Affiliations: [a] Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA | [b] Duke Clinical Research Institute, Durham, NC, USA | [c] Merck Research Lab, Merck & Co, North Wales, PA, USA
Correspondence to: Sheng Luo, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27710, USA. Tel.: +1 919 668 8038; Fax: +1 919 668 7059; E-mail: [email protected].
Abstract: Background:Huntington’s disease (HD) has gradually become a public health threat, and there is a growing interest in developing prognostic models to predict the time for HD diagnosis. Objective:This study aims to develop a novel prognostic model that leverages multiple longitudinal biomarkers to inform the risk of HD. Methods:The multivariate functional principal component analysis was used to summarize the essential information from multiple longitudinal markers and to obtain a set of prognostic scores. The prognostic scores were used as predictors in a Cox model to predict the right-censored time to diagnosis. We used cross-validation to determine the best model in PREDICT-HD (n = 1,039) and ENROLL-HD (n = 1,776); external validation was carried out in ENROLL-HD. Results:We considered six commonly measured longitudinal biomarkers in PREDICT-HD and ENROLL-HD (Total Motor Score, Symbol Digit Modalities Test, Stroop Word Test, Stroop Color Test, Stroop Interference Test, and Total Functional Capacity). The prognostic model utilizing these longitudinal biomarkers significantly improved the predictive performance over the model with baseline biomarker information. A new prognostic index was computed using the proposed model, and can be dynamically updated over time as new biomarker measurements become available. Conclusion:Longitudinal measurements of commonly measured clinical biomarkers substantially improve the risk prediction of Huntington’s disease diagnosis. Calculation of the prognostic index informs the patient’s risk category and facilitates patient selection in future clinical trials.
Keywords: Cognitive disorders, cross validation, functional principal component analysis, Huntington’s disease, motor diagnosis, risk prediction