There are many clinical trials investigating various treatments for MND across the world. Here we focus on trials that are in the spotlight and provide you with updates on the latest results and related news.
This Phase 3 trial is currently ACTIVE and RECRUITING.
Arimoclomol is being tested by Orphazyme for its effectiveness in MND. The compound works by protecting cells from accumulation of misfolded proteins by using the cell's natural defence mechanism, the heath shock response, resulting in production of protective heat-shock protein in stressed cells.
A previous Phase 2 trial, which tested arimoclomol in 36 people with SOD1 MND, found that the treatment was safe and well tolerated by the participants. Indication of improvement in survival and ALSFRS was also observed.
The Phase 3 quadruple-blinded, placebo-controlled trial which initiated in August 2018, aims to recruit 212 participants to test effectiveness of arimoclomol when given in form of oral capsules across 18 months. The primary outcomes will measure function and survival (using the Combined Assessment of Function and Survival (CAFS) measure), with additional outcomes of interest focusing on ALSFRS and SVC progression.
This Phase 3 trial is currently ACTIVE and RECRUITING.
This trial is run by Ionis Pharmaceuticals in partnership with Biogen.
BIIB067 (also known as SOD1Rx) is specifically designed to treat familial MND caused by mistakes in the SOD1 gene. It uses an approach known as ‘antisense’, in which the drug directly interferes with the faulty instructions for making SOD1 protein, thus stopping the production of the disease-causing substance.
The first phase of the trial began in early 2016, recruiting 70 people with MND in the USA, Canada and Europe (including one centre in the UK). To date, the drug has shown acceptable safety and tolerability. Early analyses showed that delivering the highest dose led to significant reduction of SOD1 protein levels in the cerebrospinal fluid and showed signs of slower clinical progression.
This Phase 3 trial is currently ACTIVE and RECRUITING.
Levosimendan (ODM-109) was developed by Orion Pharma. It is licensed to treat some forms of congestive heart failure by strengthening the action of heart muscle. The trial is investigating whether the drug might also have some usefulness in MND by helping to improve the function of the diaphragm muscle, one of the main muscles involved in breathing.
Results of the Phase 2 trial (LEVALS) showed improved breathing function in participants taking levosimendan compared to those taking placebo.
The phase 3 trial (REFALS) aims to recruit 450 participants across different sites worldwide. The primary objective of the trial is to show that the drug levosimendan enhances respiratory muscle function and thus helps maintain breathing capacity in people with MND.
This Phase 2 trial is currently ACTIVE and RECRUITING.
This is a joint clinical trial between clinicians in France and the UK that will test a molecule that occurs naturally in our bodies called interleukin-2 (IL-2) as a potential new therapy for MND.
Inflammation in the brain and spinal cord is thought to contribute to MND progression. Studies on animals and humans have shown that IL-2 can control a type of immune cell called a Regulatory T Cell (Treg). Tregs fight diseases and infections and help to control inflammation. The MIROCALS (Modifying Immune Response and Outcomes in ALS) project will test the effectiveness and safety of a low dose of IL-2 in people with MND, to find out what effects, good or bad, it has on people with MND and, in particular, if it may slow down the advance of the disease.
216 participants will be recruited into the trial. Only patients newly diagnosed with MND and not yet treated with riluzole (or with less than one month of riluzole exposure), are eligible to take part. The study takes place at centres across France and the UK. The seven centres in the UK include Brighton, Sheffield, Glasgow, Manchester and London.
Read more about MIROCALS in our MIROCALS information sheet.
International and completed trials
CuATSM (Copper ATSM) is a candidate MND drug that is being investigated by the Collaborative Medicinal Development company for its effects of slowing down progression and improving respiratory and cognitive function. The drug is thought to work by delivering copper to cells where the cell's energy batteries, mitochondria, have been damaged, allowing for selective delivery of the drug (i.e. to only those cells that have been damaged).
The Phase 1 results were first announced in December 2018, showing that the treatment was safe and well-tolerated, with some beneficial effect observed. You can read more about the results in our blog article.
Phase 2 is now being planned to explore whether the drug is beneficial to people with MND, in a larger cohort of people.
Edaravone was originally developed by Mitsubishi Tanabe Pharma Corporation to treat acute ischemic stroke, however it was then tested in people with MND. One theory about why motor neurones die in MND is that they are affected by oxidative stress. Edaravone acts as a ‘free radical scavenger’ helping to reduce the effects of oxidative stress (as explained in a post on our research blog).
The first Phase 3 clinical trial of edaravone in MND found no overall benefit in people with MND, but showed an improvement in breathing function in a subgroup of people with an early form of the disease. Two studies have been conducted in this subgroup of patients. Results of the second study, announced at the 27th International Symposium on ALS/MND in 2016, revealed that after 24-week intervention patients showed some signs of beneficial effect. It has been estimated that approximately 7% of people with MND were eligible to take part in the clinical trials, showing improvement in only a small amount of people.
In early May 2017, edaravone (Radicava) was approved to treat MND by the FDA (Food and Drug Administration), the drug licensing authority in the USA. Read more about edaravone on our blog.
Edaravone is currently available in Japan, South Korea, USA and Canada. In 2018, Mitsubishi Tanabe Pharma applied for consideration of edaravone as a treatment with the European Medicines Agency. Decision is expected in Q2 2019.
EH301 is a dietary supplement, combining pterostilbene and nicotinamide riboside, aiming to increase activity of sirtuins, proteins that are involved in multiple cellular processes known to go wrong in neurodegenerative disease and aging.
In February 2019, a small Phase 1 trial reported results from 32 participants who were receiving 1,200mh of EH301 a day across four months. Most people taking EH301 significantly improved on ALSFRS-R, muscle strength, activity and mass, compared to people taking placebo, who were progressing at a 'normal rate'. Some adverse events were reported and 12 people withdrew from the study.
Phase 2 trial is now being planned to replicate the findings in a larger group of people.
GM604 is a regulator peptide that monitors and corrects the nervous system. Prior research revealed that, when administered intravenously, it has neuroprotective effects in people with MND diseases. Genervon, the company behind the drug GM604, have already shown through Phase 1 and Phase 2 clinical trials that the drug is safe in people living with MND and Parkinson’s disease. Read more on our website.
The Phase 2A trial, taking place in the USA, recruited 12 patients with ALS, out of which 8 received the active agent and 4 received placebo. Results of this study reported in Genervon’s research article showed that there was no difference in ALSFRS-R ratings between patients receiving GM604 and those receiving placebo. The research article was posted on the public publishing platform F1000 in March 2017 and is currently awaiting peer-review.
No information on FDA approval of GM604 for ALS has been released, with the last updated information on the FDA website dating back to 2015.
Ibudilast, also known as MN-166, is an anti-inflammatory drug which is currently used to treat asthma, and tested for the treatment of MND and other neurodegenerative diseases (including Multiple Sclerosis) by Medicinova. It is thought to suppress inflammation, activate neuronal function and reduce the number of toxic glial (support) cells.
The Phase 2 randomised, placebo-controlled, double-blind clinical trial recruited 51 people with MND who were taking 60mg of ibudilast daily together with riluzole across 6 months, with a follow-up six month open-label phase. The treatment was shown to be safe and well-tolerated. Results of secondary outcome measures showed that, in some participants, the ALSFRS score didn’t decline. More detailed analyses revealed a connection between reduced disease progression while on ibudilast and higher survival rates after the treatment.
Ibudilast is currently being tested in a Phase 1/2 biomarker trial, which is trialling a higher dose (100mg) in 35 participants taken across 36 weeks, while tracking their progression using an MND biomarker [11C]-PBR28. This marker is a protein that is abundant in toxic glial cells and can be traced using imaging. Effectiveness of using this marker to track progression after treatment with ibudilast is the primary objective. Secondary objectives include ALSFRS , muscle strength and slow vital capacity scores.
Planning is now underway for a Phase 3 trial with 166 people with MND.
Masitinib inactivates a cellular enzyme called tyrosine kinase, which is believed to be involved in tissue inflammation. While inflammation of the central nervous system may not be a direct cause of MND, it is likely to play a role in the speed of disease progression. Reducing the activity of inflammatory cells in the brain may reduce the damage to motor neurones.
Phase 2/3 trial of this clinical trial examined the safety and effectiveness of masitinib in combination with riluzole in 394 people with MND, when taken for nearly a year. AB Science, the company behind masitinib, has recently published promising results, showing improved ALSFRS-R score when given 4.5mg/kg of masitinib per day. However, no benefit on overall survival was observed. A further clinical trial that will aim to confirm the previously-found results is planned to run through 2017-2018.
In April 2018, AB Science announced that masitinib was given a negative opinion for marketing authorisation by the European Medicines Agency (EMA).
Phase 3 trial is now planning to test masitinib at two doses (4.5 and 6mg/kg/day) in combination with riluzole in 495 participants in Canada. The study should be completed in 2024.
Neuralstem is a stem cell treatment that involves several injections of foetal-derived neural stem cells into the spinal cord of patients.
The latest Phase 2 study involved giving injections into the lower regions of the spinal cord, at increasing doses (number of cells), to help work out the optimum number of stem cells to give (these injections are given as a surgical procedure). Results from this study confirmed that the transplantation can be safely performed at high doses, to both lumbar (lower back) and cervical (neck) regions.
It is unknown whether another Phase 2/3 study will be conducted in the future.
NP001 is being developed by Neuraltus Pharmaceuticals Inc. It acts on particular cells within the immune system in the bloodstream, which in turn influences inflammation within the brain and spinal cord. The study is focusing on people with MND who are also showing signs of an elevated immune response. By ‘damping down’ the immune system, the aim is to reduce the inflammation which damages motor neurones.
Results from the initial Phase 2 study, reported in late 2012, suggested that the treatment was safe, but did not significantly slow the progression of MND. The trial recruited 136 participants in centres across USA and at one centre in Canada.
In April 2018, Neuraltus Pharmaceuticals Inc. announced that results form their follow-up Phase 2 clinical trial that tested the treatment in 138 people with MND with evidence of increased inflammatory activity in the blood (C-reactive protein). The study didn’t show slower progression of the disease or improved breathing function.
Nuedexta is a drug that treats emotional lability (‘pseudo-bulbar affect’, or PBA) in MND and other neurological conditions. Emotional lability can be described as inappropriate emotional expression often characterised by uncontrollable laughing or crying; it is a feature of MND and some other neurological conditions.
Nuedexta was originally granted a marketing authorisation by the EMA in July 2013, but Avanir Pharmaceuticals Inc, the company who developed and manufacture the drug, did not take the further necessary steps to make it available in the UK, such as agreeing a price with the NHS under the Pharmaceutical Prices Regulation Scheme.
In February 2016, the European Medicines Agency (EMA) had withdrawn its marketing authorisation for Nuedexta in the EU.
The withdrawal has been made at the request of Avanir Pharmaceuticals Inc. Avanir have never made the drug available in Europe, and this decision means that it is not available to prescribe for patients in the EU.
Because Nuedexta is a patented medicine, Avanir has the sole right to produce and distribute it; it will not be possible for another company to make it or for it to be imported into the EU – although it remains available in the USA
NurOwn reprogrammes bone marrow-derived stem cells into neurone-supporting cells. These are then transplanted back to the same patient so that they can secrete neutrotrophic factors to protect and promote growth of neurones. This study is run by Brainstorm-Cell Therapeutics.
Brainstorm’s randomised, placebo-controlled Phase 2 trial of NurOwn in the USA looked at the safety and effectiveness of stem cell transplantation in 48 people. The injections were given into the spinal cord (intrathecally) and also into the muscle. Results announced in July 2016 revealed that NurOwn treatment was safe and well-tolerated. While not a primary objective of this trial phase, the study also showed beneficial effects of NurOwn as assessed by lower levels of inflammatory biomarkers in the cerebrospinal fluid (CSF).
Phase 3 trial is currently recruiting 200 participants across centres in the USA to investigate NurOwn's effectiveness.
Tirasemtiv is a muscle activator that increases force (contraction) and power of skeletal muscles and therefore delays muscle fatigue. Instead of aiming to slow down progression of MND, the aim of this drug treatment is to increase quality of life by increasing muscular strength. The drug is being developed by Cytokinetics.
A Phase 3 clinical trial (known as VITALITY-ALS) recruited 600 people with MND in the USA, Canada and Europe (including the UK). The trial tested the effectiveness of different doses of Tirasemtiv on breathing function over a period of 48 weeks. The trial was designed to try and reduce the side effects of the drug experienced in previous studies.
In November 2017, Cytokinetics announced that tirasemtiv failed to meet its primary and secondary endpoints in their Phase 3 clinical trial. Read the press release here.
A new version of the drug, called Reldesemtiv, is being tested in a Phase 2 trial (known as FORTITUDE-ALS) which recruited 458 people with MND worldwide. Results from this trial are now expected.