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Safety and Therapeutic Potential of the FDA-approved Drug Metformin for C9orf72 ALS/FTD

Primary Purpose

C9orf72 Amyotrophic Lateral Sclerosis (ALS), Frontotemporal Dementia

Status
Active
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Metformin
Sponsored by
University of Florida
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for C9orf72 Amyotrophic Lateral Sclerosis (ALS) focused on measuring ALS, FTD, Lou Gehrigs Disease

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Subjects have a diagnosis of probable or definite ALS in accordance with the Revisited El-Escorial Criteria.
  • Subjects have a likely diagnosis of C9orf72 positive ALS/FTD.
  • Subjects must be currently on an oral diet and able to take foods, pills and liquids by mouth equivalent to a score of 4 or above on the Functional Oral Intake Scale
  • Subjects must have no known allergy to barium sulfate or Metformin.
  • Subjects or subject's legally authorized representative must be willing and able to complete informed consent/assent and HIPAA authorization.
  • Ability to comprehend and be informed of the nature of the study, as assessed by the PI or Co-Investigators.
  • Subjects prescribed to take Metformin at or before the time of first dosing. (The study is open to subjects currently taking Metformin or subjects who have taken Metformin in the past).
  • Availability to participate for the entire study duration.
  • Female subjects of childbearing potential must have a negative urine pregnancy test prior to Videofluoroscopic Swallow Study (VFSS) exam during Visit 1, 3, and 4.

Exclusion Criteria:

  • Subjects who score 3 or below on the Functional Oral Intake Scale
  • Subjects who do not carry the C9ORF72 hexanucleotide repeat expansion as determined by laboratory analysis.
  • Subjects with a history of clinically significant liver disease, renal disease, or any other medical condition judged to be exclusionary by the investigator.
  • Subjects who are unwilling to sign informed consent or subjects who for any other reason in the judgment of investigator are unable to complete the study.
  • Female subjects who have a positive urine pregnancy test (βhCG) at screening or visit 1, are trying to become pregnant or are breastfeeding.
  • Subjects with active cancer within the previous 2 years, except treated basal cell carcinoma of the skin.
  • Subjects who have taken any experimental drug within 30 days prior to enrollment or within 5 half-lives of the investigational drug -whichever is the longer period.
  • Subjects with known history or presence of moderate or severe renal impairment as defined by an estimated glomerular filtration rate (eGFR) value below 30 mL/min/1.73 m2.
  • Subjects with hepatic impairment as defined by baseline elevations of serum aminotransferases greater than 5 times upper limit of normal or evidence of liver dysfunction (e.g., elevated bilirubin).
  • Use of potentially hepatotoxic drugs: (e.g., allopurinol, methyldopa, sulfasalazine).
  • Subjects with clinically significant abnormal laboratory values in the judgment of the investigator.
  • Subject with implanted electrical device (i.e. cardiac pacemaker or a neurostimulator), metal or metallic clip(s) in their body (i.e. an aneurysm clip in the brain) that will be damaged by participation in the MRI portion of the study.
  • Anything else that, in the opinion of the investigator, would place the subject at increased risk or preclude the subject's full compliance with or completion of the study.

Sites / Locations

  • UF Health at the University of Florida

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

C9orf72 positive ALS

Arm Description

Subjects with C9orf72 positive ALS will be instructed in the use of Metformin and receive the first dose of Metformin under supervision of the investigator during Visit 1, Day 2. Subjects will then continue on Metformin per the dose escalation schedule twice daily for 24 weeks.

Outcomes

Primary Outcome Measures

Number of subjects with treatment-emergent adverse events [Safety and Tolerability]
The safety and tolerability of Metformin in participants with C9orf72 ALS currently treated with Metformin will be evaluated by the number of subjects with treatment-emergent adverse events
Change in RAN protein levels
Assess the RAN protein levels in cerebrospinal fluid (CSF) samples from participants at specific intervals.

Secondary Outcome Measures

Change in ALS Functional Rating Scale (ALSFRS-R) score
The ALSFRS-R is a quickly administered (5 minute) ordinal rating scale (ratings 0-4) used to determine subjects' assessment of their capability and independence in 12 functional activities/questions. Scores of 4 equaling 'normal' and scores of 0 equaling total lack of ability.

Full Information

First Posted
January 3, 2020
Last Updated
October 2, 2023
Sponsor
University of Florida
Collaborators
ALS Association
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1. Study Identification

Unique Protocol Identification Number
NCT04220021
Brief Title
Safety and Therapeutic Potential of the FDA-approved Drug Metformin for C9orf72 ALS/FTD
Official Title
A Single-Center, Open Label Study to Assess the Safety and Tolerability of Metformin in Subjects With C9orf72 Amyotrophic Lateral Sclerosis Over 24 Weeks of Treatment
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
January 10, 2020 (Actual)
Primary Completion Date
February 28, 2024 (Anticipated)
Study Completion Date
May 22, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Florida
Collaborators
ALS Association

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The primary objective is to assess the safety and tolerability of Metformin in subjects with C9orf72 amyotrophic lateral sclerosis administered for 24 weeks. The overall objective is to determine if Metformin is safe in C9orf72 ALS patients and is a potentially viable therapeutic treatment for C9-ALS that reduces repeat-associated non-canonical start codon - in DNA (non-ATG) (RAN) proteins that are produced by the C9orf72 repeat expansion mutation.
Detailed Description
The C9orf72 repeat expansion is the most common cause of amyotrophic lateral sclerosis and frontotemporal dementia (C9-ALS/FTD). Metformin, a well-tolerated diabetes drug, blocks a key pathway for expression of toxic proteins produced from the C9orf72 repeat expansion via repeat associated non-canonical start codon - in RNA (non-AUG) (RAN) translation. In mouse model of C9-ALS/FTD, metformin treatment decreases RAN protein levels and improves disease features. This current study is a small-scale clinical trial to assess the safety and potential efficacy of metformin for the treatment of C9-ALS/FTD.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
C9orf72 Amyotrophic Lateral Sclerosis (ALS), Frontotemporal Dementia
Keywords
ALS, FTD, Lou Gehrigs Disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Model Description
All participants receive medication
Masking
None (Open Label)
Allocation
N/A
Enrollment
18 (Actual)

8. Arms, Groups, and Interventions

Arm Title
C9orf72 positive ALS
Arm Type
Experimental
Arm Description
Subjects with C9orf72 positive ALS will be instructed in the use of Metformin and receive the first dose of Metformin under supervision of the investigator during Visit 1, Day 2. Subjects will then continue on Metformin per the dose escalation schedule twice daily for 24 weeks.
Intervention Type
Drug
Intervention Name(s)
Metformin
Other Intervention Name(s)
Metformin hydrochloride sustained-release (SR)
Intervention Description
Metformin is a widely used, well-tolerated drug that has been used for decades as a first-line defense for treating type 2 diabetes. Its safety has been well established. Subjects will begin treatment with Metformin at a dosage of 500mg with an escalation of dosage by 500mg every week to a maximal dosage of 2000mg. Dosing will be twice daily.
Primary Outcome Measure Information:
Title
Number of subjects with treatment-emergent adverse events [Safety and Tolerability]
Description
The safety and tolerability of Metformin in participants with C9orf72 ALS currently treated with Metformin will be evaluated by the number of subjects with treatment-emergent adverse events
Time Frame
Baseline through 24 weeks
Title
Change in RAN protein levels
Description
Assess the RAN protein levels in cerebrospinal fluid (CSF) samples from participants at specific intervals.
Time Frame
baseline through week 24
Secondary Outcome Measure Information:
Title
Change in ALS Functional Rating Scale (ALSFRS-R) score
Description
The ALSFRS-R is a quickly administered (5 minute) ordinal rating scale (ratings 0-4) used to determine subjects' assessment of their capability and independence in 12 functional activities/questions. Scores of 4 equaling 'normal' and scores of 0 equaling total lack of ability.
Time Frame
Baseline through Week 52

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subjects have a diagnosis of probable or definite ALS in accordance with the Revisited El-Escorial Criteria. Subjects have a likely diagnosis of C9orf72 positive ALS/FTD. Subjects must be currently on an oral diet and able to take foods, pills and liquids by mouth equivalent to a score of 4 or above on the Functional Oral Intake Scale Subjects must have no known allergy to barium sulfate or Metformin. Subjects or subject's legally authorized representative must be willing and able to complete informed consent/assent and HIPAA authorization. Ability to comprehend and be informed of the nature of the study, as assessed by the PI or Co-Investigators. Subjects prescribed to take Metformin at or before the time of first dosing. (The study is open to subjects currently taking Metformin or subjects who have taken Metformin in the past). Availability to participate for the entire study duration. Female subjects of childbearing potential must have a negative urine pregnancy test prior to Videofluoroscopic Swallow Study (VFSS) exam during Visit 1, 3, and 4. Exclusion Criteria: Subjects who score 3 or below on the Functional Oral Intake Scale Subjects who do not carry the C9ORF72 hexanucleotide repeat expansion as determined by laboratory analysis. Subjects with a history of clinically significant liver disease, renal disease, or any other medical condition judged to be exclusionary by the investigator. Subjects who are unwilling to sign informed consent or subjects who for any other reason in the judgment of investigator are unable to complete the study. Female subjects who have a positive urine pregnancy test (βhCG) at screening or visit 1, are trying to become pregnant or are breastfeeding. Subjects with active cancer within the previous 2 years, except treated basal cell carcinoma of the skin. Subjects who have taken any experimental drug within 30 days prior to enrollment or within 5 half-lives of the investigational drug -whichever is the longer period. Subjects with known history or presence of moderate or severe renal impairment as defined by an estimated glomerular filtration rate (eGFR) value below 30 mL/min/1.73 m2. Subjects with hepatic impairment as defined by baseline elevations of serum aminotransferases greater than 5 times upper limit of normal or evidence of liver dysfunction (e.g., elevated bilirubin). Use of potentially hepatotoxic drugs: (e.g., allopurinol, methyldopa, sulfasalazine). Subjects with clinically significant abnormal laboratory values in the judgment of the investigator. Subject with implanted electrical device (i.e. cardiac pacemaker or a neurostimulator), metal or metallic clip(s) in their body (i.e. an aneurysm clip in the brain) that will be damaged by participation in the MRI portion of the study. Anything else that, in the opinion of the investigator, would place the subject at increased risk or preclude the subject's full compliance with or completion of the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Laura Ranum, PhD
Organizational Affiliation
University of Florida
Official's Role
Principal Investigator
Facility Information:
Facility Name
UF Health at the University of Florida
City
Gainesville
State/Province
Florida
ZIP/Postal Code
32610
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
10540002
Citation
Cedarbaum JM, Stambler N, Malta E, Fuller C, Hilt D, Thurmond B, Nakanishi A. The ALSFRS-R: a revised ALS functional rating scale that incorporates assessments of respiratory function. BDNF ALS Study Group (Phase III). J Neurol Sci. 1999 Oct 31;169(1-2):13-21. doi: 10.1016/s0022-510x(99)00210-5.
Results Reference
background
PubMed Identifier
16084801
Citation
Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005 Aug;86(8):1516-20. doi: 10.1016/j.apmr.2004.11.049.
Results Reference
background
PubMed Identifier
8721066
Citation
Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996 Spring;11(2):93-8. doi: 10.1007/BF00417897.
Results Reference
background
PubMed Identifier
25548957
Citation
Watanabe H, Atsuta N, Nakamura R, Hirakawa A, Watanabe H, Ito M, Senda J, Katsuno M, Izumi Y, Morita M, Tomiyama H, Taniguchi A, Aiba I, Abe K, Mizoguchi K, Oda M, Kano O, Okamoto K, Kuwabara S, Hasegawa K, Imai T, Aoki M, Tsuji S, Nakano I, Kaji R, Sobue G. Factors affecting longitudinal functional decline and survival in amyotrophic lateral sclerosis patients. Amyotroph Lateral Scler Frontotemporal Degener. 2015 Jun;16(3-4):230-6. doi: 10.3109/21678421.2014.990036. Epub 2014 Dec 30.
Results Reference
background

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Safety and Therapeutic Potential of the FDA-approved Drug Metformin for C9orf72 ALS/FTD

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