Premium
Phase II trial of CoQ10 for ALS finds insufficient evidence to justify phase III
Author(s) -
Kaufmann Petra,
Thompson John L.P.,
Levy Gilberto,
Buchsbaum Richard,
Shefner Jeremy,
Krivickas Lisa S.,
Katz Jonathan,
Rollins Yvonne,
Barohn Richard J.,
Jackson Carlayne E.,
Tiryaki Ezgi,
LomenHoerth Catherine,
Armon Carmel,
Tandan Rup,
Rudnicki Stacy A.,
Rezania Kourosh,
Sufit Robert,
Pestronk Alan,
Novella Steven P.,
HeimanPatterson Terry,
Kasarskis Edward J.,
Pioro Erik P.,
Montes Jacqueline,
Arbing Rachel,
Vecchio Darleen,
Barsdorf Alexandra,
Mitsumoto Hiroshi,
Levin Bruce
Publication year - 2009
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.21743
Subject(s) - placebo , amyotrophic lateral sclerosis , medicine , coenzyme q10 , clinical trial , clinical endpoint , surrogate endpoint , stage (stratigraphy) , riluzole , disease , pathology , biology , paleontology , alternative medicine
Abstract 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, placebo‐controlled, 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. Ann Neurol 2009;66:235–244