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CompletedNCT04788745MetFlexUpdated Jul 20, 2023

Targeting Metabolic Flexibility in Amyotrophic Lateral Sclerosis (ALS)

A Phase 2 interventional study of Trimetazidine Dihydrochloride in Amyotrophic Lateral Sclerosis and Motor Neuron Disease, sponsored by The University of Queensland. Completed at 3 sites in 3 countries. Open to participants aged 18 Years to 75 Years. Per ClinicalTrials.gov, last updated 2023-07-20.

Sponsored by The University of Queensland · Phase 2, Interventional, and Treatment

Phase
Phase 2
Study type
Interventional
Enrollment
21
Allocation
Not applicable
Ages
18 Years to 75 Years
Sex
All
01

Study summary

MetFlex is an investigator led, open-label, single-arm, Phase 2a trial to determine the safety and tolerability of trimetazidine for the treatment of amyotrophic lateral sclerosis/motor neuron disease (ALS/MND).

Read the detailed description

The study will consist of a 4-week lead-in period to obtain a stable baseline measurement of clinical markers of disease and oxidative stress. After the lead-in phase, participants will receive trimetazidine for 12 weeks. Participants will visit the clinic at 6-week intervals, during which we will obtain a blood sample to measure the pharmacodynamic response. We will also collect information regarding the rate of disease progression (i.e. ALSFRS-R and SVC). At weeks 3 and 9 of treatment, participants will conduct a teleconference visit, during which we will collect data on ALSFRS-R. Adverse events will be collected and recorded throughout the entire trial duration. At the end of the on-treatment period, a close-out visit will occur after four weeks. The total study period per participant will be 20 weeks.

02

Conditions studied

  • Amyotrophic Lateral Sclerosis
  • Motor Neuron Disease
03

In context

Motor Neuron Disease

717 studies on the registry are indexed under Motor Neuron Disease; 137 are open to participants now.

This study's enrollment of 21 is below the median of 35 across 461 interventional studies indexed under Motor Neuron Disease.

Browse Motor Neuron Disease studies →

Lead sponsor

The University of Queensland is the lead sponsor of 89 studies on the registry; 25 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years to 75 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Age between 18 and 75 years
  • Signed informed consent prior to the initiation of any study-specific procedures
  • Familial or sporadic ALS/MND, defined as clinically possible, probable, or definite as per the El Escorial criteria
  • Relative TRICALS risk score between -6.0 to -2.0 (75% of patients with ALS/MND)
  • Metabolic index ≥110%, at the screening visit.
  • The use of riluzole will be permitted during the study. Individuals taking riluzole must be on a stable dose for at least 30 days prior to the baseline visit, or stopped taking riluzole at least 30 days prior to the baseline visit.
  • Ability to swallow tablets
  • Able to lie with torso elevated at a 35° angle for 30 minutes without respiratory support
  • Able to give informed consent (as judged by the investigator) and able to comply with all study visits and all study procedures
  • Females must not be able to become pregnant (e.g. post-menopausal, surgically sterile or using highly effective birth control methods) for the duration of the study. Highly effective methods of birth control are those with a failure rate of \< 1% per year when employed consistently and correctly, e.g. Combined (oestrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation:

    • oral
    • intravaginal
    • transdermal
    • Progestogen-only hormonal contraception associated with inhibition of ovulation:
    • oral
    • injectable
    • implantable
    • intrauterine device (IUD)
    • intrauterine hormone-releasing system ( IUS)
    • vasectomised partner
  • Females of child-bearing potential must have a negative serum pregnancy test at screening and baseline and be non-lactating

Exclusion criteria

Exclusion Criteria:

  • Unable to provide informed consent
  • History of, or current diagnosis of diabetes or medical condition that impacts whole body energy expenditure (e.g. Hashimoto's, heart disease)
  • Parkinson's disease or parkinsonism, tremor, restless-leg syndrome
  • Safety Laboratory Criteria at screening related to significant kidney disease:

    • Creatinine clearance \< 50 mL / min (Cockcroft-Gault) based on Cystatin C
  • Tracheostomy or non-invasive ventilation (NIV) use > 22 hours per day
  • Inability to swallow tablets
  • Contraindication therapy:

    • Allergy for one of the product's active pharmaceutical ingredients (APIs) or excipients.
    • Antihypertensive treatment [Trimetazidine may cause hypotension]
  • Evidence of malignant disease
  • Significant neuromuscular disease other than ALS/MND
  • Ongoing disease that may cause neuropathy
  • Pregnancy or breastfeeding
  • Females actively seeking to become pregnant who are not using an adequate form of contraceptive as detailed in the Inclusion criteria.
  • Deprivation of freedom by administrative or court order
05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
21 participants (actual)

Study arms

  • Experimental
    Experimental

    Trimetazidine 35mg

    Drug: Trimetazidine Dihydrochloride

Interventions

  • DrugTrimetazidine Dihydrochloride

    Oral tablet, twice-daily

06

What researchers measure

Primary outcomes

  1. Incidence of Treatment-Emergent Adverse Events; Safety and Tolerability

    The occurrence of adverse events, as assessed by Common Terminology Criteria for AEs Version 5, during the 12-week on-treatment period and 4-week wash-out period (16 weeks total).

    Time frame: 16 weeks

  2. Level of expression of oxidative stress markers in the plasma and/or serum of trial participants

    Expression of oxidative stress markers (malondialdehyde, 8-hydroxy-2'-deoxyguanosine, interleukin-6; assessed by liquid chromatography-mass spectrometry/mass-spectrometry or multiplexing) in the plasma and/or serum of trial participants throughout the treatment period (12-week) and at the end of the wash-out period (4 weeks)

    Time frame: 16 weeks

Secondary outcomes

  1. Level of expression of oxidative stress markers in the plasma and/or serum of trial participants to inform future clinical trials in ALS/MND

    Assessment of the expression of oxidative stress markers (malondialdehyde, 8-hydroxy-2'-deoxyguanosine, interleukin-6; assessed by liquid chromatography-mass spectrometry/mass-spectrometry or multiplexing) in the plasma and/or serum of trial participants throughout the treatment period (12-week) and at the end of the wash-out period (4 weeks) to determine suitability for incorporation into future trial design

    Time frame: 16 weeks

07

Study locations

3 sites
  • Royal Brisbane & Women's Hospital
    Brisbane, Queensland 4029, Australia
  • University Medical Centre Utrecht
    Utrecht, Netherlands
  • King's College London
    London, United Kingdom
08

References and documents

Individual participant data

Plan to share: No

No publications or documents are linked to this record.

09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Jul 20, 2023, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT04788745
Lead sponsor
The University of Queensland
Collaborators
FightMND, UMC Utrecht, King's College London, Julius Clinical
Responsible party
Sponsor
First posted
Mar 9, 2021
Start date
Jun 29, 2021
Primary completion
May 24, 2023
Completion
May 24, 2023
Last update
Jul 20, 2023

Study contacts

Shyuan Ngo, PhD
principal investigator · The University of Queensland
Robert Henderson, MBBS, PhD
principal investigator · Royal Brisbane & Women's Hospital
Leonard van den Berg, MD, PhD
principal investigator · UMC Utrecht
Ammar Al-Chalabi, MB ChB, PhD
principal investigator · King's College London
Frederik Steyn, PhD
principal investigator · The University of Queensland
Ruben van Eijk, MD, PhD
principal investigator · UMC Utrecht

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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This study is completed, as verified in Nov 2022. You cannot join it, but the record below documents what was studied.

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