Clinical studies offer insight into what causes ALS and how the disease works.
A Phase 3, Double-Blind, Randomized, Placebo-Controlled, Parallel Group, Multicenter Study with an Open-Label Extension to Evaluate the Efficacy and Safety of Ravulizumab in Patients with Amyotrophic Lateral Sclerosis (ALS)
Ravulizumab (developed by Alexion Pharmaceuticals) is being investigated as a potential new therapy to slow progression of ALS. Ravulizumab is being developed to block complement activity in patients with ALS, which should help lower the immune reaction. The complement system is part of your immune system which fights against infections. In patients with ALS, abnormal complement activity is present, which may cause damage to the structures in the body that are responsible for neuromuscular transmission (how the brain sends signals to the muscles).
AMX0035 in Patients with Amyotrophic Lateral Sclerosis
AMX0035 is a combination therapy designed to reduce neuronal death through blockade of key cellular death pathways originating in the mitochondria and endoplasmic reticulum (ER). This clinical trial was designed to demonstrate that treatment is safe, tolerable, and able to slow decline in function as measured by the ALSFRS-R. The trial also assessed the effects of AMX0035 on muscle strength, vital capacity, and biomarkers of ALS including markers of neuronal death and neuroinflammation.
Assessment of Olfactory Dysfunction as a Potential Biomarker in Amyotrophic Lateral Sclerosis
Although there are several candidate biomarkers for ALS, none have been found to be applicable to therapy development or to predict disease progression at the time of diagnosis. Even the El Escorial criteria stage at the time of diagnosis inconsistently correlates with the disease’s progression. New biomarkers are necessary in order to shorten delay in diagnosis, initiate treatment sooner, and predict prognosis. The goal of this project was to test the possibility of using olfactory dysfunction (also known as hyposmia) as a biomarker of diagnosis or prognosis. Its ease to implement in clinic, lack of discomfort to the patient, and low cost make it an attractive candidate. Olfactory dysfunction has been found in patients with neurodegenerative disorders such as Parkinson’s disease (PD), Alzheimer’s disease, and frontotemporal dementia (FTD). Interestingly, olfactory impairment has been shown to predict the degree of cognitive impairment associated with PD. A cohort study found that worse baseline olfaction in patients with PD was associated with higher rates of cognitive decline. This project sought to conduct a pilot study to assess the potential use of olfactory dysfunction as a viable biomarker for ALS.
Answer ALS: Individualized Initiative for ALS Discovery
This initiative created a large repository of induced pluripotent stem cells (iPSC), bio-fluid samples (blood and spinal fluid (optional)), and cell lines for ALS gene identification. These were combined carefully with collected measures of the pattern of the symptoms people with ALS have and how these change over time. The clinical and biological samples from over 1000 patients and controls is available to the research public free of charge.
Methodology Study of Novel Electrophysiological, Physical, and Imaging Outcome Measures to Assess the Progression of Amyotrophic Lateral Sclerosis
This study looked at new methods of measuring ALS symptoms over time to see if these new approaches are better at detecting changes than the currently used methods. The methods that are found to be the most valuable in this study will be considered for use in future ALS clinical studies. The methods for measuring ALS symptoms that were used in this study include electrophysiological (i.e. the electrical properties of cells and tissues) tests, muscle strength tests, lung function tests, questionnaires about ALS status.
In addition, this study looked to find biomarkers linked to certain aspects of ALS that differ between individuals in order to help target future therapies to the patients’ most likely to benefit. Biomarkers are naturally occurring substances in the body. Examples of biomarkers are proteins, parts of proteins, or ribonucleic acid ([RNA], which tells the cells in your body which proteins to produce). Biomarkers can be found in your blood, spinal fluid, and tissue.
Understanding Clinical Phenotype and Collecting Biomarker Samples in C9ORF72 ALS
This research study was performed to better understand a specific form of Amyotrophic Lateral Sclerosis (ALS) caused by a mutation (or abnormality) of the C9ORF72 gene. This mutation is the most common genetic cause of ALS, and is present in 40% of ALS patients with a family history of ALS and 5-10% of ALS patients without a family history of ALS.
A Phase 1, Double-Blind, Placebo-Controlled, Single-Ascending-Dose Study to Evaluate the Safety, Tolerability, Pharmacokinetics, and Pharmacodynamics of BIIB100 Administered Orally to Adult Participants with Amyotrophic Lateral Sclerosis.
This is a first in human trial for this drug being studied for ALS. The main focus of this study is to show that BIIB100 will cause no harm to humans. In animal studies, BIIB100 was found to slow neurodegeneration and protect neurons from further degeneration. There will be 5 cohorts with 8 subjects in each cohort across 10 sites in the US. The first cohort will get the lowest dose and each additional cohort will get an ascending dose until the target dose is reached. Each person will get one oral dose of BIIB100, one time. 1 out of every 4 subjects will receive a placebo instead of BIIB100. This study requires a 4 day, 3 night stay in the hospital for drug administration and careful monitoring.
Effects of Oral Levosimendan (ODM-109) on Respiratory Function in Patients with ALS
Animal and human studies have shown that levosimendan may be useful to improve the muscle strength of the diaphragm and thereby the breathing function for patients with ALS. If ALS patients get increased breathing function, their overall well-being and function may be increased.
Levosimendan (Simdax®) is currently approved as a medication given through a vein for heart failure. It is approved by the regulatory authorities in 60 countries. Simdax® is not available on the market in the United States. In this study, levosimendan was tested for ALS, given as a capsule (to be taken orally). It is not approved by the FDA, but they gave permission for levosimendan to be used in this study.
A Phase 1 Multiple-Ascending-Dose Study to Assess the Safety, Tolerability, and Pharmacokinetics of BIIB078 Administered Intrathecally to Adults with C9ORF72-Associated Amyotrophic Lateral Sclerosis
Principal Investigator: Jeffrey Rothstein, M.D., Ph.D.
Contact: Betsy Mosmiller | 410-502-0495
Route of Administration: Intrathecal
Length of Study: 6 months + optional open label extension
This research was done to find out about the safety, tolerability and pharmacokinetics (PK) of a range of the study drug BIIB078, administered intrathecally (into the spine) in adult subjects with ALS. PK looks at the level of the study drug in your body and what happens to this level over time from the moment that it is given to you up to the point at which it is completely eliminated from your body. It is studied by measuring the amount of study drug that gets into your blood, urine and cerebrospinal fluid after you take the study drug. Cerebrospinal fluid (CSF) is the fluid around the spinal cord.
This study was for patients who have a known mutation in the C9ORF72 gene. The study drug BIIB078, is an antisense therapy meant to specifically reduce the toxicity of the expanded C9ORF72 gene.
A Single-Ascending-Dose Study of GDC-0134 to Determine Initial Safety, Tolerability, and Pharmacokinetic Parameters in Patients with Amyotrophic Lateral Sclerosis
GDC-0134 is a drug investigated by the Genentech company as a potential new therapy to prevent nerve cell death in patients with ALS. The purpose of this study was to evaluate the safety and pharmacokinetics of GDC-0134 in patients with Amyotrophic Lateral Sclerosis (ALS). This was a double-blind, placebo controlled study in which patients were randomly assigned to the study drug or a placebo.
A Phase 2 Pharmacodynamic Study of Ezogabine on Neuronal Excitability in Amyotrophic Lateral Sclerosis
A motor neuron is a type of cell in the nervous system that can make muscles move. One of the major disease features of ALS is the progressive death of motor neurons. Past research has shown that the motor neurons of ALS patients may be producing more electrical activity than motor neurons of people without ALS, and that this extra electrical activity tires the neurons and contributes to their death. This research study was done to find out whether the drug ezogabine would lower motor neuron activity in people with ALS. It was also done to determine whether the drug is tolerable and safe for patients with ALS.
About 120 participants with ALS and 72 healthy control volunteers (people without an ALS diagnosis) took part in this research study at about 12 centers across the United States.
Trial of Resistance and Endurance Exercise in Amyotrophic Lateral Sclerosis
ALS is a neurodegenerative disorder with no known cure. Exercise and activity, in some form, are part of nearly every patient’s daily life and the question about whether it is safe or beneficial to exercise is an often asked question by ALS patients—yet few data exist on this topic. This pilot trial was designed to be the first step in rigorously addressing the role of resistance, endurance, and range of motion exercises in ALS. We anticipate that the data gathered in this study will aid in the design of a larger efficacy study and eventually the inclusion of recommendations for exercise in an ALS practice parameter.