Publications by authors named "Tulinius M"

The aim of this study was to examine the concordance between parental and self-rated and performance-based tests of executive function in boys with Duchenne muscular dystrophy (DMD). A secondary aim was to explore how this concordance is related to parents' self-rated life satisfaction and status as a carrier mother versus non-carrier mother. In a cross-sectional study design, 70 boys with DMD, aged 5-14, and their parents were included.

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Stride velocity 95th centile (SV95C) is a wearable-derived endpoint representing the 5% fastest strides taken during everyday living. In July 2023, SV95C received European Medicines Agency (EMA) qualification for use as a primary endpoint in trials of patients with Duchenne muscular dystrophy (DMD) aged ≥ 4 years-becoming the first digital endpoint to receive such qualification. We present the data supporting this qualification, providing insights into the evidentiary basis of qualification as a digital clinical outcome assessment.

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Background: Duchenne muscular dystrophy (DMD) is a neuromuscular disorder with progressive decline of pulmonary function increasing the risk of early mortality. The aim of this study was to explore the respiratory-related comorbidities, and the effect of these comorbidities and treatments on life expectancy and causes of death.

Methods: All male patients living in Sweden with DMD, born and deceased 1970-2019, were included.

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Article Synopsis
  • Vamorolone, a glucocorticoid receptor agonist, was tested to assess its effectiveness and safety over 48 weeks compared to prednisone in children with Duchenne muscular dystrophy (DMD).
  • A double-blind clinical trial involved 121 participants aged 4 to under 7 years, receiving varying doses of vamorolone and prednisone, with improvements monitored in motor skills and growth.
  • Results indicated that vamorolone (6 mg/kg/day) maintained motor skill improvements over 48 weeks, with significant growth benefits seen after participants switched from prednisone to vamorolone.
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Aim: Individuals with spinal muscular atrophy (SMA) are at risk of developing skeletal problems. This study investigated bone mineral density (BMD), bone turnover markers and motor function in children and adolescents with SMA type 2 and type 3 over a two-year period. The effect of nusinersen was studied in a subgroup.

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Objective: Strategic Targeting of Registries and International Database of Excellence (STRIDE) is an ongoing, international, multicenter registry of real-world ataluren use in individuals with nonsense mutation Duchenne muscular dystrophy (nmDMD) in clinical practice. This updated interim report (data cut-off: January 31, 2022), describes STRIDE patient characteristics and ataluren safety data, as well as the effectiveness of ataluren plus standard of care (SoC) in STRIDE versus SoC alone in the Cooperative International Neuromuscular Research Group (CINRG) Duchenne Natural History Study (DNHS).

Methods: Patients are followed up from enrollment for at least 5 years or until study withdrawal.

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The aim of this study was to describe behavioral strengths and difficulties in relation to intellectual function and age in boys with DMD. In a cross-sectional design, 70 boys with DMD were tested at 5, 8, 11, and 14 years of age (mean age 10y 5 m). Parental ratings of behavioral strengths and difficulties were studied in relation to age, intellectual function, motor function, and family socioeconomic status (SES).

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Article Synopsis
  • Long-term use of corticosteroidal anti-inflammatory drugs can negatively impact patient quality of life, highlighting the need for safer alternatives.
  • The study tested vamorolone, a new type of dissociative steroid, for its effectiveness and safety in boys aged 4 to under 7 with Duchenne muscular dystrophy (DMD) over a 24-week period.
  • Results showed that vamorolone (6 mg/kg) significantly improved motor function compared to placebo, while the safety profile was potentially better than traditional corticosteroids.
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Objective: The objective of this study was to assess the face validity of a disease model evaluating the cost-effectiveness of ataluren for the treatment of nonsense mutation Duchenne muscular dystrophy (nmDMD).

Methods: This was a Delphi panel study comprising of physicians with first-hand experience of ataluren for the treatment of nmDMD. Consensus was sought for previously unvalidated model data, including patient health status and quality of life measured using the Health Utility Index (HUI), mortality, informal caregiving, and the expected benefit of early ataluren treatment across four states: (1) ambulatory, (2) non-ambulatory, not yet requiring ventilation support, (3) non-ambulatory, night-time ventilation support, and (4) non-ambulatory, full-time ventilation support.

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Aims: This study aimed to investigate associations between renal and extrarenal manifestations of mitochondrial diseases and their natural history as well as predictors of renal disease severity and overall disease outcome. The secondary aim was to generate a protocol of presymptomatic assessment and monitoring of renal function in patients with a defined mitochondrial disease.

Methods: A multicenter, retrospective cohort study was performed by the Mitochondrial Clinical and Research Network (MCRN).

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Article Synopsis
  • Vamorolone is a synthetic steroid that shows strong anti-inflammatory effects, and earlier studies indicated it improved motor function in boys with Duchenne muscular dystrophy (DMD) after 6 months of high-dose treatment.
  • This study aimed to evaluate the outcomes of 30 months of ongoing vamorolone treatment in DMD patients, conducted by the Cooperative International Neuromuscular Research Group across multiple locations.
  • Results indicated that while the mean time-to-stand velocity of participants on higher doses of vamorolone showed a slight decrease over the treatment period, this change was not statistically significant, suggesting the need for further research.
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Background: Large-scale mitochondrial DNA deletions (LMD) are a common genetic cause of mitochondrial disease and give rise to a wide range of clinical features. Lack of longitudinal data means the natural history remains unclear. This study was undertaken to describe the clinical spectrum in a large cohort of patients with paediatric disease onset.

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Duchenne muscular dystrophy (DMD) is a severe neuromuscular disorder with increasing life expectancy from late teens to over 30 years of age. The aim of this nationwide study was to explore the prevalence, life expectancy and leading causes of death in patients with DMD in Sweden. Patients with DMD were identified through the National Quality Registry for Neuromuscular Diseases in Sweden, the Swedish Registry of Respiratory Failure, pathology laboratories, neurology and respiratory clinics, and the national network for neuromuscular diseases.

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We investigated the effect of ataluren plus standard of care (SoC) on age at loss of ambulation (LoA) and respiratory decline in patients with nonsense mutation Duchenne muscular dystrophy (nmDMD) versus patients with DMD on SoC alone. Study 019 was a long-term Phase III study of ataluren safety in nmDMD patients with a history of ataluren exposure. Propensity score matching identified Study 019 and CINRG DNHS patients similar in disease progression predictors.

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Introduction: Ataluren is a relatively new treatment for male patients with Duchenne muscular dystrophy (DMD) due to a premature stop codon. Long-term longitudinal data as well as efficacy data on non-ambulant patients are still lacking. Here we present the results from a long-term follow-up study of all DMD patients treated with ataluren and followed at the Queen Silvia Children's Hospital in Gothenburg, Sweden, with focus on the evolution of patients' upper motor and respiratory function over time.

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Background: Edasalonexent (CAT-1004) is an orally-administered novel small molecule drug designed to inhibit NF-κB and potentially reduce inflammation and fibrosis to improve muscle function and thereby slow disease progression and muscle decline in Duchenne muscular dystrophy (DMD).

Objective: This international, randomized 2 : 1, placebo-controlled, phase 3 study in patients ≥4 - < 8 years old with DMD due to any dystrophin mutation examined the effect of edasalonexent (100 mg/kg/day) compared to placebo over 52 weeks.

Methods: Endpoints were changes in the North Star Ambulatory Assessment (NSAA; primary) and timed function tests (TFTs; secondary).

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The development of therapeutics for muscle diseases such as facioscapulohumeral dystrophy (FSHD) is impeded by a lack of objective, minimally invasive biomarkers. Here we identify circulating miRNAs and proteins that are dysregulated in early-onset FSHD patients to develop blood-based molecular biomarkers. Plasma samples from clinically characterized individuals with early-onset FSHD provide a discovery group and are compared to healthy control volunteers.

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  • Reversible infantile respiratory chain deficiency (RIRCD) is a rare mitochondrial condition in infants that usually improves on its own after six months; it’s linked to a specific mitochondrial mutation but affects only 1% of carriers.* -
  • Research on 27 affected infants revealed additional mutations in nuclear genes related to mitochondrial function in most cases, suggesting a dual genetic influence on the condition.* -
  • Analysis of patient muscle indicates that metabolic changes involving stress responses and mitochondrial growth may contribute to recovery in RIRCD, which could also explain differences seen in other mitochondrial disorders.*
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  • Vamorolone is a new investigational drug for treating Duchenne muscular dystrophy (DMD) that aims to reduce muscle weakness without some of the negative effects seen with long-term corticosteroid use.
  • In an 18-month study involving participants aged 4 to 7, vamorolone showed significant clinical improvements in motor functions compared to baseline measurements.
  • The study also compared outcomes from vamorolone-treated patients with those on no corticosteroids and those already receiving corticosteroid treatment, finding similar improvements in standing ability for vamorolone and corticosteroid-naïve participants.
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  • - This study examined serum biomarkers FGF21 and GDF15 to see if they are useful for diagnosing mitochondrial disease compared to muscle tissue analysis, using data from 194 patients.
  • - Findings revealed that only 39% of patients with confirmed mitochondrial disease showed muscle pathology, while 62% had elevated biomarkers, indicating a stronger correlation between biomarker levels and disease.
  • - The study concluded that measuring FGF21 and GDF15 could improve diagnostic accuracy for mitochondrial disorders, especially in patients whose muscle biopsies were less informative, suggesting these biomarkers should be prioritized in diagnosis alongside traditional methods.
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Assess the totality of efficacy evidence for ataluren in patients with nonsense mutation Duchenne muscular dystrophy (nmDMD). Data from the two completed randomized controlled trials (ClinicalTrials.gov: NCT00592553; NCT01826487) of ataluren in nmDMD were combined to examine the intent-to-treat (ITT) populations and two patient subgroups (baseline 6-min walk distance [6MWD] ≥300-<400 or <400 m).

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Strategic Targeting of Registries and International Database of Excellence (STRIDE) is an ongoing, multicenter registry providing real-world evidence regarding ataluren use in patients with nonsense mutation Duchenne muscular dystrophy (nmDMD). We examined the effectiveness of ataluren + standard of care (SoC) in the registry versus SoC alone in the Cooperative International Neuromuscular Research Group (CINRG) Duchenne Natural History Study (DNHS), DMD genotype-phenotype/-ataluren benefit correlations and ataluren safety. Propensity score matching was performed to identify STRIDE and CINRG DNHS patients who were comparable in established disease progression predictors (registry cut-off date, 9 July 2018).

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Article Synopsis
  • The study evaluated vamorolone, a novel anti-inflammatory drug, in 48 boys aged 4-7 with Duchenne muscular dystrophy (DMD) to determine the optimal dosage and effectiveness.
  • Conducting a 24-week trial with varying doses (0.25, 0.75, 2.0, and 6.0 mg/kg/d), researchers found that the 2.0 mg/kg/d dose significantly improved muscle function without the common side effects associated with glucocorticoids.
  • Results indicated that vamorolone was safe and well-tolerated, showing potential benefits in bone health and lower risk of adrenal suppression and insulin resistance compared to traditional glucocorticoid treatments.
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Strategic Targeting of Registries and International Database of Excellence (STRIDE) is an ongoing, multicenter registry providing real-world evidence regarding ataluren use in patients with nonsense mutation Duchenne muscular dystrophy (DMD) in clinical practice (NCT02369731). Here, we describe the initial demographic characteristics of the registry population. Patients will be followed up from enrollment for ≥5 years or until study withdrawal.

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