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Rho Kinase Inhibitor in Amyotrophic Lateral Sclerosis (REAL) (REAL)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT05218668
Recruitment Status : Recruiting
First Posted : February 1, 2022
Last Update Posted : March 16, 2022
Information provided by (Responsible Party):
Woolsey Pharmaceuticals

Brief Summary:
A Phase 2a Open-Label Preliminary Safety, Efficacy, and Biomarker Study of WP-0512 in Patients with Amyotrophic Lateral Sclerosis (ALS)

Condition or disease Intervention/treatment Phase
Amyotrophic Lateral Sclerosis Drug: Fasudil (WP-0512) Phase 2

Detailed Description:

The study population will consist of subjects with possible, probable laboratory-supported, probable, or definite ALS, as defined by El Escorial Revised ALS diagnostic criteria, who have ALSFRS-R declining by an average of 0.5-1.5 points per 4 weeks at the time of Screening 1/Visit 1.

After consent, participants will undergo two screening evaluations, which will occur over the course of the 8 weeks prior to dosing with study drug. At Screening 1/Visit 1 (8 weeks before start of dosing), ALS assessments of ALSFRS-R/SVC/HHD will be performed, as will safety assessments. Subjects who meet the pertinent inclusion/exclusion criteria will return for a second screening visit (Screening 2/Visit 2) approximately 4 weeks later, and ALS and safety assessment will again be conducted. Subjects who meet the pertinent Screening 2 study entry criteria will be enrolled into the study.

On Visit 3, evaluations will be performed and dosing with study drug will begin. Dosing will be initiated at 180 mg/day; after at least 10 subjects have been enrolled and safely treated at 180 mg/day for 4 weeks, subsequent subjects may be enrolled at 240 mg/day. Study drug will be taken for 24 weeks. Participants will have an in-person or telephone visit at Week 1 (Visit 4) to assess for safety and drug compliance. Additional follow-up visits will occur at Weeks 4 (Visit 5), 8 (Visit 6), 12 (Visit 7), 18 (Visit 8) and 24 (Visit 9), during which ALS assessments of ALSFRS-R/SVC/HHD will be performed. A final visit (Visit 10) will be conducted at Week 25 for post-treatment follow-up evaluations.

Plasma biomarker collection will occur between enrollment and commencement of treatment, and at Week 12 (Visit 7) and Week 24 (Visit 9). CSF biomarker collection will occur between enrollment and commencement of treatment, and at Week 24 (Visit 9).

Laboratory safety assessments and adverse events will be collected at each study visit.

Subjects/caregivers will will be asked to maintain a log of study drug compliance, which will be reviewed at each visit.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 20 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Intervention Model Description: Open label, single arm
Masking: None (Open Label)
Masking Description: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase 2a Open-Label Preliminary Safety, Efficacy, and Biomarker Study of WP-0512 in Patients With Amyotrophic Lateral Sclerosis (ALS)
Actual Study Start Date : December 22, 2021
Estimated Primary Completion Date : February 2023
Estimated Study Completion Date : February 2023

Arm Intervention/treatment
Experimental: Fasudil
Oral fasudil 180 mg/day or 240 mg/day
Drug: Fasudil (WP-0512)
Oral fasudil 180 mg/day or 240 mg/day

Primary Outcome Measures :
  1. Incidence of Adverse Events (AEs) and Serious Adverse Events (SAEs) [ Time Frame: Through study completion, up to 25 weeks ]
    Incidence of Adverse Events (AEs] and Serious Adverse Events (SAEs) as assessed by clinically significant abnormal physical examination findings; changes in vital signs; 12-lead electrocardiogram (ECG); magnetic resonance imaging (MRI); and hematology, blood chemistry, liver function, and urine tests.

Secondary Outcome Measures :
  1. Change in the slope of the decline in Slow Vital Capacity (SVC) during treatment vs pre-treatment [ Time Frame: Monthly from Screening to Week 12; Every six weeks to Week 24 ]

    The SVC will be measured using the study-approved portable spirometer, and assessments will be performed using a face mask. Three SVC trials are required for each testing session, however up to 5 trials may be performed if the variability between the highest and second highest SVC is 10% or greater for the first 3 trials.

    The highest SVC recorded is utilized for eligibility. At least 3 measurable SVC trials must be completed to score SVC for all visits after screening. Predicted SVC values and percent predicted SVC values will be calculated using the Quanjer Global Lung Initiative equations.

  2. Change in the slope of the decline in Hand-Held Dynamometry (HHD) during treatment vs pre-treatment [ Time Frame: Monthly from Screening to Week 12; Every six weeks to Week 24 ]
    A spring-loaded device that "breaks" at pre-set forces will be used to assess readings obtained by HHD throughout the study. Grip strength dynamometry for both hands will be acquired, and the mean force in kilograms will be calculated. Measures will be obtained from each hand in triplicate.

  3. Change in the slope of the decline Revised ALS Functional Rating Scale (ALSFRS-R) during treatment vs pre-treatment [ Time Frame: Monthly from Screening to Week 12; Every six weeks toWeek 24] ]
    The ALSFRS-R is a validated rating instrument for monitoring the progression of disability inpatients with ALS and is utilized for monitoring functional change in ALS patients. The score assesses various 4 domains including: (i) bulbar function (speech, salivation, swallowing); (ii)fine motor task (handwriting, cutting food and handling utensils, with or without gastrostomy, dressing and hygiene); (iii) gross motor task (turning in bed, walking, climbing stairs); and (iv)respiratory function (dyspnea, orthopnea and respiratory insufficiency).

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Between 18 and 75 years of age (inclusive) at Screening 1.
  2. A diagnosis at Screening 1 and Screening 2 of possible, probable laboratory-supported, probable, or definite ALS, as defined by El Escorial Revised ALS diagnostic criteria.
  3. Average decrease in ALSFRS-R of 0.5 to 1.5 (inclusive) points per 4 weeks [use the change between the Screening 1 ALSFRS-R and the most recent ALSFRS-R measure that is at least 12 weeks prior to Screening 1. If no prior values are available, the rate of decline can be estimated as follows: (48-value at screening)/[estimated number of months between screening and ALS symptom onset (weakness and/or dysarthria, and/or dysphagia)].
  4. SVC > 50% of predicted value for gender, height, and age at Screening 1.
  5. ALS symptom onset (weakness and/or dysarthria, and/or dysphagia) within 48 months of Screening 1.
  6. Either no ALS treatment for 4 weeks prior to Screening 1, or stable dosing of riluzole (4 weeks on same dose) and/or at least 2 cycles of edaravone prior to Screening 1; and no change in treatment with either drug between Screening 1 and Screening 2.
  7. Women of childbearing potential (WCBP) must agree to abstain from sex or use an adequate method of contraception for the duration of the screening period, the study drug treatment period, and for 28 days after the last dose of study drug.
  8. Males must agree to abstain from sex with WCBP or use an adequate method of contraception for the duration of the study drug treatment period and for 75 days after.
  9. Capable of providing informed consent and following trial procedures (where subject consents but is unable to sign the informed consent a legally authorized representative (LAR)/surrogate must sign on their behalf).

Exclusion Criteria:

  1. ALSFRS-R < 24 at Screening 1.
  2. Expected change in dosing of riluzole and/or edaravone between Screening 1 and the end of the study.
  3. Presence of other causes of neuromuscular weakness or other neurodegenerative diseases that could interfere with the objectives of the study or the safety of the subject, in the opinion of the Investigator.
  4. Mechanical ventilation via tracheostomy. (Use of non-invasive ventilation e.g., continuous positive airway pressure, non-invasive bi-level positive airway pressure or non-invasive volume ventilation is not an exclusion).
  5. Any severe comorbidity (including cardiovascular, hematologic, renal, hepatic, or psychiatric diseases) that in the opinion of the Investigator would disallow safe participation in the trial.
  6. Suicidal ideation per the Columbia-Suicide Severity Rating Scale (C-SSRS) that in the opinion of the Investigator would pose a safety risk.
  7. ALT ≥ 3 x upper limit of normal (ULN) or aspartate aminotransferase (AST) ≥ 3 x ULN at Screening 2.
  8. Estimated glomerular filtration rate (eGFR) < 45 mL/min/1.73m2 at Screening 2.
  9. Participants who, in the opinion of the Investigator, are unable or unlikely to comply with the dosing schedule or study evaluations.
  10. Treatment with another investigational drug within 28 days or 5 half-lives of drug before start of study drug, whichever is longer.
  11. Treatment with phenylbutyrate and tauroursodeoxycholic acid.
  12. On more than one of the following drug classes: long-acting nitrates, beta-blockers, or calcium channel blockers. (Note: subjects may be on one of the drug classes.)
  13. Systolic blood pressure < 90 mmHg and/or diastolic blood pressure < 60 mmHg at Screening 2. (Note: in the case of a systolic blood pressure < 90 and/or diastolic blood pressure < 60, BP measurements should be repeated after 10 minutes, and the higher reading used for Inclusion/Exclusion.)
  14. Known hypersensitivity to the active (fasudil) or inactive ingredients in the study drug.
  15. Known to be pregnant or lactating; or positive pregnancy test for WCBP.
  16. At Screening 2, neutrophil count < 1,500/mm3, platelets < 100,000/mm3, international normalized ratio (INR) > 1.5 or any contraindication to or unable to tolerate lumbar puncture, including use of anticoagulant medications such as warfarin. Daily administration of aspirin up to 81 mg is not a contraindication, as long as the dose is held 3 days before lumbar puncture.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT05218668

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Contact: Ann C Tunstall, Ph. D. +1-703-981-8338
Contact: Sabrina Williams +1-703-501-7820

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United States, Arizona
Neuromuscular Research Center Not yet recruiting
Phoenix, Arizona, United States, 85028
Contact: Diane Newman    602-410-1675      
Principal Investigator: Kumaraswamy Sivakumar, MD         
United States, Colorado
University of Colorado Not yet recruiting
Aurora, Colorado, United States, 80045
Contact: Brianna Blume    303-724-3496      
Principal Investigator: Laura Foster, MD         
National Jewish Health Not yet recruiting
Denver, Colorado, United States, 80206
Contact: Jami Hennriksen    303-398-1233      
Principal Investigator: Jinny Tavee, MD         
United States, Florida
Lakes Research Recruiting
Miami Lakes, Florida, United States, 33014
Contact: Priscila Valdiviezo    786-362-5763      
Principal Investigator: David Ross, MD         
University of South Florida Not yet recruiting
Tampa, Florida, United States, 33620
Contact: Jessica Shaw    813-844-8061      
Principal Investigator: Tuan Vu, MD         
United States, Illinois
Northwestern University Not yet recruiting
Chicago, Illinois, United States, 60611
Contact: Emma Schmidt    312-503-0671      
Principal Investigator: Senda Arjoud-Driss, MD         
United States, Kentucky
University of Kentucky Not yet recruiting
Lexington, Kentucky, United States, 40506
Contact: Debby Taylor    617-671-9597      
Principal Investigator: Vishakhadatta Kumaraswamy, MD         
United States, Missouri
Cox Medical Center Not yet recruiting
Springfield, Missouri, United States, 65807
Contact: Jessica Ratcliff    417-885-3888      
Principal Investigator: Tania Papsdorf, MD         
United States, New York
Hospital for Special Surgery Not yet recruiting
New York, New York, United States, 10021
Contact: Shara Holzberg    646-797-8917      
Principal Investigator: Dale Lange, MD         
Australia, New South Wales
Macquarie University Hospital Not yet recruiting
Sydney, New South Wales, Australia, NSW 2109
Contact: Richard Gan   
Principal Investigator: Dominic Rowe         
Australia, Queensland
Royal Brisbane and Women's Hospital Not yet recruiting
Brisbane, Queensland, Australia, QLD 4029
Contact: Susan Heggie    (07) 3646 3111   
Principal Investigator: Robert Henderson, MD         
Australia, Victoria
Calvary Health Bethlehem Hospital Recruiting
Melbourne, Victoria, Australia, VIC 3195
Contact: Emma Windebank    (03) 9596 2853   
Principal Investigator: Susan Mathers         
Sponsors and Collaborators
Woolsey Pharmaceuticals
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Responsible Party: Woolsey Pharmaceuticals Identifier: NCT05218668    
Other Study ID Numbers: WP-0512-003
First Posted: February 1, 2022    Key Record Dates
Last Update Posted: March 16, 2022
Last Verified: March 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Woolsey Pharmaceuticals:
Additional relevant MeSH terms:
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Motor Neuron Disease
Amyotrophic Lateral Sclerosis
Pathologic Processes
Neurodegenerative Diseases
Nervous System Diseases
Neuromuscular Diseases
Spinal Cord Diseases
Central Nervous System Diseases
TDP-43 Proteinopathies
Proteostasis Deficiencies
Metabolic Diseases
Calcium Channel Blockers
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Calcium-Regulating Hormones and Agents
Physiological Effects of Drugs
Vasodilator Agents
Protein Kinase Inhibitors
Enzyme Inhibitors