Phase IIa trial of fingolimod for amyotrophic lateral sclerosis demonstrates acceptable acute safety and tolerability

James D. Berry; Sabrina Paganoni; Nazem Atassi; Eric A. Macklin; Namita Goyal; Michael Rivner; Ericka Simpson; Stanley Appel; Daniela L. Grasso; Nicte I. Mejia; Farrah Mateen; Alan Gill; Fernando Vieira; Valerie Tassinari; Steven Perrin

doi:10.1002/mus.25733

Phase IIa trial of fingolimod for amyotrophic lateral sclerosis demonstrates acceptable acute safety and tolerability

James D. Berry, Sabrina Paganoni, Nazem Atassi, Eric A. Macklin, Namita Goyal, Michael Rivner, Ericka Simpson, Stanley Appel, Daniela L. Grasso, Nicte I. Mejia, Farrah Mateen, Alan Gill, Fernando Vieira, Valerie Tassinari, Steven Perrin

Neurology

Research output: Contribution to journal › Article

8 Scopus citations

Abstract

Introduction: Immune activation has been implicated in progression of amytrophic lateral sclerosis (ALS). Oral fingolimod reduces circulating lymphocytes. The objective of this phase IIa, randomized, controlled trial was to test the short-term safety, tolerability, and target engagement of fingolimod in ALS. Methods: Randomization was 2:1 (fingolimod:placebo). Treatment duration was 4 weeks. Primary outcomes were safety and tolerability. Secondary outcomes included circulating lymphocytes and whole-blood gene expression. Results: Thirty participants were randomized; 28 were administered a drug (fingolimod 18, placebo 10). No serious adverse events occurred. Adverse events were similar by treatment arm, as was study discontinuation (2 fingolimod vs. 0 placebo, with no statistical difference). Forced expiratory volume in 1 second (FEV₁) and FEV₁/slow vital capacity changes were similar in the fingolimod and placebo arms. Circulating lymphocytes decreased significantly in the fingolimod arm (P < 0.001). Nine immune-related genes were significantly downregulated in the fingolimod arm, including forkhead box P3 (P < 0.001) and CD40 ligand (P = 0.003). Discussion: Fingolimod is safe and well-tolerated and can reduce circulating lymphocytes in ALS patients. Muscle Nerve 56: 1077–1084, 2017.

Original language	English (US)
Pages (from-to)	1077-1084
Number of pages	8
Journal	Muscle and Nerve
Volume	56
Issue number	6
DOIs	https://doi.org/10.1002/mus.25733
State	Published - Dec 2017

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Keywords

FOXP3
RNA profiling
circulating lymphocytes
clinical trial
neuroinflammation
target engagement

ASJC Scopus subject areas

Physiology
Clinical Neurology
Cellular and Molecular Neuroscience
Physiology (medical)

Cite this

Berry, J. D., Paganoni, S., Atassi, N., Macklin, E. A., Goyal, N., Rivner, M., Simpson, E., Appel, S., Grasso, D. L., Mejia, N. I., Mateen, F., Gill, A., Vieira, F., Tassinari, V., & Perrin, S. (2017). Phase IIa trial of fingolimod for amyotrophic lateral sclerosis demonstrates acceptable acute safety and tolerability. Muscle and Nerve, 56(6), 1077-1084. https://doi.org/10.1002/mus.25733

Phase IIa trial of fingolimod for amyotrophic lateral sclerosis demonstrates acceptable acute safety and tolerability. / Berry, James D.; Paganoni, Sabrina; Atassi, Nazem; Macklin, Eric A.; Goyal, Namita; Rivner, Michael; Simpson, Ericka; Appel, Stanley; Grasso, Daniela L.; Mejia, Nicte I.; Mateen, Farrah; Gill, Alan; Vieira, Fernando; Tassinari, Valerie; Perrin, Steven.

In: Muscle and Nerve, Vol. 56, No. 6, 12.2017, p. 1077-1084.

Research output: Contribution to journal › Article

Berry, JD, Paganoni, S, Atassi, N, Macklin, EA, Goyal, N, Rivner, M, Simpson, E, Appel, S, Grasso, DL, Mejia, NI, Mateen, F, Gill, A, Vieira, F, Tassinari, V & Perrin, S 2017, 'Phase IIa trial of fingolimod for amyotrophic lateral sclerosis demonstrates acceptable acute safety and tolerability', Muscle and Nerve, vol. 56, no. 6, pp. 1077-1084. https://doi.org/10.1002/mus.25733

Berry, James D. ; Paganoni, Sabrina ; Atassi, Nazem ; Macklin, Eric A. ; Goyal, Namita ; Rivner, Michael ; Simpson, Ericka ; Appel, Stanley ; Grasso, Daniela L. ; Mejia, Nicte I. ; Mateen, Farrah ; Gill, Alan ; Vieira, Fernando ; Tassinari, Valerie ; Perrin, Steven. / Phase IIa trial of fingolimod for amyotrophic lateral sclerosis demonstrates acceptable acute safety and tolerability. In: Muscle and Nerve. 2017 ; Vol. 56, No. 6. pp. 1077-1084.

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abstract = "Introduction: Immune activation has been implicated in progression of amytrophic lateral sclerosis (ALS). Oral fingolimod reduces circulating lymphocytes. The objective of this phase IIa, randomized, controlled trial was to test the short-term safety, tolerability, and target engagement of fingolimod in ALS. Methods: Randomization was 2:1 (fingolimod:placebo). Treatment duration was 4 weeks. Primary outcomes were safety and tolerability. Secondary outcomes included circulating lymphocytes and whole-blood gene expression. Results: Thirty participants were randomized; 28 were administered a drug (fingolimod 18, placebo 10). No serious adverse events occurred. Adverse events were similar by treatment arm, as was study discontinuation (2 fingolimod vs. 0 placebo, with no statistical difference). Forced expiratory volume in 1 second (FEV1) and FEV1/slow vital capacity changes were similar in the fingolimod and placebo arms. Circulating lymphocytes decreased significantly in the fingolimod arm (P < 0.001). Nine immune-related genes were significantly downregulated in the fingolimod arm, including forkhead box P3 (P < 0.001) and CD40 ligand (P = 0.003). Discussion: Fingolimod is safe and well-tolerated and can reduce circulating lymphocytes in ALS patients. Muscle Nerve 56: 1077–1084, 2017.",

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10.1002/mus.25733