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    Clinical Trial Results:
    A Phase II pilot safety and tolerability study of ILB in patients with Motor Neurone Disease (MND)/Amyotrophic Lateral Sclerosis (ALS)

    Summary
    EudraCT number
    2018-000668-28
    Trial protocol
    GB  
    Global end of trial date
    28 Jul 2021

    Results information
    Results version number
    v1(current)
    This version publication date
    29 Mar 2025
    First version publication date
    29 Mar 2025
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    RG_17-250
    Additional study identifiers
    ISRCTN number
    ISRCTN83738603
    US NCT number
    NCT03705390
    WHO universal trial number (UTN)
    -
    Other trial identifiers
    Sponsor number: RG_17-250
    Sponsors
    Sponsor organisation name
    University of Birmingham
    Sponsor organisation address
    Mindelsohn Way, Birmingham, United Kingdom,
    Public contact
    Mr Darren Barton, University of Birmingham, D3B Team, Cancer Research UK Clinical Trials Unit, ALS@trials.bham.ac.uk
    Scientific contact
    Mr Darren Barton, University of Birmingham, D3B Team, Cancer Research UK Clinical Trials Unit, ALS@trials.bham.ac.uk
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    28 Jul 2021
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    28 Jul 2021
    Global end of trial reached?
    Yes
    Global end of trial date
    28 Jul 2021
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    The Primary Objective is: To determine the safety and acceptability of ILB in ALS patients
    Protection of trial subjects
    The trial was designed with input from the clinical and pre-clinical teams from the University of Birmingham and The Queen Elizabeth Hospital to allow quick and effective achievement of the clinical trial objectives to minimise the burden on patients
    Background therapy
    None
    Evidence for comparator
    Not applicable
    Actual start date of recruitment
    11 Mar 2019
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United Kingdom: 11
    Worldwide total number of subjects
    11
    EEA total number of subjects
    0
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    9
    From 65 to 84 years
    2
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Prior to screening- informed consent obtained and patients taking Riluzole had to discontinue 28 days prior to starting ILB treatment

    Pre-assignment
    Screening details
    Prior to starting treatment, patients completed a baseline screening assessment

    Period 1
    Period 1 title
    Recruited
    Is this the baseline period?
    No
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    ILB® arm
    Arm description
    -
    Arm type
    Experimental

    Investigational medicinal product name
    ILB®
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Subcutaneous use, Solution for injection
    Dosage and administration details
    ILB® subcutaneous injection at a dose of 2mg/kg once per week for up to a maximum of 48 weeks

    Number of subjects in period 1
    ILB® arm
    Started
    11
    Completed
    11
    Period 2
    Period 2 title
    Treated patients
    Is this the baseline period?
    Yes [1]
    Allocation method
    Not applicable
    Blinding used
    Not blinded
    Blinding implementation details
    Number of patients who underwent treatment

    Arms
    Arm title
    ILB Treatment
    Arm description
    -
    Arm type
    Experimental

    Investigational medicinal product name
    ILB®
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Subcutaneous use, Solution for injection
    Dosage and administration details
    ILB® subcutaneous injection at a dose of 2mg/kg once per week for up to a maximum of 48 weeks

    Notes
    [1] - Period 1 is not the baseline period. It is expected that period 1 will be the baseline period.
    Justification: Period 1 is the recruitment period, whereas period 2 describes the analysis population
    Number of subjects in period 2
    ILB Treatment
    Started
    11
    Completed
    9
    Not completed
    2
         Trial suspended for COVID-19
    2

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    ILB Treatment
    Reporting group description
    -

    Reporting group values
    ILB Treatment Total
    Number of subjects
    11 11
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    9 9
        From 65-84 years
    2 2
        85 years and over
    0 0
    Age continuous
    Units: years
        median (inter-quartile range (Q1-Q3))
    57 (53 to 62) -
    Gender categorical
    Units: Subjects
        Female
    4 4
        Male
    7 7
    Family history of Motor Neurone Disease
    Units: Subjects
        No
    10 10
        Yes
    1 1
    Family history of fronto-temporal dementia
    Units: Subjects
        No
    11 11
        Yes
    0 0
    Time from ALS diagnosis to trial entry
    Units: months
        median (inter-quartile range (Q1-Q3))
    4.69 (3.58 to 11.63) -

    End points

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    End points reporting groups
    Reporting group title
    ILB® arm
    Reporting group description
    -
    Reporting group title
    ILB Treatment
    Reporting group description
    -

    Primary: Safety Assessed by SAEs - Measured by Incidence

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    End point title
    Safety Assessed by SAEs - Measured by Incidence [1]
    End point description
    Measured by the incidence of serious adverse events (SAEs) and adverse events (AEs) using CTCAE grading v4.0
    End point type
    Primary
    End point timeframe
    From informed consent up to 30 days after last administration of trial treatment
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Trial is single arm in nature, therefore all analysis is descriptive
    End point values
    ILB Treatment
    Number of subjects analysed
    11
    Units: number of SAEs
    1
    No statistical analyses for this end point

    Primary: Safety Assessed by AEs - Measured by Incidence

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    End point title
    Safety Assessed by AEs - Measured by Incidence [2]
    End point description
    Measured by the incidence of adverse events (AEs) using CTCAE grading v4.0.
    End point type
    Primary
    End point timeframe
    From informed consent up to 30 days after last administration of trial treatment
    Notes
    [2] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Trial is single arm in nature, therefore all analysis is descriptive
    End point values
    ILB Treatment
    Number of subjects analysed
    11
    Units: number of AEs
    270
    No statistical analyses for this end point

    Primary: Safety Assessed by AEs - Measured by Grade

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    End point title
    Safety Assessed by AEs - Measured by Grade [3]
    End point description
    Measured by the incidence of adverse events (AEs) using CTCAE grading v4.0.
    End point type
    Primary
    End point timeframe
    From informed consent up to 30 days after last administration of trial treatment
    Notes
    [3] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Trial is single arm in nature, therefore all analysis is descriptive
    End point values
    ILB Treatment
    Number of subjects analysed
    11
    Units: number of AEs
        Grade 1
    265
        Grade 2
    4
        Grade 3
    1
        Grade 4
    0
        Grade 5
    0
    No statistical analyses for this end point

    Primary: Safety Assessed by AEs - Summarised by Causality

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    End point title
    Safety Assessed by AEs - Summarised by Causality [4]
    End point description
    Relatedness categories: 1 = unrelated, 2 = unlikely to be related, 3 = possibly related, 4 = probably related, 5 = definitely related
    End point type
    Primary
    End point timeframe
    From informed consent up to 30 days after last administration of trial treatment
    Notes
    [4] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Trial is single arm in nature, therefore all analysis is descriptive
    End point values
    ILB Treatment
    Number of subjects analysed
    11
    Units: number of AEs
        Unrelated
    127
        Unlikely to be related
    45
        Possibly related
    4
        Probably related
    1
        Definitely related
    93
    No statistical analyses for this end point

    Primary: Safety Assessed by SAEs - Summarised by Admitting Event Grade

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    End point title
    Safety Assessed by SAEs - Summarised by Admitting Event Grade [5]
    End point description
    Grade refers to the severity of the admitting event as follows: Grade 1 - Mild; asymptomatic or mild symptoms; clinical or diagnostic observations only; intervention not indicated. Grade 2 - Moderate; minimal, local or non-invasive intervention indicated; limiting age-appropriate instrumental activities of daily living. Grade 3 - Severe or medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self care activities of daily living. Grade 4 - Life-threatening consequences; urgent intervention indicated. Grade 5 - Death related to AE.
    End point type
    Primary
    End point timeframe
    From informed consent up to 30 days after last administration of trial treatment
    Notes
    [5] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Trial is single arm in nature, therefore all analysis is descriptive
    End point values
    ILB Treatment
    Number of subjects analysed
    11
    Units: number of AEs
        Grade 1
    0
        Grade 2
    0
        Grade 3
    1
        Grade 4
    0
        Grade 5
    0
    No statistical analyses for this end point

    Primary: Safety Assessed by SAEs - Summarised by Admitting Event Relatedness

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    End point title
    Safety Assessed by SAEs - Summarised by Admitting Event Relatedness [6]
    End point description
    Relatedness categories: 1 = unrelated, 2 = unlikely to be related, 3 = possibly related, 4 = probably related, 5 = definitely related
    End point type
    Primary
    End point timeframe
    From informed consent up to 30 days after last administration of trial treatment
    Notes
    [6] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Trial is single arm in nature, therefore all analysis is descriptive
    End point values
    ILB Treatment
    Number of subjects analysed
    11
    Units: number of SAEs
        Unrelated
    1
        Unlikely to be related
    0
        Possibly related
    0
        Probably related
    0
        Definitely related
    0
    No statistical analyses for this end point

    Primary: Safety Assessed by SAEs - Summarised by Admitting Event Type

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    End point title
    Safety Assessed by SAEs - Summarised by Admitting Event Type [7]
    End point description
    From informed consent up to 30 days after last administration of trial treatment
    End point type
    Primary
    End point timeframe
    Description of the event type at admission
    Notes
    [7] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Trial is single arm in nature, therefore all analysis is descriptive
    End point values
    ILB Treatment
    Number of subjects analysed
    11
    Units: number of SAEs
        Generalised muscle weakness
    1
        Other admitting event types
    0
    No statistical analyses for this end point

    Primary: Safety Assessed by SAEs - Summarised by Sequelae

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    End point title
    Safety Assessed by SAEs - Summarised by Sequelae [8]
    End point description
    Outcome of serious adverse events only: Resolved with sequelae or Resolved without sequelae
    End point type
    Primary
    End point timeframe
    From informed consent up to 30 days after last administration of trial treatment
    Notes
    [8] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Trial is single arm in nature, therefore all analysis is descriptive
    End point values
    ILB Treatment
    Number of subjects analysed
    11
    Units: number of SAEs
        Resolved with Sequelae
    0
        Resolved without Sequelae
    1
    No statistical analyses for this end point

    Primary: Tolerability Assessed by the Incidence of Intolerable Adverse Events

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    End point title
    Tolerability Assessed by the Incidence of Intolerable Adverse Events [9]
    End point description
    An intolerable adverse event will satisfy all of the following criteria: 1. Associated with a serious adverse event or a drug discontinuation of greater than three weeks; 2. Grade 3, 4 or 5 in severity according to CTCAE version 4; 3. In the opinion of the Investigator is i) definitely related or ii) probably related or iii) possibly related to the study drug treatment. Adverse events which are considered unrelated or probably not related will not be classed as intolerable events
    End point type
    Primary
    End point timeframe
    From informed consent up to 30 days after last administration of trial treatment
    Notes
    [9] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Trial is single arm in nature, therefore all analysis is descriptive
    End point values
    ILB Treatment
    Number of subjects analysed
    11
    Units: number of intolerable adverse events
    0
    No statistical analyses for this end point

    Primary: Quantity of Study Drug Administered - Total Drug Administered

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    End point title
    Quantity of Study Drug Administered - Total Drug Administered [10]
    End point description
    Total drug administered over the study period (measured in milligrams)
    End point type
    Primary
    End point timeframe
    From baseline to final treatment visit
    Notes
    [10] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Trial is single arm in nature, therefore all analysis is descriptive
    End point values
    ILB Treatment
    Number of subjects analysed
    11
    Units: mg
        median (inter-quartile range (Q1-Q3))
    4200 (1902 to 5754)
    No statistical analyses for this end point

    Primary: Quantity of Study Drug Administered - Number of Administrations

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    End point title
    Quantity of Study Drug Administered - Number of Administrations [11]
    End point description
    Numerical count of the number of study drug injections given whilst on the trial
    End point type
    Primary
    End point timeframe
    From baseline to final treatment visit
    Notes
    [11] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Trial is single arm in nature, therefore all analysis is descriptive
    End point values
    ILB Treatment
    Number of subjects analysed
    11
    Units: number of drug administrations
        median (inter-quartile range (Q1-Q3))
    24 (14 to 35)
    No statistical analyses for this end point

    Primary: Quantity of Study Drug Administered - Number of Interruptions

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    End point title
    Quantity of Study Drug Administered - Number of Interruptions [12]
    End point description
    Numerical count of the number of study drug injections missed whilst on the trial
    End point type
    Primary
    End point timeframe
    From baseline to final treatment visit
    Notes
    [12] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Trial is single arm in nature, therefore all analysis is descriptive
    End point values
    ILB Treatment
    Number of subjects analysed
    11
    Units: number of interruptions
        median (inter-quartile range (Q1-Q3))
    1.0 (0 to 3)
    No statistical analyses for this end point

    Primary: Quantity of Study Drug Administered - Duration of Interruptions

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    End point title
    Quantity of Study Drug Administered - Duration of Interruptions [13]
    End point description
    Length of interruptions in weeks between study drug injections for those participants that experienced a treatment interruption whilst on the trial
    End point type
    Primary
    End point timeframe
    From baseline to final treatment visit
    Notes
    [13] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Trial is single arm in nature, therefore all analysis is descriptive
    End point values
    ILB Treatment
    Number of subjects analysed
    11
    Units: weeks
        median (inter-quartile range (Q1-Q3))
    1.5 (1 to 2)
    No statistical analyses for this end point

    Primary: Quantity of Study Drug Administered - Number of Discontinuations

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    End point title
    Quantity of Study Drug Administered - Number of Discontinuations [14]
    End point description
    numerical count of patients who discontinued study drug treatment
    End point type
    Primary
    End point timeframe
    From baseline to final treatment visit
    Notes
    [14] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Trial is single arm in nature, therefore all analysis is descriptive
    End point values
    ILB Treatment
    Number of subjects analysed
    11
    Units: number of treatment discontinuations
        number (not applicable)
    0
    No statistical analyses for this end point

    Secondary: Revised Amyotrophic Lateral Sclerosis Functional Rating Scale Revised (ALSFRS-R) Change

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    End point title
    Revised Amyotrophic Lateral Sclerosis Functional Rating Scale Revised (ALSFRS-R) Change
    End point description
    A functional rating scale including assessments of communication, mobility, feeding, dressing and respiration. The total score range is 0 - 40; with 0 being the best outcome and 40 being the worst. Change from baseline to final treatment visit
    End point type
    Secondary
    End point timeframe
    From baseline to final treatment visit
    End point values
    ILB Treatment
    Number of subjects analysed
    11
    Units: Change in ALSFRS-R score from baseline
        median (inter-quartile range (Q1-Q3))
    2.0 (0.5 to 3.0)
    No statistical analyses for this end point

    Secondary: Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ-40) Score Change

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    End point title
    Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ-40) Score Change
    End point description
    This patient-reported outcome measures the subjective well-being of patients. There are 5 scales which are calculated and scored: physical mobility, independence, eating and drinking, communication, emotional functioning. For ALSAQ-40, an improved condition is represented by a decreasing sub-scale score. The scales are as follows: 0 - 19: Never or very rarely experience problems 20 - 19: Rarely experience problems 40 - 59: Sometimes experience problems 60 - 79: Often experience 80 - 100: Problems (nearly) always or unable to do at all
    End point type
    Secondary
    End point timeframe
    From baseline to final treatment visit
    End point values
    ILB Treatment
    Number of subjects analysed
    11
    Units: change in ALSAQ-40 score from baseline
    median (inter-quartile range (Q1-Q3))
        Physical mobility
    -5.0 (-15.0 to -3.8)
        Activities of daily living
    -2.5 (-17.5 to 2.5)
        Eating and drinking
    0 (-12.5 to 0)
        Communication
    0 (-8.9 to 0)
        Emotional functioning
    -7.5 (-18.5 to -5.0)
        Summary index score
    -6.2 (-15.0 to -1.9)
    No statistical analyses for this end point

    Secondary: Urinary p75ECD Change

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    End point title
    Urinary p75ECD Change
    End point description
    Urinary p75 extracellular domain (p75ECD) is a biological fluid-based biomarker of ALS disease progression
    End point type
    Secondary
    End point timeframe
    From baseline to final treatment visit
    End point values
    ILB Treatment
    Number of subjects analysed
    11
    Units: ng/mmol creatinine
        median (inter-quartile range (Q1-Q3))
    -0.62 (-0.98 to 0.22)
    No statistical analyses for this end point

    Secondary: Pharmacokinetics (PK; Amount of Detectable Drug) of ILB® in Plasma Following Administration

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    End point title
    Pharmacokinetics (PK; Amount of Detectable Drug) of ILB® in Plasma Following Administration
    End point description
    This outcome measure quantifies the amount of drug detectable in the blood after administration over time
    End point type
    Secondary
    End point timeframe
    0.5 to 6 hours after ILB® administration
    End point values
    ILB Treatment
    Number of subjects analysed
    6 [15]
    Units: μg/mL
    arithmetic mean (standard deviation)
        0.5 hours
    3.73 ( 1.41 )
        1 hour
    4.86 ( 1.18 )
        2 hours
    5.56 ( 1.45 )
        2.5 hours
    5.66 ( 1.5 )
        3.0 hours
    5.4 ( 1.03 )
        4.0 hours
    4.76 ( 1.17 )
        6.0 hours
    3.72 ( 0.76 )
    Notes
    [15] - Not all patient samples were of sufficient quality for reporting
    No statistical analyses for this end point

    Secondary: Pharmacokinetics (PK; Tmax) Statistics of ILB® in Plasma Following Administration

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    End point title
    Pharmacokinetics (PK; Tmax) Statistics of ILB® in Plasma Following Administration
    End point description
    Tmax (the time the peak concentration occurred) was calculated to characterise the kinetic profile of ILB® in plasma post-administration
    End point type
    Secondary
    End point timeframe
    0.5 hours to 6 hours after ILB® administration
    End point values
    ILB Treatment
    Number of subjects analysed
    6 [16]
    Units: hours
        arithmetic mean (standard deviation)
    2.42 ( 0.38 )
    Notes
    [16] - Not all patient samples were of sufficient quality for reporting
    No statistical analyses for this end point

    Secondary: Pharmacokinetics (PK; Cmax) Statistics of ILB® in Plasma Following Administration

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    End point title
    Pharmacokinetics (PK; Cmax) Statistics of ILB® in Plasma Following Administration
    End point description
    Cmax (peak concentration of ILB® in plasma post-administration) was calculated to characterise the kinetic profile of ILB® in plasma post-administration
    End point type
    Secondary
    End point timeframe
    0.5 hours to 6 hours after ILB® administration
    End point values
    ILB Treatment
    Number of subjects analysed
    6 [17]
    Units: μg/mL
        arithmetic mean (standard deviation)
    6.03 ( 1.16 )
    Notes
    [17] - Not all patient samples were of sufficient quality for reporting
    No statistical analyses for this end point

    Secondary: Pharmacokinetics (PK; AUC0-last) Statistics of ILB® in Plasma Following Administration

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    End point title
    Pharmacokinetics (PK; AUC0-last) Statistics of ILB® in Plasma Following Administration
    End point description
    AUC0−last (area under the curve time 0 (time of administration) to the last value above the limit of quantification) was calculated to characterise the kinetic profile of ILB® in plasma post-administration
    End point type
    Secondary
    End point timeframe
    0.5 hours to 6 hours after ILB® administration
    End point values
    ILB Treatment
    Number of subjects analysed
    6 [18]
    Units: μg*h/mL
        arithmetic mean (standard deviation)
    27.18 ( 5.62 )
    Notes
    [18] - Not all patient samples were of sufficient quality for reporting
    No statistical analyses for this end point

    Secondary: Pharmacokinetics (PK; t1/2) Statistics of ILB® in Plasma Following Administration

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    End point title
    Pharmacokinetics (PK; t1/2) Statistics of ILB® in Plasma Following Administration
    End point description
    t1/2 (terminal half-life of ILB® in plasma post-administration) was calculated to characterise the kinetic profile of ILB® in plasma post-administration
    End point type
    Secondary
    End point timeframe
    0.5 hours to 6 hours after ILB® administration
    End point values
    ILB Treatment
    Number of subjects analysed
    3 [19]
    Units: hours
        arithmetic mean (standard deviation)
    3.74 ( 1.63 )
    Notes
    [19] - Not all patient samples were of sufficient quality for reporting
    No statistical analyses for this end point

    Secondary: NfL in Plasma Change

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    End point title
    NfL in Plasma Change
    End point description
    Plasma neurofilament light chain (NfL) is a blood-based biomarker for neurodegeneration
    End point type
    Secondary
    End point timeframe
    from baseline to final treatment visit
    End point values
    ILB Treatment
    Number of subjects analysed
    11
    Units: ng/L
        median (inter-quartile range (Q1-Q3))
    1.5 (-3.0 to 4.5)
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Details of all Adverse Events (AEs) were documented and reported from the signing of the informed consent and included the collection of all baseline AEs. AE collection continued until 30 days after the end of treatment visit.
    Adverse event reporting additional description
    All AEs, either observed by the Investigator or reported by the subject, were recorded by the Investigator (on an adverse event form) and evaluated. AEs were reviewed using the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    CTCAE
    Dictionary version
    4
    Reporting groups
    Reporting group title
    ILB® arm
    Reporting group description
    -

    Serious adverse events
    ILB® arm
    Total subjects affected by serious adverse events
         subjects affected / exposed
    1 / 11 (9.09%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    0
    Musculoskeletal and connective tissue disorders
    Generalised muscle weakness
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    ILB® arm
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    11 / 11 (100.00%)
    Investigations
    Abnormal CRP blood results
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Abnormal eosinophil blood results
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Abnormal glucose levels (3.1, normal results 3.5-11.0)
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Abnormal hdl level, clinically insignificant
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Abnormal mean cell haemoglobin level, clinically insignificant
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Abnormal platelet distribution width result
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Abnormal ptt blood result (elevated)
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Abnormal redcell distribution levels
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Abnormal red cell distribution levels
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Activated partial thromboplastin time prolonged
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Alanine aminotransferase increased
         subjects affected / exposed
    2 / 11 (18.18%)
         occurrences all number
    3
    Alkaline phosphatase increased
         subjects affected / exposed
    2 / 11 (18.18%)
         occurrences all number
    2
    Aspartate aminotransferase increased
         subjects affected / exposed
    3 / 11 (27.27%)
         occurrences all number
    6
    Blood bilirubin increased
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    4
    CRP increased
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Cholesterol high
         subjects affected / exposed
    5 / 11 (45.45%)
         occurrences all number
    8
    Creatinine level decreased
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Decreased aptt result
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Decreased basophil count
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Decreased basophil level
         subjects affected / exposed
    2 / 11 (18.18%)
         occurrences all number
    2
    Decreased basophil results
         subjects affected / exposed
    4 / 11 (36.36%)
         occurrences all number
    4
    Decreased creatinine
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Decreased creatinine levels
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    2
    Decreased creatinine result
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Decreased creatinine value - not clinically significant
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Decreased haematocrit value - not clinically significant
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Decreased haemoglobin value
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Decreased hdl cholesterol result
         subjects affected / exposed
    2 / 11 (18.18%)
         occurrences all number
    2
    Decreased hdl cholesterol value - not clinically significant
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Decreased hdl cholesterol value -not clinically significant
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Decreased hdl value - not clinically significant
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Decreased igm result
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Decreased monocyte result
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Decreased potassium level
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Decreased rbc dist width
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Decreased rbc distribution width
         subjects affected / exposed
    2 / 11 (18.18%)
         occurrences all number
    2
    Decreased red blood cell value - not clinically significant
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Decreased sodium levels
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Elevated aptt ratio
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    2
    Elevated ast blood level
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Elevated c- reactive protein blood results
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Elevated calcim level
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Elevated calcium level
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Elevated ck levels
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Elevated creatine kinase result
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Elevated crp result
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Elevated crp value - not clinically significant
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Elevated eosinophil result
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Elevated haematocrit blood level
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Elevated hdl cholesterol blood levels
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Elevated mean cell haemoglobin
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Elevated mean cell hb concentration
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Elevated mean cell hb level
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Elevated mean cell hb result
         subjects affected / exposed
    2 / 11 (18.18%)
         occurrences all number
    2
    Elevated monocyte result
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Elevated red blood cell count
         subjects affected / exposed
    3 / 11 (27.27%)
         occurrences all number
    4
    Elevated sodium levels
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Elevated total protein result
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Hdl cholesterol levels high
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Hemoglobin increased
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Increased ck value - not clinically significant
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Increased crp level
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Increased eosinophils count - not clinically significant
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Increased esr value - not clinically significant
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Increased iga value - not clinically significant
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Increased monocyte count - not clinically significant
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Increased neutrophil count - not clinically significant
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    2
    Increased platelet dist width
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Increased platelet dist. width
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Increased rbc distribution width
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Increased white blood cell value - not clinically significant
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Low albumin level
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Low haematocrit
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Low sodium
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Lymphocyte count decreased
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Mean cell hb concentration level elevated
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Neutrophil count decreased
         subjects affected / exposed
    2 / 11 (18.18%)
         occurrences all number
    3
    Prolonged pr interval on ecg
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Raised ast blood levels
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    2
    Raised ast levels
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Raised blood glucose level
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Raised crp result
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Raised eosinophil count
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Raised eosinophils
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Raised hdl cholesterol blood levels
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Raised sodium level
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Raised total protein result
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Reduced aptt ratio value - not clinically significant
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Reduced free thyroxine levels
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    White blood cell decreased
         subjects affected / exposed
    3 / 11 (27.27%)
         occurrences all number
    5
    Fractured nasal bone following fall
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Reduced basophil count
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Injury, poisoning and procedural complications
    Bruising
         subjects affected / exposed
    9 / 11 (81.82%)
         occurrences all number
    92
    Bruising to right hip from fall
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Bruising to right shoulder following fall
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Bruising to the face following fall
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Fall
         subjects affected / exposed
    5 / 11 (45.45%)
         occurrences all number
    9
    Fall up the stairs leading to flat due to increasing leg weakness
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Fall while getting out of bed, due to increase in leg weakness
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Nervous system disorders
    Headache
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Blood and lymphatic system disorders
    Not clinically significant abnormal blood creatinine
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Not clinically significant creatinine kinase, 286, (normal range 30-200)
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Not clinically significant monocyte count, 0.9, (normal range 0.2 - 0.8)
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Not clinically significant raised red cell distribution, 14.8 (normal range 11-14)
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    General disorders and administration site conditions
    Chesty cough
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Cold chills down left arm
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Cramps in the chest and abdomen
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Discomfort at injection site when touched
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Patient fell faint
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Eye disorders
    'Sticky' left eye
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Gastrointestinal disorders
    Constipation
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Diarrhoea
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Rectal bleeding
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Respiratory, thoracic and mediastinal disorders
    Allergic rhinitis
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Pneumonia
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Sore throat
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Skin and subcutaneous tissue disorders
    Rash on abdomen around injection site
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Rash on both feet
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Eczema
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Increased leg weakness leading to inability to stand resulting in admission to hospital
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Muscle spasm in legs
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Occasional spasm in neck when yawning
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Painful left shoulder blade
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Right hip pain
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Infections and infestations
    Bilateral ear infection
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Chest infection
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Common cold
         subjects affected / exposed
    3 / 11 (27.27%)
         occurrences all number
    4
    Patient visited the dentist and had a filling
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    04 Apr 2019
    Section 4.0 eligibility criteria amended to update the lung function assessments inclusion criteria (inclusion criteria 4), changes to the homeostasis markers (inclusion criteria 6) and clarification to exclusion criteria 10. Amendment to schedule of assessments, section 7.3.1 Myoglobin has been removed from the biochemistry sample analysis
    26 Jun 2019
    Clinical coordinator added Time frame for primary objective removed Eligibility criteria to continue onto the treatment extension added. Trial duration amended depending on if patients continue onto treatment extension Trial Schema updated based on treatment extension Pregnancy testing to be completed at screening and prior to Day 1 treatment. Additional schedule of events added for patients who go onto the treatment extension after 10 weeks. Patient process to re-consent to treatment extension ‘Maximum of 2 weeks without treatment’ removed. This is reviewed at clinicians discretion.
    16 Jan 2020
    Schedule of events updated with option to extend treatment to a maximum of up to 48 weeks based on clinical assessments and a discussion between the patient and clinician. Week 11 lung function tests moved to week 9. Week 11 intensive visit moved to week 10. Trial Schema updated to reflect the possible further treatment period of up to a maximum of 48 weeks. Thyroid and troponin tests removed from clinical assessments post week 24 in order to reduce treatment costs Dynamometer test introduced in order to assess the muscle strength using a hand-held device.
    24 Nov 2020
    Trial Synopsis updated to include single point long-term remote follow up visit starting in Q1 2021; Amended secondary outcome measures and exploratory outcome measures; list of biomarkers to be analysed; Updated trial duration Schedule of assessments updated to include single point long-term remote follow up visit and collection of ALSFRS-R. ALSAQ-40, concomitant and current medication Trial Schema updated to include single point long-term remote follow up visit Secondary Outcome Measures updated to include PK analysis Exploratory Outcome Measures updated with list of all biomarkers to be analysed Trial Design updated to include single point long-term remote follow up visit Added electronic re-consent for the single point long-term remote follow up visit to consent form Updated Quality of life to include the collection of QoL data in the form of ALSAQ-40 in single point long-term remote follow up visit Sample collection amended throughout to reflect planned analysis, sample storage and laboratories involved Patient Follow Up updated to include single point follow-up visit Serious Adverse Events updated to reflect e-mail reporting procedure. End of Trial Definition amended to coincide with updated timelines; final summary of clinical trial report and addendum including data from single point long-term remote follow up visits

    Interruptions (globally)

    Were there any global interruptions to the trial? Yes
    Date
    Interruption
    Restart date
    27 Mar 2020
    At the end of March 2020 all ALS trial research activity was suspended at the participating centre due to the escalation of the COVID-19 Pandemic. This meant that all on-site visits ended with the last visit on 26th March 2020 as this particular patient group were categorised as High Risk and susceptible to COVID-19 complications. A formal decision to halt recruitment and any further treatment visits, due to the ongoing COVID-19 pandemic and IMP expiry date, was made by the sponsor in October 2020. A protocol amendment was submitted and approved on 11th January 2021 which allowed for quality of life data collection from those patients already enrolled who consented to this visit. This data is to be included in the final clinical study report.
    11 Jan 2021

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    Early termination due to the COVID-19 pandemic meant that both recruitment and further treatment was suspended after 11 patients had been recruited. As a result, patients were treated with interrupted and varying numbers of weekly ILB® treatments.

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/38990927
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