal.
• Arch Neurol Chicago. 2006 Apr 1;63(4):557-60.

BackgroundThe marked variability in progression of amyotrophic lateral sclerosis (ALS) requires large numbers of patients to detect a significant effect in current clinical trial designs.ObjectiveTo test the utility of a lead-in period to assess rate of progression so that patients with rapidly progressive ALS can be selected for subsequent clinical trials.DesignProspective study.SettingThe ALS Center, University of Lisbon, Lisbon, Portugal.PatientsFifty-seven consecutively recruited patients assessed at diagnosis and 3 months later (end of lead-in period).InterventionsChange in ALS Functional Rating Scale (ALS-FRS) score was analyzed to establish a statistically significant cutoff point to define patients with rapid (group 1) or slow (group 2) progression. Patients from both groups were reexamined 1 and 3 months after the lead-in period.Main Outcome MeasuresChanges in ALS-FRS score, motor unit number estimation, and neurophysiologic index, and resultant grouping of patients according to rate of progression at 1 and 3 months.ResultsBoth the 80th percentile and 2 SDs above the mean of the change in ALS-FRS score identified the same patients. Twelve patients showed rapid progression (group 1) and 45 showed slow progression (group 2). One month after the lead-in period there was a significant reduction in ALS-FRS score, motor unit number estimation, and neurophysiologic index in group 1, and after 3 months all these measurements changed significantly in both groups.ConclusionsThis strategy of selecting patients with rapidly progressing ALS for inclusion in exploratory, short phase II clinical trials offers substantial savings in costs and time, and could accelerate the process of testing potentially useful drugs for the treatment of ALS.

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