E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Amyotrophic Lateral Sclerosis (ALS) |
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E.1.1.1 | Medical condition in easily understood language |
A disease that affects nerve cells in the brain and the spinal cord |
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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 | 21.1 |
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 |
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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 |
Double-blind Phase
• To determine the safety and tolerability of AP-101 after multiple intravenous (IV) doses over 6 months of treatment
Open-label Extension
• To determine the safety and tolerability of AP-101 after multiple IV doses |
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E.2.2 | Secondary objectives of the trial |
Double-blind Phase
• To determine the Pharmacokinetic (PK) profile of AP-101 after multiple IV dose administrations
• To determine cerebrospinal fluid (CSF) penetration of AP-101 after multiple IV dosing
• To determine effects of AP-101 on phospho-neurofilament heavy chain (pNfH) and neurofilament light chain (NfL) levels in CSF and plasma after multiple IV doses of AP-101
Open-label Extension
• To determine the PK profile of AP 101 after multiple IV dose administrations
• To determine effects of AP-101 on pNfH and NfL levels in CSF and plasma after multiple IV doses of AP 101 |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Male and female participants. Contraceptive use by men or women should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies.
a. Male participants who agree to use highly effective/effective methods of contraception may participate in this trial:
i. All men should refrain from sperm donation for the duration of the study and for 6 months after the final administered dose of AP-101
ii. Male participants with partners of childbearing potential must either remain abstinent (if this is their preferred and usual lifestyle), or must use condoms during intercourse for the duration of the study, and for 6 months after the final administered dose
iii. Male participants who are in exclusively same sex relationships are not required to use contraception.
b. Male participants must adhere to the contraception restrictions specified in Section 10.6 of the Protocol.
c. Female participants of childbearing potential must adhere to contraception restrictions specified in Section 10.6 of the Protocol. Female participants should refrain from egg donation for the duration of the study and for 6 months following the final administered dose of AP-101.
d. Female participants are considered women not of child bearing potential if
i. they have a congenital anomaly such as Mullerian agenesis,
ii. they are infertile due to surgical sterilization, or
iii. they are post- menopausal (as defined in protocol).
2. Aged 18 years or over.
3. Have possible, clinically probable, clinically probable-laboratory supported or definite familial or sporadic ALS in accordance with the El-Escorial criteria (Appendix 9, Section 10.9 of the Protocol) or who have a diagnosis of ALS as defined by the Gold Coast Criteria; progressive motor impairment documented by history or repeated clinical examination, preceded by normal motor development, and presence of upper and lower motor neuron dysfunction in at least 1 body region or lower motor neuron dysfunction in at least 2 body regions and investigations excluding other conditions.
4. In familial ALS patients, a confirmed pathogenic SOD1 mutation.
5. Onset of symptoms i.e., weakness within past 24 months prior to screening, at the time of obtaining informed consent.
6. Have SVC of ≥50% of predicted values. Participants with SVC of <50% of predicted values may be permitted to enter the OLE, based on the opinion of the investigator.
7. Absence of bilevel positive airway pressure (BiPAP)/proportional assist ventilation (PAV) >4 hours for symptoms attributable to ALS. Use of a CPAP for pre-existing conditions will be allowed.
8. If on riluzole, must be on a stable dose for at least 30 days prior to baseline (randomization) and remain on a stable dose throughout the study. Riluzole cannot be initiated during the double blind phase of the study. Riluzole can be initiated during the OLE after Week 3 if needed based on the opinion of the investigator and the dose may be adjusted as appropriate.
9. If on edaravone, must have completed 2 cycles at baseline (randomization) and are expected to remain on the same dose throughout the study. Edaravone cannot be initiated once the participant is randomized and for the duration of the double blind phase of the study. Edaravone can be initiated during the OLE after Week 3 if needed based on the opinion of the investigator and the dose may be adjusted as appropriate.
10. If on sodium phenylbutyrate or taurursodiol, patients must be on a stable dose for at least 30 days prior to baseline (randomization) and remain on a stable dose throughout the study. Treatment with sodium phenylbutyrate or taurursodiol cannot be initiated during the double-blind phase of the study. Treatment with sodium phenylbutyrate or taurursodiol can be initiated during the OLE after Week 3 if needed based on the opinion of the investigator and the dose may be adjusted as appropriate.
11. Capable of giving signed informed consent as described in Appendix 1 (Section 10.1.3), which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol.
12. Have venous access sufficient to allow for blood sampling as per protocol.
13. Have clinical laboratory test results within normal reference range for the population or study site, or results with acceptable deviations that are judged to be not clinically significant by the investigator.
14. Are able to visit the study site for outpatient treatment.
15. Are willing to make themselves available for the duration of the study and are willing to follow study specific procedures. |
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E.4 | Principal exclusion criteria |
1. Are investigator or site personnel affiliated with this study, or the immediate family of any of these. Immediate family is defined as a spouse, parent, child or sibling, whether biological or legally adopted.
2. Are participating in, or have participated in another clinical trial (or have taken an experimental therapy within the context of a clinical trial) within 5 half-lives of baseline (Day 1).
3. Have undergone a tracheostomy for ALS symptoms.
4. Are on nasal intermittent positive pressure ventilation (NIPPV) >4 hours per day for the treatment of ALS related symptoms.
5. Have other causes of neuromuscular weakness.
6. Have severe active psychiatric illness.
7. Have a diagnosis of another neurodegenerative disease (e.g. Parkinson disease, Alzheimer’s disease).
8. Have a significant pulmonary disorder not attributed to ALS or who require treatments that might complicate the evaluation of the effect of ALS on respiratory function.
9. Have cognitive impairment, severe disease in the renal, cardiovascular or hematological system.
10. Pregnant or nursing women.
11. Have been exposed to any antisense treatment targeting SOD1, including tofersen, within 6 months of the baseline visit or have known allergies or reactions to AP-101 or any of its excipients.
12. Have undergone stem cell therapy.
13. In the opinion of the investigator or sponsor, are unsuitable for inclusion in the study for any reason. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Double-blind Phase
• Incidence of AEs and SAEs including immunogenicity.
• Incidence of abnormalities in vital signs, clinical laboratory assessments, physical and neurological examinations, electrocardiograms and changes in weight.
Open-label Extension
• Incidence of AEs and SAEs including immunogenicity
• Incidence of abnormalities in vital signs, clinical laboratory assessments, physical and neurological examinations, electrocardiograms and changes in weight
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
• AEs and SAEs: Screening through 16 weeks PLD/ET
• Immunogenicity: Baseline through 16 weeks PLD/ET
• Vital signs, laboratory measurements, electrocardiograms, changes in weight: Screening (baseline for OLE) through 16 weeks PLD/ET
• Electrocardiograms (Double-blind Phase): Screening through 16 weeks PLD/ET
• Electrocardiograms (OLE): Baseline, W3, W6, W12, W24, through 16 weeks PLD/ET
• Physical and neurological exam (Double-blind Phase): screening, baseline, W3, W12, W24, through 16 weeks PLD/ET
• Physical and neurological exam (OLE): baseline, W3, W6, W12, W24, through 16 weeks PLD/ET
PLD/ET = post last dose or early termination
All excluding phone call |
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E.5.2 | Secondary end point(s) |
Double-blind Phase
• The primary PK parameters are AUC, concentration at the end of infusion and t1/2
• AP-101 levels in the CSF
• Measurement of pNfH and NfL levels in the CSF and plasma after multiple IV doses of AP-101
Open-label Extension
• The primary PK parameters are AUC, concentration at end of infusion and t1/2
• Measurement of pNfH and NfL levels in CSF and plasma after multiple IV doses of AP-101 |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Double-blind Phase
• PK sampling from baseline through 16 weeks post last dose or early termination (excluding phone call)
• CSF samples at baseline, W12, W24 and 16 weeks post last dose or early termination
Open-label Extension
• PK sampling at baseline, Dose 2 and 21 days - 16 weeks post last dose or early termination
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 8 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Canada |
Korea, Republic of |
United States |
Belgium |
Germany |
Sweden |
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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
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The end of the study is defined as the date after the last participant completed 6 months of study treatments and completed any applicable follow-up.
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 1 |
E.8.9.1 | In the Member State concerned days | 28 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 1 |
E.8.9.2 | In all countries concerned by the trial days | 28 |