Fifty patients with amyotrophic lateral sclerosis that is progressing rapidly will be randomized to receive either the monoclonal antibody IC14 or placebo to be given intravenously over two hours twice weekly for 12 weeks. Blood and urine tests will be done to measure biomarkers in order to evaluate clinical response and to monitor for safety. Other evaluations include patient questionnaires about function, quality of life and mental function; pulmonary function test; and sniff nasal pressure.
This will be a placebo-controlled, double-blind, parallel-group comparison. Fifty patients with rapidly progressive ALS will be randomised to receive one of the following regimens: * IC14 4 mg/kg given intravenously twice weekly for 12 weeks; or * Identical-appearing placebo given intravenously twice weekly for 12 weeks. There will be an interim safety review by an independent Data Safety Monitoring Board after the initial 20 subjects have completed 4 weeks and 8 weeks of treatment. Study observation will continue until 12 weeks after the last dose of study drug. The primary endpoint is: • Treatment-related change in disease biomarker profiles \[e.g., neurofilaments (Nf), urinary p75 neurotrophin receptor (p75NTR), cytokines, and soluble CD14\]. The secondary endpoints are: * Safety, tolerability and lack of immunogenicity of IC14. * Treatment-related change in the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R). * Treatment-related change in respiratory function by seated forced vital capacity (FVC) parameters. * Treatment-related change in inspiratory muscle strength by sniff nasal pressure (SNP) test. * Treatment-related change in quality of life by the ALS Specific Quality of Life-Revised (ALSSQOL-R) score. * Treatment-related change in cognitive function by Edinburgh Cognitive and Behavioural Assessment (ECAS) score. * Treatment-related changes stratified by disease severity and prognostic indicators. * Peak serum IC14 concentration following administration of the initial dose and peak serum concentration following a course of treatment. * Area under the serum IC14 concentration versus time curve (AUC) following administration of the initial dose and following a course of treatment.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Royal Brisbane and Women's Hospital
Herston, Queensland, Australia
Neurofilament (biomarker)
Treatment-related change in concentration of neurofilament (picograms per milliliter)
Time frame: 12 weeks
Urinary p75 neurotrophin receptor (biomarker)
Treatment-related change in concentration of urinary p75 neurotrophin receptor (nanograms per milligram creatinine)
Time frame: 12 weeks
Monocyte CD14 receptor occupancy
Treatment-related change in percent monocyte receptor occupancy
Time frame: 12 weeks
Functional status
Treatment-related change in Revised Amyotrophic Lateral Sclerosis Functional Rating Scale \[0 (worst) to 48 (best)\]
Time frame: 12 weeks
Respiratory function
Treatment-related change in percent normal Forced Vital Capacity \[0% (worst) to 100%(best)\]
Time frame: 12 weeks
Muscle function
Treatment-related change in percent normal Sniff Nasal Pressure \[0% (worst) to 100% (best)\]
Time frame: 12 weeks
Quality of life measured by ALSSQOL
Treatment-related change in Amyotrophic Lateral Sclerosis Specific Quality of Life - Revised questionnaire \[0 (worst) to 460 (best)\]
Time frame: 12 weeks
Cognitive and behavioural assessment
Treatment-related change in Edinburgh Cognitive and Behavioural Assessment Score \[0(worst) to 136 (best)\]
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Time frame: 12 weeks
Maximum plasma concentration (Cmax)
Maximum serum IC14 concentration (micrograms per milliliter)
Time frame: 12 weeks
Area under the curve
Area under the curve for serum IC14 (microgram x hr/mL)
Time frame: 12 weeks
Immunogenicity
Development of human anti-monoclonal antibodies following treatment
Time frame: 16 weeks
Adverse events (safety, tolerability)
Incidence of treatment-emergent adverse events (safety, tolerability) classified by MedDRA
Time frame: 16 weeks