Abstract
Autosomal recessive cerebellar ataxias (ARCAs) form an ultrarare yet expanding group of neurodegenerative multisystemic diseases affecting the cerebellum and other neurological or non-neurological systems. With the advent of targeted therapies for ARCAs, disease registries have become a precious source of real-world quantitative and qualitative data complementing knowledge from preclinical studies and clinical trials. Here, we review the ARCA Registry, a global collaborative multicenter platform (>15 countries, >30 sites) with the overarching goal to advance trial readiness in ARCAs. It presents a good clinical practice (GCP)- and general data protection regulation (GDPR)-compliant professional-reported registry for multicenter web-based capture of cross-center standardized longitudinal data. Modular electronic case report forms (eCRFs) with core, extended, and optional datasets allow data capture tailored to the participating site's variable interests and resources. The eCRFs cover all key data elements required by regulatory authorities [European Medicines Agency (EMA)] and the European Rare Disease (ERD) platform. They capture genotype, phenotype, and progression and include demographic data, biomarkers, comorbidity, medication, magnetic resonance imaging (MRI), and longitudinal clinician- or patient-reported ratings of ataxia severity, non-ataxia features, disease stage, activities of daily living, and (mental) health status. Moreover, they are aligned to major autosomal-dominant spinocerebellar ataxia (SCA) and sporadic ataxia (SPORTAX) registries in the field, thus allowing for joint and comparative analyses not only across ARCAs but also with SCAs and sporadic ataxias. The registry is at the core of a systematic multi-component ARCA database cluster with a linked biobank and an evolving study database for digital outcome measures. Currently, the registry contains more than 800 patients with almost 1,500 visits representing all ages and disease stages; 65% of patients with established genetic diagnoses capture all the main ARCA genes, and 35% with unsolved diagnoses are targets for advanced next-generation sequencing. The ARCA Registry serves as the backbone of many major European and transatlantic consortia, such as PREPARE, PROSPAX, and the Ataxia Global Initiative, with additional data input from SPORTAX. It has thus become the largest global trial-readiness registry in the ARCA field.
Highlights
Specialty section: This article was submitted to Movement Disorders, a section of the journal Frontiers in Neurology
They capture genotype, phenotype, and progression and include demographic data, biomarkers, comorbidity, medication, magnetic resonance imaging (MRI), and longitudinal clinician- or patient-reported ratings of ataxia severity, non-ataxia features, disease stage, activities of daily living, and health status. They are aligned to major autosomal-dominant spinocerebellar ataxia (SCA) and sporadic ataxia (SPORTAX) registries in the field, allowing for joint and comparative analyses across autosomal recessive cerebellar ataxia (ARCA) and with SCAs and sporadic ataxias
The registry contains more than 800 patients with almost 1,500 visits representing all ages and disease stages; 65% of patients with established genetic diagnoses capture all the main ARCA genes, and 35% with unsolved diagnoses are targets for advanced next-generation sequencing
Summary
EMA, European Medicines Agency. *Indirect assessment by longitudinal capture of current treatment; **planned; ***once closer to monitoring of drug treatments. The network PROSPAX (An integrated multimodal PROgression chart in SPastic atAXias), launched in 2020 and funded by the European Joint Program on Rare Diseases (EJP RD), will establish a paradigmatic integrated trial-ready model of disease progression and mechanistic evolution in spastic ataxias. With establishing trial-ready cohorts and cross-center harmonized clinician-reported outcome measures and PROMs as one of its key tasks, the AGI uses the ARCA Registry as one of its key registries This reflects the fact that the ARCA Registry already captures all outcome measures that were stipulated by the AGI as the common core set of clinical outcome measures to be used by ataxia centers worldwide. The SPATAX network, which includes all types (i.e., autosomal recessive) of ataxias and HSPs, has contributed subsets of data to the ARCA Registry
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