Radicava® (Edaravone) Findings in Biomarkers From ALS (REFINE-ALS)

Study Overview
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Brief Summary
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REFINE-ALS is a prospective, observational, longitudinal, multicenter study designed to identify biomarkers to serve as quantifiable biological non-clinical measures of Edaravone effects in ALS. Epigenetic and protein biomarkers will also be investigated.

Detailed Description
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Treatment will be prescribed by HCPs in accordance with their clinical judgement and the prescribing information for Edaravone. The decision to prescribe Edaravone to the participants should be made separately from the decision to enroll then in the study. There will be no randomized assignments to treatment and no restrictions on the use of commercially available medications (but those participating in an experimental study, even if taking Edaravone, will be excluded). No experimental treatment is evaluated in this study. The intervention is limited to the collection of blood and urine samples for biomarker testing. During the estimated study period, eligible patients who are prescribed Edaravone within the approved indication will be invited to participate in the study. An initial screening/baseline visit will be scheduled for participants who are considered for study participation. Participants in this study will be followed from enrollment up to 24 weeks after treatment initiation (6 treatment cycles [each cycle consisting of 28 days], corresponding to a treatment period of approximately 24 weeks) or premature study discontinuation. Throughout the study period, the investigators will record participant baseline and follow-up information and perform clinical and biomarker assessments.

Official Title
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Radicava® (Edaravone) Findings in Biomarkers From ALS (REFINE-ALS)

Conditions
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ALS, Amyotrophic Lateral Sclerosis

Intervention / Treatment
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* Drug: Edaravone (Radicava®/Radicava ORS®)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male and female aged 18 years or older at enrollment Sporadic or familial ALS diagnosed as possible, probable, probable-laboratory supported or definite as defined by the World Federation of Neurology revised El Escorial criteria Decision made to prescribe Edaravone prior to screening Participant will likely be able to obtain commercial Edaravone and likely to complete 6 cycles of treatment, per site investigator estimation Participant either naïve to Edaravone or who did not receive any Edaravone does within 1 month prior to screening Signed informed consent by the subject, or a witness if a subject cannot read or write or is physically unable to talk or write, obtained before any study-related activities are undertaken Exclusion Criteria: Participant with a contraindication to Edaravone Participant is participating in an interventional clinical trial

Ages Eligible for Study
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Minimum Age: 18 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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Edaravone (Radicava®/Radicava ORS®)<br>During an estimated 12-month period, eligible participants who are prescribed Edaravone within the approved indication will be invited to participate in the study. | Drug: Edaravone (Radicava®/Radicava ORS®)<br>* Participants will be followed from enrollment up to 24 weeks after treatment initiation (6 treatment cycles - 28 days per cycle, corresponding to a treatment period of approximately 24 weeks) or premature study discontinuation. Biomarker testing and clinical assessments will be performed at baseline (at enrollment or before the start of cycle 1), and at cycles 1, 3, and 6. Dosing is 60 mg daily by intravenous infusion for 14 days for the initial treatment cycle, followed by daily dosing on 10 out of 14 days in subsequent treatment cycles.<br>* Other names: Radicava ORS®;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in levels of 8-F2 isoprostanes as a potential biomarker of oxidative stress, inflammation or neurodegeneration. | Collection of blood and/or urine samples for 8-F2 isoprostanes. | Cycles 1, 3, and 6 of each Edaravone cycle (each cycle is 28 days). | 
| Change in levels of 3-nitrotyrosine (3-NT) as a potential biomarker of oxidative stress, inflammation or neurodegeneration. | Collection of blood and/or urine samples for 3-NT. | Cycles 1, 3, and 6 of each Edaravone cycle (each cycle is 28 days). | 
| Change in levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG) as a potential biomarker of oxidative stress, inflammation or neurodegeneration. | Collection of blood and/or urine samples 8-OHdG. | Cycles 1, 3, and 6 of each Edaravone cycle (each cycle is 28 days). | 
| Change in levels of urate as a potential biomarker of oxidative stress, inflammation or neurodegeneration. | Collection of blood and/or urine samples for urate. | Cycles 1, 3, and 6 of each Edaravone cycle (each cycle is 28 days). | 
| Change in levels of matrix metalloproteinase-9 (MMP-9) as a potential biomarker of oxidative stress, inflammation or neurodegeneration. | Collection of blood and/or urine samples for MMP-9. | Cycles 1, 3, and 6 of each Edaravone cycle (each cycle is 28 days). | 
| Change in levels of urinary neutrophin receptor p75 as a potential biomarker of oxidative stress, inflammation or neurodegeneration. | Collection of blood and/or urine samples for urinary neutrophin receptor p75. | Cycles 1, 3, and 6 of each Edaravone cycle (each cycle is 28 days). | 
| Change in levels of neurofilaments (Nf) (Heavy and Light) as a potential biomarker of oxidative stress, inflammation or neurodegeneration. | Collection of blood and/or urine samples for neurofilaments (Nf) (Heavy and Light). | Cycles 1, 3, and 6 of each Edaravone cycle (each cycle is 28 days). | 
| Change in levels of creatinine as a potential biomarkers of oxidative stress, inflammation or neurodegeneration. | Collection of blood and/or urine samples for creatinine. | Cycles 1, 3, and 6 of each Edaravone cycle (each cycle is 28 days). | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline in the ALSFRS-R (ALS Functional Rating Scale .Revised) Score | The ALSFRS-R is a quickly administered ordinal rating scale (ratings 0-4) used to determine participants' assessment of their capability and independence in 12 functional activities. | Cycles 1, 3, and 6 of each Edaravone cycle (each cycle is 28 days). | 
| Change from baseline in the King's Clinical Staging. | The King's clinical staging is based on the number of body regions affected by ALS and the presence of respiratory or nutritional failure. | Cycles 1, 3, and 6 of each Edaravone cycle (each cycle is 28 days). | 
| Change from baseline in the ALSAQ-40 (ALS Assessment Questionnaire). | The ALSAQ-40 is a questionnaire that consists of 40 questions/items with 5 discrete scales: physical mobility, activities of daily living and independence, eating and drinking, communication, emotional reactions. | Cycles 1, 3, and 6 of each Edaravone cycle (each cycle is 28 days). | 
| Change from baseline in the Appel ALS Score. | The Appel ALS score consists of five sub-scores: bulbar, respiratory, muscle strength, and lower extremity and upper extremity function. | Cycles 1, 3, and 6 of each Edaravone cycle (each cycle is 28 days). | 
| Change from baseline in slow vital capacity. | The vital capacity (VC) (percent of predicted normal) will be determined, using the upright slow VC method. | Cycles 1, 3, and 6 of each Edaravone cycle (each cycle is 28 days). | 
| Change from baseline in hand-held dynamometry. | Hand-held dynamometry (HHD) will be used as a quantitative measure of muscle strength for this study. | Cycles 1, 3, and 6 of each Edaravone cycle (each cycle is 28 days). | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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biomarkers, edaravone, Radicava®, Radicava ORS®, motor neuron disease