A Study To Evaluate Safety and Tolerability of CK-2017357 (CK-357) in Patients with Amyotrophic Lateral Sclerosis Using a Twice-Daily, Dose-Titration Regimen (P04.155)

Abstract

Objective: The primary objective of this study was to determine the safety and tolerability of CK-357 as the dose was increased over 3 weeks in ALS patients taking concomitant riluzole at a dose half that normally prescribed. Measures of strength, endurance, and function were obtained to pilot assessments for a planned efficacy study. Background CK-357 is an orally bioavailable fast skeletal muscle troponin activator that increases the force response of muscle to neuronal input. In a single-dose Evidence of Effect Phase 2a study, both patient- and investigator global assessments reflected dose-related improvement; and gains were noted in some measures of respiratory function and muscle fatigue. Additionally, small strength improvements were observed in some muscles 24 hours post-dose. Plasma riluzole levels were increased approximately 2 to 3-fold after a single dose of CK-357. Design/Methods: Eligible patients had a Slow Vital Capacity (SVC) of greater than 50% of predicted, and diminished but measurable grip strength in at least one hand. All 24 enrolled patients took 50 mg riluzole each morning. Patients were randomized to receive placebo or CK-357 tablets, administered twice daily. The dose of CK-2017357 was increased at weekly intervals starting at 125 mg BID, increasing to 250 mg BID (500 mg total daily dose) over a 3-week period. Safety and efficacy measures were collected prior to and at the end of dosing, and one week after study drug was discontinued. Clinical outcome measures included ALSFRS-R, strength of selected muscle groups, submaximal handgrip endurance, respiratory function (SVC, Sniff Nasal Inspiratory Pressure, and Maximum Voluntary Ventilation), nocturnal pulse oximetry, and Timed Up-and-Go test. Results: Demographic data, safety and tolerability information, and outcomes data will be presented. Conclusions: This study will provide information to aid in dose selection for future Phase 3 studies of CY-2017357 in ALS. Supported by: Cytokinetics, Inc. Disclosure: Dr. Shefner has received personal compensation for activities with Biogen Idec, GlaxoSmithKline, Cytokinetics, Inc., and Trophos. Dr. Shefner has received personal compensation in an editorial capacity for UpToDate. Dr. Shefner has received research support from the National Institutes of Health, the ALS Association, the ALS Therapy Alliance, GlaxoSmithKline, Neuralstem, Isis Pharmaceuticals, Biogen Idec, Cytokinetics, Inc., and Sanofi Pharmaceuticals. Dr. Andrews has received personal compensation for activities with AVANIR. Dr. Bedlack has received personal compensation for activities with Pfizer Inc, Athena Diagnostics, Eli Lilly & Company, UCB Pharma and Guidepoint Pharmacy as a speaker and/or consultant. Dr. Berry has nothing to disclose. Dr. Goslin has nothing to disclose. Dr. Jackson has received personal compensation for activities with Avanir Pharmaceuticals.Dr. Jackson has received research support from Knopp Pharmaceuticals, Biogen Idec and Cytokinetics. Dr. Kissel has nothing to disclose. Dr. Lange has nothing to disclose. Dr. Licht has received research support from Avanir Pharmaceuticals. Dr. Mozaffar has nothing to disclose. Dr. Pestronk has received personal compensation or activities with Athena Diagnostics.Dr. Pestronk has received (royalty or license fee or contractual rights) payments from Athena Diagnostics.Dr. Pestronk holds stock and/or stock options in Johnson & Johnson.Dr. Pestronk has received research support from Knopp, ISIS, Sanofi-Aventis, and Prosensa. Dr. Rosenfeld has received personal compensation for activities with Avanir Pharmaceuticals, Cytokinetics, Gerson Lehrman Group and Guidepoint Global as a speaker and consultant. Dr. Wolff has received personal compensation for activities with Cytokinetics, Inc as an employee. Dr. Wolff holds stock and/or stock options in Cytokinetics, Inc which sponsored research in which Dr. Wolff was involved as an investigator. Dr. Wolff holds stock and/or stock options in Cytokinetics, Inc. Dr. Wolff has received research support from Cytokinetics, Inc. Dr. Lee has received personal compensation for activities with Cytokinetics as an employee. Dr. Masonek has received personal compensation for activities with Cytokinetics, Inc., as an employee. Dr. Jones has received personal compensation for activities with Cytokinetics, Inc. as an employee. Dr. Meng has received personal compensation for activities with Cytokinetics, Inc., as an employee. Dr. Cedarbaum has received personal compensation for activities with Cytokinetics, Inc. as an employee.