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Effect of Oral Levosimendan (ODM-109) on Respiratory Function in Patients with ALS (REFALS)

Study Purpose:

The purpose of the study is to evaluate safety and the effectiveness of levosimendan in preserving respiratory function in patients with amyotrophic lateral sclerosis (ALS).

Disease:

Amyotrophic Lateral Sclerosis (ALS),  Familial ALS,  Sporadic ALS

Study Type:

Interventional Trial

Study Category:

Drug Trial

Study Status:

Not enrolling

Phase:

Phase III

Study Chair(s)/Principal Investigator(s):

Merit Cudkowicz, MD, Massachusetts General Hospital

Clinicaltrials.gov ID (11 digit #):

NCT03505021

Neals Affiliated?

Yes

Coordinating Center Contact Information

Massachusetts General Hospital
Merit E Cudkowicz, MD / .(JavaScript must be enabled to view this email address) / 617-726-2383
Merja Mäkitalo / .(JavaScript must be enabled to view this email address) / +358 10 426 7737
Boston, Massachusetts 02114 United States

Full Study Summary:

This study will evaluate whether prolonged oral levosimendan can preserve respiratory function more effectively than placebo, resulting in better patient functionality as measured by the ALSFRS-R scale. In this randomized, double-blind, placebo-controlled, parallel-group, multicenter study, subjects are allocated in a 2:1 ratio to receive either levosimendan (1 -2 mg daily) or placebo for 48 weeks. The primary endpoint is slow vital capacity (SVC) at 12 weeks, with the impact on patient function assessed through 48 weeks, adjusted for patient outcome, using ALSFRS-R (combined assessment of function and survival, CAFS). Other important efficacy measures include time to respiratory events, clinical global impression (CGI), assessment of dyspnea using the Borg scale and sleep scales (Pittsburgh sleep quality index and Epworth sleepiness scale). Patient safety is monitored using conventional methods including adverse events, safety laboratory tests, vital signs and 12-lead EKG. Following screening and baseline visits, patients attend the clinic at 2, 4, 8, 12, 24, 36 and 48 weeks, with telephone assessments conducted at weeks 18, 30 and 42. An end of study visit is performed 14-25 days after the last study treatment administration. The study will be monitored by an independent data and safety monitoring board.  A long-term extension study will be available for patients completing the study.

Study Sponsor:

Orion Corporation, Orion Pharma

Participant Duration:

Total study duration for each subject will be 51-52 weeks, including the screening period, 48 weeks treatment and an end-of-study visit.

At screening, the visit length will be approximately 2 – 2.5hrs. 

For visits 2, 3 and 8, the visit length will be approximately 3 – 5 hrs.

For visits 4 to 7, the visit length will be approximately 2 – 3hrs.

There will also be three telephone contacts made in-between sites visits that should not last longer than 30 minutes.

Depending on location of sites, the study participant may be required to travel.  

Estimated Enrollment:

450

Estimated Study Start Date:

06/21/2018

Estimated Study Completion Date:

10/30/2020

Posting Last Modified Date:

01/22/2019

Date Study Added to alsconsortium.org:

07/06/2018
  • Eligibility Criteria

    Gender:

    Female, Male

    Minimum Age:

    18

    Maximum Age:

    N/A

    Min Vital Capacity (% predicted normal):

    60-90

    Time since Symptom Onset:

    Time since Diagnosis:

    Can participants use Riluzole?

    Yes


    Inclusion criteria

    Written or verbal informed consent (IC) for participation in the study
    Diagnosis of laboratory supported probable, probable or definite ALS according to El Escorial revised criteria.
    Able to swallow study treatment capsules, and in the opinion of the investigator, is expected to continue to do so during the study.
    Disease duration from symptom onset (defined by first muscle weakness or dysarthria) 12-48 months at the time of visit 1 (baseline)
    Able to perform supine SVC in an adequate and reliable way at screening and baseline visits as judged by the investigator.
    Subjects with or without riluzole (up to 100mg/day, stable at least 4 weeks) and/or edaravone (at least one 28-day treatment cycle completed).

    Exclusion criteria

    Other causes of neuromuscular weakness not excluded.
    Diagnosis of another neurodegenerative disease (e.g. Parkinson’s or Alzheimer’s disease).
    Assisted ventilation of any type within 3 months before the screening visit or at screening.
    Any use of a diaphragm pacing system (DPS) within 3 months before the screening visit.
    Any form of stem cell or gene therapy for the treatment of ALS.
    Known hypersensitivity to levosimendan.
    Administration of levosimendan within 3 months before the screening visit or previous participation in oral levosimenan trial.
    Any use of tirasemtiv or reldesemtiv within 1 month before the screening visit.
    Participation in a clinical trial with any experimental treatment within 30 days or within 5 half-lives of that treatment (whichever is longer) before the screening visit.
    Any botulinum toxin use within 3 months before the screening visit.
    Recorded diagnosis or evidence of major psychiatric diagnosis, significant cognitive impairment or clinically evident dementia that may interfere with the patient’s ability to comply with study procedures.
    Pulmonary illness (e.g. asthma or COPD) requiring regular treatment.
    Haemodynamically significant uncorrected valve disease or hypertrophic cardiomyopathy or restrictive cardiomyopathy.
    Any cardiovascular event (e.g. myocardial infarction, HF, arrhythmia or stroke) requiring hospitalisation within 3 months before the screening visit.
    History of Torsades de Pointes (TdP) or diagnosed long QT-syndrome.
    History of life-threatening ventricular arrhythmia, unless treated with reliable measures to prevent recurrence (e.g. with placement of implantable cardioverter defibrillator [ICD] or catheter ablation).
    History of second or third degree atrioventricular (AV) block or sinus node disease at screening, if not treated with pacemaker.
    HR repeatedly > 100 bpm in the 12-lead ECG after a 5-minute rest at screening.
    Systolic blood pressure (SBP) < 90 mmHg at screening.
    Potassium < 3.7 mmol/l or > 5.5 mmol/l at screening.
    Severe renal impairment (creatinine clearance < 30 ml/min at screening), creatinine > 170 μmol/l at screening or on dialysis.
    Blood haemoglobin < 10 g/dl at screening or blood donation or loss of significant amount of blood within 60 days before the screening visit.
    Clinically significant hepatic impairment at the discretion of the investigator.
    Body mass index (BMI) ≤ 18.5kg/m2 (BMI = weight/height2).
    Women who are lactating or of reproductive age without a negative pregnancy test and without a commitment to using a highly effective method of contraception (e.g. oral hormonal contraceptives associated with inhibition of ovulation, intrauterine devices and long acting progestin agents), if sexually active during the study, and for 1 month after the last dose of the study treatment. Women who are postmenopausal (1 year since last menstrual cycle), surgically sterilised or who have undergone a hysterectomy are considered not to be reproductive and can be included.
    Patient judged to be actively suicidal by the investigator during 3 months before the screening visit.
    Patients with known history of human immunodeficiency virus (HIV) infection.
    Any other clinically significant cardiovascular, gastrointestinal, hepatic, renal, neurological or psychiatric disorder or any other major concurrent illness that in the opinion of the investigator could interfere with the interpretation of the study results or constitute a health risk for the subject if he/she took part in the study.

  • Site Contact Information

    Neuromuscular Research Center and Neuromuscular Clinic of Arizona
    Kumaraswamy Sivakumar, MD / .(JavaScript must be enabled to view this email address) / 480-314-1007
    Phoenix, Arizona 85028
    United States

    Phoenix Neurological Associates
    Phoenix, Arizona 85006
    United States

    University of California San Diego
    Rose Previte / .(JavaScript must be enabled to view this email address) / La Jolla, California 92037
    United States

    Cedars-Sinai Medical Center
    Dana Fine / .(JavaScript must be enabled to view this email address) / 310-423-8497
    Los Angeles, California 90048
    United States

    University of California Irvine
    Ivonne Turner / .(JavaScript must be enabled to view this email address) / 714-546-8323
    Orange, California 92868
    United States

    California Pacific Medical Center
    San Francisco, California 94115
    United States

    Colorado Springs Neurological Associates
    Lisa Deschaine / 719-389-1129
    Colorado Springs, Colorado 80907
    United States

    Hospital for Special Care
    Honora Dalamagas / .(JavaScript must be enabled to view this email address) / 860-612-6356
    Stephanie Beck / .(JavaScript must be enabled to view this email address) / 860-827-1958 ext 5753
    New Britain, Connecticut 06053
    United States

    The George Washington Medical Faculty Associates
    Lindsey Covington / .(JavaScript must be enabled to view this email address) / 202-741-2745
    Washington, District of Columbia 20037
    United States

    Georgetown University
    Sasha Warren / 202-444-6941
    Washington, District of Columbia 20007
    United States

    University of Florida Health - Jacksonville
    Lisa Smith / .(JavaScript must be enabled to view this email address) / Jacksonville, Florida 32209
    United States

    University of South Florida
    Brittany Harvey / .(JavaScript must be enabled to view this email address) / 813-974-9413
    Tampa, Florida 33612
    United States

    Holy Cross Medical Center
    Lindita Burba / .(JavaScript must be enabled to view this email address) / 954-489-4314
    Fort Lauderdale, Florida 33308
    United States

    Mayo Clinic
    Arijana Draganovic / .(JavaScript must be enabled to view this email address) / 904-953-6912
    Jacksonville, Florida 32224
    United States

    University of Florida
    Jennifer Steshyn / .(JavaScript must be enabled to view this email address) / Gainesville, Florida 32611
    United States

    Emory University School of Medicine
    Jane Bordeau / .(JavaScript must be enabled to view this email address) / Atlanta, Georgia 30322
    United States

    Augusta University
    Michael H. Rivner, MD / .(JavaScript must be enabled to view this email address) / Augusta, Georgia 30912
    United States

    Northwestern University Feinberg School of Medicine
    Benjamin Joslin / .(JavaScript must be enabled to view this email address) / Chicago, Illinois 60611
    United States

    University of Kentucky Chandler Medical Center
    Meha Joshi / .(JavaScript must be enabled to view this email address) / 859-218-5046
    Lexington, Kentucky 40536
    United States

    Kentucky Neuroscience Research
    Annette Robinson / .(JavaScript must be enabled to view this email address) / 502-540-3585
    Louisville, Kentucky 40202
    United States

    Johns Hopkins Hospital
    Kristen Riley / .(JavaScript must be enabled to view this email address) / Baltimore, Maryland 21205
    United States

    Massachuesetts General Hospital
    Olivia Pijanowski / .(JavaScript must be enabled to view this email address) / 617-643-2522
    Boston, Massachuesetts 02114
    United States

    University of Michigan
    Jayna Duell / .(JavaScript must be enabled to view this email address) / 734-936-8776
    Kalamazoo, Michigan 49007
    United States

    Mayo Clinic - Rochester
    Rochester, Minnesota 55905
    United States

    HealthPartners Specialty Center
    Gaurav Guliani / .(JavaScript must be enabled to view this email address) / 651-495-6363
    Saint Paul, Minnesota 55130
    United States

    Washington University School of Medicine
    Kelly Streckfuss / .(JavaScript must be enabled to view this email address) / Saint Louis, Missouri 63110
    United States

    Neurology Associates
    Ashley Calhoun / .(JavaScript must be enabled to view this email address) / 402-770-7403
    Lincoln, Nebraska 68506
    United States

    Mount Sinai Beth Israel
    Stephen Scelsa, MD / .(JavaScript must be enabled to view this email address) / 212-844-8490
    New York, New York 10003
    United States

    Hospital for Special Surgery
    Shara Holzberg / .(JavaScript must be enabled to view this email address) / 646-797-8592
    New York, New York 10021
    United States

    Columbia Presbyterian Hospital
    Jinsy Andrews, MD / .(JavaScript must be enabled to view this email address) / Meenakshi Rozenstrauch / .(JavaScript must be enabled to view this email address) / 212-305-2233
    New York, New York 10032
    United States

    Neurosciences Institute - Neurology Charlotte
    Cynthia Lary / .(JavaScript must be enabled to view this email address) / Charlotte, North Carolina 28207
    United States

    Duke University Medical Center
    Karen Grace / .(JavaScript must be enabled to view this email address) / 919-668-2844
    Durham, North Carolina 27705
    United States

    Wake Forest University Baptist Medical Center
    James Caress, MD / 336-713-8577
    Winston-Salem, North Carolina 27157
    United States

    The Ohio State University
    Adam Quick / .(JavaScript must be enabled to view this email address) / Rory Eustace / .(JavaScript must be enabled to view this email address) / Columbus, Ohio 43210
    United States

    Providence Brain and Spine Institute
    Arlena Cummings / .(JavaScript must be enabled to view this email address) / 503-962-1171
    Portland, Oregon 97213
    United States

    Oregon Health and Science University
    Anneka Sonstroem / .(JavaScript must be enabled to view this email address) / 503-494-7394
    Portland, Oregon 97201
    United States

    University of Pittsburgh Medical Center
    Danielle Rowlands / .(JavaScript must be enabled to view this email address) / 412-864-2873
    Pittsburgh, Pennsylvania 15213
    United States

    University of Pennsylvania
    Kelly Almasy / .(JavaScript must be enabled to view this email address) / 215-829-5041
    Philadelphia, Pennsylvania 19107
    United States

    Allegheny General Hospital
    Sandeep Rana / .(JavaScript must be enabled to view this email address) / Pittsburgh, Pennsylvania 15212
    United States

    Temple University School of Medicine
    Kathleen Hatala / .(JavaScript must be enabled to view this email address) / 215-707-4171
    Theresa Ropars / .(JavaScript must be enabled to view this email address) / 215-707-5440
    Philadelphia, Pennsylvania 19140
    United States

    Nerve and Muscle Center of Texas
    Zinah Rasheed / .(JavaScript must be enabled to view this email address) / 713-795-0033
    Houston, Texas 77030
    United States

    Texas Neurology
    Daragh Heitzman / 214-827-3610
    Dallas, Texas 75214
    United States

    University of Utah
    Mark Bromberg / 801-585-7575
    Salt Lake City, Utah 84108
    United States

    University of Vermont Medical Center
    Shannon Lucy / .(JavaScript must be enabled to view this email address) / 802-656-4582
    Burlington, Vermont 05401
    United States

    Swedish Neuroscience Institute
    Robin Smith / .(JavaScript must be enabled to view this email address) / 206-320-2334
    Seattle, Washington 98122
    United States

    University of Washington Medical Center
    Laura Sissons-Ross / .(JavaScript must be enabled to view this email address) / 206-543-0081
    Seattle, Washington 98195
    United States

    Froedtert Hospital
    Lynn Wheeler / .(JavaScript must be enabled to view this email address) / 414-805-9307
    Milwaukee, Wisconsin 53226
    United States

    Brain and Mind Centre
    Eleanor Ramsey / 02 9351 0976
    Camperdown, New South Wales 2050
    Australia

    Perron Institute for Neurological and Translational Science
    Joanne Borrelli / .(JavaScript must be enabled to view this email address) / Murdoch, Western Australia 6150
    Australia

    Calvary Health Care Bethlehem
    Emma Windebank / .(JavaScript must be enabled to view this email address) / Caulfield South, Victoria 3162
    Australia

    Flinders Medical Centre
    David Schultz / 61 8 8204 4187
    Bedford Park, South Australia 5042
    Australia

    Royal Brisbane and Women's Hospital
    Susan Heggie / .(JavaScript must be enabled to view this email address) / 07 3646 8111
    Brisbane, Queensland 4029
    Australia

    Universität Innsbruck
    Wolfgang Löscher / .(JavaScript must be enabled to view this email address) / Marina Peball / .(JavaScript must be enabled to view this email address) / 43-512-504-25810
    Innsbruck, Tyrol 6020
    Austria

    Salzkammergut-Klinikum Vöcklabruck
    Vöcklabruck, Upper Austria 4840
    Austria

    Medizinische Universität Wien
    Wien, 1090
    Austria

    Universitaire Ziekenhuis Leuven
    Philip Van Damme / 016 344280
    Leuven, Flemish 3000
    Belgium

    Algemeen Ziekenhuis St. Lucas Gent
    Jan De Bleeker / 32-9-2246530
    Gent, Oost-Vlaanderen 9000
    Belgium

    Centre Hospitalier Régional de la Citadelle
    Stephanie Delstanche / .(JavaScript must be enabled to view this email address) / 00 32 4 321 82 24
    Liège, Liege 4000
    Belgium

    Stan Cassidy Centre for Rehabilitation
    Colleen O'Connell / .(JavaScript must be enabled to view this email address) / Susan McCully / .(JavaScript must be enabled to view this email address) / Fredericton, New Brunswick E3B 0C7
    Canada

    Centre De Recherche Du Centre Hospitalier de l'Universite de Montreal - Hopital Notre-Dame
    Geneviève Matte / 514-890-8000 ext 27208
    Montreal, Quebec H2L 4M1
    Canada

    Alberta Health Services - Neuromuscular Clinic
    Jose Martinez / .(JavaScript must be enabled to view this email address) / 403-210-7009
    Janet Petrillo / .(JavaScript must be enabled to view this email address) / 403-210-7006
    Calgary, Alberta T3M 1M4
    Canada

    Montreal Neurological Institute and Hospital
    Angela Genge, MD / .(JavaScript must be enabled to view this email address) / 514-298-3868
    Natalie Saunders / .(JavaScript must be enabled to view this email address) / 514-398-6526
    Montreal, Quebec H3A 2B4
    Canada

    University of Alberta
    Wendy Johnston / 780-248-1089
    Kelsey Tymkow / 780-248-1329
    Edmondton, Alberta T6G 2G3
    Canada

    Moncton Hospital, Southeast Regional Health Authority
    Cynthia Lary / .(JavaScript must be enabled to view this email address) / Moncton, New Brunswick E1C 2Z3
    Canada

    Sunnybrook Health Sciences Centre
    Adrienne Sulistyo / .(JavaScript must be enabled to view this email address) / 416-480-6100 ext 87561
    Toronto, Ontario M4N 3M5
    Canada

    McMaster University Medical Centre
    Daniela Trapsa / .(JavaScript must be enabled to view this email address) / Hamilton, Ontario L8N 3Z5
    Canada

    Centre Hospitalier Affilie Universitaire de Quebec
    Alexandra Simard / 418-649-0252
    Quebec, Quebec G1J 1Z4
    Canada

    Etelä-Karjalan keskussairaala
    Lappeenranta, 53130
    Finland

    Turku University Hospital
    Turku, 20521
    Finland

    Neurologian Poliklinikka - Meilahden Tornisairaala 3
    Helsinki, 00029
    Finland

    Universitätsklinikum Jena
    Julian Großkreutz / .(JavaScript must be enabled to view this email address) / 4936419323428
    Jena, Thuringen 07747
    Germany

    Deutsche Klinik für Diagnostik
    Martina Müller / .(JavaScript must be enabled to view this email address) / 49 611-577652
    Wiesbaden, Hessen 65191
    Germany

    Universitätsklinikum Münster
    Matthias Boentert / .(JavaScript must be enabled to view this email address) / +49 251-834-8196
    Münster, Nordrhein-Westfalen 48149
    Germany

    Universitätsklinikum Carl Gustav Carus
    Andreas Hermann / R. Guenther / 493514582524
    Dresden, Sachsen 01307
    Germany

    Charité Universitätsmedizin Berlin - Campus Virchow-Klinikum
    Thomas Meyer / 0049 30 450 560 028
    Berlin, 13353
    Germany

    Universitätsklinikum Ulm
    A. C. Ludolph / .(JavaScript must be enabled to view this email address) / Ulm, Baden-Württemberg 89081
    Germany

    Universitätsmedizin Rostock
    Rostock, Mecklenburg-western-pommerania 18147
    Germany

    Medizinische Hochschule Hannover
    Susanne Petri / .(JavaScript must be enabled to view this email address) / Hannover, Niedersachsen 30625
    Germany

    Alfried Krupp Krankenhaus Rüttenscheid
    Essen, Nordrhein-westfalen 45131
    Germany

    Beaumont Hospital - Ireland
    Orla Hardiman / .(JavaScript must be enabled to view this email address) / Dublin, 9
    Ireland

    Azienda Ospedaliera - Universitaria Città della Salute e della Scienza di Torino
    Adriano Chio / .(JavaScript must be enabled to view this email address) / 39 0116709170
    Torino, 10126
    Italy

    Azienda Ospedaliera Universitaria-Maggiore della Carità di Novara
    Latizia Mazzini / .(JavaScript must be enabled to view this email address) / Novara, 28100
    Italy

    ICS Maugeri Spa SB
    Gabriele Mora / .(JavaScript must be enabled to view this email address) / Pavia, 27100
    Italy

    Azienda Ospedaliero-Universitaria Pisana Ospedale Santa Chiara
    Pisa, 56126
    Italy

    Policlinico Umberto I di Roma
    Roma, 0016
    Italy

    Universitair Medisch Centrum Utrecht - Rudolf Magnus Instituut voor Neurowetenschappen
    Leonard Van den Berg / .(JavaScript must be enabled to view this email address) / 020 5668227
    Utrecht, 3584 CG
    Netherlands

    Academisch Medisch Centrum
    Marije Voermans / .(JavaScript must be enabled to view this email address) / 20 5668227
    Amsterdam, Noord-Holland 1105 AZ
    Netherlands

    Hospital San Rafael - Madrid
    Jesus S Mora Pardina / .(JavaScript must be enabled to view this email address) / Madrid, 28016
    Spain

    Hospital Universitari de Bellvitge
    Berta Blanco Burguet / 34932607586
    Barcelona, 08207
    Spain

    Hospital Universitario y Politécnico de La Fe
    Juan Francisco Vázquez / .(JavaScript must be enabled to view this email address) / Paula Lizandra / .(JavaScript must be enabled to view this email address) / Valencia, 46026
    Spain

    Hospital Universitario Reina Sofia
    Córdoba, 14011
    Spain

    Hospital de Basurto
    Luis Verona / .(JavaScript must be enabled to view this email address) / Bilbao, Vizcaya 48013
    Spain

    Norrlands Universitetssjukhus
    Peter M Andersen / .(JavaScript must be enabled to view this email address) / Umeå, 907
    Sweden

    Karolinska Universitetssjukhuset
    Karolina Palmback / 08 51771231
    Stockholm, 14186
    Sweden

    Centralsjukhuset Karlstad
    Karlstad, 651 85
    Sweden

    The Walton Centre NHS Foundation Trust
    C A Young / 0151 529-5666
    Liverpool, L9 7LJ
    United Kingdom

    Barts Health NHS Trust
    Aleksandar Radunovic / Kimberley Allen-Phillbey / 02035940637/8
    London, England E1 1BB
    United Kingdom

    King's College Hospital NHS Foundation Trust
    London , England SE5 9RS
    United Kingdom