Ambroxol is a simple cough medicine that is predicted to slow ALS disease progression. This study aims to investigate if ambroxol in high doses is effective in treating ALS. This study will be carried out across 5 research sites in Australia (2 NSW, 1 VIC, 1 SA and 1 TAS), where newly diagnosed ALS patients will be asked to participate. Participation will be over a 32-week period, where they will come in for a 4-week screening, 24-week treatment, and 4-week end of study safety follow-up period. The participants will receive either the placebo or drug solution that they will take three times a day, up-dosing each week until they reach the maximum dose or highest dose they can tolerate. Throughout the study their disease progression will be assessed using tests, questionnaires, and blood biomarkers.
This study is a double-blind, randomised, placebo-controlled phase 2 clinical trial, to assess the safety, tolerability and efficacy of ambroxol therapy in ALS patients by using electrophysiological and functional measures to detect preservation of motor units. The study design will have participants be randomised to either ambroxol or placebo at a 2:1 ratio (ambroxol (n=34) and placebo (n=16)). Participants randomised to the active arm will receive various doses of ambroxol in solution, taken orally, three times a day. Doses will be increased pending a safety review for each participant. The doses will be 180mg per day, 260mg per day, 540mg per day, 900mg per day, and 1260 mg per day. Each week safety bloods will be performed to assess tolerance to the dose. Participants randomised to the control arm will receive a placebo for the duration of the study. Disease progression will be assessed by the following, time to event (death, need for tracheostomy, the need for gastrostomy feeding or non-invasive ventilation support (≥12 hours a day in a 24-hour period), or ≥6-point progression (ALS functional rating score-revised).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
50
Participants in the study will receive varying doses of ambroxol in solution, 3 times per day. Doses will be increased pending a safety review, up to a maximum of 1260mg/day. Blood tests will be conducted weekly to assess tolerance. Compliance will be monitored by returning used bottles. The study will last 32 weeks, including 24 weeks of drug administration and follow-up visits. After the final follow-up, there will be an end of study safety visit occurring 4 weeks later. The total time of participation will be 32 weeks. This includes a screening visit up to 4 weeks prior to Baseline, then a Baseline visit, followed by 24 weeks of follow-up (3x in clinic follow-up visits). These 24 weeks will be the drug administration period, meaning that the total duration of drug administration is 24 weeks. Following this drug administration and follow-up period, there will be an EoS safety-follow up visit that will occur 4 weeks after the final follow-up visit (28 weeks from baseline).
Participants randomised to the control arm will receive a placebo for the duration of the study. The placebo will look and taste like ambroxol, but will have no active ingredient. Participants will not be told which arm they have been randomised to. The placebo will primarily be a glucose solution, however it will also have flavouring (e.g. bitters) and colouring, so as to make it look and taste like ambroxol, to maintain blinding.
Brain and Mind Centre
Sydney, New South Wales, Australia
RECRUITINGConcord Repatriation General Hospital
Sydney, New South Wales, Australia
RECRUITINGFlinders Medical Centre
Adelaide, South Australia, Australia
RECRUITINGLaunceston General Hospital
Launceston, Tasmania, Australia
RECRUITINGCalvary Health Care Bethlehem
Melbourne, Victoria, Australia
RECRUITINGTime to event
Time to event (death, need for tracheostomy, the need for gastrostomy feeding or non-invasive ventilation (NIV) support (greater than or equal to 12 hours a day in a 24-hour period), or greater than or equal to 6-point progression on the Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS)) This will be measured by patient medical records, and the completion of the ALSFRS by investigators.
Time frame: Time to event for a maximum of 24 weeks from baseline
ALS functional rating score-revised (ALSFRS-R)
Change in ALSFRS-R Score
Time frame: 24 weeks from Baseline
Motor unit number estimation (MUNIX)
Change in MUNIX values
Time frame: 24 weeks from Baseline
Split Hand Index (SI)
Change in SI value
Time frame: 24 weeks from Baseline
Neurophysiology Index (NPI)
Change in NPI Value
Time frame: 24 weeks from Baseline
Kings staging system
Change in Kings stage
Time frame: 24 weeks from Baseline
Muscle strength assessment as measured by the Medical Research Council (MRC) Scale for Muscle Strength
Change in Muscle strength, where Grade 0 is no visible contraction and Grade 5 is Normal
Time frame: 24 weeks from Baseline
Respiratory function (FVC) as measure by a Spirometer
Change in FVC
Time frame: 24 weeks from Baseline
Survival
Overall survival rate
Time frame: 24 weeks from Baseline
Serum NFL levels
Change in Serum NFL Levels
Time frame: 24 weeks from Baseline
Assessment of Quality of Life (AQoL)
Change in AQoL score
Time frame: 24 weeks from Baseline
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.