Familial Amyotrophic Lateral Sclerosis
Conditions
Keywords
ALS, Familial ALS, SOD1 Gene Mutation
Brief summary
The objective of this study will be to evaluate the safety, tolerability and effect on SOD1 levels by pyrimethamine in patients with familial amyotrophic lateral sclerosis.
Detailed description
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease causing relentlessly progressive weakness of the arms, legs and respiratory muscles that is uniformly fatal. There are approximately 30,000 patients living with ALS in the United States. There is no treatment. The cause is uncertain in most patients. However, 3% of patients (\< 1000 in number) have a familial form of ALS (FALS), phenotypically identical to the sporadic illness, that is caused by a mutation in the gene coding for the free radical scavenging enzyme copper/zinc superoxide dismutase (SOD1). Inserting the SOD1 mutant gene into mice causes them to develop a disease closely resembling ALS. Inhibiting expression of the SOD1 gene prevents animals from developing the disease. Increasing or decreasing the number of mutated genes proportionately speeds or slows the progression of the disease. Therefore, reducing SOD1 levels in patients with SOD1 associated FALS may be a promising therapeutic approach. Through an extensive in vitro screening program for medications having the ability to reduce SOD1 levels, several molecules that reduce SOD1 protein levels are known. One of the most potent molecules is pyrimethamine, an FDA approved medication used for the treatment of malaria and toxoplasmosis. Pyrimethamine dramatically reduces SOD1 levels in mice and our preliminary studies show similar findings in humans. Our study's primary objective is to determine if familial ALS patients taking pyrimethamine will show a decline in SOD1 levels in the CSF by 15% or more. We will also determine if SOD1 and pyrimethamine are present in the blood and if the SOD-1 levels decline over the course of the study. We will also evaluate the safety and tolerability of pyrimethamine in patients with FALS. Secondary objectives will be to determine dose optimization for maximal SOD1 level reduction and tolerability of medication. We will also assess the feasibility of proceeding to phase II/III studies using pyrimethamine. Change in ALS-FRS, Appel ALS score and quality of life will also be measured. A clinical effect realized in patients with FALS associated with an SOD1 mutation may serve as an important foundation toward finding a treatment for sporadic ALS.
Interventions
DRUGPyrimethamine
Open Label, dose escalating,
Sponsors
Muscular Dystrophy Association
Weill Medical College of Cornell University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Subjects with definite, probable, or laboratory supported probable ALS will be eligible. 1. ALS diagnosed as probable, laboratory supported probable or definite according to the World Federation of Neurology El Escorial criteria \[Brooks et al. 2000\] 2. Age 18 or older 3. Capable of providing informed consent and complying with trial procedures 4. SOD1 mutation confirmation by study team 5. Not taking Riluzole (Rilutek) or on a stable dose for 30 days 6. Not taking Coenzyme QR10R or on a stable dose and brand for 30 days 7. Absence of
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean Change in SOD1 CSF | baseline, Visit 6 week 18, end of study | Reported change in mean SOD1 CSf from baseline to visit 6 (week 18) and end of study for all subjects who completed the measure |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Appel ALS Score | Week 0, 6, 18, and end of study | an objective and timed measurement of strength and function of subjects including muscle testing, respiratory function and fine motor function, all summed together for a total value, and is measured at baseline, visit 2, visit 6 and end of study. The scale ranges from 30 in a healthy person to to 164 in a maximally impaired person; an increase in score indicates progression and is expected in disease progression. |
Countries
Germany, Italy, Sweden, United States
Participant flow
Recruitment details
Patient were recruited from all sites and referrals received from other physicians. Subjects also contacted sites from ClinicalTrials.gov posting
Participants by arm
| Arm | Count |
|---|---|
| Pyrimethamine Open label. Only one arm will receive the intervention.
Pyrimethamine: Open Label, dose escalating, | 32 |
| Total | 32 |
Baseline characteristics
| Characteristic | Pyrimethamine |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 1 Participants |
| Age, Categorical Between 18 and 65 years | 31 Participants |
| Age, Continuous | 48 years |
| Region of Enrollment Germany | 4 participants |
| Region of Enrollment Italy | 8 participants |
| Region of Enrollment United States | 20 participants |
| Sex: Female, Male Female | 16 Participants |
| Sex: Female, Male Male | 16 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 32 |
| other Total, other adverse events | 14 / 32 |
| serious Total, serious adverse events | 1 / 32 |
Outcome results
Primary
Mean Change in SOD1 CSF
Reported change in mean SOD1 CSf from baseline to visit 6 (week 18) and end of study for all subjects who completed the measure
Time frame: baseline, Visit 6 week 18, end of study
Population: 24 subjects completed up to visit 6 and 21 subjects for final study visit. Reported is the change in SOD1 CSF from baseline to week 36.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Pyrimethamine | Mean Change in SOD1 CSF | 6.8 ng/ml |
Secondary
Appel ALS Score
an objective and timed measurement of strength and function of subjects including muscle testing, respiratory function and fine motor function, all summed together for a total value, and is measured at baseline, visit 2, visit 6 and end of study. The scale ranges from 30 in a healthy person to to 164 in a maximally impaired person; an increase in score indicates progression and is expected in disease progression.
Time frame: Week 0, 6, 18, and end of study
Population: 22 subjects completed to visit 9 and had a final score for Appel Score. Reported is the mean change from Baseline to week 36
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Pyrimethamine | Appel ALS Score | 18 units on a scale |