Study of Safety and Proof of the Mechanism of BLZ945 in ALS Patients

Phase 2

Terminated

• Conditions: Amyotrophic Lateral Sclerosis
• Interventions: Drug: BLZ945

• Registration Number: NCT04066244
• Lead Sponsor: Novartis Pharmaceuticals

Brief Summary

It was an open label study to evaluate safety, tolerability and brain microglia response in participants with Amyotrophic Lateral Sclerosis (ALS) following multiple doses of BLZ945.

Detailed Description

The purpose of the study was to identify a dose (or doses) of BLZ945, that measurably decrease(s) 18 KDa Translocator Protein (TSPO) binding in the brain of participants with ALS. The study also aimed to evaluate the safety and tolerability of BLZ945 in participants with ALS at different doses and dosing regimens, and safety related effects on extracellular matrix (ECM) accumulation.

This was an exploratory, adaptive , open label study of approximately 16 participants in cohorts of 4 participants per cohort at increasing doses of BLZ945 with the last dose determined after the completion of cohorts 1 to 3.

Each cohort received treatment for 4 days and continued with a 32 day follow up period with an end of study visit at day 36.

After completion of the 4 initial cohorts a fifth cohort was initiated with two parallel arms receiving BLZ945 for up to 12 weeks at two different treatment regimens, either once weekly or 4 days of treatment followed by 10 days off drug.

Study Timeline

• Study First Submitted: 2019-08-21
• Study First Submitted QC: 2019-08-21
• Study First Posted: 2019-08-26
• Study Start: 2019-12-30
• Primary Completion: 2024-02-01
• Study Completion: 2024-02-01
• Results First Submitted: 2025-01-28
• Status Verified: 2025-02
• Results First Submitted QC: 2025-02-28
• Last Update Submitted: 2025-02-28
• Results First Posted: 2025-03-19
• Last Update Posted: 2025-03-19

Recruitment & Eligibility

• Status: TERMINATED
• Sex: All
• Target Recruitment: 28

Inclusion Criteria

• Able to communicate well with the investigator, to understand and comply with the study visits and procedures of the study
• Written informed consent must be obtained before any assessment is performed.
• Male and female participants who are 18 years old or older at screening, and who are diagnosed with familial or sporadic ALS according to the World Federation of Neurology Revised El Escorial criteria of either bulbar or limb onset.
• Disease duration from symptoms onset no longer than 48 months at the screening visit.
• Females of childbearing potential must have a negative pregnancy test at screening and/or baseline.
• Treatment with approved ALS therapies is allowed, but participants need to be on a stable dose and regimen for at least 30 days prior to baseline.
• Having completed the Core Treatment Period to be able to continue in the Extended Treatment Period.

Exclusion Criteria

• A history of clinically significant ECG abnormalities
• Active medical or neurologic diseases other than ALS, that in the opinion of the investigator would limit their participation in the current study.
• Use of other investigational drugs within 5 half-lives of screening, or until the expected PD effect has returned to baseline, whichever is longer; or longer if required by local regulations.
• History of hypersensitivity to any of the study treatments or excipients or to drugs of similar chemical classes.
• Presence of human immunodeficiency virus (HIV) infection based on screening lab results.
• Evidence of active or latent tuberculosis as assessed by Quantiferon testing at the screening visit.
• Positive serology for hepatitis B surface antigen, or hepatitis C antibodies confirmed by an appropriate licensed test at screening.
• Signs or symptoms, in the judgement of the investigator, of a clinically significant systemic viral, bacterial or fungal infection within 30 days prior to the screening visit.
• Cardiac disorders, such as recent cardiac history (within 6 months of screening) of acute coronary syndrome, acute heart failure, or significant ventricular arrhythmia at the screening visit or participants with a history of severe pulmonary hypertension. Participants with cardiac failure class 3 or 4 of the NYHA classification, or history of reduced LVEF or individuals with implanted cardiac pacemaker, or defibrillator.
• Significant hematological laboratory abnormalities.
• Clinical evidence of liver disease or liver injury or any of the following hepatic conditions at the screening visit:
• Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, unless they are using highly effective methods of contraception during dosing and for 14 days after last dose of BLZ945.
• Pregnant or nursing female participants
• Sexually active males unless they use a condom during intercourse while taking the drug during treatment, for 14 days after stopping BLZ945 and should not father a child in this period.
• History or presence of impaired renal function at the screening visit.
• Active suicidal ideation.
• History of drug abuse or harmful alcohol use within the 12 months prior to dosing within the judgement of the investigator, or evidence of such abuse as indicated by the laboratory assays conducted during screening.
• Active GI conditions such as Barrett's esophagus, achalasia, esophageal varices and active or history of esophageal cancer, pre-existing pancreatic disease at screening visit.
• History of active vasculitis or history of autoimmune disease autoimmune disease associated with vasculitis (eg., RA, SLE, Sjögrens disease, scleroderma).
• History or active cardiac valve disorder, congenital valve disease, or other clinical condition that might affect cardiac valve function
• Use of systemic anticoagulation that cannot be temporarily paused before study procedures
• Abnormal values on CT scan or echocardiography, signs of vasculitis, or evidence of a significant medical condition meeting treatment discontinuation criteria will be exclusionary for continuation in the extended treatment period.
• Participants who are planning to initiate treatment with an additional approved ALS therapy in the next 24 weeks are not allowed to continue in the extended treatment period.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SEQUENTIAL

Arm && Interventions

Group	Intervention	Description
Cohort 1	BLZ945	BLZ945 300mg
Cohort 2	BLZ945	BLZ945 600mg
Cohort 3	BLZ945	BLZ945 1200mg
Cohort 4	BLZ945	BLZ945 800mg
Cohort 5 Arm #1	BLZ945	BLZ945 800mg (4 days treatment + 10 days off)
Cohort 5 Arm #2	BLZ945	BLZ945 800mg (once weekly)

Primary Outcome Measures

Name	Time	Method
Cohorts 1-4 : Change From Baseline in Volume of Distribution (Vt) in Different Brain Regions for [11C]-PBR28 PET Scan	Baseline, day 5	\[11C\]-PBR28 is a positron emission tomography (PET) radiotracer for the 18 kDa translocator protein (TSPO) that is used to image neuroinflammation in vivo. \[11C\]PBR28 imaging was used to measure microglial volume at baseline and after BLZ945 treatment in ALS participants.; Relative % change from baseline in volume of distribution (Vt) of \[11C\]-PBR28 in different brain regions after BLZ945 treatment
Cohort 5 (PET Sub-study): Change From Baseline in Volume of Distribution (Vt) in Different Brain Regions for [11C]-PBR28 PET Scan	Baseline, day 84	\[11C\]-PBR28 is a positron emission tomography (PET) radiotracer for the 18 kDa translocator protein (TSPO) that is used to image neuroinflammation in vivo. \[11C\]PBR28 imaging was used to measure microglial volume at baseline and after BLZ945 treatment in ALS participants.; Relative % change from baseline in volume of distribution (Vt) of \[11C\]-PBR28 in different brain regions after BLZ945 treatment
Cohort 5: Change From Baseline in Esophageal Wall Thickness	Baseline, Day 84	Mean change from baseline in esophageal wall thickness measured in mm
Cohort 5: Cardiac Valve Thickness at Day 84 Compared to Baseline	Baseline, Day 84	Cardiac valve thickness on a three point ordinal scale. Categorized by imaging vendor into three semiquantitative (normal, mild-moderate and severe) categories
Cohort 5: Cardiac Valve Stenosis at Day 84 Compared to Baseline	Baseline, Day 84	Cardiac valve stenosis on a four point ordinal scale. Categorized by imaging vendor into four semiquantitative (normal, mild, moderate and severe) categories
Cohort 5: Cardiac Valve Regurgitation Severity at Day 84 Compared to Baseline	Baseline, Day 84	Cardiac valve regurgitation severity on a four point ordinal scale. Categorized by imaging vendor into four semiquantitative (normal, mild, moderate and severe) categories
Cohort 5: Change From Baseline in Left Ventricular Ejection Fraction (LVEF)	Baseline, day 84	Mean change from baseline in Left Ventricular Ejection Fraction.; LVEF is defined as the percentage of blood volume ejected from the left ventricle during systole (contraction phase) relative to the total volume of blood present in the ventricle at the end of diastole (relaxation phase).
Cohort 5: Adverse Events Related to Extracellular Matrix (ECM) Accumulation	Up to Day 84	Number of patients with adverse events related to ECM accumulation

Secondary Outcome Measures

Name	Time	Method
Cohorts 1-5: Plasma Pharmacokinetics (PK) of BLZ945 - Tmax	Cohort 1-4: Pre-dose, 0.5, 1, 2, 4, 6, 8, 12 and 24 hours after BLZ945 dosing on Day 1 and Day 4. Cohort 5: pre-dose, 1, 2 and 4 hours after BLZ945 dosing on Day 1 (Arm#2 only) and Day 4 (Arm#1 only)	Measured by Tmax - Time to Reach the Maximum Concentration After Drug Administration of BLZ945.; Actual recorded sampling times were taken into consideration for the calculation of PK parameters.
Cohorts 1-5: Plasma Pharmacokinetics (PK) of BLZ945 - AUC	Cohort 1-4: Pre-dose, 0.5, 1, 2, 4, 6, 8, 12 and 24 hours after BLZ945 dosing on Day 1 and Day 4. Cohort 5: pre-dose, 1, 2 and 4 hours after BLZ945 dosing on Day 1 (Arm#2 only) and Day 4 (Arm#1 only)	Measured by AUC - Area under the curve of BLZ945; AUC0-24h is the AUC calculated from time zero to 24 hours after dosing (end of a dosing interval).; AUClast is the AUC from time zero to the last measurable concentration sampling time.
Cohorts 1-4: Plasma Pharmacokinetics (PK) of BLZ945 - T1/2	Cohort 1-4: Pre-dose, 0.5, 1, 2, 4, 6, 8, 12 and 24 hours after BLZ945 dosing on Day 1 and Day 4.	Measured by T1/2 - The elimination half-life of BLZ945
Cohorts 1-4: Renal Clearance (CLR) of BLZ945	pre-dose, 0-4, 4-8, 8-12 and 12-24 hours after BLZ945 dosing on Day 1 and Day 4	Urine renal clearance (CLR) of BLZ945
Cohorts 1-5: Plasma Pharmacokinetics (PK) of BLZ945 - Cmax	Cohort 1-4: Pre-dose, 0.5, 1, 2, 4, 6, 8, 12 and 24 hours after BLZ945 dosing on Day 1 and Day 4. Cohort 5: pre-dose, 1, 2 and 4 hours after BLZ945 dosing on Day 1 (Arm#2 only) and Day 4 (Arm#1 only)	Measured by Cmax - The maximum plasma concentration of BLZ945
Cohorts 1-5: Number of Patients With Adverse Events (AEs) and Serious Adverse Events (SAEs)	From first dose of study treatment up to 32 days after last dose (Day 36) for Cohorts 1-4 and up to 4 weeks after last dose (Day 330) for Cohort 5. *Maximum duration of exposure in Cohort 5 was 302 days. 302 + 28 days of FU=330 days	Incidence and severity of AEs and SAEs by treatment group.; AE grades to characterize the severity of the AEs were based on the Common Terminology Criteria for Adverse Events (CTCAE) version 5. For CTCAE, Grade 1 = mild; Grade 2 = moderate; Grade 3 = severe; Grade 4 = life-threatening; Grade 5 = death related to AE

Trial Locations

Locations (3)

Yale University School of Medicine; 🇺🇸 New Haven, Connecticut, United States

Massachusetts General Hospital; 🇺🇸 Boston, Massachusetts, United States

Novartis Investigative Site; 🇸🇪 Stockholm, Sweden