Official Title:  Answer ALS: The Individualized ALS Treatment Initiative (IATI)

Purpose of the Study: The purpose of this research is to create a large repository of cells, bio-fluid samples (blood and spinal fluid (optional)), and cell lines for ALS gene identification. Samples and information will be used mainly to study ALS and other motor neuron diseases. This will be combined carefully with collected measures of the pattern of the symptoms people with ALS have and how these change over time. This research is a stepping-stone to understanding ALS and through AnswerALS.org.

Eligibility Criteria:

• Diagnosis of Amyotrophic Lateral Sclerosis (ALS) 
• Age 18 and over

Study Status: recruiting participants

Principal Investigator: Stephen Kolb, M.D., Ph.D.

Contact: Ify Okoh, 614-688-7837, Ifeanyi.okoh@osumc.edu

Funding/Study Sponsor: Packard Center for ALS Research at Johns Hopkins and ALS Finding a Cure

Purpose of the Study: 

The purpose of the study is to assess the efficacy and safety of ravulizumab for the treatment of adult participants with ALS.

Eligibility Criteria:

• A diagnosis of sporadic or familial ALS, defined by the El Escorial criteria (possible, laboratory-supported probable, probable, or definite ALS).
• ALS onset ≤ 36 months from Screening.
• Documented meningococcal vaccination not more than 3 years prior to, or at the time of, initiating study treatment.
• Upright slow vital capacity ≥ 65% predicted at Screening.
• If on riluzole, participant must be on a stable dose for 30 days; if on edaravone, participant must be on a stable dose for 60 days (2 cycles).
• Body weight ≥ 40 kilograms at Screening.
• Contraceptive use by men or women should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies.

Exclusion Criteria

• History of Neisseria meningitidis infection.
• Human immunodeficiency virus (HIV) infection (evidenced by HIV 1 or HIV 2 antibody titer).
• Dependence on invasive or non-invasive mechanical ventilation.
• Previously or currently treated with a complement inhibitor.
• Exposure to an investigational drug or device within 30 days of Screening or 5 half lives of the study drug, whichever is greater.

Link:

https://clinicaltrials.gov/ct2/show/NCT04248465?term=ALS+Alexion&draw=2&rank=1

Sponsor:

Alexion Pharmaceuticals

Purpose of the Study: 

The HEALEY ALS Platform Trial is a perpetual multi-center, multi-regimen clinical trial evaluating the safety and efficacy of investigational products for the treatment of ALS.

Eligibility Criteria:

• Sporadic or familial ALS diagnosed as clinically possible, probable, lab-supported probable, or definite ALS defined by revised El Escorial criteria.
• Age 18 years or older.
• Capable of providing informed consent and complying with study procedures, in the SI's opinion.
• Time since onset of weakness due to ALS ≤ 36 months at the time of the Master Protocol Screening Visit.
• Vital Capacity ≥ 50% of predicted capacity for age, height, and sex at the time of the Master Protocol Screening Visit measured by Slow Vital Capacity (SVC), or, if required due to pandemic related restrictions, Forced Vital Capacity (FVC).
• Participants must either not take riluzole or be on a stable dose of riluzole for ≥ 30 days prior to the Master Protocol Screening Visit. Riluzole-naïve participants are permitted in the study.
• Participants must either not take edaravone or have completed at least one cycle of edaravone prior to the Master Protocol Screening Visit. Edaravone-naïve participants are permitted in the study.
• Participants must have the ability to swallow pills and liquids at the time of the Master Protocol Screening Visit and, in the SI's opinion, have the ability to swallow for the duration of the study.
• Geographically accessible to the site.

Exclusion Criteria

• Clinically significant unstable medical condition (other than ALS) that would pose a risk to the participant, according to SI's judgment (e.g., cardiovascular instability, systemic infection, untreated thyroid dysfunction, or clinically significant laboratory abnormality or EKG changes). Lab abnormalities include, but are not limited to: Hemoglobin < 10 g/dL, White Blood Cells < 3.0 x 103/mm3, Neutrophils, Absolute ≤ 1000/mm3, Eosinophilia (absolute eosinophil count of ≥ 500 eosinophils per microliter), low platelet counts (< 150 x 109 per liter), alanine aminotransferase (ALT) or aspartate aminotransferase (AST) greater than 3 times the upper limit of normal (ULN), eGFR < 30 mL/min/1.73m2, thyroid-stimulating hormone (TSH) levels >10 mIU/L or <0.01 mIU/L.
• Presence of unstable psychiatric disease, cognitive impairment, dementia or substance abuse that would impair ability of the participant to provide informed consent, in the SI's opinion.
• Active cancer or history of cancer, except for the following: basal cell carcinoma or successfully treated squamous cell carcinoma of the skin, cervical carcinoma in situ, prostatic carcinoma in situ, or other malignancies curatively treated and with no evidence of disease recurrence for at least 3 years.
• Use of investigational treatments for ALS (off-label use or active participation in a clinical trial) within 5 half-lives (if known) or 30 days (whichever is longer) prior to the Master Protocol Screening Visit.
• Exposure at any time to any gene therapies under investigation for the treatment of ALS (off-label use or investigational).
• If female, breastfeeding, known to be pregnant, planning to become pregnant during the study, or of child-bearing potential and unwilling to use effective contraception for the duration of the trial and for 3 months, or longer as specified in each RSA, after discontinuing study treatment.
• If male of reproductive capacity, unwilling to use effective contraception for the duration of the trial and for 3 months, or longer as specified in each RSA, after discontinuing study treatment.
• Anything that would place the participant at increased risk or preclude the participant's full compliance with or completion of the study, in the SI's opinion.
• If a participant is being re-screened, the disqualifying condition has not been resolved, or the mandatory wash-out duration has not occurred.
• For those participating in the optional CSF collection, contraindication to undergoing a lumbar puncture (LP) in the SI's opinion. Participants undergoing the LP must not be currently taking anticoagulation medications such as warfarin that would be a contraindication to LP; aspirin and non-steroidal anti-inflammatories are allowed.

Link:

https://clinicaltrials.gov/ct2/show/NCT04297683?term=Platform+Trial&cond=ALS&draw=2&rank=1#eligibility

Sponsor:

Merit E. Cudkowicz, MD

Purpose of the Study: Creation of a large repository of induced pluripotent stem cells (iPSC), bio-fluid samples (blood and spinal fluid (optional)), and cell lines for ALS gene identification. This will be combined carefully with collected measures of the pattern of the symptoms people with ALS have and how these change over time. People with other motor neuron diseases and healthy controls will be included as comparisons.

Key Inclusion Criteria:

• Participants with familial or sporadic ALS diagnosed as possible, laboratory-supported probable, probable or definite according to the World Federation of Neurology (WFN) El Escorial criteria, Primary Lateral Sclerosis Flail Arm ALS, Progressive Muscular Atrophy, Monomelic Amyotrophy, Motor Neuron Disease, Asymptomatic ALS Gene Carriers
• Participants who are ages 18-100, inclusive.

Key Exclusion Criteria:

• Participants with Spinal-Bulbar Muscular Atrophy
• Known diagnosis of HIV/AIDS, Hepatitis B, or Hepatitis C.

Study Status: Completed.

Sponsor: Johns Hopkins University

Purpose of the Study: AMX0035 is a combination therapy designed to reduce neuronal death through blockade of key cellular death pathways originating in the mitochondria and endoplasmic reticulum (ER). This clinical trial is designed to demonstrate that treatment is safe, tolerable, and able to slow decline in function as measured by the ALSFRS-R. The trial will also assess the effects of AMX0035 on muscle strength, vital capacity, and biomarkers of ALS including markers of neuronal death and neuroinflammation.

Key Inclusion Criteria:

• Male or female, aged 18-80 years of age
• Sporadic or familial ALS diagnosed as definite as defined by the World Federation of Neurology revised El Escorial criteria
• Less than or equal to 18 months since ALS symptom onset
• Capable of providing informed consent and following trial procedures
• Slow Vital Capacity (SVC) >60% of predicted value for gender, height, and age at the Screening Visit
• Subjects must either not take riluzole or be on a stable dose of riluzole for at least 30 days prior to the Screening Visit. Riluzole-naïve subjects are permitted in the study.
• Women of child bearing potential (e.g. not post-menopausal for at least one year or surgically sterile) must agree to use adequate birth control for the duration of the study and 3 months after last dose of study drug. Women must not be planning to become pregnant for the duration of the study and 3 months after last dose of study drug
• Men must agree to practice contraception for the duration of the study and 3 months after last dose of study drug. Men must not plan to father a child or provide for sperm donation for the duration of the study and 3 months after last dose of study drug

Key Exclusion Criteria:

• Presence of tracheostomy
• Exposure to PB, Taurursodiol or UDCA within 3 months prior to the Screening Visit or planning to use these medications during the course of the study
• History of known allergy to PB or bile salts
• Abnormal liver function defined as AST and/or ALT > 3 times the upper limit of the normal
• Renal insufficiency as defined by a serum creatinine > 1.5 times the upper limit of normal
• Poorly controlled arterial hypertension (SBP>160mmHg or DBP>100mmHg) at the Screening Visit
• Pregnant women or women currently breastfeeding
• History of cholecystectomy
• Biliary disease which impedes biliary flow including active cholecystitis, primary biliary cirrhosis, sclerosing cholangitis, gallbladder cancer, gallbladder polyps, gangrene of the gallbladder, abscess of the gallbladder.
• History of Class III/IV heart failure (per New York Heart Association - NYHA)
• Severe pancreatic or intestinal disorders that may alter the enterohepatic circulation and absorption of TUDCA including biliary infections, pancreatitis and ileal resection
• The presence of unstable psychiatric disease, cognitive impairment, dementia or substance abuse that would impair ability of the subject to provide informed consent, according to Site Investigator judgment
• Clinically significant unstable medical condition (other than ALS) that would pose a risk to the subject if they were to participate in the study
• Active participation in an ALS clinical trial evaluating a small molecule within 30 days of the Screening Visit
• Exposure at any time to any biologic under investigation for the treatment of subjects with ALS (off-label use or investigational) including cell therapies, gene therapies, and monoclonal antibodies.
• Implantation of Diaphragm Pacing System (DPS)

Study Status: Completed.

Sponsor: Amylyx Pharmaceuticals Inc.

Purpose of the Study: 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.

Key Inclusion Criteria:

• Written or verbal informed consent (IC) for participation in the study
• Male or female subjects with diagnosis of laboratory supported probable, probable or definite ALS according to El Escorial revised criteria. Full electromyogram (EMG) report available consistent with ALS (but not necessarily fulfilling the electrodiagnostic criteria for ALS) from an experienced neurophysiologist
• Able to swallow study treatment capsules, and in the opinion of the investigator, is expected to continue to do so during the study
• Sitting SVC between 60-90% of the predicted value for age, height and sex at screening visit
• 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 and/or edaravone. If using riluzole (any daily dose up to 100 mg), the dose must have been stable for at least 4 weeks before the screening visit and should not be changed during the study. If using edaravone, the treatment should have been started at least 4 weeks before the screening visit (at least one 28-day treatment cycle as indicated) and should not be changed during the study. If not on riluzole and/or edaravone, the respective treatments should not be started during the study

Key Exclusion Criteria:

• Subject in whom other causes of neuromuscular weakness have not been excluded
• Subject with a 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 the present phase III study or earlier study with oral levosimendan in ALS patients (LEVALS)
• 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. If the HR is > 100 bpm in the first recording, then the second recording must be done after another 5 min rest to confirm HR > 100 bpm
• 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

Study Status: Completed.

Sponsor: Orion Corporation, Orion Pharma

Purpose of the Study: Interventional/Observational: to determine if DPS is associated with improved survival or diaphragm function

Eligibility Criteria:

1. Age 21 years or older
2. Sporadic or familial ALS
3. Evidence of hypoventilation at screening with at least one of the following:

1. Maximal static inspiratory pressure (MIP) <60 cm H20
2. Upright or supine forced vital capacity (FVC) <50% predicted for gender, age and height

4. Subjects must not have taken riluzole for at least 30 days, or be on a stable dose of riluzole for at least 30 days, prior to randomization (riluzole-naïve subjects are permitted in the study)
5. Geographically accessible to the site
6. Negative urine pregnancy test

Study Status: recruiting participants

Principal Investigator: Adam Quick, MD

Contact: Ify Okoh, 614-688-7837, Ifeanyi.okoh@osumc.edu

Funding: Barrow Neurological Institute, ALS Association, Muscular Dystrophy Association, Synapse Biomedical

Purpose of the Study: Observational: to derive induced pluripotent stem (iPS) cells from cells in the skin of patients with motor neuron diseases for the purpose of understanding the basic mechanisms of disease

Eligibility Criteria:
Inclusion for healthy control group:

• 18 years of age
• Individuals who do not have a diagnosis of a motor neuron disease (including those with other neurological diseases)

• 18 years of age
• Individuals who have a diagnosis of amyotrophic lateral ssclerosis (ALS), spinal muscular atrophy (SMA), progressive bulbar palsy (PBP) or other related diseases

Study Status: currently recruiting

Principal Investigator: Stephen Kolb, MD, PhD

Contact: Ify Okoh, 614-688-7837, Ifeanyi.Okoh@osumc.edu

Funding: OSU faculty development funds

Purpose of the Study: Observational: to evaluate the soluble factors in the cerebral spinal fluid in individuals with motor neuron disease

Eligibility Criteria:
Inclusion Criteria for Affected Participants:

1. Diagnosis of ALS
2. 18 years of age at the time of consent
3. Medically safe to have lumbar puncture

1. Absence of a known neurological disorder
2. 18 years of age at the time of consent
3. Medically safe to have lumbar puncture

Study Status: recruiting participants

Principal Investigator: Stephen Kolb, MD, PhD

Contact: Ify Okoh, 614-688-7837, Ifeanyi.Okoh@osumc.edu

Funding: OSU faculty development funds

Official Title: A Phase 3, Multi-National, Double-Blind, Randomized, Placebo-Controlled, Stratified, Parallel Group, Study to Evaluate the Safety, Tolerability and Efficacy of tirasimtiv in Patients with Amyotrophic Lateral Sclerosis (ALS)

Purpose of the Study: This is a Phase 3, placebo-controlled clinical trial testing the effectiveness of a medication called tirasemtiv to slow the rate of decline of respiratory, muscle, and physical function in individuals with ALS.

Description: CY 4031 is a multi-national, double-blind, randomized, placebo-controlled, study in patients with ALS with study medication, tirasemtiv. The study includes three phases; an open-label phase (2 weeks), a double-blind, placebo-controlled phase (48 weeks), and a double-blind, placebo-controlled tirasemtiv withdrawal phase (4 weeks). Patients who can complete two weeks of treatment with open-label tirasemtiv (125 mg twice daily) will be randomized to placebo and three different dose levels of tirasemtiv. Patients who enter the study on riluzole 50 mg twice daily will continue on riluzole but at a reduced dose of 50 mg once daily.

Eligibility Criteria: 

• Male or female 18 years of age or older
• A diagnosis of familial or sporadic ALS ≤ 24 months prior to screening
• Upright SVC ≥ 70 % of predicted for age, height and sex
• Able to swallow tablets without crushing

Study Status: currently recruiting

Principal Investigator: Stephen Kolb, MD, PhD

Contact: Sharon Chelnick, 614-293-4973, Sharon.chelnick@osumc.edu

Funding/Study Sponsor: Cytokinetics, Inc.

Purpose of the Study: Friedreich's ataxia is an autosomal recessive cerebellar ataxia caused by triplet-repeat expansions. The causative mutation is a trinucleotide (GAA) repeat expansion in the first intron of the frataxin gene, leading to impaired transcription of frataxin. The pathological consequences of frataxin deficiency include a severe disruption of iron-sulfur cluster biosynthesis, mitochondrial iron overload coupled to cellular iron dysregulation, and an increased sensitivity to oxidative stress.

A hallmark of Friedreich's ataxia is impairment of antioxidative defense mechanisms, which play a major role in disease progression. Studies have demonstrated that nuclear factor erythroid-derived 2-related factor 2 (Nrf2) signaling is grossly impaired in patients with Friedreich's ataxia. Therefore, the ability of omaveloxolone (RTA 408) to activate Nrf2 and induce antioxidant target genes is hypothesized to be therapeutic in patients with Friedreich's ataxia. This 2-part study will evaluate the efficacy, safety, and pharmacodynamics of omaveloxolone (RTA 408) in the treatment of patients with Friedreich's ataxia.

Key Inclusion Criteria:

• Have genetically confirmed Friedreich's ataxia
• Have a modified FARS score ≥20 and ≤80
• Be male or female and ≥16 years of age and ≤40 years of age
• Have no changes to exercise regimen within 30 days prior to Study Day 1 and be willing to remain on the same exercise regimen during the 16-week study period
• Have the ability to complete maximal exercise testing
• Be able to swallow capsules

Key Exclusion Criteria:

• Have uncontrolled diabetes (HbA1c >11.0%)
• Have B-type natriuretic peptide value >200 pg/mL
• Have a history of clinically significant left-sided heart disease and/or clinically significant cardiac disease
• Have known active fungal, bacterial, and/or viral infection, including human immunodeficiency virus or hepatitis virus (B or C)
• Have known or suspected active drug or alcohol abuse
• Have clinically significant abnormalities of clinical hematology or biochemistry, including but not limited to elevations greater than 1.5 times the upper limit of normal of aspartate aminotransferase, or alanine aminotransferase
• Have any abnormal laboratory test value or serious pre-existing medical condition that, in the opinion of the investigator, would put the patient at risk by study enrollment
• Have taken any of the following drugs within 7 days prior to Study Day 1 or plan to take any of these drugs during the time of study participation:
  Sensitive substrates for cytochrome P450 2C8 or 3A4 (e.g., repaglinide, midazolam, sildenafil)
  Moderate or strong inhibitors or inducers of cytochrome P450 3A4 (e.g., carbamazepine, phenytoin, ciprofloxacin, grapefruit juice)
  Substrates for p-glycoprotein transporter (e.g., ambrisentan, digoxin)
• Have participated in any other interventional clinical study within 30 days prior to Study Day 1
• Have a cognitive impairment that may preclude ability to comply with study procedures
• Prior participation in a trial with omaveloxolone (RTA 408)

Study Status: Active, not recruiting.

Sponsor: Reata Pharmaceuticals, Inc.

Purpose of the Study: Observational: to validate clinical outcome measures in FA and build a DNA/RNA bank for future research

Eligibility Criteria:

1. Males or females age 7 to 80 years
2. Genetically confirmed diagnosis of FA, or clinically confirmed diagnosis of FA, pending confirmatory genetic testing

Study Status: Recruiting participants

Principal Investigator: J. Chad Hoyle, MD

Contact: Amy Barlett, 614-366-9050, Amy.bartlett@osumc.edu

Funding: Friedreich’s Ataxia Research Alliance

Purpose of the Study: Interventional: to evaluate the safety and tolerability of RTA-408 and the change in peak work in maximal exercise testing in individuals with Friedreich’s Ataxia

Eligibility Criteria:

1. Genetically confirmed Friedreich’s ataxia
2. Male or female, age 16-40 inclusive
3. No changes to their exercise regimen within 30 days prior to study day 1 and willing to remain on the same exercise regimen during the study
4. Ability to complete maximal bicycle testing
5. Adequate kidney function
6. Able to swallow capsules

Study Status: Recruiting participants

Principal Investigator: J. Chad Hoyle, MD

Contact: Amy Barlett, 614-366-9050, Amy.bartlett@osumc.edu

Funding: Reata Pharmaceuticals, Inc.

Purpose of the Study: Interventional: to evaluate the safety and efficacy of fingolimod for the treatment of CIDP

Eligibility Criteria:

1. Patients must either have a clinical diagnosis of CIDP
2. A documented history of disability sufficient to require treatment within the past 2 years following reduction or interruption of CIDP treatment
3. Receiving IVIg treatment or corticosteroids
4. History of documented clinically meaningful deterioration confirmed by clinical examination
5. Stable CIDP symptoms without significant change in treatment regimen
6. Male or female, aged 18 years or older

• Electrophysiological criteria for demyelinating
• Have documented clinically meaningful response to treatment with steroids, IVIg or plasma exchange, confirmed by clinical examination within previous year

Study Status: recruiting participants

Principal Investigator: Stanley Iyaduari, PhD, MD

Contact: Amy Bartlett, 614-366-9050, Amy.bartlett@osumc.edu

Funding: Novartis Pharmaceuticals

Purpose of the Study: Interventional: to evaluate the safety and efficacy of two different doses of subcutaneous immunoglobulin for the treatment of CIDP

Eligibility Criteria:

1. Definite or probable CIDP
2. An IVIG treatment during the past 8 weeks prior to enrollment
3. Age ≥18 years
4. Male or female

• Positive IgG dependency test

• Maintenance of INCAT score

Study Status: Recruiting participants

Principal Investigator: Miriam Freimer, MD

Contact: Amy Bartlett, 614-366-9050, Amy.bartlett@osumc.edu

Funding: CSL Behring, ICON Clinical Research

Purpose of the Study: The primary cause of facioscapulohumeral muscular dystrophy (FSHD), a common adult-onset dystrophy, was recently discovered identifying targets for therapy. As multiple drug companies pursue treatments for FSHD, there is an urgent need to define the clinical trial strategies which will hasten drug development, including creating disease-relevant outcome measures and optimizing inclusion criteria. This proposal will develop two new outcome measures and optimize eligibility criteria by testing 160 patients in 7 sites over a period of 18 months.

Key Inclusion Criteria:

• Patients with genetically confirmed FSHD1 or clinical diagnosis of FSHD with characteristic findings on exam and an affected parent or offspring
• Patients with symptomatic limb weakness
• Patients must be able to walk 30 feet without the support of another person or assistance (canes, walking sticks, and braces allowed; no walker).
• If taking over the counter supplements, willing to remain consistent with supplement regimen throughout the course of the study
  
   

Key Exclusion Criteria:

• Patients with cardiac or respiratory dysfunction (deemed clinically unstable, or would interfere with safe testing, in the opinion of the Investigator)
• Patients with orthopedic conditions that preclude safe testing of muscle function
• Patients that regularly use available muscle anabolic/catabolic agents such as corticosteroids, oral testosterone or derivatives, or oral beta agonists
• Patients that have used an experimental drug in an FSHD clinical trial within the past 30 days
• Patients that are pregnant

Study Status: Active, not recruiting.

Sponsor: University of Kansas Medical Center

Purpose of the Study: This is a study to evaluate the safety and efficacy of Losmapimod in treating patients with Facioscapulohumeral Muscular Dystrophy (FSHD) over 48 weeks.

Key Inclusion Criteria:

• The patient must have consented to participate and must have provided signed, dated and witnessed IRB-approved informed consent form that conforms to federal and institutional guidelines.
  Male or female subjects
• Patients must be between 18 and 65 years of age, inclusive
• Confirmed diagnosis of FSHD1 with 1 to 9 repeats via assessment of the size of the D4Z4 array on chromosome 4. Genetic confirmation must be obtained prior to the screening MRI and baseline muscle biopsy.
• Clinical severity score of 2 to 4 (RICCI Score; Range 0-5), inclusive at screening
• Must have a MRI-eligible muscle for biopsy
• Must be willing and able to comply with scheduled visits, treatment plan, study restrictions, laboratory tests, contraceptive guidelines and other study procedures.
• Will practice an approved method of birth control
  
   

Key Exclusion Criteria:

• Has a history of any illness or any clinical condition that, in the opinion of the investigator, might confound the results of the study or pose an additional risk in administering study drug to the subject. This may include, but is not limited to, a history of relevant drug or food allergies; history of cardiovascular or central nervous system disease; neuromuscular diseases except FSHD (eg, myopathy, neuropathy, neuromuscular junction disorders); or clinically significant history of mental disease.
• For subjects who are on drug(s) or supplements that may affect muscle function, as determined by the treating physician, or that are included in the list of drugs presented in the protocol, subjects must be on a stable dose of that drug(s) or supplement for at least 3 months prior to the first dose of study drug and remain on that stable dose for the duration of the study. Changes to the dose or treatment discontinuation during the study can only be done for strict medical reasons by the treating physician with clear documentation and notification to the sponsor.
• Acute or chronic history of liver disease or known to have current alanine aminotransferase ≥2 × upper limit of normal (ULN) or total bilirubin >1.5 × ULN, or known history of hepatitis B or C.
• Known severe renal impairment (defined as a glomerular filtration rate of <30 mL/min/1.73m2).
• Positive screen for hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) antibody, or antibodies against human immunodeficiency virus (HIV)-1 and -2.
• Male subjects with a female partner who is planning to become pregnant during the study or within 90 days after the last dose of study drug.
• Use of another investigational product within 30 days or 5 half-lives (whichever is longer), or according to local regulations, or currently participating in a study with an investigational product. Note: concurrent participation in other non-drug studies may be acceptable if confirmed in writing by the sponsor.

Study Status: Completed

Sponsor: Fulcrum Therapeutics

Purpose of the Study: This study is an open-label extension to evaluate the safety and tolerability of long-term dosing of Losmapimod in patients with FSHD1 who participated in the ReDux4 study.

Key Inclusion Criteria:

• The patient must have consented to participate and must have provided signed, dated and witnessed an IRB-approved informed consent form that conforms to federal and institutional guidelines.
• Male or female subjects
• Patients must be between 18 and 65 years of age, inclusive
• Confirmed diagnosis of FSHD1 with 1 to 9 repeats via assessment of the size of the D4Z4 array on chromosome 4. Genetic confirmation must be obtained prior to the screening MRI and baseline muscle biopsy.
• Clinical severity score of 2 to 4 (RICCI Score; Range 0-5), inclusive at screening
• Must have a MRI-eligible muscle for biopsy
• Must be will and able to comply with scheduled visits, treatment plan, study restrictions, laboratory tests, contraceptive guidelines and other study procedures.
• Will practice an approved method of birth control

Key Exclusion Criteria:

• Has a history of any illness or any clinical condition that, in the opinion of the investigator, might confound the results of the study or pose an additional risk in administering study drug to the subject. This may include, but is not limited to, a history of relevant drug or food allergies; history of cardiovascular or central nervous system disease; neuromuscular diseases except FSHD (eg, myopathy, neuropathy, neuromuscular junction disorders); or clinically significant history of mental disease.
• For subjects who are on drug(s) or supplements that may affect muscle function, as determined by the treating physician, or that are included in the list of drugs presented in the protocol, subjects must be on a stable dose of that drug(s) or supplement for at least 3 months prior to the first dose of study drug and remain on that stable dose for the duration of the study. Changes to the dose or treatment discontinuation during the study can only be done for strict medical reasons by the treating physician with clear documentation and notification to the sponsor.
• Acute or chronic history of liver disease or known to have current alanine aminotransferase ≥2 × upper limit of normal (ULN) or total bilirubin >1.5 × ULN, or known history of hepatitis B or C.
• Known severe renal impairment (defined as a glomerular filtration rate of <30 mL/min/1.73m2).
• Positive screen for hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) antibody, or antibodies against human immunodeficiency virus (HIV)-1 and -2.
• Male subjects with a female partner who is planning to become pregnant during the study or within 90 days after the last dose of study drug.
• Use of another investigational product within 30 days or 5 half-lives (whichever is longer), or according to local regulations, or currently participating in a study with an investigational product. Note: Concurrent participation in other non-drug studies may be acceptable if confirmed in writing by the sponsor.

Study Status: Enrolling by invitation.

Sponsor: Fulcrum Therapeutics

Purpose of Study: Observational: to evaluate outcome measures for future clinical trials in FSHD

Eligibility Criteria:

• Clinical diagnosis of FSHD with genetic confirmation as previously described (19, 20)
• Age: 18-75 years
• Symptomatic: The subject has to have symptomatic limb weakness
• Independently ambulatory: able to walk 30 feet without the support of another person

Study Status: Recruiting participants

Contact: Amy Bartlett, 614-366-9050, Amy.bartlett@osumc.edu

Purpose of the Study: Interventional: to evaluate the safety, tolerability and biological activity of ATYR 1940-C-002 in individuals with FSHD

Eligibility Criteria:

• Patient is a male or female aged 18 to 65, inclusive
• Patient has an established, genetically confirmed diagnosis of FSHD
• Patient has imaging findings meeting defined criteria for muscle inflammation in at least 1 skeletal muscle

Study Status: Recruiting participants

Principal Investigator: Stanley Iyadurai, MD, PhD

Contact: Amy Bartlett, 614-366-9050, Amy.bartlett@osumc.edu

Funding: aTyr Pharma, Inc.

Purpose of the Study: Building on previous work of the Myotonic Dystrophy Clinical Research Network (DMCRN), the present study seeks to overcome insufficient data on natural history; lack of reliable biomarkers; and incomplete characterization and limited biological understanding of the phenotypic heterogeneity of Myotonic Dystrophy 1 by examining strategies to improve the reliability by making further refinements in our sample collection and analysis procedures by developing strategies for managing patient heterogeneity going forward.

Key Inclusion Criteria:

• Age 18 to 70 (inclusive)
• Competent to provide informed consent
• Clinical diagnosis of DM1 based on research criteria1 or positive genetic test
• Comment: The clinical research criteria require myotonia, muscle weakness in a characteristic distribution, and history of similar findings in a first degree relative. Genetic testing confirmed the diagnosis of DM1 in > 99% of individuals who satisfied these criteria
• Of the 95 patients undergoing the tibialis anterior muscle biopsy, at least half will have at least moderate weakness of ankle dorsiflexion, defined as MRC score ≤ 4+. This is in order to obtain a muscle tissue sample in a person more severely affected with myotonic dystrophy. Approximately 10 patients at each site will undergo the muscle biopsy.

Key Exclusion Criteria:

• Symptomatic renal or liver disease, uncontrolled diabetes or thyroid disorder, or active malignancy other than skin cancer.
• Current alcohol or substance abuse
• Concurrent enrollment in clinical trial for DM1, or participation in trial within 6 months of entry.
• Concurrent pregnancy or planned pregnancy during the course of the study.
• Concurrent medical condition that would, in the opinion of the investigator or clinical evaluator, compromise performance on study measures.
  Note: non-ambulatory participants are not excluded, but are limited to <15% of enrollment.
• Known CTG repeat expansion size less than 100 repeats, unless there are clear cut signs of limb weakness and muscle wasting. This is in order to obtain a muscle tissue sample in a person more severely affected with myotonic dystrophy.
• Use of anticoagulant such as warfarin or a direct oral anticoagulant (e.g. dabigatran) due to the increased risk of bleeding.
• Use of aspirin or non-steroidal anti-inflammatory agents should be discontinued 3 days prior to the biopsy procedure, if possible.
• Platelet count <50,000 (if known) due to the increased risk of bleeding.
• History of a bleeding disorder due to the increased risk of bleeding.
• Advanced wasting of tibialis anterior (TA) muscle that precludes needle muscle biopsy in order to ensure that a sample taken would be of muscle and not just fat and fascia.
• Previous muscle biopsy of either TA in order to provide muscle tissue samples of non-biopsied muscles.

Study Status: Enrolling by invitation.

Sponsor: Virginia Commonwealth University

Purpose of the Study: Interventional: to test the safety, tolerability and pharmacokinetics of multiple escalating doses of ISIS-DMPKRx

Eligibility Criteria:

1. Males or females aged 20 to 55
2. BMI < 35.0 kg/m2/li>
3. Genetic confirmation of DM1 with DMPK CTG repeat length ≥ 100
4. Onset of DM1 symptoms after the age of 12/li>
5. Ambulatory (orthoses allowed, canes and walkers not allowed) and able to walk at least 25 meters at screening

Study Status: Recruiting participants

Contact: Amy Bartlett, 614-366-9050, Amy.bartlett@osumc.edu

Funding: Isis Pharmaceuticals

Purpose of the Study: Observational: to identify biomarkers for myotonic dystrophy

Eligibility Criteria:

1. Men and women, 18 to 70, inclusive
2. BMI ≤33
3. Onset of DM1 after age 10
4. Clinical diagnosis of DM1 or prior genetic testing with confirmation of DMPK CTG repeat length ≥70
5. Ability to complete a 6-minute walk test (ankle foot orthoses are allowed, but canes and walkers are not)

Study Status: Recruiting participants

Contact: Amy Bartlett, 614-366-9050, Amy.bartlett@osumc.edu

Funding: National Institute of Neurological Disorders and Stroke (NINDS)

Purpose of the Study: THAOS is a global, multi-center, longitudinal observational survey open to all patients with transthyretin amyloidosis (ATTR), including ATTR-PN (polyneuropathy), ATTR-CM (cardiomyopathy) and wild-type ATTR-CM. It is open-ended with a minimum duration of 10 years. Patients will be followed as long as they are able to participate. The principal aims of this outcome survey are to better understand and characterize the natural history of the disease by studying a large and heterogenous patient population. Survey data may be used to develop new treatment guidelines and recommendations, and to inform and educate clinicians about the management of this disease.

Key Inclusion Criteria:

• Evidence of a personally signed and dated informed consent document indicating that the participant (or a legally acceptable representative) has been informed of all pertinent aspects of the study.
• Males and females greater than or equal to 18 years of age.
• Confirmed genotyped TTR mutation with or without a diagnosis of hereditary or wild-type ATTR amyloidosis. Confirmation of ATTRwt amyloidosis will be determined by genotyped confirmation that patient does not possess a known mutation in TTR gene (ie, is a carrier of wild-type allele only) via genetic testing and one of the following set of criteria (a, b, or c):
  Presence of amyloid in cardiac biopsy tissue confirmed as TTR amyloid by mass spectrometry or immunohistochemistry; or
  Evidence of cardiac involvement by echocardiogram as defined by left ventricle wall thickness of >12 mm, and presence of amyloid in non-cardiac tissue confirmed as TTR amyloid by mass spectrometry or immunohistochemistry; or
  Evidence of cardiac involvement by echocardiogram as defined by left ventricle wall thickness of >12 mm, and presence of amyloid in cardiac tissue indirectly confirmed by scintigraphy with a "bone seeking tracer" eg, 99mTC-DPD [99mTC-3,3-diphosphono-1,2-propano-dicarboxylic acid], 99mTC- PYP [Pyrophosphate], and 99mTC-HMDP [hydroxymethylene diphosphonate] with Perugini grade greater than or equal to 2.

Key Exclusion Criteria:

• Patient has evidence of primary (light chain) or secondary amyloidosis.

Study Status: Recruiting.

Sponsor: Pfizer

Purpose of the Study: The purpose of this study is to evaluate the safety and efficacy of long-term dosing with ALN-TTR02 (patisiran) in patients with transthyretin (TTR) mediated amyloidosis (ATTR).

Key Inclusion Criteria:

• Have completed a patisiran study (i.e., completed the last efficacy visit in the parent study) and, in the opinion of the investigator, tolerated study drug
• Be willing and able to comply with the protocol-required visit schedule and visit requirements and provide written informed consent

Key Exclusion Criteria:

• Any new or uncontrolled condition that could make the patient unsuitable for participation

Study Status: Active, not recruiting.

Sponsor: Alnylam Pharmaceuticals

Purpose of the Study: The TopCSPN trial is a double blinded randomized placebo controlled study of oral topiramate as a potential disease modifying therapy for cryptogenic sensory peripheral neuropathy (CSPN). Patients with CSPN who also have metabolic syndrome (defined by the ATPIII criteria) who do not have an alternative cause for neuropathy will be potentially eligible. The co primary outcome measures are change in the Norfolk Quality of Life - Diabetic Neuropathy (NQOL-DN) Scale and intraepidermal nerve fiber density (IEFND) at the distal thigh. The treatment phase will last 24 months.

Key Inclusion Criteria:

• Age 18-80
• Diagnosis of confirmed symptomatic distal symmetric peripheral polyneuropathy based on the Toronto consensus criteria for probable neuropathy (the presence of unequivocal signs and symptoms of neuropathy)45.
• Evidence of symptomatic neuropathy based on a screening visit NQOL-DN score of >9.
• Metabolic syndrome based on modified ATPIII criteria. Specific criteria require 3 of the following 6 to be present at the screening visit.
  Waist circumference >102 cm for men, >88 cm for women
  Serum triglycerides of > 150 mg/dl
  HDL < 40 mg/dl for men, < 50 mg/dl for women
  Those with either a normal HDL or TRG who are taking a lipid lowering medication for this purpose
  Blood pressure 130/85 mm Hg or use of anti-hypertension drug
  Hyperglycemia based on American Diabetes Association (ADA) criteria at screening based on any one or more of the following: fasting plasma glucose > 100 mg/dL (5.6 mmol/L), 2-hour glucose tolerance test > 140 mg/dL (7.8 mmol/L), or hemoglobin A1c > 5.7% .
• No current or prior history of therapy with topiramate.
• If female of child-bearing potential (i.e., not surgically sterile or post-menopausal defined as age > 51 years without menses for ≥ 2 years), negative serum pregnancy test at screening and negative urine pregnancy test at baseline visit.
• Women of child-bearing potential or men with sexual partners of childbearing potential be willing to use an acceptable method of birth control for the duration of the study and for 12 weeks following completion of study drug therapy. Acceptable methods of birth control include abstinence, oral contraceptives, the contraceptive patch, intra-uterine device, the contraceptive ring, and or barrier contraception such as condoms with spermicide.

Key Exclusion Criteria:

• CSS-PI clinical determination of an alternative cause for peripheral neuropathy (including but not limited to rheumatological disorders, Hepatitis B or C, breast cancer treated with neurotoxic chemotherapy within the past 15 years). All potential subjects will have screening neuropathy labs including assessment for diabetes (Hemoglobin A1c, oral glucose tolerance test), vitamin B12 level, and immunofixation47.
• Type I diabetes or current use of insulin or use of insulin in the past 3 months.
• HgA1c > 7.5%. Borderline screening labs can be repeated within two weeks with PPI approval.
• History of recurrent nephrolithiasis, a single episode of nephrolithiasis within one year prior to screening, or use of ongoing preventative treatment.
• Family history of a hereditary neuropathy in a first-degree relative.
• Severe neuropathy: Utah Early Neuropathy Score > 24 at screening
• Active foot ulceration or a history of a nontraumatic foot amputation.
• ECG with QTc more than 450 ms in men, or 470 ms in women.
• Risk of excessive bleeding at the skin biopsy site based on the clinical assessment of the CSS-PI.
• Chronic corticosteroid use excluding topical or inhaled treatment.
• Use of a carbonic anhydrase inhibitor (such as acetazolamide) due to risk of nephrolithiasis.
• Planned bariatric surgery.
• Use of other weight loss medications.
• Use of scheduled opiates, or as needed opiate medications more than three times weekly.
• Use of topical capsaicin products within 16 weeks of screening or at any time on study.
• Medication change for neuropathy symptoms during the 8 weeks prior to screening; or anticipated change for the duration of study participation.
• Current use of an intrathecal pain pump or spinal cord stimulator.
• Screening laboratory creatinine ≥ 2.0 mg/dl.
• Severe edema, dermatologic or lower extremity condition that would increase risk of skin biopsy.
• Major depression, bipolar affective disorder, or other mental health disorders that are sufficiently severe to increase adverse event risk or impact neuropathy assessment in the opinion of the responsible site principal investigator.
• Current suicidal ideation within one year prior to the baseline visit as evidenced by answering "yes" to Questions 4 or 5 on the suicidal ideation portion of the Columbia-Suicide Severity Rating Scale (C-SSRS).
• Ataxia sufficiently severe to represent an unacceptable fall risk in the opinion of the site principal investigator.
• A serious medical condition expected to dramatically shorten life span or prevent participation.
• Any clinically significant condition or illness, which, in the opinion of the CSS-PI, would pose a risk to the subject or might confound the study including metabolic acidosis, bone marrow suppression, blood dyscrasias, bleeding disorder, or closed angle glaucoma.
• History of alcohol or drug abuse within the past two years, or existing neuropathy related to past drug or alcohol abuse.
• History of malignancy within five years prior to study enrollment, except for adequately treated basal cell or squamous cell skin cancer or in situ cervical cancer.
• A history of epilepsy.
• An inability to understand or cooperate with the procedures of the study.
• Pregnant, or intending to become pregnant, or breastfeeding.

Study Status: Active, not recruiting.

Sponsor: Virginia Commonwealth University

Purpose of the Study: To evaluate the safety and efficacy of intravenous onasemnogene abeparvovec-xioi in pre-symptomatic patients with SMA and 2 or 3 copies SMN2

Key Inclusion Criteria:

• Age ≤6 weeks (≤42 days) at time of dose
• Ability to tolerate thin liquids as demonstrated through a formal bedside swallowing test
• Compound muscle action potential (CMAP) ≥2mV at Baseline; centralized review of CMAP data will be conducted
• Gestational age of 35 to 42 weeks
  • Patients with pre-symptomatic SMA Type 1 as determined by the following features:
• 2 copies of SMN2 Patients with 2 copies of SMN2 (n ≥12)
  • Patients with pre-symptomatic SMA Type 2 as determined by the following features:
• 3 copies of SMN2

Key Exclusion Criteria:

• Weight at screening visit <2 kg
• Hypoxemia (oxygen saturation <96% awake or asleep without any supplemental oxygen or respiratory support) at the screening visit or for altitudes >1000 m, oxygen saturation <92% awake or asleep without any supplemental oxygen or respiratory support at the screening visit
• Any clinical signs or symptoms at screening or immediately prior to dosing that are, in the opinion of the Investigator, strongly suggestive of SMA
• Tracheostomy or current prophylactic use or requirement of noninvasive ventilatory support at any time and for any duration prior to screening or during the screening period
• Patients with signs of aspiration/inability to tolerate nonthickened liquids based on a formal swallowing test performed as part of screening or patients receiving any non-oral feeding method
• Clinically significant abnormalities in hematology or clinical chemistry parameters as determined by investigator or medical monitor
• Treatment with an investigational or commercial product, including nusinersen, given for the treatment of SMA. This includes any history of gene therapy, prior antisense oligonucleotide treatment, or cell transplantation.
• Patients whose weight-for-age is below the third percentile based on World Health Organization (WHO) Child Growth Standards
• Biological mother with active viral infection as determined by screening laboratory samples (includes human immunodeficiency virus [HIV] or positive serology for hepatitis B or C)
  • Biological mothers with clinical suspicion of Zika virus that meet Centers for Disease Control and Prevention (CDC) Zika virus epidemiological criteria including history of residence in or travel to a geographic region with active Zika transmission at the time of travel will be tested for Zika virus RNA. Positive results warrant confirmed negative Zika virus RNA testing in the patient prior to enrollment.
• Serious nonrespiratory tract illness requiring systemic treatment and/or hospitalization within 2 Weeks prior to screening
• Upper or lower respiratory infection requiring medical attention, medical intervention, or increase in supportive care of any manner within 4 Weeks prior to dosing
• Severe nonpulmonary/respiratory tract infection within 4 Weeks before administration of gene replacement therapy or concomitant illness that, in the opinion of the Investigator or Sponsor medical monitor, creates unnecessary risks for gene replacement therapy such as:
  Major renal or hepatic impairment
  Known seizure disorder
  Diabetes mellitus
  Idiopathic hypocalciuria
  Symptomatic cardiomyopathy
• Known allergy or hypersensitivity to prednisolone or other glucocorticosteroids or their excipients
• Previous, planned or expected major surgical procedure including scoliosis repair surgery/procedure during the study assessment period
• Concomitant use of any of the following: drugs for treatment of myopathy or neuropathy, agents used to treat diabetes mellitus, or ongoing immunosuppressive therapy, plasmapheresis, immunomodulators such as adalimumab, immunosuppressive therapy within 4 Weeks prior to gene replacement therapy
• AntiAAV9 antibody titer >1:50 as determined by Enzyme-linked Immunosorbent Assay (ELISA) binding immunoassay
  • Should a potential patient demonstrate AntiAAV9 antibody titer >1:50, he or she may receive retesting inside the 30-Day screening period and will be eligible to participate if the AntiAAV9 antibody titer upon retesting is ≤1:50, provided the <6 Week age requirement at the time of dosing is still met
• Biological mother involved with the care of the child refuses anti-AAV9 antibody testing prior to dosing

Study Status: Active, not recruiting.

Sponsor: Novartis Gene Therapies

Purpose of the Study: Anti-myelin-associated glycoprotein (MAG) is a rare autoimmune disorder of the peripheral nerves that presents with weakness, gait imbalance, and loss of sensation. It almost always occurs in the setting of excess protein buildup in the body in the form of immunoglobulin monoclonal (IgM) gammopathy. Anti-MAG neuropathy currently has no established therapies. It is diagnosed through blood tests (anti-MAG and IgM), nerve conduction studies (which showed marked velocity slowing), and clinical exam findings.The efficacy of lenalidomide has been demonstrated in anti-MAG peripheral neuropathy with two separate dosing regimens: 25mg on days 1-21 of each 28 day cycle in conjunction with oral dexamethasone 20mg/day on days 1-4 of each cycle as well as at 5mg on days 1-21 of each cycle without oral dexamethasone. This phase 1 study aims to determine the maximum tolerated dose (MTD) of Lenalidomide in patients with anti-MAG neuropathy. We will explore preliminary efficacy and postulate that this drug is effective in this subset of patients, using preselected, specifically tailored outcome measures that encompass quality of life, neurologic function, serum protein levels, and focused measures of proprioception.

Key Inclusion Criteria:

• Patients must have Distal acquired demyelinating sensorimotor (DADS) peripheral neuropathy phenotype as defined per European Federation of Neurological Societies (EFNS) demyelinating criteria with preferential distal nerve involvement, as captured per terminal latency index [terminal distance/(conduction velocity x terminal latency)], in the setting of a monoclonal gammopathy
• Patients must be at least 18 years of age with no evidence of multiple myeloma, light chain amyloidosis or other hematologic disorder requiring treatment.
• Patient may be enrolled at any time from last line of therapy.
• Patients must have ANC > 1000/µL and Platelets ≥75,000/µL
• Patients must have adequate hepatic function as evidenced by: total bilirubin < 1.5 mg/dL, alkaline phosphatase < 3X the ULN, and AST/ALT < 2X the ULN.
• Patients must be able to take any of the following once lenalidomide starts and for at least 5 days after last dose lenalidomide: 1) 81-325 mg of coated aspirin daily; 2) full dose warfarin (target INR 2-3); 3) 2.5 mg or above of apixaban twice daily; 4) low molecular weight heparin; 5) 20 mg or above of rivaroxaban daily.
• Patients must have adequate renal function as evidenced by serum creatinine < 2mg/dL or calculated creatinine clearance of ≥ 40ml/min within 14 days of registration using MDRD formula.
• Patient must be able to swallow capsule or tablet.
• Patients must provide informed consent.
• All study participants must be registered into the mandatory Revlimid REMS® program, and be willing and able to comply with the requirements of the REMS® program.
• Females of reproductive potential must adhere to the scheduled pregnancy testing as required in the Revlimid REMS® program.
• Two negative pregnancy tests will be required for all women of child bearing potential, with the second negative test having been at least 7 days prior to starting the study drug. Breast feeding is not permitted.
• Fertility requirements
  Female patients with child bearing potential must have two negative pregnancy tests, with the second negative test having been at least 7 days prior to starting the study drug.
  Male patients must agree to use an adequate method of contraception starting from screening to 90 days after stopping the drug.
  Female patients must be either posy-menopausal, free from menses ≥2 yrs., surgically sterilized, willing to use two adequate barrier methods of contraception to prevent pregnancy, or agree to abstain from sexual activity starting from screening to 90 days after stopping the drug.
  Female patients of child bearing potential must agree to comply with the fertility and pregnancy test requirements dictated by the Rev-Assist program.

Key Exclusion Criteria:

• Patient with concurrent hematologic or oncologic malignancy requiring systemic treatment
• History of allergic reaction (including erythema nodosum) to lenalidomide
• Patients who have undergone major surgery ≤ 2 weeks prior to starting study drug or who have not recovered from the side-effects of surgery
• Patients with a history of gastrointestinal surgery or other procedure that might, in the opinion of the investigator(s), interfere with the absorption or swallowing of the study drugs.
• Patients with any significant history of non-compliance to medical regimens or unwilling or unable to comply with the instructions given to them by the study staff.
• Any other medical condition, including mental illness or substance abuse deemed by the investigator(s) to likely interfere with the patient's ability to sign informed consent, cooperate and participate in the study, or interfere with the interpretation of the results.

Study Status: Recruiting.

Sponsor: Ohio State University

Purpose of the Study: This is a phase 3 double-blind randomized study to study the efficacy and safety of intravenous ATB200 Co-administered with oral AT2221 in adult subjects with Late Onset Pompe Disease compared with Alglucosidase Alfa/placebo.

Key Inclusion Criteria:

• Subject must provide signed informed consent prior to any study-related procedures being performed.
• Male and female subjects are ≥ 18 years old and weigh ≥ 40 kg at screening.
• Female subjects of childbearing potential and male subjects must agree to use medically accepted methods of contraception during the study and for 90 days after the last dose of study drug.
• Subject must have a diagnosis of LOPD based on documentation of one of the following:
  deficiency of GAA enzyme
  GAA genotyping
• Subject is classified as one of the following with respect to ERT status:
  ERT-experienced, defined as currently receiving standard of care ERT (alglucosidase alfa) at the recommended dose and regimen (ie, 20 mg/kg dose every 2 weeks) for ≥ 24 months
  ERT-naïve, defined as never having received investigational or commercially available ERT
• Subject has a sitting FVC ≥ 30% of the predicted value for healthy adults (National Health and Nutrition Examination Survey III) at screening.
• Subject performs two 6MWTs at screening that are valid, as determined by the clinical evaluator, and that meet all of the following criteria:
  both screening values of 6MWD are ≥ 75 meters
  both screening values of 6MWD are ≤ 90% of the predicted value for healthy adults
  the lower value of 6MWD is within 20% of the higher value of 6MWD

Key Exclusion Criteria:

• Subject has received any investigational therapy or pharmacological treatment for Pompe disease, other than alglucosidase alfa, within 30 days or 5 half-lives of the therapy or treatment, whichever is longer, before Day 1 or is anticipated to do so during the study.
• Subject has received gene therapy for Pompe disease
• Subject is taking any of the following prohibited medications within 30 days before Day 1:
  miglitol (eg, Glyset)
  miglustat (eg, Zavesca)
  acarbose (eg, Precose or Glucobay)
  voglibose (eg, Volix, Vocarb, or Volibo)
  Note: None of these medications have a half-life that, when multiplied by 5, is longer than 30 days.
• Subject requires the use of invasive or noninvasive ventilation support for > 6 hours per day while awake.
• Subject has a hypersensitivity to any of the excipients in ATB200, alglucosidase alfa, or AT2221.
• Subject has a medical condition or any other extenuating circumstance that may, in the opinion of the investigator or medical monitor, pose an undue safety risk to the subject or may
• compromise his/her ability to comply with or adversely impact protocol requirements. This includes clinical depression (as diagnosed by a psychiatrist or other mental health professional) with uncontrolled or poorly controlled symptoms.
• Subject, if female, is pregnant or breastfeeding at screening.
• Subject, whether male or female, is planning to conceive a child during the study.
• Subject does not have documentation of diagnosis of Pompe disease and refuses to undergo genetic testing.

Study Status: Completed.

Sponsor: Amicus Therapeutics

Purpose of the Study: The purpose of the study is to evaluate the safety and efficacy of RA101495 in patients with generalized Myasthenia Gravis (gMG). Subjects will be randomized in a 1:1:1 ratio to receive daily SC doses of 0.1 mg/kg RA101495, 0.3 mg/kg RA101495, or matching placebo for 12 weeks.

Key Inclusion Criteria:

• Diagnosis of gMG [Myasthenia Gravis Foundation of America (MGFA) Class II-IVa] at Screening
• Positive serology for acetylcholine receptor (AChR) autoantibodies
• QMG score ≥ 12 at Screening and Randomization
• No change in corticosteroid dose for at least 30 days prior to Randomization or anticipated to occur during the 12-week Treatment Period
• No change in immunosuppressive therapy, including dose, for at least 30 days prior to Randomization or anticipated to occur during the 12-week Treatment Period.
   

Key Exclusion Criteria:

• Thymectomy within 6 months prior to Randomization or scheduled to occur during the 12 week Treatment Period
• History of meningococcal disease
• Current or recent systemic infection within 2 weeks prior to Randomization or infection requiring intravenous (IV) antibiotics within 4 weeks prior to Randomization

Study Status: Completed

Sponsor: Ra Pharmaceuticals

Purpose of the Study: The primary purpose of this study is to evaluate the safety and efficacy of ravulizumab for the treatment of participants with generalized myasthenia gravis (gMG).

Key Inclusion Criteria:

• Diagnosed with Myasthenia Gravis at least 6 months (180 days) prior to the date of the Screening Visit as confirmed by specific criteria.
• Myasthenia Gravis Foundation of America Clinical Classification Class II to IV at screening.
• MG-ADL profile must be ≥ 6 at screening and randomization (Day 1).
• Vaccinated against meningococcal infections within 3 years prior to, or at the time of, initiating study drug to reduce the risk of meningococcal infection (N meningitidis).
   

Key Exclusion Criteria:

• Any active or untreated thymoma. History of thymic carcinoma or thymic malignancy unless deemed cured by adequate treatment with no evidence of recurrence for ≥ 5 years before screening.
• History of thymectomy within the 12 months prior to screening.
• History of N meningitidis infection.
• Use of the following within the time period specified below:
  IV immunoglobulin within 4 weeks of randomization
  Use of plasma exchange within 4 weeks of randomization
  Use of rituximab within 6 months of screening
• Participants who have received previous treatment with complement inhibitors (for example, eculizumab).

Study Status: Active, not recruiting.

Sponsor: Alexion Pharmaceuticals

Purpose of the Study: The purpose of the MycarinGstudy is to demonstrate the clinical efficacy and to assess safety and tolerability of rozanolixizumab in patients with generalized myasthenia gravis (MG).

Key Inclusion Criteria:

• Study participant must be ≥18 years of age, at the time of signing the informed consent
• Study participant has documented diagnosis of generalized myasthenia gravis (gMG) at Visit 1, based on study participant's history and supported by previous evaluations
• Study participant has a confirmed positive record of autoantibodies against acetylcholine receptor (AChR) or muscle-specific kinase (MuSK) at Screening (Visit 1).The presence of autoantibodies may be confirmed with repeat testing at Visit 1
• Study participant has Myasthenia Gravis Foundation of America (MGFA) Class II to IVa at Visit 1
• Study participant with a Myasthenia Gravis-Activities of Daily Living (MG-ADL) score of at least 3 (with ≥3 points from non-ocular symptom) AND a quantitative myasthenia gravis (QMG) score of at least 11 at Visit 1 and at Baseline (Visit 2)
• Study participant is considered for additional treatment such as intravenous immunoglobulin g (IVIg) or plasma exchange (PEX) by the Investigator
   

Key Exclusion Criteria:

• Study participant has a known history of hyperprolinemia
• Study participant has a clinically relevant active infection (eg, sepsis, pneumonia, or abscess) in the opinion of the Investigator, or had a serious infection (resulting in hospitalization or requiring parenteral antibiotic treatment) within 6 weeks prior to the first dose of investigational medicinal product (IMP)
• Study participant with a known tuberculosis (TB) infection, at high risk of acquiring TB infection, or latent tuberculosis infection (LTBI), or current/history of nontuberculous mycobacterial infection (NTMBI) will be excluded
• Study participant has experienced hypersensitivity reaction after exposure to other anti-neonatal Fc receptor (FcRn) drugs
• Study participant with severe (defined as Grade 3 on the Myasthenia Gravis-Activities of Daily Living (MG-ADL) scale) weakness affecting oropharyngeal or respiratory muscles, or who has myasthenic crisis or impending crisis at Visit 1 or Visit 2
• Study participant has a history of a solid organ transplant or hematopoietic stem cell/marrow transplant

Study Status: Recruiting.

Sponsor: UCB Biopharma SRL

Purpose of the Study: The RAISE study is a multicenter, randomized, double-blind, placebo controlled study to confirm the efficacy, safety, and tolerability of zilucoplan in subjects with generalized Myasthenia Gravis. Subjects will be randomized in a 1:1 ratio to receive daily SC doses of 0.3 mg/kg zilucoplan or placebo for 12 weeks.

Key Inclusion Criteria:

• Diagnosis of gMG [Myasthenia Gravis Foundation of America (MGFA) Class II-IV] at Screening
• Positive serology for acetylcholine receptor (AChR) autoantibodies
• MG-ADL Score of ≥ 6 at Screening and Baseline
• QMG score ≥ 12 at Screening and Baseline
• No change in corticosteroid dose for at least 30 days prior to Baseline or anticipated to occur during the 12-week Treatment Period
• No change in immunosuppressive therapy, including dose, for at least 30 days prior to Baseline or anticipated to occur during the 12-week Treatment Period

Key Exclusion Criteria:

• Thymectomy within 12 months prior to Baseline or scheduled to occur during the 12 week Treatment Period
• History of meningococcal disease
• Current or recent systemic infection within 2 weeks prior to Baseline or injection requiring intravenous (IV) antibiotics within 4 weeks prior to Baseline

Study Status: Recruiting.

Sponsor: Ra Pharmaceuticals

Purpose of the Study: Myasthenia gravis is an autoimmune condition that causes muscle weakness. Autoimmune means the body makes antibodies that attack its own cells and tissues. These types of antibodies are also known as autoantibodies. People with generalized myasthenia gravis have a weakness in many muscles. TAK-079 is a medicine to help people with generalized myasthenia gravis. The main aim of this study is to check if people with generalized myasthenia gravis have side effects from 2 doses of TAK-079. Other aims are to learn if TAK-079 improves their clinical condition and lowers their autoantibody levels.

Key Inclusion Criteria:

• Diagnosis of Myasthenia Gravis (MG) supported by a positive serologic test for anti-AChR or anti-MuSK antibodies at screening.
• Myasthenia Gravis Foundation of America (MGFA) clinical classification II to IV at screening.
• Myasthenia Gravis Activities of Daily Living (MG-ADL) total score of 6 or greater at screening, with at least 4 points attributed to nonocular items.
• If receiving immunosuppressive drugs (ie, mycophenolate mofetil, methotrexate, cyclosporine, tacrolimus, cyclophosphamide), therapy must be ongoing for at least 6 months, with stable dosing ongoing for at least 3 months before screening. Participants receiving azathioprine must be on a stable dose for at least 6 months before screening.
• If receiving oral corticosteroids, therapy must be ongoing for at least 3 months, with a stable dose at least 1 month before screening. Corticosteroids, including dexamethasone, must be given as oral, daily or every-other-day therapy, as opposed to pulse therapy.
• If receiving cholinesterase inhibitors, therapy with a stable dose is required at least 2 weeks before screening.
• The doses of concomitant standard background therapy must be expected to remain stable throughout the study unless dose reduction is required due to toxicities. Allowed background therapy is defined as no more than a cholinesterase inhibitor ± corticosteroid ± 1 steroid-sparing immunosuppressive drug (limited to azathioprine, mycophenolate mofetil, methotrexate, cyclosporine, tacrolimus, or cyclophosphamide). Participants must be on at least one allowed background medication.
   

Key Exclusion Criteria:

• Presence of a thymoma (previous history of a fully encapsulated thymoma removed ≥ 12 months before screening is allowed) or history of invasive thymic malignancy unless deemed cured by adequate treatment with no evidence of recurrence for ≥ 5 years before screening.
• History of thymectomy within 12 months before screening.
• MGFA class I or V.
• Received intravenous immunoglobulin (IVIg), subcutaneous immunoglobulin (SCIg), or plasmapheresis/plasma exchange within 4 weeks before screening, or an expectation that any therapy besides the participants standard background therapies may be used for treatment of MG (eg, a rescue therapy) between screening and dosing.
• Chronic obstructive pulmonary disease (COPD) or asthma with a pre-bronchodilatory forced expiratory volume in 1 second (FEV1) <50% of predicted normal.
  Note: FEV1 testing is required for participants suspected of having COPD or asthma.
• Received rituximab, belimumab, eculizumab, or any monoclonal antibody for immunomodulation within 6 months before first dosing. Participants with prior exposure to rituximab must have CD19 counts within the normal range at screening.
• Known autoimmune disease other than MG that could interfere with the course and conduct of the study.
• Received a live vaccine within 4 weeks before screening or has any live vaccination planned during the study.
• Opportunistic infection ≤12 weeks before initial study dosing or currently receiving treatment for a chronic opportunistic infection, such as tuberculosis (TB), pneumocystis pneumonia, cytomegalovirus, herpes simplex virus, herpes zoster, or atypical mycobacteria. A mild, localized herpes simplex infection within 12 weeks of study dosing is allowed, as long as the lesion has resolved without systemic therapy prior to Day 1.

Study Status: Recruiting.

Sponsor: Takeda

Purpose of the Study: The RAISE-XT study is an open-label extension study to evaluate the long-term efficacy, safety, and tolerability of zilucoplan in subjects with gMG who have previously participated in a qualifying Ra Pharmaceuticals sponsored zilucoplan study.

Key Inclusion Criteria:

• Completion of a qualifying Ra Pharmaceuticals sponsored zilucoplan study
  
   

Key Exclusion Criteria:

• With the exception of a prior zilucoplan trial, participation in another concurrent clinical trial involving an experimental therapeutic intervention (participation in observational studies and/or registry studies is permitted)

Study Status: Enrolling by invitation.

Sponsor: Ra Pharmaceuticals

Purpose of the Study: Interventional: to evaluate the efficacy and safety of rituximab in individuals with MG

Eligibility Criteria:

1. Male or female patients, age 21 to 90 years old
2. Patients must be on a stable standard immunosuppressive regimen
3. No history of thymoma, tumor, infection or interstitial lung disease on chest CT, MRI or chest X-ray

Study Status: Currently recruiting participants

Contact: Amy Bartlett, 614-366-9050, Amy.bartlett@osumc.edu

Funding: Yale University, National Institutes of Health

Purpose of the Study: Interventional: to evaluate the efficacy and safety of eculizumab in individuals with generalized MG

Eligibility Criteria:

1. Male or female patients aged ≥18 years old
2. Diagnosis of MG
3. Subjects who have failed treatment over 1 year or more

Study Status: Recruiting participants

Principal Investigator: Miriam Freimer, MD

Contact: Amy Bartlett, 614-366-9050, Amy.bartlett@osumc.edu

Funding: Alexion Pharmaceuticals

Purpose of the Study: Interventional: to evaluate the efficacy and safety of belimumab in individuals with generalized MG

Eligibility Criteria:

1. Subjects aged 18 years and older
2. Diagnosis of MG
3. Stable dose of treatment medication
4. Normal liver function

Study Status: Active, not recruiting

Principal Investigator: Miriam Freimer, MD

Contact: Amy Bartlett, 614-366-9050, Amy.bartlett@osumc.edu

Funding: GlaxoSmithKline

Purpose of the Study: Funding Source - FDA OOPD. The purpose of this study is to evaluate the safety and efficacy of the study drug, Arimoclomol in IBM patients.

Key Inclusion Criteria:

• Meet any of the European Neuromuscular Centre Inclusion Body Myositis research diagnostic criteria 2011 categories for IBM
• Demonstrate being able to arise from a chair without support from another person or device
• Able to ambulate at least 20 ft/6 meters with or without assistive device. Once arisen from the chair, participant may use any walking device, i.e. walker/frame, can, crutches, or braces. They cannot be supported by another person and cannot use furniture or wall for support.
• Body weight of >= 40 kg
• Pre-menopausal women must have a negative pregnancy tst prior to dosing iwht study medication.
• If a participant in the bimagrumab study, the participant must be off of the study medication for at least 6 months.
• Able to give informed consent
   

Key Exclusion Criteria:

• History of any of the following excludes subject participation in the study: chronic infection particularly HIV or Hepatitis B or C; cancer other than basal cell cancer less than five years prior; or other chronic serious medical illnesses.
• Presence of any of the following on routine blood screening: WEB <3000; platelets < 100,000; hematocrit , 30%; BUN > 30 mg%; creatinine > 1.5 mg%; symptomatic liver disease with serum albumin < 3 g/dL.
• History of most recent creatine kinase >15x the upper limit of normal without any other explanation besides IBM.
• History of non-compliance with other therapies
• Use of testosterone except for physiologic replacement doses in case of androgen deficiency. Participants must have documented proof of the androgen deficiency.
• Coexistence of other disease that would be likely to affect outcome measures.
• Drug or alcohol abuse within past three months
• Participation in a recent drug study in the last 30 days prior to the screening visit or use of a biologic agent less than 6 months prior to the screening visit.
• Women who are lactating or unwilling to use adequate method of birth control who are not surgically sterile. Adequate birth control includes use of intrauterine device, abstinence, or oral contraceptives or a double barrier method, e.g condom plas diaphragm will be necessary for both male and female participants.
• Participants taking >7.5 mg prednisolone or equivalent or participants on IVIg or other immunosuppressants within the last 3 months.

Study Status: Completed

Sponsor: Orphazyme

Purpose of the Study: Interventional: to evaluate the efficacy and safety of bimagrumab/BYM338 in individuals with IBM

Eligibility Criteria:

• Male and female patients age 36 to 85 (inclusive)
• Diagnosed with pathologically defined or clinically defined sporadic inclusion body myositis
• Must not be wheelchair-bound (intermittent use of wheelchair is allowed)

Study Status: Ongoing, but not recruiting participants

Contact: Amy Bartlett, 614-366-9050, Amy.bartlett@osumc.edu

Funding: Novartis Pharmaceuticals

Purpose of the Study: Observational: to use DNA sequencing to identify the mechanism that causes Sporadic Inclusion Body Myositis

Eligibility Criteria:

• Male or female patients
• Definite or possible IBM

Study Status: recruiting participants

Contact: Amy Bartlett, 614-366-9050, Amy.bartlett@osumc.edu