Amyotrophic Lateral Sclerosis
Conditions
Keywords
ALS, Placebo-Controlled, Double-Blind, Regimen Specific Appendix, Lou Gehrig's Disease, ABBV-CLS-7262, Calico Life Sciences
Brief summary
The HEALEY ALS Platform Trial is a perpetual multi-center, multi-regimen clinical trial evaluating the safety and efficacy of investigational products for the treatment of ALS. Regimen F will evaluate the safety and efficacy of a single study drug, ABBV-CLS-7262, in participants with ALS.
Detailed description
The HEALEY ALS Platform Trial is a perpetual multi-center, multi-regimen clinical trial evaluating the safety and efficacy of investigational products for the treatment of ALS. This trial is designed as a perpetual platform trial. This means that there is a single Master Protocol dictating the conduct of the trial. The HEALEY ALS Platform Trial Master Protocol is registered as NCT04297683. Once a participant enrolls into the Master Protocol and meets all eligibility criteria, the participant will be eligible to be randomized into any currently enrolling regimen. All participants will have an equal chance of being randomized to any currently enrolling regimen. If a participant is randomized to Regimen F ABBV-CLS-7262, the participant will complete a screening visit to assess additional Regimen F eligibility criteria. Once Regimen F eligibility criteria are confirmed, participants will complete a baseline assessment and be randomized in an overall 3:1 ratio to either active ABBV-CLS-7262 or matching placebo. The first 240 participants will be assigned in a 2:1:1 allocation ratio to Dose 1 ABBV-CLS-7262, Dose 2 ABBV-CLS-7262, or placebo. The final approximately 60 participants will be assigned in a 3:1 allocation ratio to Dose 1 ABBV-CLS-7262 or placebo. Regimen F will enroll by invitation, as participants may not choose to enroll in Regimen F. Participants must first enroll into the Master Protocol and be eligible to participate in the Master Protocol before being able to be randomly assigned to Regimen F. For a list of enrolling sites, please see the HEALEY ALS Platform Trial Master Protocol under NCT04297683.
Interventions
ABBV-CLS-7262 is administered orally once per day for 24 weeks.
ABBV-CLS-7262 is administered orally once per day for 24 weeks.
Matching placebo is administered orally once per day for 24 weeks.
Sponsors
Study design
Eligibility
Inclusion criteria
* No additional inclusion criteria beyond the inclusion criteria specified in the Master Protocol (NCT NCT04297683).
Exclusion criteria
* The following
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Disease Progression as Assessed by the ALSFRS-R-Slope | Baseline to 24 Weeks | Change in disease severity as measured by the ALS Functional Rating Scale-Revised (ALSFRS-R) total score using a Bayesian repeated measures model that accounts for loss to follow-up due to mortality. Each of 12 questions assessing distinct functional ability is scored from 4(normal) to 0 (no ability), with a maximum total score of 48 and a minimum total score of 0. Participants with higher scores have more physical function. Note that only participants who survived to their Week 24 visit contribute to the estimate. |
| Mortality Event Rate | Baseline to 24 weeks | Mortality is defined as death or death equivalent. A participant is determined to meet the criteria of death equivalent if permanent assisted ventilation (PAV) is used for more than 22 hours per day for more than seven days in a row. The rate of mortality was estimated from a Bayesian shared-parametric model that assumed exponentially distributed survival times. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Upper Limb Muscle Strength | Baseline to 24 weeks | Change in upper limb muscle strength over time as measured isometrically using hand-held dynamometry and grip strength, calculated as the average percent change from baseline of the following muscles/maneuvers: shoulder flexion, elbow flexion, elbow extension, wrist extension, abductor pollicis brevis contraction, abductor digiti minimi contraction, first dorsal interosseous contraction, and grip strength. Note that only those with measurable strength at baseline were included. |
| Disease Progression Biomarker | Baseline to 24 Weeks | Change in log-transformed serum neurofilament light protein (NfL) concentration from baseline to Week 24. |
| Function by ALSFRS-R Total Score | Baseline to 24 weeks | Change from baseline to Week 24 in function as assessed by ALSFRS-R total score. |
| Number of Participants That Experienced Death or Death Equivalent | Baseline to 24 weeks | The number of participants who died or met the criterion for a death equivalent from the date of their baseline visit to the end of the Week 24visit window (generally 175 days after baseline). The death equivalent criterion is use of permanent assisted ventilation (PAV) for more than 22 hours per day for more than 7 days in a row. |
| Activities of Daily Living | Baseline to 24 weeks | Change from baseline to Week 24 in the activities of daily living (ADL)/independence domain score as assessed by the Amyotrophic Lateral Sclerosis Assessment Questionnaire-40 (ALSAQ-40). The ALSAQ-40, a patient-self reported outcome, consists of 40 questions that are used to measure the subjective well-being of participants, and each question is scored from 0 (never) to 5 (always or cannot do at all). The ADL/independence domain score is based on 10 out of the 40 questions, with a maximum ADL/independence domain score of 50 and minimum score of 0. Higher domain scores indicate a worse subjective well-being or less independence completing ADLs. |
| Respiratory Function | Baseline to 24 Weeks | Change in respiratory function over time as measured by Slow Vital Capacity (SVC). |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| ABBV-CLS-7262 Dose 1 ABBV-CLS-7262 is administered orally once per day for 24 weeks. | 155 |
| ABBV-CLS-7262 Dose 2 ABBV-CLS-7262 is administered orally once per day for 24 weeks. | 79 |
| Matching Placebo Matching placebo is administered orally once per day for 24 weeks. | 76 |
| Total | 310 |
Baseline characteristics
| Characteristic | Total | Matching Placebo | ABBV-CLS-7262 Dose 2 | ABBV-CLS-7262 Dose 1 |
|---|---|---|---|---|
| Age, Continuous | 57.7 Years STANDARD_DEVIATION 11.11 | 58.0 Years STANDARD_DEVIATION 11.13 | 58.2 Years STANDARD_DEVIATION 11.02 | 57.3 Years STANDARD_DEVIATION 11.2 |
| ALS Diagnosis from R El Escorial Criteria Clinically Definite ALS | 102 Participants | 22 Participants | 34 Participants | 46 Participants |
| ALS Diagnosis from R El Escorial Criteria Clinically Possible ALS | 31 Participants | 7 Participants | 7 Participants | 17 Participants |
| ALS Diagnosis from R El Escorial Criteria Clinically Probable ALS | 119 Participants | 33 Participants | 28 Participants | 58 Participants |
| ALS Diagnosis from R El Escorial Criteria Clinically Probable ALS - Laboratory Supported | 58 Participants | 14 Participants | 10 Participants | 34 Participants |
| ALSFRS-R Total Score | 35.90 Points STANDARD_DEVIATION 6.89 | 36.8 Points STANDARD_DEVIATION 6.68 | 35 Points STANDARD_DEVIATION 7.67 | 36 Points STANDARD_DEVIATION 6.54 |
| ALS Onset Location Axial | 2 Participants | 0 Participants | 2 Participants | 0 Participants |
| ALS Onset Location Bulbar | 46 Participants | 11 Participants | 8 Participants | 27 Participants |
| ALS Onset Location Generalized | 1 Participants | 0 Participants | 1 Participants | 0 Participants |
| ALS Onset Location Limb | 257 Participants | 65 Participants | 67 Participants | 125 Participants |
| ALS Onset Location Multiple | 2 Participants | 0 Participants | 1 Participants | 1 Participants |
| ALS Onset Location Respiratory | 2 Participants | 0 Participants | 0 Participants | 2 Participants |
| Baseline Edaravone Use No | 119 Participants | 30 Participants | 30 Participants | 59 Participants |
| Baseline Edaravone Use Yes | 191 Participants | 46 Participants | 49 Participants | 96 Participants |
| Baseline Relyvrio Use No | 127 Participants | 30 Participants | 32 Participants | 65 Participants |
| Baseline Relyvrio Use Yes | 183 Participants | 46 Participants | 47 Participants | 90 Participants |
| Baseline Riluzole Use No | 44 Participants | 11 Participants | 11 Participants | 22 Participants |
| Baseline Riluzole Use Yes | 266 Participants | 65 Participants | 68 Participants | 133 Participants |
| Body Mass Index | 27.12 kg/m^2 STANDARD_DEVIATION 5.83 | 27.3 kg/m^2 STANDARD_DEVIATION 5.33 | 26.4 kg/m^2 STANDARD_DEVIATION 4.77 | 27.4 kg/m^2 STANDARD_DEVIATION 6.53 |
| Delay in ALS Symptom Onset and Diagnosis | 9.71 Months STANDARD_DEVIATION 5.36 | 8.9 Months STANDARD_DEVIATION 4.74 | 9.3 Months STANDARD_DEVIATION 5.44 | 10.4 Months STANDARD_DEVIATION 5.56 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 26 Participants | 6 Participants | 8 Participants | 12 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 284 Participants | 70 Participants | 71 Participants | 143 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| King Stage 1 Region with Neuromuscular Dysfunction | 71 Participants | 20 Participants | 18 Participants | 33 Participants |
| King Stage 2 Region with Neuromuscular Dysfunction | 74 Participants | 20 Participants | 17 Participants | 37 Participants |
| King Stage 3 Region with Neuromuscular Dysfunction; | 81 Participants | 22 Participants | 19 Participants | 40 Participants |
| King Stage 4a/b Nutritional/Respiratory Failure | 84 Participants | 14 Participants | 25 Participants | 45 Participants |
| Pre-Baseline Decline in ALSFRS-R | 0.65 Points per Month STANDARD_DEVIATION 0.51 | 0.6 Points per Month STANDARD_DEVIATION 0.41 | 0.8 Points per Month STANDARD_DEVIATION 0.66 | 0.6 Points per Month STANDARD_DEVIATION 0.44 |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 0 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 10 Participants | 5 Participants | 1 Participants | 4 Participants |
| Race (NIH/OMB) Black or African American | 6 Participants | 3 Participants | 0 Participants | 3 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 8 Participants | 3 Participants | 2 Participants | 3 Participants |
| Race (NIH/OMB) White | 285 Participants | 65 Participants | 75 Participants | 145 Participants |
| Serum Creatinine Concentration | 0.7 mg/dL STANDARD_DEVIATION 0.19 | 0.7 mg/dL STANDARD_DEVIATION 0.2 | 0.7 mg/dL STANDARD_DEVIATION 0.18 | 0.7 mg/dL STANDARD_DEVIATION 0.18 |
| Serum NfL Concentration | 54.8 ng/L | 64.4 ng/L | 55.2 ng/L | 52.9 ng/L |
| Sex: Female, Male Female | 124 Participants | 34 Participants | 30 Participants | 60 Participants |
| Sex: Female, Male Male | 186 Participants | 42 Participants | 49 Participants | 95 Participants |
| SVC | 82.51 Percent predicted STANDARD_DEVIATION 17.72 | 85.0 Percent predicted STANDARD_DEVIATION 16.98 | 82.0 Percent predicted STANDARD_DEVIATION 17.2 | 81.5 Percent predicted STANDARD_DEVIATION 18.31 |
| Time Since Symptom Onset at Baseline | 20.93 Months STANDARD_DEVIATION 7.95 | 19.7 Months STANDARD_DEVIATION 7.38 | 19.6 Months STANDARD_DEVIATION 7.94 | 22.2 Months STANDARD_DEVIATION 8.07 |
| Weight | 81.19 Kg STANDARD_DEVIATION 20.39 | 81.1 Kg STANDARD_DEVIATION 19.74 | 78.8 Kg STANDARD_DEVIATION 16.68 | 82.4 Kg STANDARD_DEVIATION 22.34 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 6 / 155 | 3 / 79 | 1 / 76 |
| other Total, other adverse events | 125 / 155 | 59 / 79 | 62 / 76 |
| serious Total, serious adverse events | 21 / 155 | 7 / 79 | 6 / 76 |
Outcome results
Disease Progression as Assessed by the ALSFRS-R-Slope
Change in disease severity as measured by the ALS Functional Rating Scale-Revised (ALSFRS-R) total score using a Bayesian repeated measures model that accounts for loss to follow-up due to mortality. Each of 12 questions assessing distinct functional ability is scored from 4(normal) to 0 (no ability), with a maximum total score of 48 and a minimum total score of 0. Participants with higher scores have more physical function. Note that only participants who survived to their Week 24 visit contribute to the estimate.
Time frame: Baseline to 24 Weeks
Population: Outcome measure data was analyzed using the Efficacy Concurrent-controls Set (ECC), which included concurrent shared placebos from other regimens if randomized within 180 days of the first and last randomization for the applicable regimen, excluding any shared placebos also include in the focal regimen, as pre-specified in the Regimen Statistical Analysis Plan. Regimen F (NCT#05740813) and Regimen G (NCT#05842941) contributed placebo participants into the shared placebo cohort used for analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| ABBV-CLS-7262 Dose 1 | Disease Progression as Assessed by the ALSFRS-R-Slope | -1.00 Points per month | Standard Deviation 0.068 |
| ABBV-CLS-7262 Dose 2 | Disease Progression as Assessed by the ALSFRS-R-Slope | -0.91 Points per month | Standard Deviation 0.078 |
| Matching Placebo | Disease Progression as Assessed by the ALSFRS-R-Slope | -0.95 Points per month | Standard Deviation 0.085 |
Mortality Event Rate
Mortality is defined as death or death equivalent. A participant is determined to meet the criteria of death equivalent if permanent assisted ventilation (PAV) is used for more than 22 hours per day for more than seven days in a row. The rate of mortality was estimated from a Bayesian shared-parametric model that assumed exponentially distributed survival times.
Time frame: Baseline to 24 weeks
Population: Outcome measure data was analyzed using the Efficacy Concurrent-controls Set (ECC), which included concurrent shared placebos from other regimens if randomized within 180 days of the first and last randomization for the applicable regimen, excluding any shared placebos also include in the focal regimen, as pre-specified in the Regimen Statistical Analysis Plan. Regimen F (NCT#05740813) and Regimen G (NCT#05842941) contributed placebo participants into the shared placebo cohort used for analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| ABBV-CLS-7262 Dose 1 | Mortality Event Rate | 0.009 Events per month | Standard Deviation 0.0022 |
| ABBV-CLS-7262 Dose 2 | Mortality Event Rate | 0.008 Events per month | Standard Deviation 0.0021 |
| Matching Placebo | Mortality Event Rate | 0.009 Events per month | Standard Deviation 0.0022 |
Activities of Daily Living
Change from baseline to Week 24 in the activities of daily living (ADL)/independence domain score as assessed by the Amyotrophic Lateral Sclerosis Assessment Questionnaire-40 (ALSAQ-40). The ALSAQ-40, a patient-self reported outcome, consists of 40 questions that are used to measure the subjective well-being of participants, and each question is scored from 0 (never) to 5 (always or cannot do at all). The ADL/independence domain score is based on 10 out of the 40 questions, with a maximum ADL/independence domain score of 50 and minimum score of 0. Higher domain scores indicate a worse subjective well-being or less independence completing ADLs.
Time frame: Baseline to 24 weeks
Population: Outcome measure data was analyzed using the Efficacy Concurrent-controls Set (ECC), which included concurrent shared placebos from other regimens if randomized within 180 days of the first and last randomization for the applicable regimen, excluding any shared placebos also include in the focal regimen, as pre-specified in the Regimen Statistical Analysis Plan. Regimen F (NCT#05740813) and Regimen G (NCT#05842941) contributed placebo participants into the shared placebo cohort used for analysis.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| ABBV-CLS-7262 Dose 1 | Activities of Daily Living | 13.643 Points | Standard Error 1.2961 |
| ABBV-CLS-7262 Dose 2 | Activities of Daily Living | 12.049 Points | Standard Error 1.8617 |
| Matching Placebo | Activities of Daily Living | 13.701 Points | Standard Error 1.5115 |
Disease Progression Biomarker
Change in log-transformed serum neurofilament light protein (NfL) concentration from baseline to Week 24.
Time frame: Baseline to 24 Weeks
Population: Outcome measure data was analyzed using the Efficacy Concurrent-controls Set (ECC), which included concurrent shared placebos from other regimens if randomized within 180 days of the first and last randomization for the applicable regimen, excluding any shared placebos also include in the focal regimen, as pre-specified in the Regimen Statistical Analysis Plan. Regimen F (NCT#05740813) and Regimen G (NCT#05842941) contributed placebo participants into the shared placebo cohort used for analysis.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| ABBV-CLS-7262 Dose 1 | Disease Progression Biomarker | 0.086 ln(ng/L) | Standard Error 0.0247 |
| ABBV-CLS-7262 Dose 2 | Disease Progression Biomarker | 0.067 ln(ng/L) | Standard Error 0.0355 |
| Matching Placebo | Disease Progression Biomarker | -0.002 ln(ng/L) | Standard Error 0.0282 |
Function by ALSFRS-R Total Score
Change from baseline to Week 24 in function as assessed by ALSFRS-R total score.
Time frame: Baseline to 24 weeks
Population: Outcome measure data was analyzed using the Efficacy Concurrent-controls Set (ECC), which included concurrent shared placebos from other regimens if randomized within 180 days of the first and last randomization for the applicable regimen, excluding any shared placebos also include in the focal regimen, as pre-specified in the Regimen Statistical Analysis Plan. Regimen F (NCT#05740813) and Regimen G (NCT#05842941) contributed placebo participants into the shared placebo cohort used for analysis.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| ABBV-CLS-7262 Dose 1 | Function by ALSFRS-R Total Score | -6.110 Points | Standard Error 0.371 |
| ABBV-CLS-7262 Dose 2 | Function by ALSFRS-R Total Score | -5.468 Points | Standard Error 0.5252 |
| Matching Placebo | Function by ALSFRS-R Total Score | -5.563 Points | Standard Error 0.4106 |
Number of Participants That Experienced Death or Death Equivalent
The number of participants who died or met the criterion for a death equivalent from the date of their baseline visit to the end of the Week 24visit window (generally 175 days after baseline). The death equivalent criterion is use of permanent assisted ventilation (PAV) for more than 22 hours per day for more than 7 days in a row.
Time frame: Baseline to 24 weeks
Population: Outcome measure data was analyzed using the Efficacy Concurrent-controls Set (ECC), which included concurrent shared placebos from other regimens if randomized within 180 days of the first and last randomization for the applicable regimen, excluding any shared placebos also include in the focal regimen, as pre-specified in the Regimen Statistical Analysis Plan. Regimen F (NCT#05740813) and Regimen G (NCT#05842941) contributed placebo participants into the shared placebo cohort used for analysis.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| ABBV-CLS-7262 Dose 1 | Number of Participants That Experienced Death or Death Equivalent | 8 Participants |
| ABBV-CLS-7262 Dose 2 | Number of Participants That Experienced Death or Death Equivalent | 4 Participants |
| Matching Placebo | Number of Participants That Experienced Death or Death Equivalent | 5 Participants |
Respiratory Function
Change in respiratory function over time as measured by Slow Vital Capacity (SVC).
Time frame: Baseline to 24 Weeks
Population: Outcome measure data was analyzed using the Efficacy Concurrent-controls Set (ECC), which included concurrent shared placebos from other regimens if randomized within 180 days of the first and last randomization for the applicable regimen, excluding any shared placebos also include in the focal regimen, as pre-specified in the Regimen Statistical Analysis Plan. Regimen F (NCT#05740813) and Regimen G (NCT#05842941) contributed placebo participants into the shared placebo cohort used for analysis.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| ABBV-CLS-7262 Dose 1 | Respiratory Function | -10.882 24-week diff. of percents of normal VC | Standard Error 1.3311 |
| ABBV-CLS-7262 Dose 2 | Respiratory Function | -7.202 24-week diff. of percents of normal VC | Standard Error 1.9469 |
| Matching Placebo | Respiratory Function | -9.462 24-week diff. of percents of normal VC | Standard Error 1.5259 |
Upper Limb Muscle Strength
Change in upper limb muscle strength over time as measured isometrically using hand-held dynamometry and grip strength, calculated as the average percent change from baseline of the following muscles/maneuvers: shoulder flexion, elbow flexion, elbow extension, wrist extension, abductor pollicis brevis contraction, abductor digiti minimi contraction, first dorsal interosseous contraction, and grip strength. Note that only those with measurable strength at baseline were included.
Time frame: Baseline to 24 weeks
Population: Outcome measure data was analyzed using the Efficacy Concurrent-controls Set (ECC), which included concurrent shared placebos from other regimens if randomized within 180 days of the first and last randomization for the applicable regimen, excluding any shared placebos also include in the focal regimen, as pre-specified in the Regimen Statistical Analysis Plan. Regimen F (NCT#05740813) and Regimen G (NCT#05842941) contributed placebo participants into the shared placebo cohort used for analysis.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| ABBV-CLS-7262 Dose 1 | Upper Limb Muscle Strength | -36.281 Percent change | Standard Error 2.6896 |
| ABBV-CLS-7262 Dose 2 | Upper Limb Muscle Strength | -25.760 Percent change | Standard Error 3.8365 |
| Matching Placebo | Upper Limb Muscle Strength | -38.078 Percent change | Standard Error 3.05 |