SOD1 Inhibition by Pyrimethamine in Familial Amyotrophic Lateral Sclerosis (ALS)

This study is currently recruiting participants.
Verified August 2013 by Weill Medical College of Cornell University
Sponsor:
Collaborator:
Muscular Dystrophy Association
Information provided by (Responsible Party):
Dr. Dale J. Lange, Weill Medical College of Cornell University
ClinicalTrials.gov Identifier:
NCT01083667
First received: December 17, 2009
Last updated: August 18, 2013
Last verified: August 2013
  Purpose

The objective of this study will be to evaluate the safety, tolerability and effect on SOD1 levels by pyrimethamine in patients with familial amyotrophic lateral sclerosis.


Condition Intervention Phase
Familial Amyotrophic Lateral Sclerosis
Drug: Pyrimethamine
Phase 1
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase I/II Study of SOD1 Inhibition by Pyrimethamine in Familial ALS

Resource links provided by NLM:


Further study details as provided by Weill Medical College of Cornell University:

Primary Outcome Measures:
  • Protein in the cerebrospinal fluid [ Time Frame: baseline, week 12, end of study ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Adverse Events [ Time Frame: Week 3, 6, 9, 12, 15, 18, 24, 30, & 36 visits ] [ Designated as safety issue: No ]

Estimated Enrollment: 40
Study Start Date: November 2009
Estimated Study Completion Date: May 2014
Estimated Primary Completion Date: May 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Pyrimethamine
Open label. Only one arm will receive the intervention.
Drug: Pyrimethamine
Open Label, dose escalating,
Other Name: Daraprim

Detailed Description:

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease causing relentlessly progressive weakness of the arms, legs and respiratory muscles that is uniformly fatal. There are approximately 30,000 patients living with ALS in the United States. There is no treatment. The cause is uncertain in most patients. However, 3% of patients (< 1000 in number) have a familial form of ALS (FALS), phenotypically identical to the sporadic illness, that is caused by a mutation in the gene coding for the free radical scavenging enzyme copper/zinc superoxide dismutase (SOD1). Inserting the SOD1 mutant gene into mice causes them to develop a disease closely resembling ALS.

Inhibiting expression of the SOD1 gene prevents animals from developing the disease. Increasing or decreasing the number of mutated genes proportionately speeds or slows the progression of the disease. Therefore, reducing SOD1 levels in patients with SOD1 associated FALS may be a promising therapeutic approach. Through an extensive in vitro screening program for medications having the ability to reduce SOD1 levels, several molecules that reduce SOD1 protein levels are known. One of the most potent molecules is pyrimethamine, an FDA approved medication used for the treatment of malaria and toxoplasmosis. Pyrimethamine dramatically reduces SOD1 levels in mice and our preliminary studies show similar findings in humans. Our study's primary objective is to determine if familial ALS patients taking pyrimethamine will show a decline in SOD1 levels in the CSF by 15% or more. We will also determine if SOD1 and pyrimethamine are present in the blood and if the SOD-1 levels decline over the course of the study. We will also evaluate the safety and tolerability of pyrimethamine in patients with FALS. Secondary objectives will be to determine dose optimization for maximal SOD1 level reduction. We will also assess the feasibility of proceeding to phase II/III studies using pyrimethamine. Using futility methodology in which patients treated with pyrimethamine will be compared to historical controls, 40 patients with mild to moderate FALS and SOD1 mutations will receive up to 75 mg of pyrimethamine for 36 weeks. A change of 15% in the slope of decline will be deemed significant with a power of 80.7 percent. Change in ALS-FRS and quality of life will also be measured. A clinical effect realized in patients with FALS associated with an SOD1 mutation may serve as an important foundation toward finding a treatment for sporadic ALS.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Subjects with definite, probable, or laboratory supported probable ALS will be eligible.

    1. ALS diagnosed as probable, laboratory supported probable or definite according to the World Federation of Neurology El Escorial criteria [Brooks et al. 2000]
    2. Age 18 or older
    3. Capable of providing informed consent and complying with trial procedures
    4. SOD1 mutation confirmation by study team
    5. Not taking Riluzole (Rilutek) or on a stable dose for 30 days
    6. Not taking Coenzyme QR10R or on a stable dose and brand for 30 days
    7. Absence of exclusion criteria

Exclusion Criteria:

  1. History or evidence of malabsorption syndromes
  2. Exposure to any experimental agent within 30 days of onset of this protocol
  3. Women who are pregnant or planning to become pregnant
  4. Women of childbearing potential not practicing contraception
  5. Women who are breastfeeding
  6. Enrollment in another research study within 30 days of or during this trial
  7. Alcoholism
  8. Patients taking phenytoin (Dilantin) or other therapy affecting folate levels
  9. Dementia (MMSE <22)
  10. Seizure disorder
  11. Folate deficiency
  12. Megaloblastic anemia
  13. Cardiovascular disorder/arrhythmia
  14. Impaired kidney function, defined as creatinine levels of 2.5 x ULN
  15. Impaired liver function, defined as AST or ALT of 3 X ULN
  16. Advanced ALS patients, defined as those with any of the following: forced vital capacity <60% (use of BIPAP is allowed); tracheostomy; or mechanical ventilation
  17. Use of any of the following medications: cytosine, arabinoside, methotrexate, daunorubicin, sulfonamides, zidovudine, lorazepam, coumadin, sulfamethoxazole, and trimethoprim
  18. Patients taking Lithium within 30 days of or during this trial
  19. Incapable of providing informed consent and complying with trial procedures
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT01083667

Contacts
Contact: Nicole Kassebaum, MS 646-797-8592 KassebaumN@HSS.EDU
Contact: Mona Shahbazi, MS 212-774-2361 shahbazim@hss.edu

Locations
United States, New York
Weill Cornell Medical Center/New York Presbyterian Hospital Recruiting
New York, New York, United States, 10021
Principal Investigator: Dale J. Lange, M.D.         
United States, Texas
Methodist Neurological Institute Recruiting
Houston, Texas, United States, 77030
Contact: Sharon L Halton, LCSW    713-441-3420    SLHalton@tmhs.org   
Principal Investigator: Stanley Appel, M.D.         
Germany
Universitäts- und Rehabilitationskliniken Ulm Recruiting
Ulm, Germany
Contact: Joachim Schuster    +49(0)731 500 63000    joachim.schuster@uni-ulm.de   
Italy
Milano Neurological Institute Recruiting
Milan, Italy
Contact: Vincenzo Silani, M.D.    02 61911 2982 ext 2937    vincenzo@silani.com   
Principal Investigator: Vincenzo Silani, M.D.         
Sweden
Umea University Not yet recruiting
Umea, Sweden
Contact: Sabine Eriksson    46 90 7853312    sabine.eriksson@neuro.umu.se   
Principal Investigator: Peter Andersen, M.D.         
Sponsors and Collaborators
Weill Medical College of Cornell University
Muscular Dystrophy Association
Investigators
Principal Investigator: Dale J. Lange, M.D. Hospital for Special Surgery/Weill Cornell Medical Center
  More Information

No publications provided

Responsible Party: Dr. Dale J. Lange, Neurologist in Chief, Weill Medical College of Cornell University
ClinicalTrials.gov Identifier: NCT01083667     History of Changes
Other Study ID Numbers: 0903010259
Study First Received: December 17, 2009
Last Updated: August 18, 2013
Health Authority: United States: Food and Drug Administration

Keywords provided by Weill Medical College of Cornell University:
ALS
Familial ALS
SOD1 Gene Mutation

Additional relevant MeSH terms:
Amyotrophic Lateral Sclerosis
Sclerosis
Motor Neuron Disease
Spinal Cord Diseases
Central Nervous System Diseases
Nervous System Diseases
Neurodegenerative Diseases
TDP-43 Proteinopathies
Neuromuscular Diseases
Proteostasis Deficiencies
Metabolic Diseases
Pathologic Processes
Pyrimethamine
Antimalarials
Antiprotozoal Agents
Antiparasitic Agents
Anti-Infective Agents
Therapeutic Uses
Pharmacologic Actions
Folic Acid Antagonists
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action

ClinicalTrials.gov processed this record on April 14, 2014