Trial of Early Noninvasive Ventilation for Amyotrophic Lateral Sclerosis (ALS)

• NIPPV adherence, as summarized by weekly means and standard deviations of hours of use for the two groups (active-NIPPV and sham-NIPPV). Additionally the patients' belief as to which treatment they believed they had tried will be assessed. [ Time Frame: every three months, for the duration of the disease or as long as the person with ALS is able to participate in the study. ] [ Designated as safety issue: No ]
  

• The SF-36 will be measured as a measure of quality of life. [ Time Frame: at baseline and every three months ] [ Designated as safety issue: No ]
  
• Pulmonary function tests including FVC will be measured. [ Time Frame: at baseline and every three months ] [ Designated as safety issue: No ]
  
• The ALS FRS will be used as a measure of functional outcome. [ Time Frame: at baseline and every three months ] [ Designated as safety issue: No ]
  
• The BDI/TDI (baseline and transition dyspnea indexes). [ Time Frame: at baseline and every three months ] [ Designated as safety issue: No ]
  
• Tolerance to standard NIPPV treatment during the observational phase of the study (after FVC has fallen below 50%) will also be summarized by weekly means and standard deviations of hours of use. [ Time Frame: at baseline and every three months ] [ Designated as safety issue: No ]
  

Amyotrophic lateral sclerosis (ALS) is an untreatable neurodegenerative disorder characterized by the progressive loss of motor neuron function. Respiratory failure is the most common cause of death in persons with ALS. Treatment of respiratory muscle weakness with nocturnal noninvasive positive pressure ventilation (NIPPV) when forced vital capacity (FVC) is less than 50 percent—but prior to the development of respiratory failure—has prolonged survival in observational studies. Despite the association of NIPPV use and survival, it is unknown whether earlier NIPPV treatment will benefit people with ALS. Also, no placebo-controlled studies of NIPPV treatment and people with ALS have been conducted.

The goals of the this trial are to assess the feasibility of conducting a prospective, randomized, double-blind, clinical trial of NIPPV versus control (sham) NIPPV in people with ALS who have a FVC greater than 50 percent, and to gain preliminary data on outcome effects.

In the trial, the investigators will test the following hypotheses: (1) People with ALS who have a FVC greater than 50 percent can tolerate active NIPPV and control NIPPV, and will find control NIPPV to be a believable treatment; (2) Initiation of active NIPPV in people with ALS who have a FVC greater than 50 percent will have better clinical outcomes with respect to measures of quality of life, rate of pulmonary function decline, and functional outcome; and (3) People with ALS who start active NIPPV early will have improved tolerance later when respiratory weakness has progressed. These aims will enable planning of a subsequent, large-scale and definitive clinical trial of early NIPPV (FVC greater than 50 percent) in people with ALS.

If the benefits of early NIPPV can be confirmed, then a new treatment may be established for this progressive, fatal disease.