This is a phase II, randomized, double-blind, placebo-controlled, multicentre clinical study to evaluate the efficacy and safety of ALT001 in patients with ischemic stroke in the sequelae stage (≥180 days and ≤5 years after the most recent event). A total of 200 participants will be randomized 1:1:1:1 to receive ALT001 at 65 μg/day, 130 μg/day, or 260 μg/day, or matching placebo, by intravenous infusion once daily (over \~60 minutes) using a 14-day-on / 14-day-off cycle for 3 cycles (12 weeks) in the double-blind (DB) period, followed by an optional open-label extension (OLE) period of 3 additional cycles. The primary endpoint is the change from baseline in the Fugl-Meyer Assessment (FMA) motor score at Week 12.
Ischemic stroke (IS) is the most common type of stroke, yet for patients with persistent neurological deficits beyond 6 months (sequelae stage) there is no widely accepted effective therapy. ALT001 is an allogeneic unrelated human umbilical cord mesenchymal stem cell-derived protein complex intended to promote neurological repair. This phase II study enrolls adults (18-80 years) with unilateral limb weakness (FMA motor score ≤90) and modified Ashworth spasticity ≤2, at least 180 days but no more than 5 years after the most recent ischemic stroke. Participants are randomized to one of three ALT001 dose groups (65, 130, or 260 μg/day) or matching placebo. Study drug is reconstituted in 100 mL normal saline and given by IV infusion once daily over \~60 minutes, 14 days on / 14 days off per cycle, for 3 cycles in the DB period. Eligible participants may then enter a 3-cycle OLE period (placebo group re-randomized to an active dose). Efficacy is assessed by FMA (primary, Week 12), mRS, NIHSS, Barthel Index, and modified Ashworth scale; safety by AE/SAE monitoring; exploratory outcomes include new vascular events and immunologic/cytokine changes.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
200
A total of 150 participants in the active treatment arm were randomized in a 1:1:1 ratio to the 65 μg/day ALT001 treatment group, the 130 μg/day ALT001 treatment group, or the 260 μg/day ALT001 treatment group, with 50 participants in each group. For each treatment group, according to the assigned dose, ALT001 was dissolved in 100 mL of normal saline injection and administered by intravenous infusion once daily, completed within approximately 60 minutes. Dosing schedule: Fourteen days of continuous dosing followed by 14 days off constituted one cycle. The DB period consisted of 3 consecutive cycles, Participants who complete the DB period will enter the OLE treatment period, using the same administration method as in the DB period. The active treatment groups will continue to receive the dose level of their assigned dose group, and the OLE period consisted of 3 consecutive cycles.
The placebo group consisted of 50 participants. The placebo was dissolved in 100 mL of normal saline injection and administered by intravenous infusion once daily, completed within approximately 60 minutes. Dosing schedule: Fourteen days of continuous dosing followed by 14 days off constituted one cycle. The DB period consisted of 3 consecutive cycles, and the OLE period consisted of 3 consecutive cycles. Participants who complete the DB period will enter the OLE treatment period. The placebo group will be randomly assigned to the 3 dose groups and receive treatment for 3 consecutive cycles (12 weeks).
Capital Medical University Affiliated Beijing Tiantan Hospital
Beijing, Beijing Municipality, China
Change from baseline in Fugl-Meyer Assessment (FMA) motor score
The Fugl-Meyer Assessment (FMA) is used to evaluate the motor function of patients with ischemic stroke. It comprises an upper-extremity motor function subscore (66 points) and a lower-extremity motor function subscore (34 points), for a total of 100 points. Total-score grading: 0-49 = severe motor impairment; 50-84 = marked motor impairment; 85-95 = moderate motor impairment; 96-99 = mild motor impairment.
Time frame: Week 12 (double-blind period)
Change from baseline in the Fugl-Meyer Assessment (FMA) Motor score
The Fugl-Meyer Assessment (FMA) is used to evaluate the motor function of patients with ischemic stroke. It comprises an upper-extremity motor function subscore (66 points) and a lower-extremity motor function subscore (34 points), for a total of 100 points. Total-score grading: 0-49 = severe motor impairment; 50-84 = marked motor impairment; 85-95 = moderate motor impairment; 96-99 = mild motor impairment.
Time frame: After 4 and 8 weeks of treatment during the double-blind treatment period
Change from baseline in modified Rankin Scale (mRS) distribution / proportion of patients by mRS grade
The modified Rankin Scale (mRS) is a global outcome measure of disability and functional independence after stroke, graded on an ordinal scale from 0 to 6: 0 = no symptoms, 1 = no clinically significant disability, 2 = slight disability, 3 = moderate disability (requires some help), 4 = moderately severe disability (unable to walk unassisted), 5 = severe disability (bedridden, requiring constant care), and 6 = death. The mRS score range is 0 to 6; higher scores indicate worse outcome (greater disability). The proportion of patients in each mRS grade and the shift in mRS distribution from baseline will be summarized at Weeks 4, 8, and 12.
Time frame: Weeks 4, 8, and 12
Change from baseline in National Institutes of Health Stroke Scale (NIHSS) score
Difference in NIHSS score from baseline to Weeks 4, 8, and 12 of the double-blind treatment period. The National Institutes of Health Stroke Scale (NIHSS) is an ordinal scale used to quantify neurological impairment in stroke patients, assessing 11 domains including level of consciousness, gaze, visual fields, facial palsy, motor function of the arms and legs, limb ataxia, sensory loss, language (aphasia), dysarthria, and inattention (extinction/inattention). The NIHSS score range is 0 to 42, with lower scores indicating less severe neurological impairment. Higher scores indicate worse outcome (more severe neurological deficit).
Time frame: Weeks 4, 8, and 12
Change from baseline in Barthel Index (BI) score
Difference in Barthel Index (BI) score from baseline to Weeks 4, 8, and 12 of the double-blind treatment period. The Barthel Index (BI) is an ordinal scale that measures functional independence in activities of daily living (ADL), assessing 10 items: feeding, bathing, grooming, dressing, bowel control, bladder control, toilet use, transfers, mobility, and stairs. Each activity is scored on a 5-level scale, with level 1 being the lowest and level 5 the highest. A higher level indicates a greater degree of independence. The BI score range is 0 to 100, with higher scores indicating better outcome (greater independence in daily living).
Time frame: Weeks 4, 8, and 12
Change from baseline in the Modified Ashworth Scale (MAS) score
The Modified Ashworth Scale (MAS) is used to assess muscle tone and degree of spasticity during passive movement of skeletal muscles; the investigator performs passive stretching of the target muscle group and grades the increase in tone and resistance to passive movement. Scoring ranges from grade 0 to grade 4, with grade 1+ indicating a slight increase in tone with resistance intermediate between grade 1 and grade 2 (numeric range 0 to 4). Higher scores indicate worse outcome (more severe spasticity). In this study, six movements are assessed separately: upper limb - elbow flexion, wrist flexion, forearm pronation; lower limb - knee extension, knee flexion, ankle plantar flexion. Assessed once per cycle during the 3-cycle OLE period.
Time frame: Weeks 4, 8, and 12
Incidence of adverse events (AEs) and serious adverse events (SAEs)
Incidence of treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs), summarized by system organ class and preferred term (MedDRA coded), and graded according to CTCAE v5.0. Events are collected from the first dose of study drug through the 28-day post-treatment safety follow-up and reported for the double-blind period, the open-label extension period, and the overall treatment period.
Time frame: Through study completion, up to approximately 28 weeks (up to 24 weeks of treatment, comprising the 12-week double-blind period and the 12-week open-label extension period, plus a 28-day safety follow-up after the last dose).
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