A Machine-Learning Derived Huntington's Disease Progression Model: Insights for Clinical Trial Design.

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Applying machine-learning algorithms to large datasets such as those available in Huntington's disease offers the opportunity to discover hidden patterns, often not discernible to clinical observation.

A computer model of Huntington's disease progression is missing.

Longitudinal data encompassing 2079 assessment measures from four observational studies were integrated and machine-learning methods were applied to develop a probabilistic model of disease progression. The model was validated using a separate Enroll-HD dataset and compared with existing clinical reference assessments and CAG-age product.

Nine disease states were discovered based on 44 motor, cognitive, and functional measures, which correlated with reference assessments.

The validation set included 3158 participants of whom 61.5% had manifest disease. Analysis of transition times showed that "early-disease" states 1 and 2, which occur before motor diagnosis, lasted ~16 years.

Increasing numbers of participants had motor onset during "transition" states 3 to 5, which collectively lasted ~10 years, and the "late-disease" states 6 to 9 also lasted ~10 years. The annual probability of conversion from one of the nine identified disease states to the next ranged from 5% to 27%.

The natural history of Huntington's disease can be described by nine disease states of increasing severity. The ability to derive characteristics of disease states and probabilities for progression through these states will improve trial design and participant selection. © 2021 International Parkinson and Movement Disorder Society.

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