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A Study of Monepantel in Individuals With Motor Neurone Disease

Primary Purpose

Motor Neuron Disease

Status
Recruiting
Phase
Phase 1
Locations
Australia
Study Type
Interventional
Intervention
Monepantel
Sponsored by
PharmAust Ltd
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Motor Neuron Disease

Eligibility Criteria

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

Inclusion Criteria:

  • Signed informed consent obtained prior to initiation of any study-specific procedures and treatment
  • Familial or sporadic ALS/MND diagnosed as clinically possible, probable, or definite according to Awaji-shima Consensus Recommendations
  • Seated slow vital capacity (SVC) ≥ 3L in males and ≥ 2.5L in females at screening
  • Not taking riluzole or on a stable dose of riluzole for at least 4 weeks prior to the screening visit. While on study, subjects are not allowed to start taking riluzole during the study
  • Patient has a competent caregiver who can support the patient's involvement in the study, including assisting the administration of study drug
  • Adequate bone marrow reserve, renal and liver function:

    1. absolute neutrophil count (ANC) ≥1500/µL;
    2. platelet count ≥ 100,000/µL;
    3. hemoglobin ≥ 9 g/dL;
    4. creatinine clearance ≥ 60 mL/min (Cockroft & Gault formula);
    5. alanine aminotransferase ALT, SGPT) and/or aspartate aminotransferase (AST, SGOT)
    6. ≤ 2 x upper limit of normal (ULN);
    7. total bilirubin ≤ 1.5 x ULN;
    8. serum albumin ≥ 2.8 g/dL
  • Women and men with partners of childbearing potential must use effective contraception while on study treatment and women of childbearing potential must have a negative pregnancy test at screening

Exclusion Criteria:

  • Inability to swallow oral medications or presence of a gastrointestinal disorder (e.g., malabsorption) deemed to jeopardize intestinal absorption of study drug
  • Dependence on mechanical ventilation (invasive or non-invasive, including Continuous Positive Airway Pressure (CPAP) or Bi-level Positive Airway Pressure (BiPAP) for any part of day or night prior to the screening visit. Dependence on mechanical ventilation is defined as being unable to lie flat (supine) without it, unable to sleep without it, or daytime use
  • Exposure to any other investigational agent within 3 months prior to the screening visit
  • Active gastrointestinal disease within 30 days of the screening visit. Gastro-esophageal reflux disease (GERD) is not considered active gastrointestinal disease and is not exclusionary
  • Known immune compromising illness or treatment
  • Presence of any of the following clinical conditions:

    1. drug abuse or alcoholism;
    2. unstable cardiac, pulmonary, renal, hepatic, endocrine, or hematologic disease;
    3. active infectious disease;
    4. AIDS or AIDS-related complex;
    5. diagnosis of malignancy within 2 years of screening (adequately treated basal cell or squamous cell carcinoma of skin or non-invasive bladder cancer or carcinoma in situ of the bladder, breast or cervix are allowed;
    6. unstable psychiatric illness defined as psychosis or untreated major depression within 90 days of the screening visit;
    7. neuromuscular disease other than ALS/MND
  • Dementia that may affect either outcome measures or patient understanding and/or compliance with study requirements and procedures
  • Women and men of childbearing potential not using effective contraception while on study treatment
  • Women who are breast-feeding
  • Patients at risk of or known to carry a SOD1 mutation or VCP mutation

Sites / Locations

  • Macquarie UniversityRecruiting
  • Calvary Health Care BethlehemRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Monepantel treatment arm

Arm Description

Monepantel tablets will be administered to participants in this arm daily for 28 days. Dose escalation will occur at the end of each 28 day period according to a modified Fibonacci sequence based upon recommendations from the safety management committee

Outcomes

Primary Outcome Measures

Determination of Phase 2 Dose
A recommended phase 2 dose will be determined by the number of participants at each dose level recording dose limiting toxicities
Blood Plasma Pharmacokinetics of Monepantel
Characterise monepantel blood plasma levels following administration to individuals living with ALS/MND
Blood Plasma Pharmacokinetics of Monepantel Sulfone
Characterise monepantel's major metabolite monepantel sulfone blood plasma levels following administration of monepantel to individuals living with ALS/MND

Secondary Outcome Measures

Treatment related changes in peripheral blood mononuclear cell phosphorylated ribosomal protein S6 kinase B1 (RPS6KB1) levels (pharmacodynamics)
Changes RPS6KB1 phosphorylation levels will assist in determining if the proposed targeted mammalian target of rapamycin (mTOR) pathway is being correctly affected (photostimulated luminescence units)
Treatment related changes in peripheral blood mononuclear cell phosphorylated eukaryotic initiation factor 4 E binding protein 1 (EIF4EBP1) levels (pharmacodynamics)
Changes EIF4EBP1 phosphorylation levels will assist in determining if the proposed targeted mammalian target of rapamycin (mTOR) pathway is being correctly affected (photostimulated luminescence units)
Treatment-related changes from Baseline on the ALS Functional Rating Scale (ALSFRS) at Week 4
The ALS Functional Rating Scale (ALSFRS) is a validated rating instrument for monitoring the progression of disability in patients with amyotrophic lateral sclerosis (ALS). Measurements include: (1) speech (2) salivation (3) swallowing (4) handwriting (5) cutting food and handling utensils (with or without gastrostomy) (6) dressing and hygiene (7) turning in bed and adjusting bed clothes (8) walking (9) climbing stairs and (10) breathing. Possible scores range from 0 (normal function) to 4 (severe loss of function). Change = (Week 4 score - Baseline score)
Treatment-related changes from Baseline in Edinburgh Cognitive and Behavioural Amyotrophic Lateral Sclerosis Screen (ECAS) at Week 4
The ECAS-cognitive screen is a validated screen comprises 16 items organized into two sub-scales. An ALS-specific sub-scale taps into the cognitive domains of language, verbal fluency, and executive and social functions. A non-ALS-specific sub-scale specifically assesses memory and visuospatial function. The sub-scales of the ECAS-cognitive screen range, respectively, from 0 to 100 and from 0 to 36. Low scores indicate a greater deficit. Change = (Week 4 score - Baseline score)
Treatment-related changes from Baseline in slow vital capacity (SVC)
A decline in SVC would indicate a decline in respiratory function and is an important indicator of any clinical progression (L/s)
Treatment-related changes in urinary p75 levels
Urinary p75 level reflect nerve damage and therefore increased levels would act as a proxy to disease progression (ng/mg creatinine)
Treatment-related changes in 3 Tesla magnetic resonance imaging (MRI)
MRI is a method used to investigate and exclude conditions that may mimic motor neuron dysfunction (Tesla)
Treatment-related changes in serum neurofilament light (NfL) chain levels
Serum NfL chain levels correlate with disease progression, so stable NfL levels would correlate with stable disease (pg/ml)
Treatment-related changes in central spinal fluid (CSF) NfL chain levels
CSF NfL chain levels correlate with disease progression. Levels in individuals living with MND are 5 to 10 fold higher than those of healthy individuals (pg/ml)

Full Information

First Posted
May 5, 2021
Last Updated
October 10, 2022
Sponsor
PharmAust Ltd
Collaborators
FightMND, Calvary Health Care Bethlehem, Macquarie University, Australia
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1. Study Identification

Unique Protocol Identification Number
NCT04894240
Brief Title
A Study of Monepantel in Individuals With Motor Neurone Disease
Official Title
A Phase I Tolerability, Safety, Pharmacokinetics and Preliminary Efficacy Study of Oral Monepantel in Individuals With Motor Neurone Disease
Study Type
Interventional

2. Study Status

Record Verification Date
June 2022
Overall Recruitment Status
Recruiting
Study Start Date
June 28, 2022 (Actual)
Primary Completion Date
December 1, 2022 (Anticipated)
Study Completion Date
May 1, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
PharmAust Ltd
Collaborators
FightMND, Calvary Health Care Bethlehem, Macquarie University, Australia

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Amyotrophic lateral sclerosis/ Motor Neurone Disease (ALS/MND) is a rare and invariably fatal neurological disease. ALS/MND has a terribly high burden on patients, family and carers, and carries great socioeconomic burden. Current best treatment options are expensive and attempt to control disease progression and manage symptoms while offering no cure. Better treatments are wanting. Monepantel is a well-known veterinary drug, registered as a livestock wormicide in 39 countries. The industry collaborator, PharmAust Ltd, has found that monepantel shows off-target activity, inhibiting a cellular signaling system controlled by mammalian target of rapamycin (mTOR). This stops cancer growth and reduces protein accumulation in diseased cells. PharmAust has already tested monepantel in humans and pet dogs in Phase I and II anti-cancer clinical trials, respectively, in Australia. Data from these trials show that monepantel treatment associates with an exceptionally high safety profile, mTOR signaling inhibition and anticancer activity. Abnormal protein accumulation within motor neurons of the brain associates with the cause of ALS/MND. Inhibition of the mTOR signaling pathway slows disease progression in certain preclinical models of ALS/MND and is suggested to provide synergy with the ALS/MND standard-of-care drug, riluzole. An alternative mTOR inhibitor, rapamycin, is currently the subject of an ALS/MND clinical trial in humans investigating control of disease progression. Monepantel has a different structure to rapamycin and an apparently better safety profile. This Phase I Clinical Trial hypothesis is that monepantel administration to individuals living with ALS/MND will safely reduce disease associated protein accumulation in motor neurons and provide therapeutic benefit. To test this hypothesis, the safety and tolerability of oral monepantel administration and markers of efficacy will be tested in individuals living with ALS/MND in a dose escalating Phase I/II Clinical Trial. To mitigate risk, only patients with sporadic and certain known familial types of ALS will be eligible. To further mitigate risk, the monepantel starting dose will be reduced a calculated five-fold compared to that already used in human cancer patients and already demonstrated to be safe and effective as an mTOR inhibitor. Dependent upon incremental outcomes, three higher doses may then be tested, each for minimally 28 days with a duration at the optimal dose of at least six months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Motor Neuron Disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
12 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Monepantel treatment arm
Arm Type
Experimental
Arm Description
Monepantel tablets will be administered to participants in this arm daily for 28 days. Dose escalation will occur at the end of each 28 day period according to a modified Fibonacci sequence based upon recommendations from the safety management committee
Intervention Type
Drug
Intervention Name(s)
Monepantel
Intervention Description
Monepantel is provided to individuals living with ALS/MND as a white oval tablet to be administered once a day following meals
Primary Outcome Measure Information:
Title
Determination of Phase 2 Dose
Description
A recommended phase 2 dose will be determined by the number of participants at each dose level recording dose limiting toxicities
Time Frame
At least 4 weeks
Title
Blood Plasma Pharmacokinetics of Monepantel
Description
Characterise monepantel blood plasma levels following administration to individuals living with ALS/MND
Time Frame
0.5, 1, 2, 3, 4, 6, 8, 10, 12 and 24 hours and 2, 8, 15, 22 and 29 days after dosing
Title
Blood Plasma Pharmacokinetics of Monepantel Sulfone
Description
Characterise monepantel's major metabolite monepantel sulfone blood plasma levels following administration of monepantel to individuals living with ALS/MND
Time Frame
0.5, 1, 2, 3, 4, 6, 8, 10, 12 and 24 hours and 2, 8, 15, 22 and 29 days after dosing
Secondary Outcome Measure Information:
Title
Treatment related changes in peripheral blood mononuclear cell phosphorylated ribosomal protein S6 kinase B1 (RPS6KB1) levels (pharmacodynamics)
Description
Changes RPS6KB1 phosphorylation levels will assist in determining if the proposed targeted mammalian target of rapamycin (mTOR) pathway is being correctly affected (photostimulated luminescence units)
Time Frame
From admission to discharge, up to 6 months
Title
Treatment related changes in peripheral blood mononuclear cell phosphorylated eukaryotic initiation factor 4 E binding protein 1 (EIF4EBP1) levels (pharmacodynamics)
Description
Changes EIF4EBP1 phosphorylation levels will assist in determining if the proposed targeted mammalian target of rapamycin (mTOR) pathway is being correctly affected (photostimulated luminescence units)
Time Frame
From admission to discharge, up to 6 months
Title
Treatment-related changes from Baseline on the ALS Functional Rating Scale (ALSFRS) at Week 4
Description
The ALS Functional Rating Scale (ALSFRS) is a validated rating instrument for monitoring the progression of disability in patients with amyotrophic lateral sclerosis (ALS). Measurements include: (1) speech (2) salivation (3) swallowing (4) handwriting (5) cutting food and handling utensils (with or without gastrostomy) (6) dressing and hygiene (7) turning in bed and adjusting bed clothes (8) walking (9) climbing stairs and (10) breathing. Possible scores range from 0 (normal function) to 4 (severe loss of function). Change = (Week 4 score - Baseline score)
Time Frame
From admission to discharge, up to 6 months
Title
Treatment-related changes from Baseline in Edinburgh Cognitive and Behavioural Amyotrophic Lateral Sclerosis Screen (ECAS) at Week 4
Description
The ECAS-cognitive screen is a validated screen comprises 16 items organized into two sub-scales. An ALS-specific sub-scale taps into the cognitive domains of language, verbal fluency, and executive and social functions. A non-ALS-specific sub-scale specifically assesses memory and visuospatial function. The sub-scales of the ECAS-cognitive screen range, respectively, from 0 to 100 and from 0 to 36. Low scores indicate a greater deficit. Change = (Week 4 score - Baseline score)
Time Frame
From admission to discharge, up to 6 months
Title
Treatment-related changes from Baseline in slow vital capacity (SVC)
Description
A decline in SVC would indicate a decline in respiratory function and is an important indicator of any clinical progression (L/s)
Time Frame
From admission to discharge, up to 6 months
Title
Treatment-related changes in urinary p75 levels
Description
Urinary p75 level reflect nerve damage and therefore increased levels would act as a proxy to disease progression (ng/mg creatinine)
Time Frame
From admission to discharge, up to 6 months
Title
Treatment-related changes in 3 Tesla magnetic resonance imaging (MRI)
Description
MRI is a method used to investigate and exclude conditions that may mimic motor neuron dysfunction (Tesla)
Time Frame
From admission to discharge, up to 6 months
Title
Treatment-related changes in serum neurofilament light (NfL) chain levels
Description
Serum NfL chain levels correlate with disease progression, so stable NfL levels would correlate with stable disease (pg/ml)
Time Frame
From admission to discharge, up to 6 months
Title
Treatment-related changes in central spinal fluid (CSF) NfL chain levels
Description
CSF NfL chain levels correlate with disease progression. Levels in individuals living with MND are 5 to 10 fold higher than those of healthy individuals (pg/ml)
Time Frame
From admission to discharge, up to 6 months

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: Signed informed consent obtained prior to initiation of any study-specific procedures and treatment Familial or sporadic ALS/MND diagnosed as clinically possible, probable, or definite according to Awaji-shima Consensus Recommendations Seated slow vital capacity (SVC) ≥ 3L in males and ≥ 2.5L in females at screening Not taking riluzole or on a stable dose of riluzole for at least 4 weeks prior to the screening visit. While on study, subjects are not allowed to start taking riluzole during the study Patient has a competent caregiver who can support the patient's involvement in the study, including assisting the administration of study drug Adequate bone marrow reserve, renal and liver function: absolute neutrophil count (ANC) ≥1500/µL; platelet count ≥ 100,000/µL; hemoglobin ≥ 9 g/dL; creatinine clearance ≥ 60 mL/min (Cockroft & Gault formula); alanine aminotransferase ALT, SGPT) and/or aspartate aminotransferase (AST, SGOT) ≤ 2 x upper limit of normal (ULN); total bilirubin ≤ 1.5 x ULN; serum albumin ≥ 2.8 g/dL Women and men with partners of childbearing potential must use effective contraception while on study treatment and women of childbearing potential must have a negative pregnancy test at screening Exclusion Criteria: Inability to swallow oral medications or presence of a gastrointestinal disorder (e.g., malabsorption) deemed to jeopardize intestinal absorption of study drug Dependence on mechanical ventilation (invasive or non-invasive, including Continuous Positive Airway Pressure (CPAP) or Bi-level Positive Airway Pressure (BiPAP) for any part of day or night prior to the screening visit. Dependence on mechanical ventilation is defined as being unable to lie flat (supine) without it, unable to sleep without it, or daytime use Exposure to any other investigational agent within 3 months prior to the screening visit Active gastrointestinal disease within 30 days of the screening visit. Gastro-esophageal reflux disease (GERD) is not considered active gastrointestinal disease and is not exclusionary Known immune compromising illness or treatment Presence of any of the following clinical conditions: drug abuse or alcoholism; unstable cardiac, pulmonary, renal, hepatic, endocrine, or hematologic disease; active infectious disease; AIDS or AIDS-related complex; diagnosis of malignancy within 2 years of screening (adequately treated basal cell or squamous cell carcinoma of skin or non-invasive bladder cancer or carcinoma in situ of the bladder, breast or cervix are allowed; unstable psychiatric illness defined as psychosis or untreated major depression within 90 days of the screening visit; neuromuscular disease other than ALS/MND Dementia that may affect either outcome measures or patient understanding and/or compliance with study requirements and procedures Women and men of childbearing potential not using effective contraception while on study treatment Women who are breast-feeding Patients at risk of or known to carry a SOD1 mutation or VCP mutation
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Roger Aston, PhD
Phone
+61402762204
Email
rogeraston@aol.com
First Name & Middle Initial & Last Name or Official Title & Degree
Sam Wright
Phone
+61 (8) 9202 6814
Email
sam@pharmaust.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Susan Mathers, MB ChB, MRCP(UK), FRACP
Organizational Affiliation
Calvary Health Care Bethlehem
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Dominic Rowe, PhD, FRACP, AM
Organizational Affiliation
Macquarie University, Sydney
Official's Role
Principal Investigator
Facility Information:
Facility Name
Macquarie University
City
Sydney
State/Province
New South Wales
ZIP/Postal Code
2109
Country
Australia
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dominic Rowe, PhD, FRACP, AM
Facility Name
Calvary Health Care Bethlehem
City
Melbourne
State/Province
Victoria
ZIP/Postal Code
3195
Country
Australia
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Susan Mathers, MB ChB, MRCP(UK), FRACP

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
32960289
Citation
Mislang A, Mollard R, Tapia Rico G, Fairlie WD, Lee EF, Harris TJ, Aston R, Brown MP. A preliminary assessment of oral monepantel's tolerability and pharmacokinetics in individuals with treatment-refractory solid tumors. Cancer Chemother Pharmacol. 2020 Nov;86(5):589-594. doi: 10.1007/s00280-020-04146-5. Epub 2020 Sep 22.
Results Reference
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A Study of Monepantel in Individuals With Motor Neurone Disease

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