ALS clinical trials review: 20 years of failure. Are we any closer to registering a new treatment?
Open accessAbstract
Amyotrophic lateral sclerosis (ALS) is a devastating condition with an estimated mortality of 30,000 patients a year worldwide. The median reported survival time since onset ranges from 24 to 48 months. Riluzole is the only currently approved mildly efficacious treatment. Riluzole received marketing authorization in 1995 in the USA and in 1996 in Europe. In the years that followed, over 60 molecules have been investigated as a possible treatment for ALS. Despite significant research efforts, the overwhelming majority of human clinical trials (CTs) have failed to demonstrate clinical efficacy. In the past year, oral masitinib and intravenous edaravone have emerged as promising new therapeutics with claimed efficacy in CTs in ALS patients. Given their advanced phase of clinical development one may consider these drugs as the most likely near-term additions to the therapeutic arsenal available for patients with ALS. In terms of patient inclusion, CT with masitinib recruited a wider, more representative, less restrictive patient population in comparison to the only successful edaravone CT (edaravone eligibility criteria represents only 18% of masitinib study patients). The present manuscript reviews >50 CTs conducted in the last 20 years since riluzole was first approved. A special emphasis is put on the analysis of existing evidence in support of the clinical efficacy of edaravone and masitinib and the possible implications of an eventual marketing authorisation in the treatment of ALS.
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Multiple small molecules with anti-inflammatory activity have been tested for ALS; most failed, but masitinib was effective in preceding clinical trials, and a Phase III trial is ongoing.
“Multiple small molecules with anti-inflammatory activity, including minocycline, masitinib, NP001, and celecoxib, have been tested for the treatment of ALS. Although most have failed, masitinib was found to be effective in the preceding clinical trials, and a Phase III clinical trial testing masitinib in ALS patients is ongoing.577”
From Role of neuroinflammation in neurodegeneration development (2023) · cites this paper as [577]
The Anti-inflammatory section lists failed ALS trials of minocycline, NP001, and celecoxib, and the Masitinib section says a Phase 3 trial was underway. However, the Results and Conclusion describe masitinib’s efficacy as a claim based on an unpublished interim analysis of that ongoing trial, not an established finding from preceding completed clinical trials. (LLM, conf=0.88)
Experimental — accuracy not yet measuredProbiotics are dietary factors that can influence the human intestinal microbiota, affect the composition and structure of the intestinal flora, protect the intestinal epithelial barrier, inhibit pathogen production, and regulate the immune system.
“Probiotics are considered to be dietary factors that can influence the human intestinal microbiota, which can affect the composition and structure of the intestinal flora; which, in turn, plays a role in protecting the intestinal epithelial barrier, inhibiting pathogen production, and regulating the immune system (3).”
From Modulation of the gut–brain axis via the gut microbiota: a new era in treatment of amyotrophic lateral sclerosis (2023) · cites this paper as [3]
Through use of probiotics, the number of SCFA-producing microorganisms in the intestine can be increased.
“Through use of probiotics, the number of SCFA-producing microorganisms in the intestine can be increased (3).”
From Modulation of the gut–brain axis via the gut microbiota: a new era in treatment of amyotrophic lateral sclerosis (2023) · cites this paper as [3]
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“Although most have failed, masitinib was found to be effective in the preceding clinical trials, and a Phase III clinical trial testing masitinib in ALS patients is ongoing.(577) dl-3-nButylphthalide (dl-NBP), a synthetic compound based on l-3-nButylphthalide that is isolated from seeds of Apium graveolens, has been f…”
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- Authors
- Petrov, D., Mansfield, C., Moussy, A., & Hermine, O.
- Affiliations
- AB Science (France) (FR)
- Hôpital Necker-Enfants Malades (FR)
- Corresponding author
- Hermine, Olivier
- Venue
- Frontiers in Aging Neuroscience
- Publisher
- Frontiers Media SA
- Published
- 2017-03-22
- Volume
- 9
- Pages
- 68-68
- ISSN
- 1663-4365 (ISSN-L)
- PMC
- PMC5360725
- OpenAlex
- W2597399186
- Cited by
- 451
- References
- 108
- Citations by year
- 2026: 28 · 2025: 41 · 2024: 45 · 2023: 46 · 2022: 65 · 2021: 63 · 2020: 53 · 2019: 52 · 2018: 50 · 2017: 8
- FWCI
- 5.94
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Frontiers in Aging Neuroscience (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Agence Nationale de la Recherche (ANR-11-LABX-0051)
- Topics
- Health Sciences › Medicine › Neurology › Amyotrophic Lateral Sclerosis Research
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Genetics › Neurogenetic and Muscular Disorders Research
- Keywords
- amyotrophic lateral sclerosis, clinical trial failure, riluzole, edaravone, masitinib, drug development, clinical efficacy, patient selection criteria, drug approval, neurodegenerative disease therapeutics
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