A low molecular weight dextran sulphate, ILB(R), for the treatment of amyotrophic lateral sclerosis (ALS): an open-label, single-arm, single-centre, phase II trial

BackgroundAmyotrophic lateral sclerosis (ALS), also known as Lou Gehri[g]s disease, is a rare neurological disease and is the most common motor neurone disease. It is a fatal disease with specific loss of motor neurons in the spinal cord, brain stem, and motor cortex leading to progressive paralysis and usually death within five years of diagnosis. There remains no cure for ALS, and management is focused on a combination of neuroprotective medication, respiratory support, and management by multidisciplinary clinics. Patients and MethodsThis prospective, single-arm, open-label phase II clinical trial of sustained weekly administration of 2 mg/kg ILB(R) (a low-molecular weight dextran sulphate) was conducted in a single UK hospital. Eligible patients were at least 18 years and had a definite diagnosis of ALS according to El Escorial Criteria. The co-primary outcomes were safety, tolerability, and quantity of ILB(R) administered. All evaluable patients were analysed in a modified intention-to-treat analysis. EudraCT number. 2018-000668-28 FindingsBetween 18-Apr-2019 and 27-Mar-2020, 11 patients were recruited and treated for up to 38 weeks. There were no treatment terminations or withdrawals. One serious adverse event was reported, which was not related to ILB(R) and resolved without sequalae. 270 mild/moderate adverse events were reported with no intolerable events occurring during the trial. The total number of ILB(R) treatments administered per patient ranged from 4 to 38, with a cumulative dose ranging from 745 to 6668 mg. As a result of the COVID-19 pandemic and the high-risk status of study participants, recruitment and treatment was suspended early in Mar-2020. At the long-term follow-up, three patients had died after the trial was halted, between 53 and 62 weeks after their final ILB(R) injection. InterpretationLong-term weekly ILB(R) injections of 2 mg/kg was well tolerated and had an acceptable safety profile in patients with ALS.