A Phase 2 interventional study of Mexiletine and Placebo in Sporadic Amyotrophic Lateral Sclerosis, sponsored by University of Washington. Completed at 10 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2021-09-29.
Sponsored by University of Washington · Phase 2, Interventional, and Treatment
The purpose of this research is to find out if mexiletine is safe and effective in people with Amyotrophic Lateral Sclerosis (ALS). In this trial, participants will be taking either 300 milligrams per day of mexiletine, 900 milligrams per day of mexiletine or placebo (non-active study drug). The safety and efficacy of these doses will be compared to see if one dose is better than the other.
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder affecting primarily motor neurons, for which treatment designed to slow or arrest progression remains lacking. Mexiletine is a use-dependent sodium channel blocker that has been FDA-approved for decades for the treatment of cardiac arrhythmias and more recently to treat neuropathic pain in diabetic polyneuropathy. Mexiletine has been shown also to be protective of neurons following spinal cord, head injury, and cerebral ischemia, largely by blocking excitotoxicity. Based on previous studies, mexiletine appears to penetrate into the central nervous system at concentrations sufficient to confer significant protection. Recent unpublished studies in the laboratory of Dr. Robert Brown at the University of Massachusetts have also demonstrated that mexiletine ingestion in mice genetically engineered to express high levels of mutant cytosolic copper-zinc superoxide dismutase-1 (SOD1) transgene prolongs survival in these animals. As mexiletine already has FDA-approval as an anti-arrhythmic agent, much is known about the pharmacology and safety of this drug in non-ALS patients. We anticipate that by excluding subjects with a known history of cardiac disease and with the known neuroprotectant properties of this medication, mexiletine is a good choice for further study in an ALS clinical trial.
717 studies on the registry are indexed under Motor Neuron Disease; 137 are open to participants now.
This study's enrollment of 75 is above the median of 35 across 461 interventional studies indexed under Motor Neuron Disease.
Browse Motor Neuron Disease studies →University of Washington is the lead sponsor of 1,397 studies on the registry; 225 are open to participants now.
Of its 154 completed or terminated interventional studies of FDA-regulated products, 132 (86%) have results posted.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
Mexiletine, 300 milligrams by mouth per day for 12 weeks.
Drug: Mexiletine
Mexiletine, 900 milligrams by mouth per day for 12 weeks.
Drug: Mexiletine
Placebo, by mouth per day for 12 weeks.
Drug: Placebo
Also known as: Mexitil
Percentage of Participants That Discontinued Study Drug
Information on adverse effects of mexiletine will be determined at each visit by direct questioning of the subjects, clinical examination, review of concomitant medications, vital signs and laboratory test results.
Time frame: Screening, Baseline Visit Pre-Dose and Post-Dose, Weeks 2, 6, and 12, and at the Final Safety Visit, if a subject discontinues study drug early. Adverse Events will be assessed via telephone Weeks 1, 10, and 16.
Trough Plasma Concentration (Cmin) of Mexiletine
Subjects will have blood drawn to assess mexiletine concentrations for pharmacokinetics (PK) at the Week 6 Visit.
Time frame: Week 6 Visit (pre-dose, hours 1, 2, 3, and 6 post-dose on Week 6)
Peak Plasma Concentration (Cmax) of Mexiletine
Subjects will have blood drawn to assess mexiletine concentrations for pharmacokinetics (PK) at the Week 6 Visit.
Time frame: Week 6 Visit (pre-dose, hours 1, 2, 3, and 6 post-dose on Week 6)
Area Under the Concentration Time Curve (AUC) of Mexiletine in Plasma.
Subjects will have blood drawn to assess mexiletine concentrations for pharmacokinetics (PK) at the Week 6 Visit.
Time frame: Week 6 Visit (up to 6 hours post dose)
Mean Cerebrospinal Fluid (CSF)/Plasma Ratio
The concentrations of Mexiletine were measured in cerebrospinal fluid (CSF) and plasma.
Time frame: Week 6 Visit (up to 6 hours post dose)
Mean Weekly Cramp Frequency
Time frame: Week 3-12, post titration of study medication
Maximal Pain Severity
At the Baseline Visit, subjects will be asked to recount the maximum intensity experienced with a muscle cramp in the previous 24 hours and the maximum intensity experienced with a muscle cramp in the previous 30 days. The visual analog scale (VAS) will be used to measures pain associated with muscle cramping. It will be used to measure muscle cramp intensity in this study. The scale rating is from 0-10; 0 equals no symptoms, 10 equals most severe symptoms. Subject will be provided with a muscle cramp diary to record muscle cramp intensity at home, daily.
Time frame: Weeks 3-12, post titration of study medication
Cramp Frequency - Ratios for Comparisons of Doses for Weeks 3-12
Time frame: Week 3-12, post titration of study medication
Maximal Pain Severity - Ratios for Comparisons of Doses for Weeks 3-12
Time frame: Week 3-12, post titration of study medication
Mean Pain Severity
At the Baseline Visit, subjects will be asked to recount the maximum intensity experienced with a muscle cramp in the previous 24 hours and the maximum intensity experienced with a muscle cramp in the previous 30 days. The visual analog scale (VAS) will be used to measures pain associated with muscle cramping. It will be used to measure muscle cramp intensity in this study. The scale rating is from 0-10; 0 equals no symptoms, 10 equals most severe symptoms. Subject will be provided with a muscle cramp diary to record muscle cramp intensity at home, daily.
Time frame: Weeks 3-12, post titration of study medication
Mean Pain Severity - Ratios for Comparisons of Doses for Weeks 3-12
Time frame: Week 3-12, post titration of study medication
Change in ALS Functional Rating Scale- Revised (ALSFRS-R) Score
The ALSFRS-R is a quickly administered (5 minutes) ordinal rating scale (ratings 0-4) used to determine subjects' assessment of their capability and independence in 12 functional activities. All 12 activities are relevant in ALS. Initial validity was established by documenting that in ALS patients, change in ALSFRS-R scores correlated with change in strength over time, was closely associated with quality of life measures, and predicted survival.
Time frame: Week 0, Week 2, Week 6, Week 12 (or Early Termination Date), and Week 16
Change in Slow Vital Capacity (SVC) Score
The vital capacity (VC) (percent of predicted normal) will be determined, using the slow VC method. The SVC can be measured using conventional spirometers that have had a calibration check prior to subject testing. A printout from the spirometer of all SVC trials will be retained.
Time frame: Week 0, Week 6, and Week 12 (or Early Termination Date)
The first subject in the study was enrolled July 23, 2013. Subjects were recruited and seen at Amyotrophic Lateral Sclerosis (ALS) clinics at 10 sites across the United States (U.S.).
| Milestone | Mexiletine, 300 Milligrams | Mexiletine, 900 Milligrams | Placebo |
|---|---|---|---|
| Started | 20 | 19 | 20 |
| Completed | 20 | 15 | 19 |
| Not completed | 0 | 4 | 1 |
Information on adverse effects of mexiletine will be determined at each visit by direct questioning of the subjects, clinical examination, review of concomitant medications, vital signs and laboratory test results.
| percentage of participants | Mexiletine, 300 Milligrams | Mexiletine, 900 Milligrams | Placebo |
|---|---|---|---|
| Percentage of Participants That Discontinued Study Drug | 5 | 32 | 5 |
Subjects will have blood drawn to assess mexiletine concentrations for pharmacokinetics (PK) at the Week 6 Visit.
| pg/mL | Mexiletine, 300 Milligrams | Mexiletine, 900 Milligrams | Placebo |
|---|---|---|---|
| Trough Plasma Concentration (Cmin) of Mexiletine | 0.23 ± 0.15 | 0.68 ± 0.38 | 0 ± 0 |
Subjects will have blood drawn to assess mexiletine concentrations for pharmacokinetics (PK) at the Week 6 Visit.
| pg/mL | Mexiletine, 300 Milligrams | Mexiletine, 900 Milligrams | Placebo |
|---|---|---|---|
| Peak Plasma Concentration (Cmax) of Mexiletine | 0.41 ± 0.19 | 1.27 ± 0.67 | 0 ± 0 |
Subjects will have blood drawn to assess mexiletine concentrations for pharmacokinetics (PK) at the Week 6 Visit.
| µg*hr/mL | Mexiletine, 300 Milligrams | Mexiletine, 900 Milligrams | Placebo |
|---|---|---|---|
| Area Under the Concentration Time Curve (AUC) of Mexiletine in Plasma. | 2.34 ± 1.08 | 6.24 ± 3.18 | 0 ± 0 |
The concentrations of Mexiletine were measured in cerebrospinal fluid (CSF) and plasma.
| ratio | Mexiletine, 300 Milligrams | Mexiletine, 900 Milligrams | Placebo |
|---|---|---|---|
| Mean Cerebrospinal Fluid (CSF)/Plasma Ratio | 0.38 ± 0.15 | 0.46 ± 0.20 | 0 ± 0 |
| cramps/week | Mexiletine, 300 Milligrams | Mexiletine, 900 Milligrams | Placebo |
|---|---|---|---|
| All Subjects n=20,19,20 | 0.785 (0.304 to 2.023) | 0.231 (0.125 to 1.250) | 2.505 (1.030 to 6.092) |
| 10+cramps previous 30 days at Baseline n=20,19,20 | 1.898 (0.494 to 7.288) | 0.595 (0.112 to 3.153) | 8.563 (3.217 to 22.79) |
The ALSFRS-R is a quickly administered (5 minutes) ordinal rating scale (ratings 0-4) used to determine subjects' assessment of their capability and independence in 12 functional activities. All 12 activities are relevant in ALS. Initial validity was established by documenting that in ALS patients, change in ALSFRS-R scores correlated with change in strength over time, was closely associated with quality of life measures, and predicted survival.
| scores on a scale | Mexiletine, 300 Milligrams | Mexiletine, 900 Milligrams | Placebo |
|---|---|---|---|
| Week 0 n=20,19,20 | 35.21 (32.9 to 37.5) | 35.21 (32.9 to 37.5) | 35.21 (32.9 to 37.5) |
| Week 2 n=20,19,20 | 35.14 (32.7 to 37.6) | 34.58 (32.0 to 37.1) | 35.47 (33.0 to 37.9) |
| Week 6 n=20,19,20 | 35.72 (33.1 to 38.3) | 33.08 (30.4 to 35.8) | 34.25 (31.7 to 36.8) |
| Week 12 n=20,19,20 | 33.33 (30.4 to 36.3) | 31.85 (28.6 to 35.1) | 33.48 (30.5 to 36.4) |
| Week 16 n=20,19,20 | 32.44 (29.2 to 35.7) | 31.94 (28.2 to 35.6) | 32.96 (29.7 to 36.2) |
The vital capacity (VC) (percent of predicted normal) will be determined, using the slow VC method. The SVC can be measured using conventional spirometers that have had a calibration check prior to subject testing. A printout from the spirometer of all SVC trials will be retained.
| percent of predicted normal | Mexiletine, 300 Milligrams | Mexiletine, 900 Milligrams | Placebo |
|---|---|---|---|
| Week 0 n=20,19,20 | 87.74 (80.0 to 95.5) | 87.74 (80.0 to 95.5) | 87.74 (80.0 to 95.5) |
| Week 6 n=20,19,20 | 86.51 (78.1 to 94.9) | 82.92 (73.9 to 91.9) | 84.79 (76.3 to 93.3) |
| Week 12 n=20,19,20 | 83.98 (75.1 to 92.8) | 77.18 (67.0 to 87.4) | 79.58 (70.7 to 88.4) |
At the Baseline Visit, subjects will be asked to recount the maximum intensity experienced with a muscle cramp in the previous 24 hours and the maximum intensity experienced with a muscle cramp in the previous 30 days. The visual analog scale (VAS) will be used to measures pain associated with muscle cramping. It will be used to measure muscle cramp intensity in this study. The scale rating is from 0-10; 0 equals no symptoms, 10 equals most severe symptoms. Subject will be provided with a muscle cramp diary to record muscle cramp intensity at home, daily.
| units on a scale | Mexiletine, 300 Milligrams | Mexiletine, 900 Milligrams | Placebo |
|---|---|---|---|
| All Subjects n=20,19,20 | 0.738 (0.364 to 1.494) | 0.340 (0.117 to 0.986) | 0.939 (0.466 to 1.893) |
| 10+cramps previous 30 days at Baseline n=20,19,20 | 1.348 (0.616 to 2.953) | 0.572 (0.176 to 1.859) | 2.033 (1.123 to 3.681) |
| ratio | 300mg vs Placebo | 900mg vs Placebo |
|---|---|---|
| All Subjects n=20,19 | 0.313 (0.100 to 0.982) | 0.158 (0.050 to 0.495) |
| 10+cramps previous 30 days at Baseline n=20,19 | 0.222 (0.079 to 0.624) | 0.069 (0.013 to 0.374) |
| ratio | 300mg vs Placebo | 900mg vs Placebo |
|---|---|---|
| All Subjects n=20,19 | 0.785 (0.342 to 1.802) | 0.361 (0.131 to 1.000) |
| 10+cramps previous 30 days at Baseline n=20,19 | 0.663 (0.347 to 1.267) | 0.281 (0.080 to 0.992) |
At the Baseline Visit, subjects will be asked to recount the maximum intensity experienced with a muscle cramp in the previous 24 hours and the maximum intensity experienced with a muscle cramp in the previous 30 days. The visual analog scale (VAS) will be used to measures pain associated with muscle cramping. It will be used to measure muscle cramp intensity in this study. The scale rating is from 0-10; 0 equals no symptoms, 10 equals most severe symptoms. Subject will be provided with a muscle cramp diary to record muscle cramp intensity at home, daily.
| units on a scale | Mexiletine, 300 Milligrams | Mexiletine, 900 Milligrams | Placebo |
|---|---|---|---|
| All Subjects n=20,19,20 | 0.241 (0.115 to 0.509) | 0.136 (0.049 to 0.379) | 0.536 (0.275 to 1.046) |
| 10+cramps previous 30 days at Baseline n=20,19,20 | 0.467 (0.145 to 1.504) | 0.201 (0.050 to 0.812) | 1.248 (0.527 to 2.958) |
| ratio | 300mg vs Placebo | 900mg vs Placebo |
|---|---|---|
| All Subjects n=20,19 | 0.450 (0.183 to 1.110) | 0.254 (0.098 to 0.658) |
| 10+cramps previous 30 days at Baseline n=20,19 | 0.374 (0.135 to 1.035) | 0.161 (0.032 to 0.795) |
Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Mexiletine, 300 Milligrams | — | 0/20 (0%) | 17/20 (85%) |
| Mexiletine, 900 Milligrams | — | 1/19 (5.3%) | 19/19 (100%) |
| Placebo | — | 2/20 (10%) | 18/20 (90%) |
| Event | Mexiletine, 300 Milligrams | Mexiletine, 900 Milligrams | Placebo |
|---|---|---|---|
| Balance DisorderNervous system disorders | 0/20 | 1/19 | 0/20 |
| Lower Limb FractureInjury, poisoning and procedural complications | 0/20 | 0/19 | 1/20 |
| DyspnoeaRespiratory, thoracic and mediastinal disorders | 0/20 | 0/19 | 1/20 |
| Respiratory FailureRespiratory, thoracic and mediastinal disorders | 0/20 | 0/19 | 1/20 |
| Event | Mexiletine, 300 Milligrams | Mexiletine, 900 Milligrams | Placebo |
|---|---|---|---|
| NauseaGastrointestinal disorders | 1/20 | 8/19 | 2/20 |
| DizzinessNervous system disorders | 3/20 | 6/19 | 4/20 |
| FallInjury, poisoning and procedural complications | 2/20 | 5/19 | 4/20 |
| Post Lumbar Puncture SyndromeInjury, poisoning and procedural complications | 2/20 | 5/19 | 2/20 |
| TremorNervous system disorders | 0/20 | 5/19 | 1/20 |
| ConstipationGastrointestinal disorders | 1/20 | 4/19 | 2/20 |
| FatigueGeneral disorders | 2/20 | 4/19 | 3/20 |
| Procedural PainInjury, poisoning and procedural complications | 1/20 | 4/19 | 2/20 |
| HeadacheNervous system disorders | 2/20 | 4/19 | 2/20 |
| AstheniaGeneral disorders | 1/20 | 3/19 | 2/20 |
| Age, Continuous(years) | Mexiletine, 300 Milligrams | Mexiletine, 900 Milligrams | Placebo | Total |
|---|---|---|---|---|
| Mean | 59.2 ± 7.1 | 58.0 ± 10.7 | 57.0 ± 7.0 | 58.0 ± 8.3 |
| Sex: Female, Male(Participants) | Mexiletine, 300 Milligrams | Mexiletine, 900 Milligrams | Placebo | Total |
|---|---|---|---|---|
| Female | 6 | 7 | 10 | 23 |
| Male | 14 | 12 | 10 | 36 |
| Race/Ethnicity, Customized(participants) | Mexiletine, 300 Milligrams | Mexiletine, 900 Milligrams | Placebo | Total |
|---|---|---|---|---|
| Asian | 1 | 0 | 0 | 1 |
| Caucasian | 19 | 19 | 20 | 58 |
| Region of Enrollment(participants) | Mexiletine, 300 Milligrams | Mexiletine, 900 Milligrams | Placebo | Total |
|---|---|---|---|---|
| United States | 20 | 19 | 20 | 59 |
| Months Since Symptom Onset(Months) | Mexiletine, 300 Milligrams | Mexiletine, 900 Milligrams | Placebo | Total |
|---|---|---|---|---|
| Mean | 21.0 ± 10.3 | 18.6 ± 9.2 | 17.5 ± 8.3 | 19.0 ± 9.3 |
| Months Since Diagnosis(Months) | Mexiletine, 300 Milligrams | Mexiletine, 900 Milligrams | Placebo | Total |
|---|---|---|---|---|
| Mean | 8.6 ± 7.7 | 8.9 ± 8.2 | 7.3 ± 5.9 | 8.3 ± 7.2 |
| Slow Vital Capacity (Max % predicted)(Max %-predicted) | Mexiletine, 300 Milligrams | Mexiletine, 900 Milligrams | Placebo | Total |
|---|---|---|---|---|
| Mean | 86.7 ± 19.1 | 86.2 ± 23.7 | 83.7 ± 22.6 | 85.6 ± 21.5 |
| Body Mass Index (BMI) (kg/m^2)(kilograms (kg)/meter squared (m^2)) | Mexiletine, 300 Milligrams | Mexiletine, 900 Milligrams | Placebo | Total |
|---|---|---|---|---|
| Mean | 28.1 ± 5.1 | 27.3 ± 4.1 | 27.1 ± 3.3 | 27.5 ± 4.2 |
5 further baseline measures are reported on the registry.
This study is completed, as verified in Sep 2021. You cannot join it, but the record below documents what was studied.
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