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Meta-Analysis
. 2024 Jun;23(3):1184-1203.
doi: 10.1007/s12311-023-01621-6. Epub 2023 Oct 27.

Therapeutic Biomarkers in Friedreich's Ataxia: a Systematic Review and Meta-analysis

Maria Gavriilaki  1 , Evangelia Chatzikyriakou  2 , Maria Moschou  2 , Marianthi Arnaoutoglou  3 , Ioanna Sakellari  4 , Vasilios K Kimiskidis  2
Affiliations
Meta-Analysis

Therapeutic Biomarkers in Friedreich's Ataxia: a Systematic Review and Meta-analysis

Maria Gavriilaki et al. Cerebellum. 2024 Jun.

Abstract

Although a large array of biomarkers have been investigated in Friedreich's ataxia (FRDA) trials, the optimal biomarker for assessing disease progression or therapeutic benefit has yet to be identified. We searched PubMed, MEDLINE, and EMBASE databases up to June 2023 for any original study (with ≥ 5 participants and ≥ 2 months' follow-up) reporting the effect of therapeutic interventions on any clinical, cardiac, biochemical, patient-reported outcome measures, imaging, or neurophysiologic biomarker. We also explored the biomarkers' ability to detect subtle disease progression in untreated patients. The pooled standardized mean difference (SMD) was calculated using a random-effects model. The study's protocol was registered in PROSPERO (CRD42022319196). In total, 43 studies with 1409 FRDA patients were included in the qualitative synthesis. A statistically significant improvement was observed in Friedreich Ataxia Rating Scale scores [combining Friedreich Ataxia Rating Scale (FARS) and modified FARS (mFARS): SMD = - 0.32 (- 0.62 to - 0.02)] following drugs that augment mitochondrial function in a sensitivity analysis. Left ventricular mass index (LVMI) was improved significantly [SMD = - 0.34 (- 0.5 to - 0.18)] after 28.5 months of treatment with drugs that augment mitochondrial function. However, LVMI remained stable [SMD = 0.05 (- 0.3 to 0.41)] in untreated patients after 6-month follow-up. None of the remaining biomarkers changed significantly following any treatment intervention nor during the natural disease progression. Nevertheless, clinical implications of these results should be interpreted with caution because of low to very low quality of evidence. Further randomized controlled trials of at least 24 months' duration using a biomarker toolbox rather than a single biomarker are warranted.

Keywords: Biomarker; Friedreich’s ataxia; Therapeutics; Treatment outcome.

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Conflict of interest statement

The authors declare no competing interests.

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of study selection
Fig. 2
Fig. 2
Clinical outcome measures changes (A ICARS, B Friedreich Ataxia Rating Scale scores (FARS/mFARS)) following drugs that augment mitochondrial function
Fig. 3
Fig. 3
Clinical outcome measures changes (A SARA, B FARS) following drugs that increase frataxin
Fig. 4
Fig. 4
Cardiac biomarker changes following drugs that augment mitochondrial function. A Left ventricular mass index (LVMI), B intraventricular septal wall (IVS), C left ventricular ejection fraction (LVEF), D left ventricular posterior wall (LVPW), E fractional shortening (FS)
Fig. 5
Fig. 5
Changes in peripheral blood mononuclear cells’ (PBMCs) frataxin (FXN) levels following drugs that increase frataxin
Fig. 6
Fig. 6
Activities of Daily Living Scale (ADLs) changes following A drugs that augment mitochondrial function, B drugs that increase frataxin
See this image and copyright information in PMC

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