Trial Outcomes & Findings for A Biomarker Study to Evaluate MN-166 in Subjects With Amyotrophic Literal Sclerosis (ALS) (NCT NCT02714036)

NCT ID: NCT02714036

Last Updated: 2024-09-24

Results Overview

Glial activation will be estimated in eligible participants in the Regular arm by combined magnetic resonance positron emission tomography (MR-PET) using the \[11C\]-PBR28 radioligand. \[11C\]-PBR28 uptake is quantified as the ratio of the standardized uptake value (SUVR). An independent neuroimaging rater blinded to the clinical data will assess for quality control of the PBR28-PET images and SUVR. The primary analysis will be performed on the modified Intent-to-Treat (mITT) population. The median (90% confidence interval \[CI\]) changes from baseline in SUVR from pre- to post-treatment visit will be presented.

Recruitment status

COMPLETED

Study phase

PHASE1/PHASE2

Target enrollment

35 participants

Primary outcome timeframe

12- 24 weeks (post treatment [11C]-PBR28-PET scan will be performed between the Week 12 and Week 24 visits.

Results posted on

2024-09-24

Participant Flow

Analysis Sets: Safety (n=35, n=30 Regular arm, n=5 Flexible arm) = All participants initiated at least the first MN-166 dose. Intent-to-Treat (ITT) (n=30) = All participants initiated at least the first MN-166 dose, excluding Flexible arm. Modified ITT (n=22) = Subset of ITT who completed pre- and post-treatment PET scans. Per Protocol (PP) (n=16) Subset of ITT who successfully titrated up to and maintained the full dose of 50 mg bid.

Participant milestones

Participant milestones
Measure
Regular
Participants will receive up to 100 mg /day MN-166 for 36 weeks. MN-166 dosing may vary based on individual tolerability.
Flexible
Participants will receive up to 100 mg /day MN-166 for 36 weeks. MN-166 dosing may vary based on individual tolerability. Participants will have all assessments except PET scans.
Overall Study
STARTED
30
5
Overall Study
COMPLETED
18
1
Overall Study
NOT COMPLETED
12
4

Reasons for withdrawal

Reasons for withdrawal
Measure
Regular
Participants will receive up to 100 mg /day MN-166 for 36 weeks. MN-166 dosing may vary based on individual tolerability.
Flexible
Participants will receive up to 100 mg /day MN-166 for 36 weeks. MN-166 dosing may vary based on individual tolerability. Participants will have all assessments except PET scans.
Overall Study
Adverse Event
9
2
Overall Study
Withdrawal by Subject
3
2

Baseline Characteristics

A Biomarker Study to Evaluate MN-166 in Subjects With Amyotrophic Literal Sclerosis (ALS)

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Regular
n=30 Participants
Participants will receive up to 100 mg /day MN-166 for 36 weeks. MN-166 dosing may vary based on individual tolerability.
Flexible
n=5 Participants
Participants will receive up to 100 mg /day MN-166 for 36 weeks. MN-166 dosing may vary based on individual tolerability. Participants will have all assessments except PET scans.
Total
n=35 Participants
Total of all reporting groups
Age, Continuous
57.1 years
STANDARD_DEVIATION 10.3 • n=5 Participants
54.0 years
STANDARD_DEVIATION 14.3 • n=7 Participants
56.6 years
STANDARD_DEVIATION 10.7 • n=5 Participants
Sex: Female, Male
Female
14 Participants
n=5 Participants
1 Participants
n=7 Participants
15 Participants
n=5 Participants
Sex: Female, Male
Male
16 Participants
n=5 Participants
4 Participants
n=7 Participants
20 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
30 Participants
n=5 Participants
5 Participants
n=7 Participants
35 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Asian
1 Participants
n=5 Participants
0 Participants
n=7 Participants
1 Participants
n=5 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Black or African American
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
White
29 Participants
n=5 Participants
5 Participants
n=7 Participants
34 Participants
n=5 Participants
Race (NIH/OMB)
More than one race
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Region of Enrollment
United States
30 participants
n=5 Participants
5 participants
n=7 Participants
35 participants
n=5 Participants
Mean years since ALS onset
2.06 mean years since ALS onset
n=5 Participants
1.93 mean years since ALS onset
n=7 Participants
2.04 mean years since ALS onset
n=5 Participants
Mean delay between symptom onset and ALS diagnosis
1.12 Mean years
n=5 Participants
0.74 Mean years
n=7 Participants
1.06 Mean years
n=5 Participants
Site of ALS onset
Bulbar onset
10 Participants
n=5 Participants
2 Participants
n=7 Participants
12 Participants
n=5 Participants
Site of ALS onset
Lower Limb
9 Participants
n=5 Participants
2 Participants
n=7 Participants
11 Participants
n=5 Participants
Site of ALS onset
Upper Limb
11 Participants
n=5 Participants
1 Participants
n=7 Participants
12 Participants
n=5 Participants

PRIMARY outcome

Timeframe: 12- 24 weeks (post treatment [11C]-PBR28-PET scan will be performed between the Week 12 and Week 24 visits.

Population: modified Intent-to-Treat population

Glial activation will be estimated in eligible participants in the Regular arm by combined magnetic resonance positron emission tomography (MR-PET) using the \[11C\]-PBR28 radioligand. \[11C\]-PBR28 uptake is quantified as the ratio of the standardized uptake value (SUVR). An independent neuroimaging rater blinded to the clinical data will assess for quality control of the PBR28-PET images and SUVR. The primary analysis will be performed on the modified Intent-to-Treat (mITT) population. The median (90% confidence interval \[CI\]) changes from baseline in SUVR from pre- to post-treatment visit will be presented.

Outcome measures

Outcome measures
Measure
Regular
n=22 Participants
Participants will receive up to 100 mg /day MN-166 for 36 weeks. MN-166 dosing may vary based on individual tolerability.
Flexible
Participants will receive MN-166 up to 100 mg/day for 36 weeks. MN-166 dosing may vary based on individual tolerability. Participants will have all assessments except PET scans.
Impact of MN-166 on [11C]-PBR28 Uptake in the Motor Cortices and Brain Stem Measured by Positron Emission Tomography (PET) Imaging at 12 - 24 Weeks
0.0015 SUV ratio
Interval -0.0082 to 0.0205

PRIMARY outcome

Timeframe: 36 weeks

Population: Intent-to-Treat population

Mean change from baseline (pre-dose) to Week 36 in blood biomarkers for neuroinflammation, including macrophage migration inhibitory factor (MIF), tumor necrosis factor (TNF)-alpha, and neurofilament light (NfL). All blood biomarkers are measured in picograms/milliliter (pg/mL).

Outcome measures

Outcome measures
Measure
Regular
n=30 Participants
Participants will receive up to 100 mg /day MN-166 for 36 weeks. MN-166 dosing may vary based on individual tolerability.
Flexible
Participants will receive MN-166 up to 100 mg/day for 36 weeks. MN-166 dosing may vary based on individual tolerability. Participants will have all assessments except PET scans.
Impact of MN-166 on Several Markers of Neuro-inflammation Measured by Blood Biomarkers at Week 36
macrophage migration inhibitory factor
-673387.22 picograms/milliliters
Standard Deviation 943313.53
Impact of MN-166 on Several Markers of Neuro-inflammation Measured by Blood Biomarkers at Week 36
tumor necrosis factor-alpha
-0.31 picograms/milliliters
Standard Deviation 0.57
Impact of MN-166 on Several Markers of Neuro-inflammation Measured by Blood Biomarkers at Week 36
neurofilament light
21.43 picograms/milliliters
Standard Deviation 47.71

SECONDARY outcome

Timeframe: 36 weeks

Population: Safety population

Clinical and laboratory treatment-emergent adverse events (TEAEs) will be collected and stratified by severity, persistence over time, and relationship to study drug.

Outcome measures

Outcome measures
Measure
Regular
n=30 Participants
Participants will receive up to 100 mg /day MN-166 for 36 weeks. MN-166 dosing may vary based on individual tolerability.
Flexible
n=5 Participants
Participants will receive MN-166 up to 100 mg/day for 36 weeks. MN-166 dosing may vary based on individual tolerability. Participants will have all assessments except PET scans.
Safety and Tolerability of MN-166 Over 36 Weeks
30 Participants
5 Participants

SECONDARY outcome

Timeframe: 36 weeks

Population: Intent-to-Treat population

Mean change from baseline to Week 36 on ALSFRS-R score. ALSFRS-R rating scale is a tool to assess patient's capability and independence in 12 functional activities. The ALSFRS-R total score is a composite of sub-scores measuring speech, salivation, swallowing, handwriting, cutting food and handling utensils, dressing and hygiene, turning in bed and adjusting bed clothes, walking, climbing stairs, dyspnea, orthopnea, and respiratory insufficiency. Each subscale ranges from 0 (no ability) to 4 (normal ability). The ALSFRS-R score is the sum total ranging from 0 (zero) to 48, with higher scores meaning better outcome.

Outcome measures

Outcome measures
Measure
Regular
n=30 Participants
Participants will receive up to 100 mg /day MN-166 for 36 weeks. MN-166 dosing may vary based on individual tolerability.
Flexible
Participants will receive MN-166 up to 100 mg/day for 36 weeks. MN-166 dosing may vary based on individual tolerability. Participants will have all assessments except PET scans.
Evaluate the Effect of MN-166 on ALS Clinical Outcomes (ALS Functional Rating Scale-revised [ALSFRS-R]) Over 36 Weeks.
-4.5 Total ALSFRS-R score
Standard Deviation 4.5

SECONDARY outcome

Timeframe: 36 weeks

Population: Intent-to-Treat population

Slow vital capacity (SVC) is the maximum volume of air that can be slowly exhaled after slow, maximal inhalation, measured in liters. The maximum volume expired is converted to percent of predicted (% pred.) normal volume. Higher SVC (% pred.) normal volume indicates better pulmonary function. The results below reflect the mean change in SVC (% pred.) from baseline to week 36.

Outcome measures

Outcome measures
Measure
Regular
n=30 Participants
Participants will receive up to 100 mg /day MN-166 for 36 weeks. MN-166 dosing may vary based on individual tolerability.
Flexible
Participants will receive MN-166 up to 100 mg/day for 36 weeks. MN-166 dosing may vary based on individual tolerability. Participants will have all assessments except PET scans.
Mean Change From Baseline in Slow Vital Capacity (Percent Predicted) Normal Volume at Week 36
-9.27 percent predicted normal volume
Standard Deviation 11.23

SECONDARY outcome

Timeframe: 36 weeks

Population: Intent-to-Treat population

HHD assesses isometric strength using a MicroFET2 hand-held dynamometer in kilograms (kg). To calculate megascores, the mean and standard deviation of each muscle group, without regard to laterality, is calculated from the baseline assessment. Nine upper and lower extremity muscles or muscle groups were examined: shoulder flexion, elbow flexion, wrist extension, first dorsal interosseous contraction, hip flexion, knee extension, and ankle dorsiflexion. Each group was measured at least twice bilaterally and the average of the 2 highest measurements were analyzed. To calculate megascores, the mean and standard deviation of each group were calculated from baseline.

Outcome measures

Outcome measures
Measure
Regular
n=30 Participants
Participants will receive up to 100 mg /day MN-166 for 36 weeks. MN-166 dosing may vary based on individual tolerability.
Flexible
Participants will receive MN-166 up to 100 mg/day for 36 weeks. MN-166 dosing may vary based on individual tolerability. Participants will have all assessments except PET scans.
Mean Change From Baseline in Isometric Strength as Measured by Hand-held Dynamometry (HHD) at Week 36.
upper limbs, proximal
-0.5803 kilograms
Standard Deviation 0.8108
Mean Change From Baseline in Isometric Strength as Measured by Hand-held Dynamometry (HHD) at Week 36.
upper limbs, distal
-0.5004 kilograms
Standard Deviation 0.4823
Mean Change From Baseline in Isometric Strength as Measured by Hand-held Dynamometry (HHD) at Week 36.
upper limbs, cumulated
-0.5324 kilograms
Standard Deviation 0.5738
Mean Change From Baseline in Isometric Strength as Measured by Hand-held Dynamometry (HHD) at Week 36.
lower limbs, proximal
-0.2778 kilograms
Standard Deviation 0.7749
Mean Change From Baseline in Isometric Strength as Measured by Hand-held Dynamometry (HHD) at Week 36.
lower limbs, distal
-0.3525 kilograms
Standard Deviation 0.6492
Mean Change From Baseline in Isometric Strength as Measured by Hand-held Dynamometry (HHD) at Week 36.
lower limbs, cumulated
-0.3151 kilograms
Standard Deviation 0.6824
Mean Change From Baseline in Isometric Strength as Measured by Hand-held Dynamometry (HHD) at Week 36.
cumulated
-0.4358 kilograms
Standard Deviation 0.5863

Adverse Events

Regular

Serious events: 6 serious events
Other events: 30 other events
Deaths: 2 deaths

Flexible

Serious events: 0 serious events
Other events: 5 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Regular
n=30 participants at risk
Participants will receive up to 100 mg /day MN-166 for 36 weeks. MN-166 dosing may vary based on individual tolerability.
Flexible
n=5 participants at risk
Participants will receive up to 100 mg /day MN-166 for 36 weeks. MN-166 dosing may vary based on individual tolerability. Participants will have all assessments except PET scans.
Gastrointestinal disorders
Abdominal pain
3.3%
1/30 • Number of events 1 • 36 weeks
0.00%
0/5 • 36 weeks
Gastrointestinal disorders
Dysphagia
3.3%
1/30 • Number of events 1 • 36 weeks
0.00%
0/5 • 36 weeks
Infections and infestations
Localized infection
3.3%
1/30 • Number of events 1 • 36 weeks
0.00%
0/5 • 36 weeks
Metabolism and nutrition disorders
Dehydration
6.7%
2/30 • Number of events 2 • 36 weeks
0.00%
0/5 • 36 weeks
Nervous system disorders
Unresponsive to stimuli
3.3%
1/30 • Number of events 1 • 36 weeks
0.00%
0/5 • 36 weeks
Respiratory, thoracic and mediastinal disorders
Dyspnea
3.3%
1/30 • Number of events 1 • 36 weeks
0.00%
0/5 • 36 weeks
Respiratory, thoracic and mediastinal disorders
Pulmonary embolism
10.0%
3/30 • Number of events 3 • 36 weeks
0.00%
0/5 • 36 weeks
Respiratory, thoracic and mediastinal disorders
Respiratory failure
3.3%
1/30 • Number of events 1 • 36 weeks
0.00%
0/5 • 36 weeks
Vascular disorders
Deep vein thrombosis
6.7%
2/30 • Number of events 2 • 36 weeks
0.00%
0/5 • 36 weeks

Other adverse events

Other adverse events
Measure
Regular
n=30 participants at risk
Participants will receive up to 100 mg /day MN-166 for 36 weeks. MN-166 dosing may vary based on individual tolerability.
Flexible
n=5 participants at risk
Participants will receive up to 100 mg /day MN-166 for 36 weeks. MN-166 dosing may vary based on individual tolerability. Participants will have all assessments except PET scans.
Gastrointestinal disorders
nausea
43.3%
13/30 • Number of events 13 • 36 weeks
60.0%
3/5 • Number of events 3 • 36 weeks
Gastrointestinal disorders
dysphagia
26.7%
8/30 • Number of events 8 • 36 weeks
0.00%
0/5 • 36 weeks
Gastrointestinal disorders
diarrhea
16.7%
5/30 • Number of events 5 • 36 weeks
40.0%
2/5 • Number of events 2 • 36 weeks
Gastrointestinal disorders
vomiting
20.0%
6/30 • Number of events 6 • 36 weeks
20.0%
1/5 • Number of events 1 • 36 weeks
Gastrointestinal disorders
salivary hypersecretion
13.3%
4/30 • Number of events 4 • 36 weeks
40.0%
2/5 • Number of events 2 • 36 weeks
Gastrointestinal disorders
abdominal discomfort
10.0%
3/30 • Number of events 3 • 36 weeks
0.00%
0/5 • 36 weeks
Gastrointestinal disorders
abdominal pain upper
6.7%
2/30 • Number of events 2 • 36 weeks
0.00%
0/5 • 36 weeks
Gastrointestinal disorders
constipation
6.7%
2/30 • Number of events 2 • 36 weeks
0.00%
0/5 • 36 weeks
Gastrointestinal disorders
flatulence
6.7%
2/30 • Number of events 2 • 36 weeks
0.00%
0/5 • 36 weeks
Gastrointestinal disorders
gastroesophageal reflux disease
6.7%
2/30 • Number of events 2 • 36 weeks
0.00%
0/5 • 36 weeks
Gastrointestinal disorders
abdominal rigidity
0.00%
0/30 • 36 weeks
20.0%
1/5 • Number of events 1 • 36 weeks
Gastrointestinal disorders
defecation urgency
0.00%
0/30 • 36 weeks
20.0%
1/5 • Number of events 1 • 36 weeks
Nervous system disorders
headache
20.0%
6/30 • Number of events 6 • 36 weeks
20.0%
1/5 • Number of events 1 • 36 weeks
Nervous system disorders
dizziness
20.0%
6/30 • Number of events 6 • 36 weeks
0.00%
0/5 • 36 weeks
Nervous system disorders
dysarthria
10.0%
3/30 • Number of events 3 • 36 weeks
0.00%
0/5 • 36 weeks
Nervous system disorders
restless leg syndrome
3.3%
1/30 • Number of events 1 • 36 weeks
20.0%
1/5 • Number of events 1 • 36 weeks
Nervous system disorders
slow speech
6.7%
2/30 • Number of events 2 • 36 weeks
0.00%
0/5 • 36 weeks
Nervous system disorders
dysgeugia
0.00%
0/30 • 36 weeks
20.0%
1/5 • Number of events 1 • 36 weeks
Injury, poisoning and procedural complications
fall
50.0%
15/30 • Number of events 15 • 36 weeks
20.0%
1/5 • Number of events 1 • 36 weeks
Injury, poisoning and procedural complications
contusion
13.3%
4/30 • Number of events 4 • 36 weeks
20.0%
1/5 • Number of events 1 • 36 weeks
Injury, poisoning and procedural complications
skin abrasion
6.7%
2/30 • Number of events 2 • 36 weeks
0.00%
0/5 • 36 weeks
Injury, poisoning and procedural complications
stoma site erythema
3.3%
1/30 • Number of events 1 • 36 weeks
20.0%
1/5 • Number of events 1 • 36 weeks
General disorders
fatigue
36.7%
11/30 • Number of events 11 • 36 weeks
40.0%
2/5 • Number of events 2 • 36 weeks
General disorders
chest discomfort
6.7%
2/30 • Number of events 2 • 36 weeks
0.00%
0/5 • 36 weeks
General disorders
edema peripheral
6.7%
2/30 • Number of events 2 • 36 weeks
0.00%
0/5 • 36 weeks
General disorders
pain
6.7%
2/30 • Number of events 2 • 36 weeks
0.00%
0/5 • 36 weeks
General disorders
disease progression
0.00%
0/30 • 36 weeks
20.0%
1/5 • Number of events 1 • 36 weeks
Musculoskeletal and connective tissue disorders
muscle weakness
16.7%
5/30 • Number of events 5 • 36 weeks
0.00%
0/5 • 36 weeks
Musculoskeletal and connective tissue disorders
back pain
10.0%
3/30 • Number of events 3 • 36 weeks
0.00%
0/5 • 36 weeks
Musculoskeletal and connective tissue disorders
muscle spasms
6.7%
2/30 • Number of events 2 • 36 weeks
20.0%
1/5 • Number of events 1 • 36 weeks
Musculoskeletal and connective tissue disorders
periarthritis
10.0%
3/30 • Number of events 3 • 36 weeks
0.00%
0/5 • 36 weeks
Musculoskeletal and connective tissue disorders
myalgia
6.7%
2/30 • Number of events 2 • 36 weeks
0.00%
0/5 • 36 weeks
Musculoskeletal and connective tissue disorders
pain in extremity
6.7%
2/30 • Number of events 2 • 36 weeks
0.00%
0/5 • 36 weeks
Respiratory, thoracic and mediastinal disorders
pulmonary embolism
10.0%
3/30 • Number of events 3 • 36 weeks
60.0%
3/5 • Number of events 3 • 36 weeks
Respiratory, thoracic and mediastinal disorders
cough
6.7%
2/30 • Number of events 2 • 36 weeks
0.00%
0/5 • 36 weeks
Respiratory, thoracic and mediastinal disorders
productive cough
6.7%
2/30 • Number of events 2 • 36 weeks
0.00%
0/5 • 36 weeks
Respiratory, thoracic and mediastinal disorders
choking
0.00%
0/30 • 36 weeks
20.0%
1/5 • Number of events 1 • 36 weeks
Psychiatric disorders
insomnia
16.7%
5/30 • Number of events 5 • 36 weeks
40.0%
2/5 • Number of events 2 • 36 weeks
Psychiatric disorders
depressed mood
6.7%
2/30 • Number of events 2 • 36 weeks
0.00%
0/5 • 36 weeks
Skin and subcutaneous tissue disorders
hyperhidrosis
10.0%
3/30 • Number of events 3 • 36 weeks
0.00%
0/5 • 36 weeks
Skin and subcutaneous tissue disorders
pruritus
10.0%
3/30 • Number of events 3 • 36 weeks
60.0%
3/5 • Number of events 3 • 36 weeks
Skin and subcutaneous tissue disorders
rash papular
0.00%
0/30 • 36 weeks
20.0%
1/5 • Number of events 1 • 36 weeks
Skin and subcutaneous tissue disorders
rash pruritic
0.00%
0/30 • 36 weeks
20.0%
1/5 • Number of events 1 • 36 weeks
Infections and infestations
upper respiratory tract infection
20.0%
6/30 • Number of events 6 • 36 weeks
0.00%
0/5 • 36 weeks
Infections and infestations
oral candidiasis
6.7%
2/30 • Number of events 2 • 36 weeks
0.00%
0/5 • 36 weeks
Infections and infestations
urinary tract infection
6.7%
2/30 • Number of events 2 • 36 weeks
0.00%
0/5 • 36 weeks
Metabolism and nutrition disorders
decreased appetite
23.3%
7/30 • Number of events 7 • 36 weeks
20.0%
1/5 • Number of events 1 • 36 weeks
Metabolism and nutrition disorders
dehydration
6.7%
2/30 • Number of events 2 • 36 weeks
0.00%
0/5 • 36 weeks
Vascular disorders
hot flush
20.0%
6/30 • Number of events 6 • 36 weeks
0.00%
0/5 • 36 weeks
Vascular disorders
deep vein thrombosis
10.0%
3/30 • Number of events 3 • 36 weeks
0.00%
0/5 • 36 weeks
Vascular disorders
flushing
3.3%
1/30 • Number of events 1 • 36 weeks
20.0%
1/5 • Number of events 1 • 36 weeks
Investigations
weight decreased
13.3%
4/30 • Number of events 4 • 36 weeks
20.0%
1/5 • Number of events 1 • 36 weeks
Renal and urinary disorders
chromaturia
0.00%
0/30 • 36 weeks
20.0%
1/5 • Number of events 1 • 36 weeks
Renal and urinary disorders
urine odor abnormal
0.00%
0/30 • 36 weeks
20.0%
1/5 • Number of events 1 • 36 weeks

Additional Information

Director, Research and Development

MEDICINOVA, INC

Phone: 858-373-1500

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place