A Double-blind Randomised, Placebo-controlled Clinical Trial to Test Ambroxol Treatment in ALS

Last updated: September 4, 2023
Sponsor: The Florey Institute of Neuroscience and Mental Health
Overall Status: Active - Recruiting

Phase

2

Condition

Scar Tissue

Amyotrophic Lateral Sclerosis (Als)

Myasthenia Gravis (Chronic Weakness)

Treatment

Placebo

Ambroxol

Clinical Study ID

NCT05959850
FLO-AMB-01
  • Ages 18-85
  • All Genders

Study Summary

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.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  1. Must have given written informed consent before any study related assessments areperformed and must be able to understand purpose of the study, including any possiblerisks and adverse events.
  2. ALS as diagnosed according to the recently proposed Gold Coast diagnostic criteria.
  3. First symptom of ALS less than or equal to 18 months prior to screening. Thequalifying first symptoms of ALS are limited to manifestations of weakness inextremity, bulbar, or respiratory muscles. Cramps, fasciculations, or fatigue shouldnot be taken in isolation as a first symptom of ALS.
  4. Forced vital capacity (FVC) greater than or equal to 60% of predicted value asadjusted for gender, height and age at the Screening Visit.
  5. Male or female patients aged 18 years or greater (inclusive) and less than 85 years atthe time of ALS diagnosis.
  6. Able to swallow liquid.
  7. Able to perform reproducible pulmonary function tests
  8. Female patients must be post-menopausal or sterilized or must not be breastfeeding,have no intention to become pregnant during the study, and use acceptable methods ofcontraception or abstain from intercourse.
  9. Male patients who have not had a vasectomy and confirmed zero sperm count must agreeafter receiving the first dose of study drug either to use acceptable methods ofcontraception or abstain from intercourse.
  10. If on riluzole, stable dosing for 30-days prior to screening.
  11. Pre-study ALSFRS-R progression between disease onset and screening of greater than orequal to 0.5 points/month (calculated by ALSFRS-R total score decline from 48 dividedby the months since onset of ALS symptoms).

Exclusion

Exclusion Criteria:

  1. Use of non-invasive ventilation (NIV) support for ALS only or gastrostomy tube at timeof screening.
  2. Exposure to investigational drug within 12-weeks prior to screening.
  3. At screening of any medically significant cardiac, pulmonary, GI, musculoskeletal, orpsychiatric illness that might interfere with the patient's ability to comply withstudy procedures or that might confound the interpretation of clinical safety or data.
  4. Patient with a history of significant other major medical conditions based on theInvestigator's judgment.
  5. Based on the investigator's judgment, patients who may have difficulty complying withthe protocol and/or any study procedures.
  6. Any person who is an employee or an Investigator or Sponsor, or an immediate relativeof an Investigator.

Study Design

Total Participants: 50
Treatment Group(s): 2
Primary Treatment: Placebo
Phase: 2
Study Start date:
June 13, 2023
Estimated Completion Date:
December 31, 2024

Study Description

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).

Connect with a study center

  • Brain and Mind Centre

    Sydney, New South Wales 2050
    Australia

    Active - Recruiting

  • Concord Repatriation General Hospital

    Sydney, New South Wales 2139
    Australia

    Active - Recruiting

  • Flinders Medical Centre

    Adelaide, South Australia 5042
    Australia

    Active - Recruiting

  • Launceston General Hospital

    Launceston, Tasmania 7250
    Australia

    Active - Recruiting

  • Calvary Health Care Bethlehem

    Melbourne, Victoria 3162
    Australia

    Active - Recruiting

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