Tamoxifen Treatment in Patients With Motor Neuron Disease

Study Overview
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Brief Summary
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The aim of this study is to survey the effect of Tamoxifen in motor neuron disease (MND) patients, amyotrophic lateral sclerosis (ALS) with regular riluzole usage. TDP-43 is related to ALS. Increased the ubiquitinated or phosphorylated TDP-43 can cause animal model of ALS, and TDP43 can be degraded either by proteasome or autophagy pathway system. Autophagy pathway can be activated by mTOR inhibition, resulting in ameliorating TDP-43 accumulation and rescue in motor function in animal model. Tamoxifen had shown ability of enhance both proteasome and autophagy pathway, therefore the investigators assume that Tamoxifen probably can ameliorate TDP-43 accumulation and inclusion body formation in ALS.

Detailed Description
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The investigators will assess the ALSFR-s in ALS patients at start, 1, 3, 6 and 12 months and correlate the score to the neurological outcome of the patients with and without tamoxifen treatment at dose of 40mg daily for one year. The study will be able to prove the investigators hypothesis: Tamoxifen, a protease and autophagy enhancer, has synergic effect with riluzole in ALS patients to slowing the progression of neurological dysfunction, and respiratory insufficiency.

Official Title
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The Study of Tamoxifen Treatment in Patients With Motor Neuron Disease

Conditions
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mTOR, Amyotrophic Lateral Sclerosis, ALS Functional Ration Scale, TAR-DNA-binding Protein-43, Tamoxifen

Intervention / Treatment
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* Drug: tamoxifen 40 mg daily for one year


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Clinical diagnosed and confirmed ALS patients, with regular follow up and oral form riluzole at National Taiwan University or Shuang- Ho Hospital for more than 6 months. Age ≧20 years old Exclusion Criteria: Patients who had already ventilator dependent, not regular followed up for more than 6 months or against medical advice, refuse to follow up at neurology department will be excluded in this study. Patients with now or previous usage of Tamoxifen Patients with any contraindications of Tamoxifen usage Patients with other internal medicine illiness

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: tamoxifen<br>tamoxifen 40 mg daily for one year | Drug: tamoxifen 40 mg daily for one year<br>* both arms with riluzole daily<br>* Other names: Nolvadex;|
| Placebo Comparator: placebo<br>placebo drugs | Drug: tamoxifen 40 mg daily for one year<br>* both arms with riluzole daily<br>* Other names: Nolvadex;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline in Amyotrophic Lateral Sclerosis Functional Ration Scales (ALSFRS) at 1, 3, 6,12 months | Amyotrophic Lateral Sclerosis Functional Ration Scales (ALSFRS) measured by a neurologist | Baseline, month 1, 3, 6, 12 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline in pulmonary function test at 1, 3, 6,12 months | Expiratory reserve volume (ERV) Forced vital capacity (FVC) Forced expiratory volume (FEV) Forced expiratory flow 25% to 75% Functional residual capacity (FRC) Maximum voluntary ventilation (MVV) Residual volume (RV) Peak expiratory flow (PEF). Slow vital capacity (SVC) Total lung capacity (TLC) | baseline, month 1, 3, 6, 12 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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amyotrophic lateral sclerosis, ALS functional ration scale, TAR-DNA-binding protein-43, tamoxifen, mTOR