Safety of Engensis in Participants With Amyotrophic Lateral Sclerosis (REViVALS-1A)
Primary Purpose
Amyotrophic Lateral Sclerosis
Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Engensis
Placebo
Sponsored by
About this trial
This is an interventional treatment trial for Amyotrophic Lateral Sclerosis
Eligibility Criteria
Inclusion Criteria:
- Clinically definite or probable Amyotrophic Lateral Sclerosis (ALS) or laboratory-supported probable ALS as defined in the revised El Escorial/Airlie House diagnostic criteria
- The site of onset of ALS symptoms is a limb and experiencing symptoms of lower motor dysfunction (e.g., weakness, atrophy, cramps, poor circulation, etc.) with upper motor neuron symptoms (e.g., weakness, brisk reflexes, spasticity)
- Onset of ALS symptoms ≤ 4 years
- Slow Vital Capacity (SVC) ≥ 50% of predicted value at Screening
- Not taking riluzole, or on a stable dose (defined as no noted toxicities) for at least 30 days prior to Screening and throughout the study
- Not taking edaravone or on a maintenance cycle for at least 30 days prior to Screening and throughout the study
- For females of childbearing potential, a negative urine pregnancy test at Screening and on Day 0
- Male Participants and their female partners must agree to use double-barrier contraception during the study or provide proof of postmenopausal state (minimum 1 year) or surgical sterility
- Male Participants must not donate sperm during the study
- Female Participants must be nonpregnant, nonlactating, and either postmenopausal for at least 1 year, or surgically sterile for at least 3 months, or agree to use double-barrier contraception from 28 days prior to randomization (Day 0) and/or their last confirmed menstrual period prior to study randomization (whichever is longer) until the end of the study
- Capable of complying and willing to comply with the requirements and restrictions in the informed consent form and this protocol
- Willing to forgo new experimental ALS treatments for at least 6 months following randomization
Exclusion Criteria:
- Progressive or degenerative neurological disorder such as Alzheimer's disease, Parkinson's disease, vascular dementia, multiple sclerosis, and other neurological or vascular disorders felt by the Investigator to preclude participation
- Requires tracheotomy ventilation or noninvasive ventilation related to bulbar function
- Evidence by physical examination, history, or laboratory evaluation of significant concomitant disease with a life expectancy of < 6 months at Screening
- INR values >2.0
- Platelet count <100,000/µL
- Inflammatory disorder of the blood vessels (inflammatory angiopathy or vasculitis, such as Buerger's disease)
- Active infection (chronic infection or severe active infection that may compromise the Participant's wellbeing or participation in the study in the Investigator's judgment)
- Chronic inflammatory disease (e.g., Crohn's disease, rheumatoid arthritis)
- Positive human immunodeficiency virus (HIV) or human T-cell lymphotrophic virus (HTLV) I/II test at Screening
- Active acute or chronic hepatitis B
- Active hepatitis C
- Immunosuppression due to underlying disease (e.g., rheumatoid arthritis, systemic lupus erythematosus) or to currently receiving immunosuppressive drugs, (e.g., chemotherapy, corticosteroids) or to radiation therapy
- Stroke or myocardial infarction within 3 months prior to Screening
- Active deep vein thrombosis
- Recent history (< 3 years) or presence of cancer except basal cell carcinoma or squamous cell carcinoma of the skin that was excised and has shown no evidence of recurrence for at least 1 year
- Major psychiatric disorder diagnosed in the past 6 months that has not been stabilized or in the Investigator's opinion would not allow the patient to participate in the scheduled procedures
- Use of an investigational drug for the treatment of ALS in the past 30 days or 5 half-lives (if available), whichever is longer, or previous participation in a clinical study with Engensis
- Stem cell administration for investigational treatment of ALS or other conditions in the 6 months prior to Screening
Sites / Locations
- St. Joseph's Hospital and Medical Center, Barrows Neurological Institute
- Northwestern University
- Johns Hopkins University Department of Neurology
- Austin Neuromuscular Center
- Hanyang University Medical Center
Arms of the Study
Arm 1
Arm 2
Arm Type
Active Comparator
Placebo Comparator
Arm Label
Engensis
Placebo
Arm Description
64 mg Engensis per Treatment Cycle, with each of 3 cycles composed of 2 days of 128 injections each to the right and left target muscles, spaced 2 weeks apart
32 mL of Placebo per Treatment Cycle, with each of 3 cycles composed of 2 days of 128 injections each to the right and left target muscles, spaced 2 weeks apart
Outcomes
Primary Outcome Measures
Safety of intramuscular (IM) injections of Engensis in Participants with Amyotrophic Lateral Sclerosis (ALS) compared to Placebo
Incidence of treatment-emergent adverse events (TEAEs) and treatment-emergent serious adverse events (TESAEs) after injections, injection site reactions, and clinically significant laboratory values for Engensis compared to Placebo
Secondary Outcome Measures
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT04632225
Brief Title
Safety of Engensis in Participants With Amyotrophic Lateral Sclerosis
Acronym
REViVALS-1A
Official Title
A Phase 2a, Double-Blind, Randomized, Placebo-Controlled, Multicenter Study to Assess the Safety of Engensis in Participants With Amyotrophic Lateral Sclerosis
Study Type
Interventional
2. Study Status
Record Verification Date
November 2022
Overall Recruitment Status
Completed
Study Start Date
February 9, 2021 (Actual)
Primary Completion Date
July 11, 2022 (Actual)
Study Completion Date
August 31, 2022 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Helixmith Co., Ltd.
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 purpose of this study is to evaluate the safety of intramuscular (IM) administration of Engensis in Participants with Amyotrophic Lateral Sclerosis (ALS) as compared to Placebo. Safety will be assessed by incidences of treatment-emergent adverse events (TEAEs), treatment-emergent serious adverse events (TESAEs), injection site reactions (ISRs) and other adverse events of special interest (AESIs), and the clinically significant laboratory values after injections of Engensis compared to Placebo. Exploratory endpoints include assessment of muscle function using the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) and ALSFRS-R subscores for Fine and Gross Motor Function; muscle strength by quantitative testing using handheld dynamometry (HHD) and the Accurate Test of Limb Isometric Strength (ATLIS) where available; quality of life using the ALS Assessment Questionnaire (ALSAQ-40); patient global impression of change (PGIC), clinical global impression of change (CGIC), and clinical global impression of severity (CGIS); and evaluation of lung function using Slow Vital Capacity (SVC). Muscle biopsies will be performed during the study for future biomarker analyses.
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 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
18 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Engensis
Arm Type
Active Comparator
Arm Description
64 mg Engensis per Treatment Cycle, with each of 3 cycles composed of 2 days of 128 injections each to the right and left target muscles, spaced 2 weeks apart
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
32 mL of Placebo per Treatment Cycle, with each of 3 cycles composed of 2 days of 128 injections each to the right and left target muscles, spaced 2 weeks apart
Intervention Type
Biological
Intervention Name(s)
Engensis
Intervention Description
Lyophilized biologic to be reconstituted containing Engensis
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Injectable liquid
Primary Outcome Measure Information:
Title
Safety of intramuscular (IM) injections of Engensis in Participants with Amyotrophic Lateral Sclerosis (ALS) compared to Placebo
Description
Incidence of treatment-emergent adverse events (TEAEs) and treatment-emergent serious adverse events (TESAEs) after injections, injection site reactions, and clinically significant laboratory values for Engensis compared to Placebo
Time Frame
From the Day 0 Visit to the Day 180 Visit
Other Pre-specified Outcome Measures:
Title
Changes in muscle function following Engensis injections compared to Placebo
Description
Change from Baseline (Day 0) in total mean Revised Amyotrophic Lateral Sclerosis Function Rating (ALSFRS-R) scores, subscores for Fine and Gross Motor Functions and Bulbar Function, and slope of the total score
Time Frame
Day 0 to Day 180
Title
Evaluation of muscle strength changes following Engensis injections compared to Placebo - HHD
Description
As assessed bilaterally by Hand-Held Dynamometry (HHD) in muscles in the upper and lower extremities
Time Frame
Day 0 to Day 180
Title
Evaluation of muscle strength changes following Engensis injections compared to Placebo - ATLIS
Description
As assessed bilaterally by the Accurate Test of Limb Isometric Strength (ATLIS) where available
Time Frame
Day 0 to Day 180
Title
Evaluation of Quality of Life improvement following Engensis injections compared to Placebo
Description
As assessed using the ALS Assessment Questionnaire with 40 items (ALSAQ-40)
Time Frame
Day 0 to Day 180
Title
Evaluation of Patient and Clinical Reported Outcome improvement following Engensis injections compared to Placebo - PGIC
Description
As assessed using the Patient Global Impression of Change (PGIC)
Time Frame
Day 84 to Day 180
Title
Evaluation of Patient and Clinical Reported Outcome improvement following Engensis injections compared to Placebo - CGIC
Description
As assessed using the Clinical Global Impression of Change (CGIC)
Time Frame
Day 84 to Day 180
Title
To determine effects of Engensis on respiratory function compared to Placebo - SVC
Description
As assessed using Slow Vital Capacity (SVC)
Time Frame
Day 0 to Day 180
Title
To determine effects of Engensis on respiratory function compared to Placebo - Tracheostomy
Description
As assessed by time to tracheostomy
Time Frame
Day 0 to Day 180
Title
To determine effects of Engensis on survival compared to Placebo
Description
Time to all-cause mortality
Time Frame
Day 0 to Day 180
Title
Comparing gene expression differences in muscle atrophy biomarkers between subjects receiving Engensis and subjects receiving Placebo by using RNA sequencing
Description
Using RNA sequencing methods to obtain genome transcription profiles of the group receiving Engensis and the group receiving Placebo, and compare the gene expression differences between these two groups
Time Frame
Day 0 to Day 180
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:
Clinically definite or probable Amyotrophic Lateral Sclerosis (ALS) or laboratory-supported probable ALS as defined in the revised El Escorial/Airlie House diagnostic criteria
The site of onset of ALS symptoms is a limb and experiencing symptoms of lower motor dysfunction (e.g., weakness, atrophy, cramps, poor circulation, etc.) with upper motor neuron symptoms (e.g., weakness, brisk reflexes, spasticity)
Onset of ALS symptoms ≤ 4 years
Slow Vital Capacity (SVC) ≥ 50% of predicted value at Screening
Not taking riluzole, or on a stable dose (defined as no noted toxicities) for at least 30 days prior to Screening and throughout the study
Not taking edaravone or on a maintenance cycle for at least 30 days prior to Screening and throughout the study
For females of childbearing potential, a negative urine pregnancy test at Screening and on Day 0
Male Participants and their female partners must agree to use double-barrier contraception during the study or provide proof of postmenopausal state (minimum 1 year) or surgical sterility
Male Participants must not donate sperm during the study
Female Participants must be nonpregnant, nonlactating, and either postmenopausal for at least 1 year, or surgically sterile for at least 3 months, or agree to use double-barrier contraception from 28 days prior to randomization (Day 0) and/or their last confirmed menstrual period prior to study randomization (whichever is longer) until the end of the study
Capable of complying and willing to comply with the requirements and restrictions in the informed consent form and this protocol
Willing to forgo new experimental ALS treatments for at least 6 months following randomization
Exclusion Criteria:
Progressive or degenerative neurological disorder such as Alzheimer's disease, Parkinson's disease, vascular dementia, multiple sclerosis, and other neurological or vascular disorders felt by the Investigator to preclude participation
Requires tracheotomy ventilation or noninvasive ventilation related to bulbar function
Evidence by physical examination, history, or laboratory evaluation of significant concomitant disease with a life expectancy of < 6 months at Screening
INR values >2.0
Platelet count <100,000/µL
Inflammatory disorder of the blood vessels (inflammatory angiopathy or vasculitis, such as Buerger's disease)
Active infection (chronic infection or severe active infection that may compromise the Participant's wellbeing or participation in the study in the Investigator's judgment)
Chronic inflammatory disease (e.g., Crohn's disease, rheumatoid arthritis)
Positive human immunodeficiency virus (HIV) or human T-cell lymphotrophic virus (HTLV) I/II test at Screening
Active acute or chronic hepatitis B
Active hepatitis C
Immunosuppression due to underlying disease (e.g., rheumatoid arthritis, systemic lupus erythematosus) or to currently receiving immunosuppressive drugs, (e.g., chemotherapy, corticosteroids) or to radiation therapy
Stroke or myocardial infarction within 3 months prior to Screening
Active deep vein thrombosis
Recent history (< 3 years) or presence of cancer except basal cell carcinoma or squamous cell carcinoma of the skin that was excised and has shown no evidence of recurrence for at least 1 year
Major psychiatric disorder diagnosed in the past 6 months that has not been stabilized or in the Investigator's opinion would not allow the patient to participate in the scheduled procedures
Use of an investigational drug for the treatment of ALS in the past 30 days or 5 half-lives (if available), whichever is longer, or previous participation in a clinical study with Engensis
Stem cell administration for investigational treatment of ALS or other conditions in the 6 months prior to Screening
Facility Information:
Facility Name
St. Joseph's Hospital and Medical Center, Barrows Neurological Institute
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85013
Country
United States
Facility Name
Northwestern University
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Facility Name
Johns Hopkins University Department of Neurology
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21205
Country
United States
Facility Name
Austin Neuromuscular Center
City
Austin
State/Province
Texas
ZIP/Postal Code
78759
Country
United States
Facility Name
Hanyang University Medical Center
City
Seoul
ZIP/Postal Code
04763
Country
Korea, Republic of
12. IPD Sharing Statement
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Safety of Engensis in Participants With Amyotrophic Lateral Sclerosis
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