Clinical trial NCT05508074: Treatment Combining Riluzole and IFB-088 in Bulbar Amyotrophic Lateral Sclerosis (TRIALS Protocol)
Official title: A Double-blind, Placebo-controlled, Exploratory Randomised Clinical Trial to Assess the Safety and Efficacy of IFB-088 Plus Riluzole 100 mg vs Placebo Plus Riluzole 100 mg in Patients With Bulbar-onset Amyotrophic Lateral Sclerosis.
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Amyotrophic Lateral Sclerosis
ALS
Keywords: IFB-088
Icerguastat
ALS
Amyotrophic Lateral Sclerosis
Motor Neuron Disease
Neurodegenerative Disease
Lead sponsor: InFlectis BioScience
Sponsor class: INDUSTRY
First posted: 2022-08-19
Enrollment: 51
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Patients will be randomised in a 2:1 allocation ratio to receive either IFB-088 + riluzole 100 mg or placebo + riluzole 100 mg.
Primary purpose: TREATMENT

Brief summary: Prospective, international, randomised, double-blind, placebo controlled, multicentre, parallel group study. Patients will be randomised in a 2:1 allocation ratio to receive either IFB-088 + riluzole 100 mg or placebo + riluzole 100 mg. This clinical trial is an exploratory study, designed to show a signal of efficacy of IFB-088 through ALSFRS-R, MITOS and King's College. Respiratory function will be followed through SVC. Biomarkers and quality of life will also be evaluated throughout the study.

Patients will be treated over a 6-month period. After a screening/consent visit, patients will undergo clinic visits at randomisation (V0), at 2 weeks (V1), and at months 1 (V2), 3 (V3) and 6 (V4). One week after V0, the patient will undergo urine analysis (dipstick)and blood sampling for measurement of creatinine

, as well as blood sampling for measurement of creatinine and calculation of eGFR at months 2, 4 and 5. At the V2 visit, in addition to other assessments, patients will undergo blood sampling for PK measurements and urine sampling for crystalluria examination. Blood and urine chemistry, as well as physical examination and vital signs assessment to assess safety will be performed at each visit for safety purpose and crystalluria examination will be repeated at the follow-up visit, performed one month ± one week after V4.


Eligibility criteria: Inclusion Criteria:

1. Diagnosis of probable or definite ALS according to the revised El Escorial criteria \[29\], with bulbar onset of disease, familial or sporadic form,
2. Onset of symptoms ≤ 18 months prior to screening, as reported by the patient,
3. Adult males or females, aged at least 18 years old,
4. SVC \> 60% of predicted value for age and sex,
5. ALSFRS-R score ≥ 36,
6. Treatment with riluzole 100 mg/day, at stable dose since at least one month and well tolerated,
7. Male or female patient of childbearing potential10 who agrees to use highly effective mechanical contraception methods (sexual abstinence, intrauterine device, bilateral tubal occlusion, vasectomised partner) throughout the study, and for 3 months after the end of the treatment,
8. Patient who read, understood and signed the ICF,
9. Patient who is willing to adhere to the study visit schedule and is capable to understand and comply with protocol requirements.

Exclusion Criteria:

1. Known other significant neurological disease(s),
2. Serious illness(es) or medical condition(s) (e.g. unstable cardiac disease, cancer, hematologic disease, hepatitis or liver failure, renal failure) that is not stabilised or that could require hospitalisation and may jeopardise the participation in the study,
3. Abnormal renal function at screening defined as estimated glomerular filtration rate (eGFR) \< 60 mL/min/1.73m2,
4. Abnormal liver function at screening defined as total bilirubin levels \>1.5 ULN, and/or AST and/or ALT \>3 ULN,
5. Neutropenia (ANC \<1.5 x 109/L) at screening,
6. Other causes of neuromuscular weakness,
7. Non progressive or very rapidly progressing ALS (ALSFRS-R decline from disease onset to randomisation ≤ 0.1 / month or ≥ 1.2 / month)11,
8. Non-invasive ventilation,
9. Tracheotomy,
10. Weight loss ≥ 10% compared to weight at symptoms onset as declared by the patient or BMI \<18 kg/m2 at screening,
11. Dementia or other severe active psychiatric illness, including suicidal ideation assessed using the Columbia-Suicide Severity Rating Scale (C-SSRS),
12. Patient with a significant pulmonary disorder not attributed to ALS or who require treatments that might complicate the evaluation of the effect of ALS on respiratory function,
13. Patient treated by edaravone for ALS,
14. Patient using unauthorised concomitant treatments, namely moderate or strong inhibitors or inducers of CYP1A2, strong inhibitors or inducers of CYP2D6 or 2C19 and strong inhibitors of OCT2, as listed in Section 6.2. Combined oral contraceptives containing ethinylestradiol are forbidden concomitant medications,
15. Smoker of \> 10 cigarettes per day (e-cigarettes and nicotine patches are permitted),
16. Known hypersensitivity to any of the ingredients or excipients of the IMPs,
17. Pregnant, lactating women,
18. Patient who participated in another trial of investigational drug(s) within 30 days prior to randomisation, or 5 half-lives of the previous investigational product, whichever is longer,
19. Patient who has forfeited their freedom by administrative or legal award, or who is under guardianship or under limited judicial protection.

Primary outcomes:
measure: Safety assessment of IFB-088 50 mg/day in patients with bulbar-onset ALS. Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]
timeFrame: from beginning of IMP intake up to 30 days after stopping the intake
Secondary outcomes:
measure: Efficacy with scale : ALSFRS-R (ALS Functional Rating Scale Revised)
timeFrame: Efficacy scale from baseline to 3 months and 6 months.
measure: Efficacy with scale : ALS_MITOS (ALS Milano-Torino Staging)
timeFrame: Efficacy scale from baseline to 3 months and 6 months.
measure: Efficacy with scale : King's college Scale (ALS staging form)
timeFrame: Efficacy scale from baseline to 3 months and 6 months.
measure: Efficacy based on assessment of respiratory function (slow vital capacity [SVC])
timeFrame: Respiratory function at screening, 3 and 6 months.
measure: Efficacy based on assessment of respiratory function (Arterial Blood Gases [ABG])
timeFrame: Respiratory function at screening, 3 and 6 months.
measure: Efficacy based on assessment of nutritional status (exploratory)
timeFrame: At baseline and 6 months
measure: Efficacy based on assessment of body composition (exploratory)
timeFrame: At baseline and 6 months
measure: Pharmacokinetic parameters (Plasma concentration)
timeFrame: PK parameters will be analysed after 4 weeks of treatment.
measure: Pharmacokinetic parameters (Area Under Curve [AUC])
timeFrame: PK parameters will be analysed after 4 weeks of treatment.
measure: Pharmacokinetic parameters (Cmax)
timeFrame: PK parameters will be analysed after 4 weeks of treatment.
measure: Pharmacokinetic parameters (Tmax)
timeFrame: PK parameters will be analysed after 4 weeks of treatment.
measure: Pharmacokinetic parameters (t1/2)
timeFrame: PK parameters will be analysed after 4 weeks of treatment.
measure: Pharmacokinetic parameters (clearance)
timeFrame: PK parameters will be analysed after 4 weeks of treatment.
measure: Pharmacokinetic parameters (Vd)
timeFrame: PK parameters will be analysed after 4 weeks of treatment.
measure: Biomarkers (TDP-43)
timeFrame: At baseline and 6 months.
measure: Biomarkers (neurofilament light chain)
timeFrame: At baseline and 6 months.
measure: Biomarkers (Inflammation biomarkers)
timeFrame: At baseline, 3 months, and 6 months.
measure: Biomarkers (3-Nitrotyrosine)
timeFrame: At baseline, 3 months, and 6 months.
measure: Quality of Life with ALSAQ-40 (ALS Assessment Questionnaire)
timeFrame: QoL will be assessed from baseline to 6 months
Other outcomes:
Locations:
city: Bron
country: France
facility: Hôpital Neurologique Pierre Wertheimer
city: Marseille Cedex 05
country: France
facility: APHM Hôpital La Timone Adultes SCE Maladies Neuromusculaires / SLA
city: Nantes
country: France
facility: CHU de Nantes - Hôpital Laennec
city: Toulouse Cedex 9
country: France
facility: CHU de Toulouse - Hôpital Pierre-Paul Riquet
city: Tours Cedex 1
country: France
facility: CHU Bretonneau
city: Baggiovara
country: Italy
facility: Ospedale Civile Sant'Agostino Estense
city: Gussago
country: Italy
facility: Centro Clinico NeMO per le Malattie Neuromuscolari
city: Milano
country: Italy
facility: IRCSS Istituto Neurologico Carlo Besta
city: Roma
country: Italy
facility: Sant'Andrea Hospital Unit of Neuromuscular Disorders
Study officials:
affiliation: Assistance Publique Hôpitaux de Marseille (APHM) Hospital La Timone Adultes, France
name: Shahram Attarian, Pr
role: PRINCIPAL_INVESTIGATOR
affiliation: IRCCS Carlo Besta Institute of Milan, Italy
name: Giuseppe Lauria, Pr
role: PRINCIPAL_INVESTIGATOR
References: