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Schwarz H, Hickey C, Zimmerman C, Mazzoni P, Moskowitz C, Rosas D, McCall M, Sanchez-Ramos J, Perlmutter J, Wernle A, Higgins D, Nickerson C, Evans S, Kumar R, Miracle D, Dure L, Pendley D, Anderson K, Cines M, Ashizawa T, Stanton P, Fernandez H, Suelter M, Leavitt B, Decolongon J, Cudkowicz M, McDermott MP, Kieburtz K, Marshall F, Cha JH, Como P, Ferrante RJ, Friedlander RM, Shoulson I, Walker F, Bausch J, de Blieck E, Doolan R, Goldstein M, Preston L, Grasso D, Sweet B.
This study assessed the futility of proceeding with a Phase 3 clinical trial of minocycline as a disease-modifying treatment for Huntington's disease (HD). One hundred fourteen research participants with HD were randomized, 87 to minocycline (200 mg/d) and 27 to placebo. The change in Total Functional Capacity (TFC) score from baseline to Mo 18 was prespecified as the primary measure of HD progression. By using a futility design, we tested the null hypothesis that minocycline would reduce the mean decline in TFC score by at least 25% compared to a fixed value obtained from a historical database, with a one-tailed significance level of 10%. The placebo group was included to facilitate blinding. Rejection of the null hypothesis would discourage a major definitive trial of minocycline in HD. For the primary analysis, missing data were handled by carrying forward the last available observation; a secondary analysis used multiple imputations. The mean TFC decline in the minocycline group was 1.55 (SD 1.85), and futility was not declared (P = 0.12) for the primary analysis. When multiple imputation was used to handle missing data, the mean TFC decline in the minocycline group of 1.71 (SD 1.96, P = 0.07) suggested futility, as was the case for prespecified secondary outcome measures. There were no safety abnormalities attributable to minocycline. Based on the threshold of 25% improvement in TFC, further study of minocycline 200 mg/d in HD was not warranted. Futility designs aid in screening potential therapies for HD.
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