Mapping the differences in care for 5,000 Spinal Muscular Atrophy patients, a survey of 24 national registries in North America, Australasia and Europe

Catherine L. Bladen, Rachel Thompson, Jacqueline M. Jackson, Connie Garland, Claire Wegel, Anna Ambrosini, Paolo Pisano, Maggie C. Walter, Olivia Schreiber, Anna Lusakowska, Maria Jedrzejowska, Anna Kostera-Pruszczyk, Ludo van der Pol, Renske I. Wadman, Ole Gredal, Ayse Karaduman, Haluk Topaloglu, Oznur Yilmaz, Vitaliy Matyushenko, Vedrana Milic Rasic, Ana Kosac, Veronika Karcagi, Marta Garami, Agnes Herczegfalvi, Soledad Monges, Angelica Moresco, Lilien Chertkoff, Teodora Chamova, Velina Guergueltcheva, Niculina Butoianu, Dana Craiu, Lawrence Korngut, Craig Campbell, Jana Haberlova, Jana Strenkova, Moises Alejandro, Alatorre Jimenez, Genaro Gabriel Ortiz, Gracia Viviana Gonzalez Enriquez, Miriam Rodrigues, Richard Roxburgh, Hugh Dawkins, Leanne Youngs, Jaana Lahdetie, Natalija Angelkova, Pascal Saugier-Veber, Jean-Marie Cuisset, Clemens Bloetzer, Pierre-Yves Jeannet, Andrea Klein, Andres Nascimento, Eduardo Tizzano, David Salgado, Eugenio Mercuri, Thomas Sejersen, Jan Kirschner, Karen Rafferty, Volker Straub, Kate Bushby, Jan Verschuuren, Christophe Beroud, Hanns Lochmüller

Spinal muscular atrophy (SMA) is an autosomal recessive genetic disorder characterised by the degeneration of motor neurons and progressive muscle weakness. It is caused by homozygous deletions in the survival motor neuron gene on chromosome 5. SMA shows a wide range of clinical severity, with SMA type I patients often dying before 2 years of age, whereas type III patients experience less severe clinical manifestations and can have a normal life span. Here, we describe the design, setup and utilisation of the TREAT-NMD national SMA patient registries characterised by a small, but fully standardised set of registry items and by genetic confirmation in all patients. We analyse a selection of clinical items from the SMA registries in order to provide a snapshot of the clinical data stratified by SMA subtype, and compare these results with published recommendations on standards of care. Our study included 5,068 SMA patients in 25 countries. A total of 615 patients were ventilated, either invasively (178) or non-invasively (437), 439 received tube feeding and 455 had had scoliosis surgery. Some of these interventions were not available to patients in all countries, but differences were also noted among high-income countries with comparable wealth and health care systems. This study provides the basis for further research, such as quality of life in ventilated SMA patients, and will inform clinical trial planning.