Clinical Trials Register

Summary
EudraCT Number:	2012-002099-15
Sponsor's Protocol Code Number:	APOCT-001
National Competent Authority:	Sweden - MPA
Clinical Trial Type:	EEA CTA
Trial Status:	Prematurely Ended
Date on which this record was first entered in the EudraCT database:	2014-08-01
Trial results

Index
A. PROTOCOL INFORMATION
B. SPONSOR INFORMATION
C. APPLICANT IDENTIFICATION
D. IMP IDENTIFICATION
D.8 INFORMATION ON PLACEBO
E. GENERAL INFORMATION ON THE TRIAL
F. POPULATION OF TRIAL SUBJECTS
G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
P. END OF TRIAL

Expand All Collapse All

A. Protocol Information

A.1

Member State Concerned

Sweden - MPA

A.2

EudraCT number

2012-002099-15

A.3

Full title of the trial

A randomised, double blind, placebo controlled trial to evaluate the safety and efficacy of Apovir for treatment of patients with Amyotrophic lateral sclerosis

A.3.1

Title of the trial for lay people, in easily understood, i.e. non-technical, language

Safety and Efficacy of Apovir for treatment of patients with ALS (Amyotrophic lateral sclerosis)

Säkerhet och effekt av Apovir vid behandling av patienter med ALS (Amyotrofisk lateralskleros)

A.4.1

Sponsor's protocol code number

APOCT-001

A.7

Trial is part of a Paediatric Investigation Plan

A.8

EMA Decision number of Paediatric Investigation Plan

B. Sponsor Information
B.Sponsor: 1
B.1.1	Name of Sponsor	Apodemus AB
B.1.3.4	Country	Sweden
B.3.1 and B.3.2	Status of the sponsor	Commercial
B.4 Source(s) of Monetary or Material Support for the clinical trial:
B.4.1	Name of organisation providing support	Apodemus AB
B.4.2	Country	Sweden
B.5 Contact point designated by the sponsor for further information on the trial
B.5.1	Name of organisation	Apodemus AB
B.5.2	Functional name of contact point	Clinical Trials Information
B.5.3	Address:
B.5.3.1	Street Address	Nobels väg 3
B.5.3.2	Town/ city	Solna
B.5.3.3	Post code	171 65
B.5.3.4	Country	Sweden
B.5.4	Telephone number	468619 7171
B.5.5	Fax number	468619 7181
B.5.6	E-mail	bo.niklasson@apodemus.se

D. IMP Identification
D.IMP: 1
D.1.2 and D.1.3	IMP Role	Test
D.2	Status of the IMP to be used in the clinical trial
D.2.1	IMP to be used in the trial has a marketing authorisation	No
D.2.5	The IMP has been designated in this indication as an orphan drug in the Community	No
D.2.5.1	Orphan drug designation number
D.3 Description of the IMP
D.3.1	Product name	Pleconaril
D.3.2	Product code	APO-P001
D.3.4	Pharmaceutical form	Capsule, hard
D.3.4.1	Specific paediatric formulation	No
D.3.7	Routes of administration for this IMP	Oral use
D.3.8 to D.3.10 IMP Identification Details (Active Substances)
D.3.8	INN - Proposed INN	PLECONARIL
D.3.9.1	CAS number	153168-05-9
D.3.9.2	Current sponsor code	APO-P001
D.3.9.4	EV Substance Code	SUB09957MIG
D.3.10	Strength
D.3.10.1	Concentration unit	mg milligram(s)
D.3.10.2	Concentration type	equal
D.3.10.3	Concentration number	200
D.3.11 The IMP contains an:
D.3.11.1	Active substance of chemical origin	Yes
D.3.11.2	Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP)	No
	The IMP is a:
D.3.11.3	Advanced Therapy IMP (ATIMP)	No
D.3.11.3.1	Somatic cell therapy medicinal product	No
D.3.11.3.2	Gene therapy medical product	No
D.3.11.3.3	Tissue Engineered Product	No
D.3.11.3.4	Combination ATIMP (i.e. one involving a medical device)	No
D.3.11.3.5	Committee on Advanced therapies (CAT) has issued a classification for this product	No
D.3.11.4	Combination product that includes a device, but does not involve an Advanced Therapy	No
D.3.11.5	Radiopharmaceutical medicinal product	No
D.3.11.6	Immunological medicinal product (such as vaccine, allergen, immune serum)	No
D.3.11.7	Plasma derived medicinal product	No
D.3.11.8	Extractive medicinal product	No
D.3.11.9	Recombinant medicinal product	No
D.3.11.10	Medicinal product containing genetically modified organisms	No
D.3.11.11	Herbal medicinal product	No
D.3.11.12	Homeopathic medicinal product	No
D.3.11.13	Another type of medicinal product	No
D.IMP: 2
D.1.2 and D.1.3	IMP Role	Test
D.2	Status of the IMP to be used in the clinical trial
D.2.1	IMP to be used in the trial has a marketing authorisation	Yes
D.2.1.1.1	Trade name	Copegus
D.2.1.1.2	Name of the Marketing Authorisation holder	Roche
D.2.1.2	Country which granted the Marketing Authorisation	Sweden
D.2.5	The IMP has been designated in this indication as an orphan drug in the Community	No
D.2.5.1	Orphan drug designation number
D.3 Description of the IMP
D.3.1	Product name	Ribavirin
D.3.4	Pharmaceutical form	Capsule, hard
D.3.4.1	Specific paediatric formulation	No
D.3.7	Routes of administration for this IMP	Oral use
D.3.8 to D.3.10 IMP Identification Details (Active Substances)
D.3.9.1	CAS number	36791-04-5
D.3.9.3	Other descriptive name	RIBAVIRIN
D.3.9.4	EV Substance Code	SUB10297MIG
D.3.10	Strength
D.3.10.1	Concentration unit	mg milligram(s)
D.3.10.2	Concentration type	equal
D.3.10.3	Concentration number	200
D.3.11 The IMP contains an:
D.3.11.1	Active substance of chemical origin	Yes
D.3.11.2	Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP)	No
	The IMP is a:
D.3.11.3	Advanced Therapy IMP (ATIMP)	No
D.3.11.3.1	Somatic cell therapy medicinal product	No
D.3.11.3.2	Gene therapy medical product	No
D.3.11.3.3	Tissue Engineered Product	No
D.3.11.3.4	Combination ATIMP (i.e. one involving a medical device)	No
D.3.11.3.5	Committee on Advanced therapies (CAT) has issued a classification for this product	No
D.3.11.4	Combination product that includes a device, but does not involve an Advanced Therapy	No
D.3.11.5	Radiopharmaceutical medicinal product	No
D.3.11.6	Immunological medicinal product (such as vaccine, allergen, immune serum)	No
D.3.11.7	Plasma derived medicinal product	No
D.3.11.8	Extractive medicinal product	No
D.3.11.9	Recombinant medicinal product	No
D.3.11.10	Medicinal product containing genetically modified organisms	No
D.3.11.11	Herbal medicinal product	No
D.3.11.12	Homeopathic medicinal product	No
D.3.11.13	Another type of medicinal product	No

D.8 Information on Placebo
D.8 Placebo: 1
D.8.1	Is a Placebo used in this Trial?	Yes
D.8.3	Pharmaceutical form of the placebo	Capsule, hard
D.8.4	Route of administration of the placebo	Oral use
D.8 Placebo: 2
D.8.1	Is a Placebo used in this Trial?	Yes
D.8.3	Pharmaceutical form of the placebo	Capsule, hard
D.8.4	Route of administration of the placebo	Oral use

E. General Information on the Trial

E.1 Medical condition or disease under investigation

E.1.1

Medical condition(s) being investigated

Amyotrophic Lateral Sclerosis (ALS)

Amyotrofisk lateralskleros (ALS)

E.1.1.1

Medical condition in easily understood language

A progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord further affecting motor neurons. Motor neurons die leading to loss of muscle control and function.

En progressiv neurodegenerativ sjukdom som påverkar nervceller i hjärna och ryggmärg som vidare påverkar motorneuron. Motorneuronen dör vilket leder till förlust av muskelkontroll och muskelfunktion.

E.1.1.2

Therapeutic area

Diseases [C] - Nervous System Diseases [C10]

MedDRA Classification

E.1.2 Medical condition or disease under investigation

E.1.2	Version	17.0
E.1.2	Level	PT
E.1.2	Classification code	10002026
E.1.2	Term	Amyotrophic lateral sclerosis
E.1.2	System Organ Class	10029205 - Nervous system disorders

E.1.3

Condition being studied is a rare disease

Yes

E.2 Objective of the trial

E.2.1

Main objective of the trial

SAFETY OBJECTIVE
To investigate the safety and tolerability of the combination therapy of Apovir in patients with ALS

PRIMARY EFFICACY OBJECTIVE
To investigate the effect of Apovir on 12-months disease progression of ALS as assessed by ALSFRS-R score from baseline compared to placebo

E.2.2

Secondary objectives of the trial

SECONDARY EFFICACY OBJECTIVES
To investigate the effect of Apovir on disease progression of ALS assessed by ALSFRS-R score at the 4-weeks, 3-, 6-, 9-months, and Follow-up visits, and forced vital capacity (FVC), vital capacity (VC) and maximal voluntary ventilation (MVV) at the 4-weeks, 3-, 6-, 9-, 12-months, and Follow-up visits

To investigate the combined effect of Apovir on ALSFRS-R, and death or the use of definitive life supporting breathing assistance and death as assessed by Combined assessment of function and survival (CAFS) at the 4-weeks, 3-, 6-, 9-, 12-months, and follow-up visits

To investigate the effect of Apovir on time from onset of ALS symptoms to the use of definitive life supporting breathing assistance, or Death

To investigate the plasma concentrations of Apovir in patients with ALS

Refer to the protocol for further secondary objectives.

E.2.3

Trial contains a sub-study

E.3

Principal inclusion criteria

1. Male or female study subjects fulfilling the probable or higher criteria for ALS according to the revised El-Escorial criteria
2. First documented symptom of ALS ≤ 24 months before screening
3. The sum of the 3 respiratory items on the ALSFRS-R, 10: dyspnoea, 11: orthopnoea and 12: respiratory insufficiency, must total at least 10 points
4. Ability to walk without other walking aids than a crutch
5. 18 – 80 years at the time of screening
6. FEV% ≥70%
7. Study subjects with or without pharmacological treatment, i.e. Riluzole for ALS (study subjects with ongoing pharmacological treatment for ALS shall have received unchanged treatment as regards drug(s) and dose(s) for at least 1 month)

E.4

Principal exclusion criteria

1. Women in fertile age with a positive pregnancy blood test, or planning to become pregnant during the period of the trial. Fertile women include any female who has experienced menarche, who has not undergone tubal ligation, and who is not postmenopausal. Postmenopausal is defined as amenorrhea ≥ 12 consecutive months without another cause
2. Sexually active men and women without highly effective contraceptive treatment, e.g. sterilisation, condoms and diaphragms with spermicide; oral contraceptives (including Progesterone-only pills in high dose) in combination with a barrier method; hormonal contraceptives alone are not sufficient
3. Active hepatitis B, active hepatitis C, or HIV infection
4. Serious cardiac disease including unstable or uncontrolled cardiac disease during the last 6 months and/or a previous history or present clinical signs of deep venous thrombosis
5. Major surgical procedure within 4 weeks prior to start of treatment
6. Participation in any other clinical trial within 30 days of inclusion (randomisation) in the trial or patients with unresolved investigational treatment-related adverse events
7. Other chronic disease or previous organ transplantation judged by the Investigator to interfere with the assessment of treatment success and/or ability to fully participate in the trial
8. Impaired kidney function with an absolute GFR calculated from cystatin C <60 mL/min
9. Known blood disease or Anaemia Haemoglobin <120 g/L for women and <130 g/L for men
10. Known haemoglobinopathy (e.g. thalassemia and sickle cell anaemia)
11. Patients that require immunosuppressive treatments including azathioprine, cyclosporine, systemic steroid treatment (e.g. prednisolone at doses of ≥10 mg/day or hydrocortisone) or has received such treatment within the last 6 months prior to randomization
12. Patients that are treated with drugs that can interact significantly with APO-P001; ethinylestradiol and/or ribavirin; azathioprine, didanosine, zidovudine, mercaptopurine, stavudine
13. Lack of suitability for participation in the trial, for any reason, as judged by the Investigator
14. Patients with clinical or other signs of frontal temporal lobe dementia (FTLD) or known heredity for FTLD

E.5 End points

E.5.1

Primary end point(s)

Primary Safety Endpoint
• Frequency and intensity of adverse events

Primary efficacy Endpoints
• Change in ALSFRS-R from baseline to 12 months using mean change of slope

E.5.1.1

Timepoint(s) of evaluation of this end point

Primary Safety Endpoint
Evaluations will be analysed throughout the whole CT.

Primary efficacy Endpoints
12 months

E.5.2

Secondary end point(s)

Change in disease progression of ALS as assessed by:
• Change in ALSFRS-R score from baseline to the 4-weeks, 3-, 6-, 9-, 12-months, and Follow-up visits
• Change in FVC, VC and MVV from baseline to the 4-weeks, 3-, 6-, 9-, 12-months, and Follow-up visits
• Change in CAFS from baseline to the 4-weeks, 3-, 6-, 9-, 12-months, and Follow-up visits
• Time from study inclusion and time of ALS symptoms onset to the use of definitive life supporting breathing assistance, or Death

Plasma concentrations of Apovir:
• Plasma concentrations Cpre dose of Apovir at the 4-weeks, 3-, 6-, and 12-months visits. Concentrations at 3 months will be compared to published data [Rhodes and Liu 2001 ; Khakoo et al 1998 ].

E.5.2.1

Timepoint(s) of evaluation of this end point

Refer to section 5.2

E.6 and E.7 Scope of the trial

E.6

Scope of the trial

E.6.1

Diagnosis

E.6.2

Prophylaxis

E.6.3

Therapy

Yes

E.6.4

Safety

Yes

E.6.5

Efficacy

Yes

E.6.6

Pharmacokinetic

E.6.7

Pharmacodynamic

Yes

E.6.8

Bioequivalence

E.6.9

Dose response

E.6.10

Pharmacogenetic

E.6.11

Pharmacogenomic

E.6.12

Pharmacoeconomic

E.6.13

Others

E.7

Trial type and phase

E.7.1

Human pharmacology (Phase I)

E.7.1.1

First administration to humans

E.7.1.2

Bioequivalence study

E.7.1.3

Other

E.7.1.3.1

Other trial type description

E.7.2

Therapeutic exploratory (Phase II)

Yes

E.7.3

Therapeutic confirmatory (Phase III)

E.7.4

Therapeutic use (Phase IV)

E.8 Design of the trial

E.8.1

Controlled

Yes

E.8.1.1

Randomised

Yes

E.8.1.2

Open

E.8.1.3

Single blind

E.8.1.4

Double blind

Yes

E.8.1.5

Parallel group

Yes

E.8.1.6

Cross over

E.8.1.7

Other

Yes

E.8.1.7.1

Other trial design description

The randomisation will be stratified by presence/absence of treatment with Riluzole at baseline.

E.8.2

Comparator of controlled trial

E.8.2.1

Other medicinal product(s)

E.8.2.2

Placebo

Yes

E.8.2.3

Other

E.8.2.4

Number of treatment arms in the trial

E.8.3

The trial involves single site in the Member State concerned

Yes

E.8.4

The trial involves multiple sites in the Member State concerned

E.8.5

The trial involves multiple Member States

E.8.6 Trial involving sites outside the EEA

E.8.6.1

Trial being conducted both within and outside the EEA

E.8.6.2

Trial being conducted completely outside of the EEA

E.8.7

Trial has a data monitoring committee

Yes

E.8.8

Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial

LVLS

E.8.9 Initial estimate of the duration of the trial

E.8.9.1

In the Member State concerned years

E.8.9.1

In the Member State concerned months

E.8.9.1

In the Member State concerned days

F. Population of Trial Subjects

F.1 Age Range

F.1.1

Trial has subjects under 18

F.1.1.1

In Utero

F.1.1.2

Preterm newborn infants (up to gestational age < 37 weeks)

F.1.1.3

Newborns (0-27 days)

F.1.1.4

Infants and toddlers (28 days-23 months)

F.1.1.5

Children (2-11years)

F.1.1.6

Adolescents (12-17 years)

F.1.2

Adults (18-64 years)

Yes

F.1.2.1

Number of subjects for this age range:

F.1.3

Elderly (>=65 years)

Yes

F.1.3.1

Number of subjects for this age range:

F.2 Gender

F.2.1

Female

Yes

F.2.2

Male

Yes

F.3 Group of trial subjects

F.3.1

Healthy volunteers

F.3.2

Patients

Yes

F.3.3

Specific vulnerable populations

Yes

F.3.3.1

Women of childbearing potential not using contraception

F.3.3.2

Women of child-bearing potential using contraception

Yes

F.3.3.3

Pregnant women

F.3.3.4

Nursing women

F.3.3.5

Emergency situation

F.3.3.6

Subjects incapable of giving consent personally

F.3.3.7

Others

F.4 Planned number of subjects to be included

F.4.1

In the member state

F.5

Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)

Continuation of treatment will not be offered.

G. Investigator Networks to be involved in the Trial

N. Review by the Competent Authority or Ethics Committee in the country concerned

Competent Authority Decision

Authorised

Date of Competent Authority Decision

2014-09-15

Ethics Committee Opinion of the trial application

Favourable

Ethics Committee Opinion: Reason(s) for unfavourable opinion

Date of Ethics Committee Opinion

2014-08-06

P. End of Trial
P.	End of Trial Status	Prematurely Ended

Select Country:	Select Age Range:
Select Trial Status:	Select Trial Phase:
Select Gender:
Select Date Range: to
Select Rare Disease:
IMP with orphan designation in the indication
Orphan Designation Number:
Results Status:
Clear advanced search filters

Austria
Belgium
Bulgaria
Croatia
Cyprus
Czechia
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Iceland
Ireland
Italy
Latvia
Liechtenstein
Lithuania
Luxembourg
Malta
Netherlands
Norway
Poland
Portugal
Romania
Slovakia
Slovenia
Spain
Sweden
United Kingdom
Outside EU/EEA

Clinical trials