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A Study of CK-2017357 in Patients With Amyotrophic Lateral Sclerosis (ALS)

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. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT01089010
Recruitment Status : Completed
First Posted : March 18, 2010
Last Update Posted : May 10, 2019
Sponsor:
Information provided by (Responsible Party):
Cytokinetics

Study Description
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Brief Summary:
The primary objective of this study is to demonstrate a pharmacodynamic effect of CK 2017357 on measures of skeletal muscle function or fatigability in patients with ALS.

Condition or disease Intervention/treatment Phase
Amyotrophic Lateral Sclerosis Drug: Placebo Drug: 250 mg CK-2017357 Drug: 500 mg CK-2017357 Phase 2

Detailed Description:
This study is a Phase II, double-blind, randomized, placebo-controlled, three-way crossover study of CK-2017357 in patients with ALS. 36 to 72 patients will be randomized to one of six different treatment sequences. Each treatment sequence consists of three dosing periods; in each dosing period¸ patients receive a single oral dose of placebo, 250 mg of CK-2017357, or 500 mg of CK-2017357. All six treatment sequences will enroll approximately the same number of patients. A washout period of at least 6 days (to a maximum of 10 days) will be employed between the doses for each patient. This study is designed to assess the effect of CK-2017357 on maximal voluntary muscle strength, on the development of fatigue at maximal and sub-maximal voluntary muscle contraction, and on selected pulmonary function parameters. The plasma concentration of CK-2017357 will be measured at selected time points after each of two single doses of CK-2017357 in men and women. The plasma concentration versus time data obtained in this study may be used to develop a population PK model and estimate inter-subject variability of PK parameters in this target patient population, in particular between male and female study patients.
Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 67 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Phase II, Double-Blind, Randomized, Placebo-Controlled, Three-Way Crossover, Pharmacokinetic and Pharmacodynamic Study of CK-2017357 in Patients With Amyotrophic Lateral Sclerosis (ALS)
Study Start Date : March 2010
Actual Primary Completion Date : November 2010
Actual Study Completion Date : November 2010

Resource links provided by the National Library of Medicine


Arms and Interventions
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Arm Intervention/treatment
Experimental: Treatment Sequence 1
Treatment sequence 1 consisted of three dosing periods in which patients received single oral doses of placebo, 250 mg, and 500 mg of CK-2017357, in that order, with approximately one week between each dose. Each patient acted as their own control, as all doses were represented in each treatment sequence.
 Drug: Placebo
Matching placebo in capsules administered as a single oral dose.

Drug: 250 mg CK-2017357
250 mg CK-2017357 in capsules administered as a single oral dose.
Other Name: tirasemtiv

Drug: 500 mg CK-2017357
500 mg CK-2017357 in capsules administered as a single oral dose.
Other Name: tirasemtiv
Experimental: Treatment Sequence 2
Treatment sequence 2 consisted of three dosing periods in which patients received single oral doses of placebo, 500 mg, and 250 mg of CK-2017357, in that order, with approximately one week between each dose. Each patient acted as their own control, as all doses were represented in each treatment sequence.
 Drug: Placebo
Matching placebo in capsules administered as a single oral dose.

Drug: 250 mg CK-2017357
250 mg CK-2017357 in capsules administered as a single oral dose.
Other Name: tirasemtiv

Drug: 500 mg CK-2017357
500 mg CK-2017357 in capsules administered as a single oral dose.
Other Name: tirasemtiv
Experimental: Treatment Sequence 3
Treatment sequence 3 consisted of three dosing periods in which patients received single oral doses of 250 mg, placebo and 500 mg of CK-2017357, in that order, with approximately one week between each dose. Each patient acted as their own control, as all doses were represented in each treatment sequence.
 Drug: Placebo
Matching placebo in capsules administered as a single oral dose.

Drug: 250 mg CK-2017357
250 mg CK-2017357 in capsules administered as a single oral dose.
Other Name: tirasemtiv

Drug: 500 mg CK-2017357
500 mg CK-2017357 in capsules administered as a single oral dose.
Other Name: tirasemtiv
Experimental: Treatment Sequence 4
Treatment sequence 4 consisted of three dosing periods in which patients received single oral doses of 250 mg, 500 mg and placebo of CK-2017357, in that order, with approximately one week between each dose. Each patient acted as their own control, as all doses were represented in each treatment sequence.
 Drug: Placebo
Matching placebo in capsules administered as a single oral dose.

Drug: 250 mg CK-2017357
250 mg CK-2017357 in capsules administered as a single oral dose.
Other Name: tirasemtiv

Drug: 500 mg CK-2017357
500 mg CK-2017357 in capsules administered as a single oral dose.
Other Name: tirasemtiv
Experimental: Treatment Sequence 5
Treatment sequence 5 consisted of three dosing periods in which patients received single oral doses of 500 mg, placebo, and 250 mg of CK-2017357, in that order, with approximately one week between each dose. Each patient acted as their own control, as all doses were represented in each treatment sequence.
 Drug: Placebo
Matching placebo in capsules administered as a single oral dose.

Drug: 250 mg CK-2017357
250 mg CK-2017357 in capsules administered as a single oral dose.
Other Name: tirasemtiv

Drug: 500 mg CK-2017357
500 mg CK-2017357 in capsules administered as a single oral dose.
Other Name: tirasemtiv
Experimental: Treatment Sequence 6
Treatment sequence6 consisted of three dosing periods in which patients received single oral doses of 500 mg, 250 mg, and placebo of CK-2017357, in that order, with approximately one week between each dose. Each patient acted as their own control, as all doses were represented in each treatment sequence.
 Drug: Placebo
Matching placebo in capsules administered as a single oral dose.

Drug: 250 mg CK-2017357
250 mg CK-2017357 in capsules administered as a single oral dose.
Other Name: tirasemtiv

Drug: 500 mg CK-2017357
500 mg CK-2017357 in capsules administered as a single oral dose.
Other Name: tirasemtiv


Outcome Measures
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Primary Outcome Measures :
  1. ALSFRS-R [ Time Frame: 2 days ]
    An instrument for evaluating the functional status of patients with ALS. Minimum score is 0 and maximum score is 40. The higher the score the more function is retained.

  2. Maximum grip strength [ Time Frame: 2 days ]
    Measured using the DynEx Electronic Hand Dynamometer. Patients asked to squeeze the device with the maximum possible force to establish the maximum voluntary contraction.

  3. Maximum grip strength fatigability [ Time Frame: 2 days ]
    Handgrip fatigue is measured using the DynEx Electronic Hand Dynamometer. Patient is asked to squeeze the device until they can no longer stay above 60% of target or 120 seconds.

  4. Shoulder extension fatigue [ Time Frame: 2 days ]
    Patient is asked to hold one arm outstretched in front of them at a 90 degree angle. The time the arm falls below 90 degrees for > 2 seconds will be recorded, up to a total evaluation time of 2 minutes. This is then repeated with the other arm.

  5. Slow Vital Capacity (SVC) [ Time Frame: 2 days ]
    SVC is measured using the Puritan Bennett Renaissance II Spirometry System and accessories.

  6. Maximum Voluntary Ventilation (MVV) [ Time Frame: 2 days ]
    MVV is the volume of air that can be exhaled during 12 seconds of rapid deep breathing. The actual volume is extrapolated to one minute. the Puritan Bennett Renaissance II Spirometry System and accessories is used for this measurement.

  7. Sniff Inspiratory Pressure (SNIP) [ Time Frame: 2 days ]
    SNIP is measured at Functional Residual Capacity, the bottom of the tidal breathing cycle, through one plugged nostril while the other remains open using the Micro Medical MicroRPM Respiratory Pressure Meter

  8. Maximum Voluntary Muscle Contraction (MVC) [ Time Frame: 2 days ]
    MVC is measured using the MicroFET 2 HHD.

  9. Repeated Sub-Maximum Grip Strength Fatigability [ Time Frame: 2 days ]
    Sub-Maximum Grip Strength Fatigability is measured using the DynEx Electronic Hand. Dynamometer


Secondary Outcome Measures :
  1. Characterize the relationship, if any, between the plasma concentration of CK-2017357 and ALSFRS-R. [ Time Frame: 2 days ]
    ALSFRS-R assessments will be paired with PK concentrations obtained at or near the same time as the ALSFRS-R assessments and analyzed for concentration related effects.

  2. Characterize the relationship, if any, between the plasma concentration of CK-2017357 and maximum grip strength [ Time Frame: 2 days ]
    Maximum grip strength assessments will be paired with PK concentrations obtained at or near the same time as the maximum grip strength assessments and analyzed for concentration related effects.

  3. Characterize the relationship, if any, between the plasma concentration of CK-2017357 and maximum grip strength fatigability [ Time Frame: 2 days ]
    Maximum grip strength fatigability assessments will be paired with PK concentrations obtained at or near the same time as the maximum grip strength fatigability assessments and analyzed for concentration related effects.

  4. Characterize the relationship, if any, between the plasma concentration of CK-2017357 and shoulder extension fatigue [ Time Frame: 2 days ]
    Shoulder extension fatigue assessments will be paired with PK concentrations obtained at or near the same time as the shoulder extension fatigue assessments and analyzed for concentration related effects.

  5. Characterize the relationship, if any, between the plasma concentration of CK-2017357 and slow vital capacity [ Time Frame: 2 days ]
    Slow vital capacity assessments will be paired with PK concentrations obtained at or near the same time as the slow vital capacity assessments and analyzed for concentration related effects.

  6. Characterize the relationship, if any, between the plasma concentration of CK-2017357 and maximum voluntary ventilation [ Time Frame: 2 days ]
    Maximum voluntary ventilation assessments will be paired with PK concentrations obtained at or near the same time as the maximum voluntary ventilation assessments and analyzed for concentration related effects.

  7. Characterize the relationship, if any, between the plasma concentration of CK-2017357 and sniff inspiratory pressure [ Time Frame: 2 days ]
    Sniff inspiratory pressure assessments will be paired with PK concentrations obtained at or near the same time as the sniff inspiratory pressure assessments and analyzed for concentration related effects.

  8. Characterize the relationship, if any, between the plasma concentration of CK-2017357 and maximum voluntary muscle contraction [ Time Frame: 2 days ]
    Maximum voluntary muscle contraction assessments will be paired with PK concentrations obtained at or near the same time as the maximum voluntary muscle contraction assessments and analyzed for concentration related effects.

  9. Characterize the relationship, if any, between the plasma concentration of CK-2017357 and repeated sub-maximum grip strength fatigability [ Time Frame: 2 days ]
    Repeated sub-maximum grip strength fatigability assessments will be paired with PK concentrations obtained at or near the same time as the repeated sub-maximum grip strength fatigability assessments and analyzed for concentration related effects.

  10. Number of patients with adverse events [ Time Frame: 4 weeks ]
  11. Effect of CK-2017357 on patient determined global functional assessment [ Time Frame: 2 days ]
    Patients will be asked to assess whether they feel the same, better or worse as compared to how they felt pre-dose

  12. Effect of CK-2017357 on investigator determined global functional assessment [ Time Frame: 2 days ]
    Investigator will assess whether they the patient appears the same, better or worse as compared to the patient's status at pre-dose


Eligibility Criteria
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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 and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria

For enrollment, patients were required to satisfy all of the following criteria at baseline:

1. Able to comprehend and willing to sign an Informed Consent Form (ICF)

  1. A diagnosis of familial or sporadic ALS (defined as meeting the possible, laboratory-supported probable, probable, or definite criteria for a diagnosis of ALS according to the World Federation of Neurology El Escorial criteria) (Brooks, Miller et al. 2000)
  2. Males or females 18 years of age or older
  3. Body Mass Index (BMI) of 18.0 to 30.0 kg/m2, inclusive
  4. Maximum voluntary grip strength in at least one hand between 10 and 40 pounds (females) or 10 and 60 pounds (males)
  5. Able to swallow capsules with water
  6. Upright Slow Vital Capacity (SVC) > 40% of predicted for age, height, and sex [See Appendix 16.6.1]
  7. Able to perform pulmonary function tests
  8. Pre-study clinical laboratory findings (including troponin I [TnI] and creatine phosphokinase [CPK]) within normal range, or, if outside of the normal range, deemed not clinically significant by the Investigator
  9. For female patients only: The patient is post-menopausal (≥ 1 year) or sterilized, or if she is of childbearing potential, she is not breastfeeding, her pregnancy test is negative, she has no intention to become pregnant during the course of the study, and she is using contraceptive drugs or devices for the duration of the study and for 10 weeks after the end of the study.

For male patients only: Male patients agree for the duration of the study and 10 weeks after the end of the study to use a condom during sexual intercourse with female partners who are of reproductive potential and to have female partners use an additional effective means of contraception (e.g., diaphragm plus spermicide or oral contraceptives) or the male patient must agree to abstain from sexual intercourse for 10 weeks after the end of the study.

Exclusion Criteria

Patients satisfying any of the following criteria at baseline were excluded from enrollment:

  1. Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 3 times the upper limit of normal (ULN)
  2. Life expectancy < 3 months
  3. Participation in any trial in which receipt of investigational study drug occurred within 30 days prior to dosing
  4. Any prior treatment with CK-2017357
  5. In the opinion of the Investigator, the patient is not suitable to participate in the study
Contacts and Locations
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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 ClinicalTrials.gov identifier (NCT number): NCT01089010


Locations
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United States, Arizona
Phoenix Neurological Associates, Ltd.
Phoenix, Arizona, United States, 85018
United States, California
University Neurology Associates
Fresno, California, United States, 93701
California Pacific Medical Center
San Francisco, California, United States, 94115
United States, Florida
Mayo Clinic Florida
Jacksonville, Florida, United States, 32224
United States, Kentucky
University of Kentucky
Lexington, Kentucky, United States, 40536
United States, Maryland
Johns Hopkins Hospital
Baltimore, Maryland, United States, 21287
United States, Massachusetts
Massachusetts General Hospital
Boston, Massachusetts, United States, 02114
United States, Missouri
Washington University
Saint Louis, Missouri, United States, 63110
United States, New York
SUNY Upstate Medical Center
Syracuse, New York, United States, 13210
United States, North Carolina
Duke University
Durham, North Carolina, United States, 27705
United States, Oregon
Providence ALS Center
Portland, Oregon, United States, 97213
United States, Pennsylvania
Drexel University College of Medicine, Dept of Neurology
Philadelphia, Pennsylvania, United States, 19102
Penn State
University Park, Pennsylvania, United States, 17033
United States, Texas
The University of Texas Health Science Center at San Antonio
San Antonio, Texas, United States, 78229
United States, Vermont
University of Vermont
Burlington, Vermont, United States, 05401
Sponsors and Collaborators
Cytokinetics
Investigators
Layout table for investigator information
Study Chair: Jeremy M Shefner, MD, PhD State University of New York - Upstate Medical University
More Information
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Additional Information:

Publications of Results:

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Responsible Party: Cytokinetics
ClinicalTrials.gov Identifier: NCT01089010    
Other Study ID Numbers: CY 4021
First Posted: March 18, 2010    Key Record Dates
Last Update Posted: May 10, 2019
Last Verified: May 2019
Additional relevant MeSH terms:
Layout table for MeSH terms
Motor Neuron Disease
Amyotrophic Lateral Sclerosis
Sclerosis
Pathologic Processes
Neurodegenerative Diseases
Nervous System Diseases
 Neuromuscular Diseases
Spinal Cord Diseases
Central Nervous System Diseases
TDP-43 Proteinopathies
Proteostasis Deficiencies
Metabolic Diseases