A Study to Evaluate Efficacy, Safety and Tolerability of CK-2127107 in Patients With Amyotrophic Lateral Sclerosis (ALS) (FORTITUDE-ALS)

• ClinicalTrials.gov Identifier: NCT03160898
• Recruitment Status: Completed
• First Posted: May 19, 2017
• Results First Posted: September 11, 2020
• Last Update Posted: September 11, 2020
• Sponsor: Cytokinetics
• Collaborator: Astellas Pharma Inc
• Information provided by (Responsible Party): Cytokinetics

Tracking Information

• First Submitted Date: May 12, 2017
• First Posted Date: May 19, 2017
• Results First Submitted Date: August 5, 2020
• Results First Posted Date: September 11, 2020
• Last Update Posted Date: September 11, 2020
• Actual Study Start Date: July 24, 2017
• Actual Primary Completion Date: March 7, 2019 (Final data collection date for primary outcome measure)

Current Primary Outcome Measures (submitted: August 5, 2020)

Change From Baseline to Week 12 in the Percent Predicted Slow Vital Capacity (SVC) [ Time Frame: Baseline to Week 12 ]

Slow vital capacity was measured using a spirometer (in units of liters). Following 3 to 5 breaths at rest, patients were instructed to take as deep an inspiration as possible followed by a maximum exhalation (blowing out all the air in their lungs). Values obtained were converted to percent predicted values using the Global Lung Initiative equation (ie, the test result as a percent of predicted values for patients of similar demographic and baseline characteristics [eg, height, age, sex]).

• Original Primary Outcome Measures (submitted: May 17, 2017): Change from baseline to Week 12 in the percent predicted slow vital capacity (SVC) [ Time Frame: Baseline to Week 12 ]

Current Secondary Outcome Measures (submitted: August 21, 2020)

• Change From Baseline to Week 12 in the ALS Functional Rating Scale - Revised (ALSFRS-R) Total Score [ Time Frame: Baseline to Week 12 ]
  The ALSFRS-R is used to measure the progression and severity of disability in patients with ALS. The ALSFRS-R consists of 12 questions, assessing a patient's capability and independence in functional activities relevant to ALS, categorized in the following 4 domains: gross motor tasks, fine motor tasks, bulbar functions, and respiratory function. Each question is scored from 0 (indicating incapable or dependent) to 4 (normal). The total score ranges from 0 to 48. Higher scores reflect more normal function and lower scores reflect more impaired function.
• Slope of Muscle Strength Mega-score From Baseline to Week 12 [ Time Frame: Baseline to Week 12 ]
  A hand-held dynamometer, with a scale of 0 to 300 pounds, was used to measure muscle strength and handgrip strength (bilateral). The muscle groups tested were: elbow flexion, wrist extension, first dorsal interosseous, hip flexion, knee extension, and ankle dorsiflexion; all muscle groups were evaluated bilaterally. For each postbaseline assessment of muscle strength, the percent change from baseline was calculated for each muscle group and handgrip strength, using the following equation: ([postbaseline value - baseline value] / baseline value) × 100. The muscle-strength mega-score was calculated as the average of the changes (ie, percent change from baseline) observed for each of the muscle groups as well as handgrip strength. For this endpoint, negative values indicate a decline in muscle strength.

Original Secondary Outcome Measures (submitted: May 17, 2017)

• Slope of change from baseline in the mega-score of muscle strength measured by hand held dynamometry and handgrip dynamometry from baseline to Week 12 in patients on CK-2127107 compared to placebo [ Time Frame: Baseline to Week 12 ]
• Change from baseline to Week 12 in the ALS Functional Rating Scale - Revised (ALSFRS-R) [ Time Frame: Baseline to Week 12 ]
• Mean plasma concentrations over time of CK-2127107 at Week 12 [ Time Frame: Day 1 to Week 12 ]

• Current Other Pre-specified Outcome Measures: Not Provided
• Original Other Pre-specified Outcome Measures: Not Provided

Descriptive Information

• Brief Title: A Study to Evaluate Efficacy, Safety and Tolerability of CK-2127107 in Patients With Amyotrophic Lateral Sclerosis (ALS)
• Official Title: A Phase 2, Multi-Center, Double-Blind, Randomized, Dose-Ranging, Placebo-Controlled Study to Evaluate the Efficacy, Safety and Tolerability of CK-2127107 in Patients With Amyotrophic Lateral Sclerosis (ALS)
• Brief Summary: The purpose of this study was to assess the effect of CK-2127107 (hereafter referred to as reldesemtiv) versus placebo on respiratory function and other measures of skeletal muscle function in patients with ALS.

Detailed Description

This was a double-blind, randomized, placebo-controlled, dose ranging study of reldesemtiv in patients with ALS. Eligible patients were randomized (1:1:1:1) to receive placebo or one of three doses of reldesemtiv (150, 300, or 450 mg twice daily) for 12 weeks. Randomization was stratified by riluzole concomitant use/non-use and edaravone concomitant use/non-use. Concomitant riluzole and edaravone were allowed as long as the riluzole dose had been stable for at least 30 days prior to screening and edaravone had been taken for 2 cycles prior to screening; these drugs could not be initiated during the study.

A total of 7 study visits were planned: screening, Day 1 (first dosing day), Weeks 2, 4, 8, and 12, and follow-up (4 weeks after the last dose of study drug). Study drug (placebo or reldesemtiv) was to be taken twice daily, approximately 12 hours (± 2 hours) apart and within 2 hours following a meal.

• Study Type: Interventional
• Study Phase: Phase 2
• Study Design: Allocation: Randomized; Intervention Model: Parallel Assignment; Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor); Primary Purpose: Treatment
• Condition: Amyotrophic Lateral Sclerosis

Intervention

• Drug: Reldesemtiv
  Oral tablet
  Other Name: CK-2127107
• Drug: Placebo
  Oral tablet

Study Arms

• Experimental: Reldesemtiv 150 mg twice daily
  Patients in this arm took 1 reldesemtiv 150 mg oral tablet and 2 matching placebo tablets every 12 hours for 12 weeks.
  Intervention: Drug: Reldesemtiv
• Experimental: Reldesemtiv 300 mg twice daily
  Patients in this arm took 2 reldesemtiv 150 mg oral tablets and 1 matching placebo tablet every 12 hours for 12 weeks.
  Intervention: Drug: Reldesemtiv
• Experimental: Reldesemtiv 450 mg twice daily
  Patients in this arm took 3 reldesemtiv 150 mg oral tablets every 12 hours for 12 weeks.
  Intervention: Drug: Reldesemtiv
• Placebo Comparator: Placebo
  Patients in this arm took 3 placebo oral tablets every 12 hours for 12 weeks.
  Intervention: Drug: Placebo

Publications *

• Rudnicki SA, Andrews JA, Genge A, Jackson C, Lechtzin N, Miller TM, Cockroft BM, Malik FI, Meng L, Wei J, Wolff AA, Shefner JM; FORTITUDE-ALS STUDY GROUP. Prescription and acceptance of durable medical equipment in FORTITUDE-ALS, a study of reldesemtiv in ALS: post hoc analyses of a randomized, double-blind, placebo-controlled clinical trial. Amyotroph Lateral Scler Frontotemporal Degener. 2022 May;23(3-4):263-270. doi: 10.1080/21678421.2021.1946083. Epub 2021 Jul 5.
• Shefner JM, Andrews JA, Genge A, Jackson C, Lechtzin N, Miller TM, Cockroft BM, Meng L, Wei J, Wolff AA, Malik FI, Bodkin C, Brooks BR, Caress J, Dionne A, Fee D, Goutman SA, Goyal NA, Hardiman O, Hayat G, Heiman-Patterson T, Heitzman D, Henderson RD, Johnston W, Karam C, Kiernan MC, Kolb SJ, Korngut L, Ladha S, Matte G, Mora JS, Needham M, Oskarsson B, Pattee GL, Pioro EP, Pulley M, Quan D, Rezania K, Schellenberg KL, Schultz D, Shoesmith C, Simmons Z, Statland J, Sultan S, Swenson A, Berg LHVD, Vu T, Vucic S, Weiss M, Whyte-Rayson A, Wymer J, Zinman L, Rudnicki SA. A Phase 2, Double-Blind, Randomized, Dose-Ranging Trial Of Reldesemtiv In Patients With ALS. Amyotroph Lateral Scler Frontotemporal Degener. 2021 May;22(3-4):287-299. doi: 10.1080/21678421.2020.1822410. Epub 2020 Sep 24.
• Shefner JM, Cudkowicz ME, Hardiman O, Cockcroft BM, Lee JH, Malik FI, Meng L, Rudnicki SA, Wolff AA, Andrews JA; VITALITY-ALS Study Group. A phase III trial of tirasemtiv as a potential treatment for amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener. 2019;0(0):1-11. doi: 10.1080/21678421.2019.1612922. Erratum In: Amyotroph Lateral Scler Frontotemporal Degener. 2019 Jul 14;:1.

Recruitment Information

• Recruitment Status: Completed
• Actual Enrollment (submitted: April 3, 2019): 458
• Original Estimated Enrollment (submitted: May 17, 2017): 445
• Actual Study Completion Date: March 7, 2019
• Actual Primary Completion Date: March 7, 2019 (Final data collection date for primary outcome measure)

Eligibility Criteria

Inclusion Criteria:

• Diagnosis of familial or sporadic ALS ≤ 24 months prior to screening
• Upright Slow Vital Capacity (SVC) ≥ 60% of predicted for age, height and sex at screening
• Able to swallow tablets
• A caregiver (if one is needed)
• Able to perform reproducible pulmonary function tests
• Pre-study clinical laboratory findings within the normal range or, if outside the normal range, deemed not clinically significant by the Investigator
• Male patients who have not had a vasectomy and confirmed zero sperm count must agree after receiving the first dose of study drug until 10 weeks after the last dose to either use acceptable methods of contraception or abstain from sex
• Female patients must be post-menopausal or sterilized or must not be breastfeeding, have a negative pregnancy test, have no intention to become pregnant during the study and use acceptable methods of contraception or abstain from heterosexual intercourse from Screening until 10 weeks after last dose of study drug
• Patients must be either on riluzole for at least 30 days prior to screening or have not taken riluzole for at least 30 days prior to screening and not planning to start riluzole during the course of the study.
• Patients on edaravone must have completed at least 2 cycles of dosing with edaravone at the time of screening or have not taken edaravone for at least 30 days prior to screening and not planning to start edaravone during the course of the study.

Exclusion Criteria:

• At the time of screening, any use of non-invasive ventilation (NIV), e.g. continuous positive airway pressure [CPAP], noninvasive bi-level positive airway pressure [NPPV] or noninvasive volume ventilation [NVV] for any portion of the day, or mechanical ventilation via tracheostomy, or on any form of oxygen supplementation
• Neurological impairment due to a condition other than ALS
• Presence at screening of any medically significant cardiac, pulmonary, GI, musculoskeletal, or psychiatric illness that might interfere with the patient's ability to comply with study procedures or that might confound the interpretation of clinical safety or efficacy data
• Has taken any investigational study drug within 30 days or five half-lives of the prior agent, whichever is longer, prior to dosing
• Known to have received CK-2127107 or tirasemtiv in any previous clinical trial
• Has received or is considering receiving during the course of the study any form of stem cell therapy for the treatment of ALS
• Has received or is considering receiving during the course of the study any form of gene therapy for the treatment of ALS
• Has received or is considering obtaining during the course of the study a diaphragmatic pacing system
• History of substance abuse within the past 2 years
• Use of certain medications

Sex/Gender

• Sexes Eligible for Study: All

• Ages: 18 Years to 80 Years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Contacts: Contact information is only displayed when the study is recruiting subjects
• Listed Location Countries: Australia, Canada, Ireland, Netherlands, Spain, United States

Administrative Information

• NCT Number: NCT03160898
• Other Study ID Numbers: CY 5022
• Has Data Monitoring Committee: Yes

U.S. FDA-regulated Product

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

IPD Sharing Statement

• Plan to Share IPD: No

• Current Responsible Party: Cytokinetics
• Original Responsible Party: Same as current
• Current Study Sponsor: Cytokinetics
• Original Study Sponsor: Same as current
• Collaborators: Astellas Pharma Inc

Investigators

• Study Director: MD Cytokinetics; Cytokinetics

• PRS Account: Cytokinetics
• Verification Date: August 2020