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Abstract
Objective: To evaluate the use and tolerability of noninvasive positive pressure ventilation (NIV) in patients with amyotrophic lateral sclerosis (ALS) early in their disease by comparing active NIV and sham NIV in patients not yet eligible for NIV use as recommended by practice guidelines.
Methods: This was a single-center, prospective, double-blind, randomized, placebo (sham)–controlled pilot trial. Patients with ALS were randomized to receive either sham NIV or active NIV and underwent active surveillance approximately every 3 months until they reached a forced vital capacity (FVC) <50% or required NIV for clinical symptom management.
Results: In total, 54 participants were randomized. The mean NIV use was 2.0 hours (95% confidence interval [CI] 1.1–3.0) per day in the sham NIV treatment group and 3.3 hours (CI 2.0–4.6) per day in the active NIV group, which did not differ by treatment group (p = 0.347). The majority of sham NIV participants (88%) and active NIV participants (73%) reported only mild or no problem with NIV use. Difference of change in FVC through the treatment period by group (0.44 per month) favored active NIV (p = 0.049). Survival and changes in maximal inspiratory or expiratory pressure did not differ between treatment groups.
Conclusions: The efficacy of early NIV in ALS should be tested in randomized, placebo-controlled trials. The trial is registered on clinicaltrials.gov (NCT00580593).
Classification of evidence: This study provides Class II evidence that for patients with ALS, adherence with NIV and sham NIV are similar.
GLOSSARY
- ALS=
- amyotrophic lateral sclerosis;
- ALSFRS-R=
- ALS Functional Rating Scale–revised;
- CI=
- confidence interval;
- EPAP=
- expiratory positive airway pressure;
- FVC=
- forced vital capacity;
- IPAP=
- inspiratory positive airway pressure;
- MEP=
- maximum expiratory pressure;
- MIP=
- maximum inspiratory pressure;
- NIV=
- noninvasive positive pressure ventilation;
- TDI=
- transitional dyspnea index
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received March 21, 2016.
- Accepted in final form July 5, 2016.
- © 2016 American Academy of Neurology
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