Usnoflast Neuromuscular Investigation for Treatment Efficacy in Amyotrophic Lateral Sclerosis

Overview

Official title

A Phase 2b, Randomized, Double-blind, Placebo-controlled, Parallel-group, Multicenter Study to Evaluate the Efficacy, Safety, Pharmacokinetics, and Pharmacodynamics of Usnoflast Administered to Adult Subjects With ALS

Brief title

Usnoflast Neuromuscular Investigation for Treatment Efficacy in Amyotrophic Lateral Sclerosis

Registration type

ClinicalTrials.gov

NCT number

NCT07023835

Status

Recruiting

Study category

Interventional, Drug trial, Biomarker, Prevention, Biospecimen

Sponsor / center

Zydus Therapeutics Inc.

Research center

Emory ALS Center

Collaborators

Not stated in the official study record.

Study type

Interventional study

Phase

Phase 2

Enrollment

240

Start date

09-17-2025

Primary completion date

03-XX-2028

Estimated / actual completion date

10-XX-2028

Last source update

09-01-2026

What is being studied?

A phase 2b, randomized, double-blind, placebo-controlled, parallel-group, multicenter 36 weeks study to evaluate the efficacy, safety, pharmacokinetics, and pharmacodynamics of Usnoflast administered to adult subjects with Amyotrophic Lateral Sclerosis followed by 16 weeks open label extension study. This Open Label Extension will be a multicenter, 16-week, single arm study to confirm the long-term safety and efficacy of Usnoflast in subjects with ALS. Eligible subjects of all three arms of the main study will be recruited in the OLE phase and will receive Usnoflast (75 mg) for a total of 16 weeks BID (oral capsule administration).

Intervention(s)

Center-specific eligibility information

Emory lists oral medication, vital capacity greater than 60%, ALSFRS score greater than 35, disease onset fewer than 24 months before screening, and a 36-week double-blind period with an optional open-label extension.

Who may be eligible?

This is a simplified summary. The official study team or research center determines eligibility.

Population / disease status

Caregiver / non-patient study if applicable, Diagnosed ALS

Diagnosis / conditions

Amyotrophic Lateral Sclerosis (ALS)

Age

18 Years to Not stated in the official study record.

Disease duration

≤ 24 months

Respiratory criteria

The official eligibility criteria include language relevant to this topic; review the full criteria below.

ALSFRS-R criteria

The official eligibility criteria include language relevant to this topic; review the full criteria below.

Genetic criteria

The official eligibility criteria include language relevant to this topic; review the full criteria below.

Medication requirements

The official eligibility criteria include language relevant to this topic; review the full criteria below.

Major inclusion and exclusion criteria from the official record

Inclusion Criteria:

* Diagnosis of probable or definite Amyotrophic lateral sclerosis, according to the revised version of the El Escorial World Federation of Neurology criteria
* Time since onset of first symptom of Amyotrophic lateral sclerosis ≤24 months. Date of Amyotrophic lateral sclerosis symptom onset. For the purposes of this study, the date of symptom onset will be defined as the date the subject first had symptoms of their disease, i.e., limb weakness, dysarthria, dysphagia, shortness of breath, or fasciculations, from the screening visit.
* Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised score of ≥35 at screening.
* Slow vital capacity: ≥60% of predicted capacity at the screening visit.
* Be able to swallow capsules.
* Either not currently receiving riluzole/sodium phenylbutyrate and taurursodiol/tofersen or on a stable dose of riluzole/sodium phenylbutyrate and taurursodiol/tofersen for at least 4 weeks before the screening visit. Subjects receiving riluzole/sodium phenylbutyrate and taurursodiol/tofersen are expected to remain on the same dose throughout the duration of the study.
* Either not currently receiving edaravone or on edaravone treatment. Subjects receiving edaravone must have completed at least 1 cycle of treatment before the screening visit and are expected to continue with a stable dose of edaravone treatment throughout the duration of the study.
* Capable of providing informed consent and complying with study procedures in the opinion of the investigator

Exclusion Criteria:

* Presence of unstable psychiatric disease, cognitive impairment, dementia, or substance abuse that would impair the ability of the subject to provide informed consent, in the opinion of the investigator.
* Serious illness (e.g., pneumonia, septicemia) within 4 weeks of the screening visit; infection requiring hospitalization or treatment with intravenous antibiotics, antivirals, or antifungals within 4 weeks of screening; chronic bacterial infection (such as tuberculosis) deemed unacceptable as per the judgment of the investigator.
* Active herpes zoster infection within 2 months prior to the screening visit.
* Any medical condition that promotes suicidal attempt or behavior within 6 months prior to the screening visit and in the opinion of the investigator might interfere with subject's participation in the study or is a risk for a suicide attempt.
* History of unstable or severe cardiac, pulmonary, oncological, hepatic, or renal disease or active cancer or another medically significant illness other than Amyotrophic lateral sclerosis, precluding safe participation of subject in this study in the opinion of the investigator.
* Known allergy, sensitivity, or intolerance to Investigational product or excipients.
* Subjects who have taken concomitant medications that are substrates of drug metaboliz-ing enzymes (Cytochrome P450 1A2 and/or Cytochrome P450 2B6) within 7 days or 5 half-lives of the medication (whichever is longer) before the first dose of Investigational product and throughout the study.
* Use of any steroids, colchicine, or anti-IL-1 inhibitors within 7 days or 5 half-lives of the medication (whichever is longer) prior to the first dose of Investigational product administration.
* Use of any investigational drug concurrently or within 4 weeks or 5 half-lives (whichever is longer) prior to the first dose of Investigational product administration.
* Any clinically significant condition and/or laboratory significant value that would prevent the subject from participating in the study in the opinion of the investigator.
* Received a live vaccine within 14 days before the screening visit or planning to receive during the study duration.
* Subjects who have received stem cell or gene therapy for Amyotrophic lateral sclerosis at any time in the past.
* Following laboratory test values at screening:

  1. Alanine aminotransferase or Aspartate aminotransferase values \>3.0 × Upper Limit of Normal
  2. Bilirubin \>1.5 × Upper Limit of Normal unless the subject has documented Gilbert's syndrome (isolated bilirubin \>1.5 × Upper Limit of Normal is acceptable if bilirubin is fractionated, and direct bilirubin is \<35%)
  3. Estimated glomerular filtration rate (eGFR) \<60 mL/min/1.73 m2
* For those participating in the optional Cerebrospinal fluid collection, contraindications to lumbar puncture including but not limited to lumbar scoliosis, coagulopathy, infection at site of puncture, or use of anticoagulants.
* Subjects with history of epilepsy within 6 months of screening visit.
* Surgery within last 3 months or planned major surgery within next 3 months from the date of screening (other than minor cosmetic surgery and minor dental surgery).
* Use or intended use of any medications/products known to alter drug absorption, metabolism, or elimination processes, including St. John's Wort, within 4 weeks of screening and up to end of study. Use of such medication will be considered on a case-by-case basis as per the opinion of the investigator and/or independent medical monitor.
* Receiving an elemental diet or parenteral nutrition.
* Received blood transfusion within 3 months prior to screening.
* Subjects with Human immunodeficiency virus, hepatitis B, hepatitis C, coronary artery disease, or active gastrointestinal condition that might interfere with drug absorption.
* Inability to be venipunctured or those not able to tolerate venous puncture.
* Employee of the investigator or study site, with direct involvement in the proposed study or other studies under the direction of that investigator or study site, as well as family members of employees of investigator or the investigator.
* Any condition not mentioned in any of above criteria that, as per the investigator, would hinder participation of the subject in the study. This may include, but not limited to, considerations of safety, compliance, or other factors that could impact the integrity of the study or the well-being of the subject.
* 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 during the study and for at least 1 month after administration of last dose of Investigational product. If male of reproductive capacity, unwilling to use effective contraception during the study and for at least 1 month after administration of last dose of Investigational product.

For Open Label Extension

Inclusion Criteria:

* Completion in the randomized, double blind Usnoflast study (main study).
* Subjects who elect to continue treatment after completion of Usnoflast phase 2b study must enrol in the OLE within 28 days of the completion of Week 36 visit of the main study.
* Provide a new informed consent to enter the OLE phase.

Exclusion Criteria:

* Discontinued IP prematurely in the double-blind phase of the study for reasons other than tracheostomy or permanent-assisted ventilation.
* Treatment with or use of any restricted medications.
* Any ongoing AE that, in the opinion of the site investigator, is clear contraindication to the IP.
* Unstable cardiac or other life-threatening disease emergent during the randomized, double-blind study
* Any major medical history or other evidence of severe illness or any other conditions that would make the subject, in the opinion of the investigator, unsuitable for the study.
* 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 during the study and for at least 1 month after administration of last dose of IP. If male of reproductive capacity, unwilling to use effective contraception during the study and for at least 1 month after administration of last dose of IP.

Genetics

Gene-specific study?

Yes

Gene or variant

Other specified ALS gene

Genetic test required?

Not stated in the official study record.

Known carrier required?

Not stated

Confirmed pathogenic variant required?

Not stated in the official study record.

Presymptomatic carriers eligible?

Not stated in the official study record.

At-risk relative eligible?

Not stated

Genetic test provided?

Not stated in the official study record.

Genetic counseling provided?

Not stated in the official study record.

Results returned / offered?

Not stated

Family history required?

Not stated in the official study record.

Study design

Randomized?

Not stated in the official study record.

Allocation

Not stated in the official study record.

Intervention model

Not stated in the official study record.

Masking

Not stated in the official study record.

Placebo

Yes

Primary purpose

Not stated in the official study record.

Endpoints

Primary outcome measures

• Efficacy of Usnoflast versus placebo assessed using the revised ALSFRS-R total score
• Efficacy of Usnoflast versus placebo assessed using the survival
• Effect of Usnoflast versus placebo on survival in Open label extension phase
• Number of participants with treatment emergent adverse events in open label extension
• Number of participants with Serious adverse events in open label extension

Secondary outcome measures

• Effect of Usnoflast versus placebo on survival
• Evaluate the effect of Usnoflast versus placebo on Slow vital capacity
• Evaluate the effect of Usnoflast versus placebo on serum levels of Neurofilament light chain protein
• Evaluate the effect of Usnoflast versus placebo on Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised total score and various functional items/domains of the ALSFRS-R total score
• Evaluate and compare the effect of Usnoflast versus placebo on overall health-related quality of life
• Number of participants with treatment emergent adverse events
• Number of participants with Serious adverse events
• Evaluate Pharmacokinetic of Usnoflast in plasma
• Evaluate Pharmacokinetic of Usnoflast in plasma
• Evaluate Pharmacokinetic of Usnoflast in plasma
• Evaluate Pharmacokinetic of Usnoflast in plasma
• Evaluate Pharmacokinetic of Usnoflast in plasma
• Evaluate Pharmacokinetic of Usnoflast in plasma
• Evaluate Pharmacokinetic of Usnoflast in plasma
• Evaluate Pharmacokinetic of Usnoflast in plasma
• Evaluate Pharmacokinetic of Usnoflast in Cerebrospinal fluid
• Effect of Usnoflast versus placebo on Cerebrospinal fluid levels of Neurofilament light chain protein
• To determine the rate of disease progression in open label extension

A biomarker outcome should not automatically be interpreted as a clinical outcome.

Locations

Contact

Research-center contact: Amber Antich · amber.antich@emory.edu

Central contact: Farheen Shaikh · fshaikh@zydustherapeutics.com · 6094534751

Study official: Deven V Parmar · Zydus Therapeutics Inc. · STUDY_DIRECTOR