Phase III Trial of AMX0035 for Amyotrophic Lateral Sclerosis Treatment (Phoenix)
Primary Purpose
Amyotrophic Lateral Sclerosis
Status
Active
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Placebo
AMX0035
Sponsored by
About this trial
This is an interventional treatment trial for Amyotrophic Lateral Sclerosis
Eligibility Criteria
Inclusion Criteria:
- Male or female, at least 18 years of age
- Diagnosis of ALS (definite or clinically probable)
- Time since onset of first symptom of ALS should be <24 months prior to randomization;
- If the participant is to be treated with riluzole and/or edaravone during the course of the trial, then treatment with riluzole and/or edaravone was, at the time of the screening visit, started and maintained at a stable regimen for at least 14 days for riluzole and/or for a full treatment cycle for edaravone;
- Capable of providing informed consent
- Capable and willing to follow trial procedures including visits to the trial clinic and visit requirements;
- Women of child bearing potential (e.g. not post-menopausal for at least one year or surgically sterile) must agree to use adequate birth control for the duration of the study and 3 months after last dose of study drug. Women must not be planning to become pregnant for the duration of the study and 3 months after last dose of study drug
- Men must agree to practice contraception for the duration of the study and 3 months after last dose of study drug. Men must not plan to father a child or provide for sperm donation for the duration of the study and 3 months after last dose of study drug
Exclusion Criteria:
- Presence of tracheostomy or permanent assisted ventilation(PAV)
- Slow Vital Capacity (SVC) less than 55%
- History of known allergy to phenyl butyrate or bile salts
- Abnormal liver function defined as bilirubin levels and/or aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) > 5 times the upper limit of the normal (obtained within 12 weeks from first dose)
- Renal insufficiency as defined by eGFR <60 mL/min/1.73m^2 (obtained within 12 weeks from first dose)
- Pregnant women (confirmed by a pregnancy test within 7 days of first dose) or women currently breastfeeding
- Current severe biliary disease which may result in the Investigator medical judgement in biliary obstruction including for example active cholecystitis, primary biliary cirrhosis, sclerosing cholangitis, gallbladder cancer, gangrene of the gallbladder, abscess of the gallbladder
- History of Class III/IV heart failure (per New York Heart Association - NYHA)
- Participant under severe salt restriction where the added salt intake due to treatment would put the participant at risk, in the Investigator clinical judgment
- Presence of unstable psychiatric disease, cognitive impairment, dementia or substance abuse that would impair ability of the participant to provide informed consent, according to Investigator judgment
- Clinically significant unstable medical condition (other than ALS) (e.g., cardiovascular instability, systemic infection, untreated thyroid dysfunction, severe laboratory test anomaly or clinically significant electrocardiogram [ECG] changes) that would pose a risk to the participant if he/she were to participate in the trial, according to Investigator judgment
- Previous treatment for ALS with cellular therapies or gene therapies
- Currently enrolled in another trial involving use of an investigational therapy
- Previous treatment with PB or taurursodiol within 30 days from Screening
- Implantation of Diaphragm Pacing System (DPS)
- Currently or previously treated within the last 30 days or planned exposure to any prohibited medications listed in Section 6.8 of the protocol
Sites / Locations
- Barrow Neurological Institute
- University of Southern California
- University of California Irvine
- California Pacific Medical Center Research Institute
- University of Colorado
- University of Florida
- University of South Florida
- Emory University
- Augusta University Neuroscience Center
- Northwestern University
- Johns Hopkins University School of Medicine Outpatient Center
- Healey & AMG Center for ALS Research at Massachusetts General Hospital
- University of Massachusetts
- Hennepin Healthcare Research Institute
- Washington University School of Medicine
- Somnos Clinical Research
- Rutgers University
- Columbia University
- University of North Carolina at Chapel Hill
- Wake Forest University Health Sciences
- The Ohio State University
- University of Pennsylvania
- Lewis Katz School of Medicine at Temple University
- Austin Neuromuscular Center
- Texas Neurology
- Virginia Commonwealth University
- Swedish Neuroscience Institute
- University of Washington
- University Hospitals Leuven
- Hospices Civils de Lyon Hôpital Neurologique Pierre Wertheimer Cellule Mutualisée de Recherche Clinique (CMRC)
- Hopital Gabriel Montpied Service de Neurologie
- CHRU de Lille - Hôpital Roger Salengro
- CHU de Limoges - Hôpital Dupuytren
- Hôpitaux Universitaires de Marseille Timone
- CHU de Montpellier
- CHU Nice
- Hôpital de la Salpêtrière
- Le Centre Hospitalier Régional Universitaire de Tours
- Charité - Universitätsmedizin Berlin
- Uniklinikum Dresden
- Hannover Medical School
- Jena University Hospital
- Medizinische Fakultät Mannheim der Universität Heidelberg
- University Medical Center Rostock
- Ulm University Medical Centre
- Trinity College Dublin/Beaumont Hospital
- Università degli Studi di Bari Aldo Moro
- Centro Clinico NEMO
- University of Milan Medical School
- Azienda Ospedaliero Universitaria Di Modena
- Università degli Studi della Campania Luigi Vanvitelli
- University of Padua
- University of Torino
- University Medical Center Utrecht
- Centrum Medyczne Linden
- City Clinic Warsaw
- Centro Hospitalar Universitário Lisboa-Norte
- Hospital del Mar
- Hospital Universitari de Bellvitge-IDIBELL
- Hospital San Rafael
- Biodonostia Health Research Institute; Hospital Universitario Donostia
- Hospital Universitario y Politécnico La Fe
- Karolinska Institutet
- Umeå University Hospital
- King's College London
- UCL Queen Square Institute of Neurology
- University of Plymouth
- Salford Royal Hospital Barnes
- Sheffield Institute for Translational Neuroscience (SITraN)
Arms of the Study
Arm 1
Arm 2
Arm Type
Placebo Comparator
Experimental
Arm Label
Placebo
AMX0035
Arm Description
Placebo administered by mouth or via feeding tube for 48 weeks: once daily for first 3 weeks and then twice daily for remainder of study if participant tolerating
Placebo administered by mouth or via feeding tube for 48 weeks: once daily for first 3 weeks and then twice daily for remainder of study if participant tolerating
Outcomes
Primary Outcome Measures
Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) Slope Change And Survival
Change in slope of Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) over treatment duration. The ALSFRS-R consists of 12 items across 4 subdomains of function (bulbar, fine motor, gross motor, and breathing) with each item scored on a scale from 0 (total loss of function) to 4 (no loss of function). Total scores range from 0 to 48, with higher scores indicating better function.
Number of Participants With Adverse Events
Comparison Between Groups of Number of Participants With Adverse Events Until Planned Completion
Number of Participants in Each Group Able to Remain on Study Drug Until Planned Discontinuation
A comparison o0f the number of participants in each group able to remain on study drug until planned discontinuation between groups
Secondary Outcome Measures
Rate of Decline in Slow Vital Capacity (SVC)
Respiratory muscle function will be assessed according to slow vital capacity (SVC). SVC is measured in an upright position for at least three trials per assessment. SVC volumes will be standardized to the percentage of predicted normal value based on age, sex, and height.
Participant Quality of Life (QOL)
QOL will be measured using the 40-item Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ-40) patient-reported outcome (PRO)
Decline in King's and MiToS Stages
The decline in King's and MiToS (Milano-Torino staging) will be derived from ALSFRS-R data
Ventilation Free Survival
The composite outcome is defined as death, a death-equivalent event (tracheostomy), or hospitalization, whichever occurs first
Participant Health Status
Participant health status will be measured using the EQ-5D descriptive system and the EQ visual analogue scale [EQ VAS] patient reported outcomes questionnaire
Assess Long-Term Survival
Long-Term Survival will be obtained by monitoring of all-cause mortality
Full Information
NCT ID
NCT05021536
First Posted
August 20, 2021
Last Updated
January 4, 2023
Sponsor
Amylyx Pharmaceuticals Inc.
1. Study Identification
Unique Protocol Identification Number
NCT05021536
Brief Title
Phase III Trial of AMX0035 for Amyotrophic Lateral Sclerosis Treatment
Acronym
Phoenix
Official Title
A Phase III, Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial to Evaluate the Safety and Efficacy of AMX0035 Versus Placebo for 48-week Treatment of Adult Patients With Amyotrophic Lateral Sclerosis (ALS)
Study Type
Interventional
2. Study Status
Record Verification Date
January 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
October 28, 2021 (Actual)
Primary Completion Date
November 1, 2023 (Anticipated)
Study Completion Date
March 1, 2024 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Amylyx Pharmaceuticals 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
The Phoenix Trial is a randomized double blind placebo controlled Phase III trial to evaluate the safety and efficacy of AMX0035 for treatment of ALS
Detailed Description
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 is designed to demonstrate that treatment is safe, tolerable, and able to slow decline in function as measured by the ALSFRS-R and survival over 48 week. The trial will also assess the effects of AMX0035 on slow vital capacity, quality of life and plasma biomarkers of ALS.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Amyotrophic Lateral Sclerosis
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
600 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo administered by mouth or via feeding tube for 48 weeks: once daily for first 3 weeks and then twice daily for remainder of study if participant tolerating
Arm Title
AMX0035
Arm Type
Experimental
Arm Description
Placebo administered by mouth or via feeding tube for 48 weeks: once daily for first 3 weeks and then twice daily for remainder of study if participant tolerating
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Matching Placebo Comparator
Intervention Type
Drug
Intervention Name(s)
AMX0035
Intervention Description
Proprietary formulation of taurursodiol and sodium phenylbutyrate
Primary Outcome Measure Information:
Title
Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) Slope Change And Survival
Description
Change in slope of Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) over treatment duration. The ALSFRS-R consists of 12 items across 4 subdomains of function (bulbar, fine motor, gross motor, and breathing) with each item scored on a scale from 0 (total loss of function) to 4 (no loss of function). Total scores range from 0 to 48, with higher scores indicating better function.
Time Frame
48 weeks
Title
Number of Participants With Adverse Events
Description
Comparison Between Groups of Number of Participants With Adverse Events Until Planned Completion
Time Frame
48 weeks
Title
Number of Participants in Each Group Able to Remain on Study Drug Until Planned Discontinuation
Description
A comparison o0f the number of participants in each group able to remain on study drug until planned discontinuation between groups
Time Frame
48 weeks
Secondary Outcome Measure Information:
Title
Rate of Decline in Slow Vital Capacity (SVC)
Description
Respiratory muscle function will be assessed according to slow vital capacity (SVC). SVC is measured in an upright position for at least three trials per assessment. SVC volumes will be standardized to the percentage of predicted normal value based on age, sex, and height.
Time Frame
48 weeks
Title
Participant Quality of Life (QOL)
Description
QOL will be measured using the 40-item Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ-40) patient-reported outcome (PRO)
Time Frame
48 weeks
Title
Decline in King's and MiToS Stages
Description
The decline in King's and MiToS (Milano-Torino staging) will be derived from ALSFRS-R data
Time Frame
48 weeks
Title
Ventilation Free Survival
Description
The composite outcome is defined as death, a death-equivalent event (tracheostomy), or hospitalization, whichever occurs first
Time Frame
48 weeks
Title
Participant Health Status
Description
Participant health status will be measured using the EQ-5D descriptive system and the EQ visual analogue scale [EQ VAS] patient reported outcomes questionnaire
Time Frame
48 weeks
Title
Assess Long-Term Survival
Description
Long-Term Survival will be obtained by monitoring of all-cause mortality
Time Frame
3 years
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Male or female, at least 18 years of age
Diagnosis of ALS (definite or clinically probable)
Time since onset of first symptom of ALS should be <24 months prior to randomization;
If the participant is to be treated with riluzole and/or edaravone during the course of the trial, then treatment with riluzole and/or edaravone was, at the time of the screening visit, started and maintained at a stable regimen for at least 14 days for riluzole and/or for a full treatment cycle for edaravone;
Capable of providing informed consent
Capable and willing to follow trial procedures including visits to the trial clinic and visit requirements;
Women of child bearing potential (e.g. not post-menopausal for at least one year or surgically sterile) must agree to use adequate birth control for the duration of the study and 3 months after last dose of study drug. Women must not be planning to become pregnant for the duration of the study and 3 months after last dose of study drug
Men must agree to practice contraception for the duration of the study and 3 months after last dose of study drug. Men must not plan to father a child or provide for sperm donation for the duration of the study and 3 months after last dose of study drug
Exclusion Criteria:
Presence of tracheostomy or permanent assisted ventilation(PAV)
Slow Vital Capacity (SVC) less than 55%
History of known allergy to phenyl butyrate or bile salts
Abnormal liver function defined as bilirubin levels and/or aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) > 5 times the upper limit of the normal (obtained within 12 weeks from first dose)
Renal insufficiency as defined by eGFR <60 mL/min/1.73m^2 (obtained within 12 weeks from first dose)
Pregnant women (confirmed by a pregnancy test within 7 days of first dose) or women currently breastfeeding
Current severe biliary disease which may result in the Investigator medical judgement in biliary obstruction including for example active cholecystitis, primary biliary cirrhosis, sclerosing cholangitis, gallbladder cancer, gangrene of the gallbladder, abscess of the gallbladder
History of Class III/IV heart failure (per New York Heart Association - NYHA)
Participant under severe salt restriction where the added salt intake due to treatment would put the participant at risk, in the Investigator clinical judgment
Presence of unstable psychiatric disease, cognitive impairment, dementia or substance abuse that would impair ability of the participant to provide informed consent, according to Investigator judgment
Clinically significant unstable medical condition (other than ALS) (e.g., cardiovascular instability, systemic infection, untreated thyroid dysfunction, severe laboratory test anomaly or clinically significant electrocardiogram [ECG] changes) that would pose a risk to the participant if he/she were to participate in the trial, according to Investigator judgment
Previous treatment for ALS with cellular therapies or gene therapies
Currently enrolled in another trial involving use of an investigational therapy
Previous treatment with PB or taurursodiol within 30 days from Screening
Implantation of Diaphragm Pacing System (DPS)
Currently or previously treated within the last 30 days or planned exposure to any prohibited medications listed in Section 6.8 of the protocol
Facility Information:
Facility Name
Barrow Neurological Institute
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85013
Country
United States
Facility Name
University of Southern California
City
Los Angeles
State/Province
California
ZIP/Postal Code
90033
Country
United States
Facility Name
University of California Irvine
City
Orange
State/Province
California
ZIP/Postal Code
92868
Country
United States
Facility Name
California Pacific Medical Center Research Institute
City
San Francisco
State/Province
California
ZIP/Postal Code
94109
Country
United States
Facility Name
University of Colorado
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Name
University of Florida
City
Gainesville
State/Province
Florida
ZIP/Postal Code
32068
Country
United States
Facility Name
University of South Florida
City
Tampa
State/Province
Florida
ZIP/Postal Code
33612
Country
United States
Facility Name
Emory University
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30322
Country
United States
Facility Name
Augusta University Neuroscience Center
City
Augusta
State/Province
Georgia
ZIP/Postal Code
30912
Country
United States
Facility Name
Northwestern University
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Facility Name
Johns Hopkins University School of Medicine Outpatient Center
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21287
Country
United States
Facility Name
Healey & AMG Center for ALS Research at Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Facility Name
University of Massachusetts
City
Worcester
State/Province
Massachusetts
ZIP/Postal Code
01655
Country
United States
Facility Name
Hennepin Healthcare Research Institute
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55415
Country
United States
Facility Name
Washington University School of Medicine
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Facility Name
Somnos Clinical Research
City
Lincoln
State/Province
Nebraska
ZIP/Postal Code
68510
Country
United States
Facility Name
Rutgers University
City
New Brunswick
State/Province
New Jersey
ZIP/Postal Code
08901
Country
United States
Facility Name
Columbia University
City
New York
State/Province
New York
ZIP/Postal Code
10032
Country
United States
Facility Name
University of North Carolina at Chapel Hill
City
Chapel Hill
State/Province
North Carolina
ZIP/Postal Code
27514
Country
United States
Facility Name
Wake Forest University Health Sciences
City
Winston-Salem
State/Province
North Carolina
ZIP/Postal Code
27109
Country
United States
Facility Name
The Ohio State University
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43210
Country
United States
Facility Name
University of Pennsylvania
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19107
Country
United States
Facility Name
Lewis Katz School of Medicine at Temple University
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19140
Country
United States
Facility Name
Austin Neuromuscular Center
City
Austin
State/Province
Texas
ZIP/Postal Code
78756
Country
United States
Facility Name
Texas Neurology
City
Dallas
State/Province
Texas
ZIP/Postal Code
72506
Country
United States
Facility Name
Virginia Commonwealth University
City
Henrico
State/Province
Virginia
ZIP/Postal Code
23233
Country
United States
Facility Name
Swedish Neuroscience Institute
City
Seattle
State/Province
Washington
ZIP/Postal Code
98122
Country
United States
Facility Name
University of Washington
City
Seattle
State/Province
Washington
ZIP/Postal Code
98195
Country
United States
Facility Name
University Hospitals Leuven
City
Leuven
Country
Belgium
Facility Name
Hospices Civils de Lyon Hôpital Neurologique Pierre Wertheimer Cellule Mutualisée de Recherche Clinique (CMRC)
City
Bron
Country
France
Facility Name
Hopital Gabriel Montpied Service de Neurologie
City
Clermont-Ferrand
Country
France
Facility Name
CHRU de Lille - Hôpital Roger Salengro
City
Lille
Country
France
Facility Name
CHU de Limoges - Hôpital Dupuytren
City
Limoges
Country
France
Facility Name
Hôpitaux Universitaires de Marseille Timone
City
Marseille
Country
France
Facility Name
CHU de Montpellier
City
Montpellier
Country
France
Facility Name
CHU Nice
City
Nice
Country
France
Facility Name
Hôpital de la Salpêtrière
City
Paris
Country
France
Facility Name
Le Centre Hospitalier Régional Universitaire de Tours
City
Tours
Country
France
Facility Name
Charité - Universitätsmedizin Berlin
City
Berlin
Country
Germany
Facility Name
Uniklinikum Dresden
City
Dresden
Country
Germany
Facility Name
Hannover Medical School
City
Hannover
Country
Germany
Facility Name
Jena University Hospital
City
Jena
Country
Germany
Facility Name
Medizinische Fakultät Mannheim der Universität Heidelberg
City
Mannheim
Country
Germany
Facility Name
University Medical Center Rostock
City
Rostock
Country
Germany
Facility Name
Ulm University Medical Centre
City
Ulm
Country
Germany
Facility Name
Trinity College Dublin/Beaumont Hospital
City
Dublin
Country
Ireland
Facility Name
Università degli Studi di Bari Aldo Moro
City
Bari
Country
Italy
Facility Name
Centro Clinico NEMO
City
Milan
Country
Italy
Facility Name
University of Milan Medical School
City
Milan
Country
Italy
Facility Name
Azienda Ospedaliero Universitaria Di Modena
City
Modena
Country
Italy
Facility Name
Università degli Studi della Campania Luigi Vanvitelli
City
Napoli
Country
Italy
Facility Name
University of Padua
City
Padova
Country
Italy
Facility Name
University of Torino
City
Turin
Country
Italy
Facility Name
University Medical Center Utrecht
City
Utrecht
Country
Netherlands
Facility Name
Centrum Medyczne Linden
City
Kraków
Country
Poland
Facility Name
City Clinic Warsaw
City
Warsaw
Country
Poland
Facility Name
Centro Hospitalar Universitário Lisboa-Norte
City
Lisbon
Country
Portugal
Facility Name
Hospital del Mar
City
Barcelona
Country
Spain
Facility Name
Hospital Universitari de Bellvitge-IDIBELL
City
Barcelona
Country
Spain
Facility Name
Hospital San Rafael
City
Madrid
Country
Spain
Facility Name
Biodonostia Health Research Institute; Hospital Universitario Donostia
City
San Sebastián
Country
Spain
Facility Name
Hospital Universitario y Politécnico La Fe
City
Valencia
Country
Spain
Facility Name
Karolinska Institutet
City
Stockholm
Country
Sweden
Facility Name
Umeå University Hospital
City
Umeå
Country
Sweden
Facility Name
King's College London
City
London
Country
United Kingdom
Facility Name
UCL Queen Square Institute of Neurology
City
London
Country
United Kingdom
Facility Name
University of Plymouth
City
Plymouth
Country
United Kingdom
Facility Name
Salford Royal Hospital Barnes
City
Salford
Country
United Kingdom
Facility Name
Sheffield Institute for Translational Neuroscience (SITraN)
City
Sheffield
Country
United Kingdom
12. IPD Sharing Statement
Learn more about this trial
Phase III Trial of AMX0035 for Amyotrophic Lateral Sclerosis Treatment
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