Ultra-high-caloric, Fatty Diet in ALS

University of Ulm392 enrolled

Overview

This study aims at evaluating efficacy and tolerability of an ultra-high-caloric, fatty diet (UFD) compared to placebo in patients with amyotrophic lateral sclerosis (ALS).

ALS is a fatal neurodegenerative disease, leading to progressive paralysis of voluntarily innervated muscles and to death caused by respiratory failure after a mean disease duration of 2-4 years.The proposed study aims at improving survival of ALS patients by targeting metabolic parameters. ALS patients feature an intrinsic hypermetabolism as signified by an increased resting energy expenditure, which significantly contributes to progressive weight loss and cachexia. The extent of weight loss is an independent prognostic factor for survival in ALS. It has been shown that survival of ALS mice can be prolonged by applying a high-caloric nutrition. Furthermore, ALS patients feature distinct alterations of lipid metabolism, and various studies suggest a protective effect of high triglyceride serum levels. In the precursor-study LIPCAL-ALS-I, a randomized, placebo-controlled, multicenter trial, evaluating the effects of a high-caloric fatty diet (HCFD), the primary endpoint (survival in the whole study population) was missed. However, post-hoc analysis revealed showed that HCFD (1) increased survival and reduced weight loss in normal to fast-progressing patients (patients with a functional decline measured by ALS Functional Rating Scale Revised) above the median at baseline; p=0.02), (2) slowed down functional decline (measured by Amyotrophic Lateral Sclerosis Functional Rating Scale Revised) in the whole study population (p\<0.0125), and (3) lowered neurofilament light chain (NfL) serum levels as a prognostic biomarker in the whole study population (p=0.0225). Therefore, this study aims at prolonging survival in ALS patients by applying 1.5-fold dosage of the same intervention as in LIPCAL-ALS I in a larger number of patients, excluding patients with slow disease progression.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

QUADRUPLE

Enrollment

392

Conditions

Amyotrophic Lateral Sclerosis

Interventions

Ultra-high-caloric fatty dietDIETARY_SUPPLEMENT

100% fat (70g), saturated fatty acids 7,5g, monounsaturated fatty acids 42,6g, polyunsaturated fatty acids 19,9g, long-chain fatty acids 100%, ratio omega-6 to omega-3 fatty acids 5:1, protein 0g, carbohydrates 0g, fiber 0g

PlaceboOTHER

\<5% fat (\<3,5g), protein 0g, carbohydrates 0g, fiber 0g

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Possible, probable (clinically or laboratory supported) or definite amyotrophic lateral sclerosis according to the revised version of the El Escorial criteria * Disease duration (onset of first paresis or bulbar symptoms) \< 24 months * Loss of amyotrophic lateral sclerosis functional rating scale revised of ≥ 0.33 points/month based on the formula: (48 - myotrophic lateral sclerosis functional rating scale revised score at screening visit) / (months between onset and screening visit) * Age ≥18 years. * Either continuously treated with a stable dose of riluzole, OR not treated with riluzole for the last 4 weeks prior to inclusion * Either continuously treated with a stable dose of edaravone, OR not treated with edaravone for the last 4 weeks prior to inclusion * Either continuously treated with a stable dose of sodium-phenylbutyrate/taurursodiol, OR not treated with sodium-phenylbutyrate/taurursodiol for the last 4 weeks prior to inclusion * Capable of thoroughly understanding all information given * full written informed consent according to good clinical practice Exclusion Criteria: * Previous participation in another interventional study involving an active treatment within the preceding 4 weeks * Tracheostomy or continuous permanent ventilator dependence (\>22 hours per day) * Pregnancy or breastfeeding * Any medical condition known to have an association with motor neuron dysfunction which might confound or obscure the diagnosis of ALS * Presence of any concomitant life-threatening disease or impairment likely to interfere with functional assessment. * Evidence of a major psychiatric disorder or clinically evident dementia precluding evaluation of symptoms. * Liable to be not cooperative or comply with study requirements as assessed by the investigator, or unable to be reached in the case of emergency

Locations (23)

RWTH Aachen

Aachen, Germany

NOT_YET_RECRUITING

Outcomes

Primary Outcomes

Survival

Time from date of randomization until date of death, tracheostomy, or permanent continous ventilation (\>22 hours per day)

Time frame: 18 months

Secondary Outcomes

Amyotrophic Lateral Sclerosis Functional Rating Scale Revised

Change per month of Amyotrophic Lateral Sclerosis Functional Rating Scale Revised

Time frame: 18 months

Rasch Overall Amyotrophic Lateral Sclerosis Disability Scale

Change per month of Rasch Overall Amyotrophic Lateral Sclerosis Disability Scale

Time frame: 18 months

Individual Quality of Life

Change of Euro Quality of Life 5D 5L (EQ-5D-5L) compared to baseline

Time frame: 18 months

Slow vital capacity

Change of slow vital capacity compared to baseline

Time frame: 18 months

Survival

Time from date of randomization until date of death, tracheostomy, or permanent continous ventilation (\>22 hours per day)

Time frame: 6 months

Survival

Time from date of randomization until date of death, tracheostomy, or permanent continous ventilation (\>22 hours per day)

Time frame: 12 months

Time to death

Time from date of randomization until date of death

Time frame: 18 months

Central Contacts

Johannes Dorst, Prof. Dr.

CONTACT

+497311775285 johannes.dorst@uni-ulm.de

Data from ClinicalTrials.gov

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