Ventilatory Investigation of Tirasemtiv and Assessment of Longitudinal Indices After Treatment for a Year (VITALITY-ALS)
Amyotrophic Lateral Sclerosis
About this trial
This is an interventional treatment trial for Amyotrophic Lateral Sclerosis focused on measuring fast skeletal troponin activator, tirasemtiv, CK-2017357, double-blind, randomized, placebo-controlled
Eligibility Criteria
Inclusion Criteria:
- A diagnosis of familial or sporadic ALS (defined as meeting the possible, laboratory-supported probable, probable, or definite criteria for a diagnosis of ALS according to the World Federation of Neurology El Escorial criteria) ≤ 24 months prior to screening
- Upright SVC ≥ 70 % of predicted for age, height and sex
- Able to swallow tablets without crushing, and in the opinion of the Investigator, is expected to continue to be able to do so during the trial
- A caregiver if one is needed
- Clinical laboratory findings within the normal range or, if outside the normal range, deemed not clinically significant by the Investigator
- Male patients must agree for the duration of the study and 10 weeks after the end of the study to use a condom during sexual intercourse with female partners who are of childbearing potential (i.e., following menarche until post-menopausal if not anatomically and physiologically incapable of becoming pregnant) and to have female partners use an additional effective means of contraception (e.g., diaphragm plus spermicide, or oral contraceptives) or the male patient must agree to abstain from sexual intercourse during and for 10 weeks after the end of the study, unless the male patient has had a vasectomy and confirmed sperm count is zero
- Female patients must be post-menopausal (≥ 1 year) or sterilized, or, if of childbearing potential, not be breastfeeding, have a negative pregnancy test, have no intention to become pregnant during the course of the study, and use effective contraceptive drugs or devices while requiring male partner to use a condom for the duration of the study and for 10 weeks after the end of the study
- Patients must be either on a stable dose of riluzole 50 mg twice daily for at least 30 days prior to screening or have not taken riluzole for at least 30 days prior to screening and are willing not to begin riluzole use until they complete study drug dosing
Exclusion Criteria:
- At the time of screening, any use of non-invasive positive pressure ventilation (NIPPV, e.g. continuous positive airway pressure [CPAP] or bi-level positive airway pressure [BiPAP]) for any portion of the day, or mechanical ventilation via tracheostomy, or on any form of oxygen supplementation
- Patients with a diaphragm pacing system (DPS) at study entry or who anticipate DPS placement during the course of the study
- BMI of 20.0 kg/m2 or lower
- Unwilling or unable to discontinue tizanidine and theophylline-containing medications during study participation
- Serum chloride outside the normal reference range
- Neurological impairment due to a condition other than ALS, including history of transient ischemic attack within the past year
Presence at screening of any medically significant cardiac, pulmonary, GI, musculoskeletal, or psychiatric illness that might interfere with the patient's ability to comply with study procedures or that might confound the interpretation of clinical safety or efficacy data, including, but not limited to:
- Poorly controlled hypertension
- NYHA Class II or greater congestive heart failure
- Chronic obstructive pulmonary disease or asthma requiring daily use bronchodilator medications
- GI disorder that might impair absorption of study drug
- History of significant liver disease defined by bilirubin > 2 times the upper limit of normal (ULN) or ALT or AST > 3 times the ULN on repeat testing
- Poorly controlled diabetes mellitus
- History of vertigo within three months of study entry
- History of syncope without an explainable or treated cause
- History of untreated intracranial aneurysm or poorly controlled seizure disorder
- Amputation of a limb
- Cognitive impairment, related to ALS or otherwise, sufficient to impair the patient's ability to give informed consent and to understand and/or comply with study procedures
- Cancer with metastatic potential (other than basal cell carcinoma, carcinoma in situ of the cervix, or squamous cell carcinoma of the skin excised with clean margins) diagnosed and treated within the last two years
- Any other condition, impairment or social circumstance that, in the opinion of the Investigator, would render the patient not suitable to participate in the study
- Patient judged to be actively suicidal or a suicide risk by the Investigator
- Has taken any investigational study drug within 30 days or five half-lives of the prior agent, whichever is greater, prior to dosing
- Prior participation in any form of stem cell therapy for the treatment of ALS
- Previously received tirasemtiv in any previous clinical trial
Sites / Locations
- St. Joseph's Hospital & Medical Center - Barrow Neurology Clinics
- University of California San Diego
- Cedars-Sinai Medical Center
- University of California, Irvine
- University of California Davis Medical Center
- Forbes Norris MDA/ALS Research Center
- Stanford Hospital and Clinics
- University of Colorado Hospital Anschutz Outpatient Pavilion
- Hospital for Special Care
- George Washington University Medical Center
- Mayo Clinic
- University of Miami
- Carol and Frank Morsini Center for Advanced Health Care - University of South Florida
- The Emory Clinic
- Georgia Regents University
- Northwestern University Feinberg School of Medicine
- Indiana University
- University of Iowa Hospitals and Clinics
- University of Kansas Medical Center
- Johns Hopkins University
- Massachusetts General Hospital
- University of Massachusetts Memorial Medical Center
- University of Michigan Hospital and Health System
- Henry Ford Health System
- Hennepin County Medical Center
- Saint Louis University
- Barnes-Jewish Hospital
- Neurology Associates
- Dartmouth Hitchcock Medical Center Dept of Neurology
- Hospital for Special Surgery
- Neurological Institute Columbia University Medical Center
- SUNY Upstate Medical University
- Neurosciences Institute: Neurology - Charlotte
- Duke Neurological Disorders Clinic
- Wake Forest University Health Sciences
- The Ohio State University Wexner Medical Center
- Providence Brain and Spine Institute ALS Center
- Oregon Health and Science Center
- Penn State Milton S. Hershey Medical Center
- The Penn Comprehensive Neuroscience Center
- Temple University School of Medicine
- Vanderbilt University Medical Center
- Texas Neurology
- Baylor College of Medicine
- University of Texas Health Science Center
- University of Virgina Health System
- University of Washington Medical Center
- West Virginia University Department of Neurology
- Froedtert Memorial Lutheran Hospital, Department of Neurology
- UZ Leuven - Campus Gasthuisberg
- University of Calgary
- Edmonton Kaye Clinic
- Stan Cassidy Centre for Rehabilitation
- QE II Health Sciences Centre, NHI Site
- McMaster University Medical Centre
- London Health Sciences Centre
- Sunnybrook Health Sciences Centre
- Notre-Dame Hospital/CHUM
- Montreal Neurological Institute and Hospital
- CHU de Quebec - Universite Laval Hopital de l'Enfant-Jesus
- Hopital R. Salengro, CHRU Lille
- CHU Dupuytren
- Hopital de la Timone
- Hopital Gui de Chauliac
- CHU de Nice - Hopital Pasteur 2
- Hopital de la Salpetriere
- Bretonneau University Hospital
- University of Ulm, Department of Neurology
- Hannover Medical School, Department of Neurology
- Charite Campus Virchow-Klinikum, Neurology Department
- Clinical Research Centre, Beaumont Hospital
- IRCCS Istituto Auxologico Italiano - U.O. Neurologia
- Centro Clinico NEMO - Fondazione Serena Onlus, ASST Grande Ospedale Metropolitano Niguarda
- Dipartimento di Neuroscienze "Rita Levi Moltalcini" A.O.U. Citta della Salute e della Scienza di Torino P.O. "Molinette"
- University Medical Center Utrecht
- Hospital Santa Maria-Centro Hospitalar Lisboa Norte
- Hospital San Rafael
- Derriford Hospital
- Walton Centre for Neurology and Neurosurgery
- Clinical Research Centre, Royal London Hospital
- Kings College Hospital
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Placebo Comparator
Experimental
Experimental
Experimental
Group 1 - Placebo
Group 2 - 250 mg tirasemtiv
Group 3 - 375 mg tirasemtiv
Group 4 - 500 mg tirasemtiv
Day 1 through Week 48: 2 placebo tablets twice daily
Day 1 through Week 48: 1 tablet of tirasemtiv (125 mg) and 1 tablet of matching placebo in the AM and 1 tablet of tirasemtiv (125 mg) and 1 tablet of matching placebo in the PM
Day 1 through Week 2: 1 tablet of tirasemtiv (125 mg) and 1 tablet of matching placebo in the AM and 1 tablet of tirasemtiv (125 mg) and 1 tablet of matching placebo in the PM; Weeks 3 through 48: 1 tablet of tirasemtiv (125 mg) and 1 tablet of matching placebo in the AM and 2 tablets of tirasemtiv (250 mg) in the PM
Day 1 through Week 2: 1 tablet of tirasemtiv (125 mg) and 1 tablet of matching placebo in the AM and 1 tablet of tirasemtiv (125 mg) and 1 tablet of matching placebo in PM; Weeks 3 and 4: 1 tablet of tirasemtiv (125 mg) and 1 tablet of matching placebo in the AM and 2 tablets of tirasemtiv (250 mg) in the PM; Weeks 5 through 48: 2 tablets of tirasemtiv (250 mg) in the AM and 2 tablets of tirasemtiv (250 mg) in the PM