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A Safety and Biomarker Study of ALZT-OP1a in Subjects With Mild-Moderate ALS Disease

Primary Purpose

Amyotrophic Lateral Sclerosis

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
ALZT-OP1a (cromolyn)
Sponsored by
AZTherapies, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Amyotrophic Lateral Sclerosis focused on measuring ALS, Amyotrophic Lateral Sclerosis, Lou Gehrig's disease, mild ALS, moderate ALS, mild to moderate ALS

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male or female subjects aged 18-75 years, both inclusive;
  • Must provide written informed consent before any study related procedures;
  • Should be capable to complete all trial related procedures, assessments and visits in the judgement of Investigator;
  • Familial or sporadic ALS diagnosed as possible, laboratory-supported probable, probable, or definite as defined by revised El Escorial criteria;
  • Disease duration from ALS diagnosis ≤24 months;
  • ALSFRS-R total score ≥ 36 at screening visit;
  • ALSFRS-R Breathing sub-score should be ≥9 at the time of screening;
  • ALSFRS-R Bulbar sub-score should be ≥9 at the time of screening;
  • Peak inspiratory flow rate (PIFR) ≥ 100 L/minute;
  • Forced vital capacity (FVC) >70% of predicted value;
  • Participant must be receiving treatment with stable dose of standard of care treatment for ≥30 days prior to signing informed consent.

Exclusion Criteria:

  • Subjects with bulbar-onset ALS;
  • Any use of non-invasive ventilation (e.g., continuous positive airway pressure, non-invasive bi-level positive airway pressure or non-invasive volume ventilation) for any portion of the day, or mechanical ventilation via tracheostomy, or on any form of oxygen supplementation;
  • Any other significant neurological disorder which can interfere with study assessments, e.g., significant cognitive impairment and/or clinical dementia;
  • Significant psychiatric illness like schizophrenia, bipolar disorder etc. Subjects with depression can be included, only if the depression has been stable and no episode of major depression has occurred in past one year;
  • Severe cardiac disease (e.g.,corrected QT interval > 500ms), Torsade de Pointes, evidence of significant heart failure (New York Heart Association [NYHA] Class 3 or greater, myocardial infarction or unstable angina in the 6 months prior to screening);
  • Any moderate-to-severe pulmonary disease or difficulty taking inhaled drugs;
  • Inability to tolerate the administration of an oral inhaled powder via dry powder inhaler (DPI);
  • Has taken any investigational study drug within 30 days or five half-lives of the drug, whichever is longer, prior to dosing;
  • Currently taking cromolyn, or has taken cromolyn, within the past 12 months;
  • Allergy to cromolyn or cromolyn products, such as Intal®, Nasalcrom®, Opticrom®, Gastrocrom®, etc.;
  • Taking inhaled protein products on a chronic basis (such as insulin, parathyroid hormone [PTH], etc.);
  • Subjects who weigh 88 lb (40 kg) or less, or, body mass index (BMI) of <17.5 or >35.0 at screening;
  • Moderate-to-severe liver disease: aspartate aminotransferase (AST), alanine aminotransferase (ALT), or bilirubin concentrations >3 times the upper limit of normal; patients with hepatic diseases such as hepatic cirrhosis, hepatic cancer and active hepatitis
  • Moderate-to-severe renal disease: creatinine clearance <45 mL/min/1.73 m2 (by Cockcroft-Gault calculation);
  • Any clinically significant disorder or laboratory abnormality that, in the investigator's opinion, could interfere with the subject's participation in the study, place the subject at increased risk, or confound interpretation of the study results;
  • Pregnant or breast-feeding females or sexually active females with childbearing potential, if no adequate contraceptive measures are used.

Sites / Locations

  • UCSD Altman Clinical and Translational Research Institute
  • Mayo Clinic
  • Hospital for Special Surgery
  • Columbia University Medical Center
  • Wake Forest School of Medicine
  • Oregon Health & Science University

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Group I (Low Dose)

Group II (High Dose)

Arm Description

Group I (n=40) will receive treatment regimen of ALZT-OP1a (cromolyn) 17.1 mg/twice a day (bid) (total of 34.2 mg/day)

Group II (n=40) will receive treatment regimen of ALZT-OP1a (cromolyn) 34.2 mg/bid (total of 68.4 mg/day)

Outcomes

Primary Outcome Measures

Plasma Biomarkers
To measure the effect of ALZT-OP1a treatment on selected plasma biomarkers in ALS patients. Candidate biomarkers in ng/mL include: Beta-tryptase, Beta-Hexosaminidase Candidate biomarkers in pg/mL include: CXCL1, interferon-y, interleukin (IL)-1a, IL-1b, IL-2, IL-5, IL-6, IL-8, IL-10, IL-15, IL-17, macrophage inflammatory protein (MIP)-1a, MIP-1b, monocyte chemoattractant protein (MCP)-1, neurofilament light protein (NfL), tumor necrosis factor (TNF)-a, and vascular endothelial growth factor (VEGF)

Secondary Outcome Measures

Changes from baseline in ALS disease progression
Measured by ALS Functional Rating Scale-Revised (ALSFRS-R) - Questionnaire
Time to Event Requiring Respiratory Support
Measured by the time to event requiring full-time or nearly full-time respiratory support from baseline by treatment arm.
Changes from baseline in pulmonary function (forced vital capacity)
Measured by changes in forced vital capacity (FVC) in percent predicted value from baseline by treatment arm.
Changes from baseline in pulmonary function (peak inspiratory flow rate)
Measured by changes in peak inspiratory flow rate (PIFR) in liters per minute from baseline by treatment arm.
Incidence of adverse event (tolerability) related to ALZT-OP1a
Evaluated by number and percentage of unexpected adverse events by treatment arm.
Number of participants with abnormal vital signs
Measured by changes in systolic / diastolic blood pressure, pulse rate, respiratory rate, and body temperature from baseline by treatment arm. The data will also be presented in shift tables as within normal limits, clinically significant, not clinically significant.
Number of participants with abnormal physical or neurological examinations
Review of all body systems and changes evaluated for clinical significance from baseline by treatment arm. The data will also be presented in shift tables as within normal limits, clinically significant, not clinically significant.
Number of participants with abnormal electrocardiograms (ECGs)
Measured by changes in heart rate, PR interval, QRS complex, and QT interval from baseline by treatment arm. The data will also be presented in shift tables as within normal limits, clinically significant, not clinically significant.
Number of participants with treatment emergent clinically significant laboratory assessments
The abnormal values will be presented by treatment arm from baseline. The data will also be presented in shift tables as within normal limits, clinically significant, not clinically significant.
Changes from baseline in suicidal ideation and behavior
Measured by changes in Columbia Suicide Severity Rating Scale (C-SSRS) from baseline; minimum score: 0 maximum score: 10; lower values represent a better outcome.
The number of study dropouts due to serious, unanticipated treatment emergent adverse events
The dropouts will be presented by treatment arm from baseline.

Full Information

First Posted
June 3, 2020
Last Updated
November 1, 2021
Sponsor
AZTherapies, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT04428775
Brief Title
A Safety and Biomarker Study of ALZT-OP1a in Subjects With Mild-Moderate ALS Disease
Official Title
A Phase IIa, Randomized, Open-label, Multi-Center, Multi-Dose Study to Evaluate the Effects of ALZT-OP1a in Subjects With Mild-Moderate Stage Amyotrophic Lateral Sclerosis (ALS)
Study Type
Interventional

2. Study Status

Record Verification Date
June 2021
Overall Recruitment Status
Terminated
Why Stopped
Low enrollment
Study Start Date
September 8, 2020 (Actual)
Primary Completion Date
October 1, 2021 (Actual)
Study Completion Date
October 1, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
AZTherapies, Inc.

4. Oversight

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

5. Study Description

Brief Summary
This is a Phase IIa, randomized, open-label, multi-center, multi-dose study for subjects with mild to moderate ALS. The protocol is designed to determine whether ALZT-OP1a treatment will positively impact neuro-inflammatory biomarkers and slow down or arrest functional decline in subjects with mild to moderate ALS.
Detailed Description
This Phase IIa study is designed as a randomized, open-label, multi-center, multi-dose study for subjects with mild to moderate ALS. The study will evaluate 1) safety, 2) tolerability, 3) changes in physical function measured using the ALSFRS-R, 4) two doses of ALZT-OP1a in order to determine an optimal and effective dose that could positively impact neuro-inflammatory biomarkers, and 5) to demonstrate preliminary evidence if this treatment could potentially slow down or arrest functional decline in subjects with mild to moderate ALS. Up to 80 evaluable subjects will be randomly assigned to one of two treatment groups: Group I (n=40) will consist of low dose ALZT-OP1a, administered via dry powder inhalation; OR Group II (n=40), which will consist of high dose ALZT-OP1a, administered via dry powder inhaler. Subjects will dose for 12 weeks and will be asked to return to the site for scheduled visits and biomarker collection at Week 4, Week 8, and Week 12.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Amyotrophic Lateral Sclerosis
Keywords
ALS, Amyotrophic Lateral Sclerosis, Lou Gehrig's disease, mild ALS, moderate ALS, mild to moderate ALS

7. Study Design

Primary Purpose
Basic Science
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Two doses of ALZT-OP1a (cromolyn) are being evaluated in this study. Each dose of ALZT-OP1a (cromolyn) will be co-administered with a stable dose of ALS standard-of-care treatment as prescribed by their physician.
Masking
None (Open Label)
Allocation
Randomized
Enrollment
12 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Group I (Low Dose)
Arm Type
Experimental
Arm Description
Group I (n=40) will receive treatment regimen of ALZT-OP1a (cromolyn) 17.1 mg/twice a day (bid) (total of 34.2 mg/day)
Arm Title
Group II (High Dose)
Arm Type
Experimental
Arm Description
Group II (n=40) will receive treatment regimen of ALZT-OP1a (cromolyn) 34.2 mg/bid (total of 68.4 mg/day)
Intervention Type
Drug
Intervention Name(s)
ALZT-OP1a (cromolyn)
Other Intervention Name(s)
Cromolyn, Cromolyn sodium, Sodium cromoglycate
Intervention Description
Mast cell stabilizer Neuroinflammatory microglial modulator anti-inflammatory
Primary Outcome Measure Information:
Title
Plasma Biomarkers
Description
To measure the effect of ALZT-OP1a treatment on selected plasma biomarkers in ALS patients. Candidate biomarkers in ng/mL include: Beta-tryptase, Beta-Hexosaminidase Candidate biomarkers in pg/mL include: CXCL1, interferon-y, interleukin (IL)-1a, IL-1b, IL-2, IL-5, IL-6, IL-8, IL-10, IL-15, IL-17, macrophage inflammatory protein (MIP)-1a, MIP-1b, monocyte chemoattractant protein (MCP)-1, neurofilament light protein (NfL), tumor necrosis factor (TNF)-a, and vascular endothelial growth factor (VEGF)
Time Frame
up to 12 weeks
Secondary Outcome Measure Information:
Title
Changes from baseline in ALS disease progression
Description
Measured by ALS Functional Rating Scale-Revised (ALSFRS-R) - Questionnaire
Time Frame
up to 12 weeks
Title
Time to Event Requiring Respiratory Support
Description
Measured by the time to event requiring full-time or nearly full-time respiratory support from baseline by treatment arm.
Time Frame
up to 12 weeks
Title
Changes from baseline in pulmonary function (forced vital capacity)
Description
Measured by changes in forced vital capacity (FVC) in percent predicted value from baseline by treatment arm.
Time Frame
up to 12 weeks
Title
Changes from baseline in pulmonary function (peak inspiratory flow rate)
Description
Measured by changes in peak inspiratory flow rate (PIFR) in liters per minute from baseline by treatment arm.
Time Frame
up to 12 weeks
Title
Incidence of adverse event (tolerability) related to ALZT-OP1a
Description
Evaluated by number and percentage of unexpected adverse events by treatment arm.
Time Frame
up to 12 weeks
Title
Number of participants with abnormal vital signs
Description
Measured by changes in systolic / diastolic blood pressure, pulse rate, respiratory rate, and body temperature from baseline by treatment arm. The data will also be presented in shift tables as within normal limits, clinically significant, not clinically significant.
Time Frame
up to 12 weeks
Title
Number of participants with abnormal physical or neurological examinations
Description
Review of all body systems and changes evaluated for clinical significance from baseline by treatment arm. The data will also be presented in shift tables as within normal limits, clinically significant, not clinically significant.
Time Frame
up to 12 weeks
Title
Number of participants with abnormal electrocardiograms (ECGs)
Description
Measured by changes in heart rate, PR interval, QRS complex, and QT interval from baseline by treatment arm. The data will also be presented in shift tables as within normal limits, clinically significant, not clinically significant.
Time Frame
up to 12 weeks
Title
Number of participants with treatment emergent clinically significant laboratory assessments
Description
The abnormal values will be presented by treatment arm from baseline. The data will also be presented in shift tables as within normal limits, clinically significant, not clinically significant.
Time Frame
up to 12 weeks
Title
Changes from baseline in suicidal ideation and behavior
Description
Measured by changes in Columbia Suicide Severity Rating Scale (C-SSRS) from baseline; minimum score: 0 maximum score: 10; lower values represent a better outcome.
Time Frame
up to 12 weeks
Title
The number of study dropouts due to serious, unanticipated treatment emergent adverse events
Description
The dropouts will be presented by treatment arm from baseline.
Time Frame
up to 12 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female subjects aged 18-75 years, both inclusive; Must provide written informed consent before any study related procedures; Should be capable to complete all trial related procedures, assessments and visits in the judgement of Investigator; Familial or sporadic ALS diagnosed as possible, laboratory-supported probable, probable, or definite as defined by revised El Escorial criteria; Disease duration from ALS diagnosis ≤24 months; ALSFRS-R total score ≥ 36 at screening visit; ALSFRS-R Breathing sub-score should be ≥9 at the time of screening; ALSFRS-R Bulbar sub-score should be ≥9 at the time of screening; Peak inspiratory flow rate (PIFR) ≥ 100 L/minute; Forced vital capacity (FVC) >70% of predicted value; Participant must be receiving treatment with stable dose of standard of care treatment for ≥30 days prior to signing informed consent. Exclusion Criteria: Subjects with bulbar-onset ALS; Any use of non-invasive ventilation (e.g., continuous positive airway pressure, non-invasive bi-level positive airway pressure or non-invasive volume ventilation) for any portion of the day, or mechanical ventilation via tracheostomy, or on any form of oxygen supplementation; Any other significant neurological disorder which can interfere with study assessments, e.g., significant cognitive impairment and/or clinical dementia; Significant psychiatric illness like schizophrenia, bipolar disorder etc. Subjects with depression can be included, only if the depression has been stable and no episode of major depression has occurred in past one year; Severe cardiac disease (e.g.,corrected QT interval > 500ms), Torsade de Pointes, evidence of significant heart failure (New York Heart Association [NYHA] Class 3 or greater, myocardial infarction or unstable angina in the 6 months prior to screening); Any moderate-to-severe pulmonary disease or difficulty taking inhaled drugs; Inability to tolerate the administration of an oral inhaled powder via dry powder inhaler (DPI); Has taken any investigational study drug within 30 days or five half-lives of the drug, whichever is longer, prior to dosing; Currently taking cromolyn, or has taken cromolyn, within the past 12 months; Allergy to cromolyn or cromolyn products, such as Intal®, Nasalcrom®, Opticrom®, Gastrocrom®, etc.; Taking inhaled protein products on a chronic basis (such as insulin, parathyroid hormone [PTH], etc.); Subjects who weigh 88 lb (40 kg) or less, or, body mass index (BMI) of <17.5 or >35.0 at screening; Moderate-to-severe liver disease: aspartate aminotransferase (AST), alanine aminotransferase (ALT), or bilirubin concentrations >3 times the upper limit of normal; patients with hepatic diseases such as hepatic cirrhosis, hepatic cancer and active hepatitis Moderate-to-severe renal disease: creatinine clearance <45 mL/min/1.73 m2 (by Cockcroft-Gault calculation); Any clinically significant disorder or laboratory abnormality that, in the investigator's opinion, could interfere with the subject's participation in the study, place the subject at increased risk, or confound interpretation of the study results; Pregnant or breast-feeding females or sexually active females with childbearing potential, if no adequate contraceptive measures are used.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David R. Elmaleh, PhD
Organizational Affiliation
AZTherapies, Inc.
Official's Role
Study Director
Facility Information:
Facility Name
UCSD Altman Clinical and Translational Research Institute
City
La Jolla
State/Province
California
ZIP/Postal Code
92037
Country
United States
Facility Name
Mayo Clinic
City
Jacksonville
State/Province
Florida
ZIP/Postal Code
32224
Country
United States
Facility Name
Hospital for Special Surgery
City
New York
State/Province
New York
ZIP/Postal Code
10021
Country
United States
Facility Name
Columbia University Medical Center
City
New York
State/Province
New York
ZIP/Postal Code
10032
Country
United States
Facility Name
Wake Forest School of Medicine
City
Winston-Salem
State/Province
North Carolina
ZIP/Postal Code
27157
Country
United States
Facility Name
Oregon Health & Science University
City
Portland
State/Province
Oregon
ZIP/Postal Code
97239
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
31776380
Citation
Granucci EJ, Griciuc A, Mueller KA, Mills AN, Le H, Dios AM, McGinty D, Pereira J, Elmaleh D, Berry JD, Paganoni S, Cudkowicz ME, Tanzi RE, Sadri-Vakili G. Cromolyn sodium delays disease onset and is neuroprotective in the SOD1G93A Mouse Model of amyotrophic lateral sclerosis. Sci Rep. 2019 Nov 27;9(1):17728. doi: 10.1038/s41598-019-53982-w.
Results Reference
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A Safety and Biomarker Study of ALZT-OP1a in Subjects With Mild-Moderate ALS Disease

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