Is ioflupane I123 injection diagnostically effective in patients with movement disorders and dementia? Pooled analysis of four clinical trials

O'Brien, J. T., Oertel, W. H., McKeith, I. G., Grosset, D. G. , Walker, Z., Tatsch, K., Tolosa, E., Sherwin, P. F. and Grachev, I. D. (2014) Is ioflupane I123 injection diagnostically effective in patients with movement disorders and dementia? Pooled analysis of four clinical trials. BMJ Open, 4(7), e005122. (doi: 10.1136/bmjopen-2014-005122) (PMID:24993764) (PMCID:PMC4091455)

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Abstract

Objectives: To pool clinical trials of similar design to assess overall sensitivity and specificity of ioflupane I123 injection (DaTSCAN or ioflupane (123I)) to detect or exclude a striatal dopaminergic deficit disorder (SDDD), such as parkinsonian syndrome and dementia with Lewy bodies. Design: Pooled analysis of three phase 3 and one phase 4 clinical trials. These four trials were selected because they were the four studies used for the US new drug application to the Food and Drug Administration (FDA). Setting: Multicentre, open-label, non-randomised. Participants: Patients with either a movement disorder or dementia, and healthy volunteers. Interventions: Ioflupane (123I) was administered. Outcome measures: Images were assessed by panels of 3–5 blinded experts and/or on-site nuclear medicine physicians, classified as normal or abnormal and compared with clinical diagnosis (reference standard) to determine sensitivity and specificity. Results: Pooling the four studies, 928 participants were enrolled, 849 were dosed and 764 completed their study. Across all studies, when images were assessed by on-site readers, ioflupane (123I) diagnostic effectiveness had an overall (95% CI) sensitivity of 91.9% (88.7% to 94.5%) and specificity of 83.6% (78.7% to 87.9%). When reads were conducted blindly by a panel of independent experts, the overall sensitivity was 88.7% (86.8% to 90.4%) and specificity was 91.2% (89.0% to 93.0%). Conclusions: In this pooled analysis, the visual assessment of ioflupane (123I) images provided high levels of sensitivity and specificity in detecting the presence/absence of an SDDD. Ioflupane (123I) imaging has the potential to improve diagnostic accuracy in patients with signs and symptoms of a movement disorder and/or dementia. Trial registration number: NCT00209456.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Grosset, Dr Donald
Authors: O'Brien, J. T., Oertel, W. H., McKeith, I. G., Grosset, D. G., Walker, Z., Tatsch, K., Tolosa, E., Sherwin, P. F., and Grachev, I. D.
College/School:College of Medical Veterinary and Life Sciences > Institute of Neuroscience and Psychology
Journal Name:BMJ Open
Publisher:BMJ Publishing Group
ISSN:2044-6055
ISSN (Online):2044-6055
Published Online:03 July 2014
Copyright Holders:Copyright © 2014 The Authors
First Published:First published in BMJ Open 4(7):e005021
Publisher Policy:Reproduced under a Creative Commons License

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