The predictive validity of pontine volume change in spinocerebellar ataxia type 1 (SCA1)

Pontine volume previously emerged as a sensitive MR marker to track disease progression in SCA1. To accept this marker as a surrogate clinical trial endpoint, long-term follow-up is necessary to confirm its sensitivity to change and to establish its predictive validity.

(1)Confirm the sensitivity to change in pontine volume after two years and identify predictors of volume reduction, and (2)to evaluate the predictive value of one-year changes in pontine volume on subsequent clinical progression after two years.

We conducted a two-year, multimodal longitudinal study in a single-center cohort of SCA1 patients, assessed at baseline, one- and two years. Responsiveness of outcome measures was estimated after both one and two years. Predictors of pontine volume changes and predictive validity of pontine volume changes on subsequent clinical changes were evaluated using correlation and regression analyses as well as mixed modelling.

Pontine volume was the most responsive outcome measure after both one (SRM -2.3) and two years (SRM -3.3). Rate of pontine atrophy accelerated during the disease course and was more pronounced in more severely affected patients. One-year changes in pontine volume showed moderate to strong correlations with progression in ataxia severity and with changes in gait after two years.

This study confirms high responsiveness of pontine volume loss and provides first evidence of its predictive validity, as one-year changes in pontine volume were associated with subsequent changes in ataxia severity and gait. Pontine volume loss is thus a candidate surrogate endpoint in SCA1 clinical trials.