Marcus Grobe‐Einsler, Stéphanie Borel, Maresa Buchholz, Sabrina Sayah, Rania Hilab, Lucie Pierron, Arif Iskandar, Brittany Humphries, Claire Ewenczyk, Anna Heinzmann, Mariana Atencio, Katrin Feldmann, Vivian Maas, Jennifer Faber, Sylvia Boesch, Elisabetta Indelicato, Kathrin Reetz, Jörg B. Schulz, A. Bischoff, Thomas Klopstock, Lüdger Schöls, Martina Minnerop, Dagmar Timmann, Elin Haf Davies, Thomas Klockgether, Alexandra Dürr, Feng Xie, Bernhard Michalowsky
Background: Friedreich ataxia (FA) is the most common autosomal recessive ataxia. Little attention has been paid to FA's impact on patient-reported, psychosocial, and health-economic outcomes. This study aimed to report these outcomes across FA's disability stages 1-5. Methods: We assessed patients in Germany, France, and Austria as part of the PROFA study, a European multicenter observational study. The protocol included a study center visit followed by a remote mobile assessment capturing ataxia severity (SARA), daily living deficits (FARS-ADL), cognitive and affective impairments (CCAS), health-related quality of life (HRQoL: PROM-Ataxia short-form, EQ-5D-5L), mental well-being (WEMWBS), communication disabilities (COMATAX), and healthcare and informal care utilization. FARS disability stages were used to demonstrate outcomes with effect size measures (Eta-Squared, Cramér's V). Multivariate regression models evaluated associations between z-standardized outcomes and disability stages. Findings: One hundred one patients (mean [SD]: age 35.0 [11.5]; GAA-repeat size 657 [299]; 50.5% women) were included. Activities of daily living, HRQoL, communication disabilities, and informal care utilization worsened significantly across disability stages with moderate to high effect sizes. Cognitive-affective impairments and mental well-being showed significant associations with small effect sizes. Twenty-three patients (33.3%) received formal care, while 40 (58.0%) received informal care (mean 12.2 h/week). Omaveloxolone was used by 33 patients (32.7%). Annual healthcare costs excluding Omaveloxolone were €13,620 (payer) and €32,679 (societal perspective, including informal care and productivity losses). Interpretation: The results emphasize the multidimensional patient, societal, and economic burden of FA and the need for comprehensive care addressing physical, mental, and psychosocial health. Funding: European Joint Programme on Rare Diseases (EJP RD).