TY - JOUR
T1 - Phase II trial of CoQ10 for ALS finds insufficient evidence to justify phase III
AU - Kaufmann, Petra
AU - Thompson, John L.P.
AU - Levy, Gilberto
AU - Buchsbaum, Richard
AU - Shefner, Jeremy
AU - Krivickas, Lisa S.
AU - Katz, Jonathan
AU - Rollins, Yvonne
AU - Barohn, Richard J.
AU - Jackson, Carlayne E.
AU - Tiryaki, Ezgi
AU - Lomen-Hoerth, Catherine
AU - Armon, Carmel
AU - Tandan, Rup
AU - Rudnicki, Stacy A.
AU - Rezania, Kourosh
AU - Sufit, Robert
AU - Pestronk, Alan
AU - Novella, Steven P.
AU - Heiman-Patterson, Terry
AU - Kasarskis, Edward J.
AU - Pioro, Erik P.
AU - Montes, Jacqueline
AU - Arbing, Rachel
AU - Vecchio, Darleen
AU - Barsdorf, Alexandra
AU - Mitsumoto, Hiroshi
AU - Levin, Bruce
PY - 2009/8
Y1 - 2009/8
N2 - Objective: Amyotrophic lateral sclerosis (ALS) is a devastating, and currently incurable, neuromuscular disease in which oxidative stress and mitochondrial impairment are contributing to neuronal loss. Coenzyme Q10 (CoQ10), an antioxidant and mitochondrial cofactor, has shown promise in ALS transgenic mice, and in clinical trials for neurodegenerative diseases other than ALS. Our aims were to choose between two high doses of CoQ10 for ALS, and to determine if it merits testing in a Phase III clinical trial. Methods: We designed and implemented a multicenter trial with an adaptive, two-stage, bias-adjusted, randomized, placebocontrolled, double-blind, Phase II design (n = 185). The primary outcome in both stages was a decline in the ALS Functional Rating Scale-revised (ALSFRSr) score over 9 months. Stage 1 (dose selection, 35 participants per group) compared CoQ10 doses of 1,800 and 2,700mg/day. Stage 2 (futility test, 75 patients per group) compared the dose selected in Stage 1 against placebo. Results: Stage 1 selected the 2,700mg dose. In Stage 2, the pre-specified primary null hypothesis that this dose is superior to placebo was not rejected. It was rejected, however, in an accompanying prespecified sensitivity test, and further supplementary analyses. Prespecified secondary analyses showed no significant differences between CoQ10 at 2,700mg/day and placebo. There were no safety concerns. Interpretation: CoQ10 at 2,700mg daily for 9 months shows insufficient promise to warrant Phase III testing. Given this outcome, the adaptive Phase II design incorporating a dose selection and a futility test avoided the need for a much larger conventional Phase III trial.
AB - Objective: Amyotrophic lateral sclerosis (ALS) is a devastating, and currently incurable, neuromuscular disease in which oxidative stress and mitochondrial impairment are contributing to neuronal loss. Coenzyme Q10 (CoQ10), an antioxidant and mitochondrial cofactor, has shown promise in ALS transgenic mice, and in clinical trials for neurodegenerative diseases other than ALS. Our aims were to choose between two high doses of CoQ10 for ALS, and to determine if it merits testing in a Phase III clinical trial. Methods: We designed and implemented a multicenter trial with an adaptive, two-stage, bias-adjusted, randomized, placebocontrolled, double-blind, Phase II design (n = 185). The primary outcome in both stages was a decline in the ALS Functional Rating Scale-revised (ALSFRSr) score over 9 months. Stage 1 (dose selection, 35 participants per group) compared CoQ10 doses of 1,800 and 2,700mg/day. Stage 2 (futility test, 75 patients per group) compared the dose selected in Stage 1 against placebo. Results: Stage 1 selected the 2,700mg dose. In Stage 2, the pre-specified primary null hypothesis that this dose is superior to placebo was not rejected. It was rejected, however, in an accompanying prespecified sensitivity test, and further supplementary analyses. Prespecified secondary analyses showed no significant differences between CoQ10 at 2,700mg/day and placebo. There were no safety concerns. Interpretation: CoQ10 at 2,700mg daily for 9 months shows insufficient promise to warrant Phase III testing. Given this outcome, the adaptive Phase II design incorporating a dose selection and a futility test avoided the need for a much larger conventional Phase III trial.
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U2 - 10.1002/ana.21743
DO - 10.1002/ana.21743
M3 - Article
C2 - 19743457
AN - SCOPUS:70249116820
SN - 0364-5134
VL - 66
SP - 235
EP - 244
JO - Annals of Neurology
JF - Annals of Neurology
IS - 2
ER -