Approval Probability
TA Base Rate
Adjusted LOA
ML Risk
Also known as CK-2017357, CK-2017357 (Part A), CK-2017357 (Part B)
tirasemtiv · 7 trials · 4 indications
The number of participants with adverse events was used as the measure for the long-term safety and tolerability of tirasemtiv.
SVC was measured using a spirometer (in units of liters). Following 3 to 5 breaths at rest, the patients were instructed to take as deep an inspiration as possible followed by a maximum exhalation (blowing out all the air in their lungs). Values obtained were converted to % predicted values (ie, the test result as a percent of predicted values for patients of similar demographic and baseline characteristics \[eg, height, age, sex\], based on Knudson 83 normative values).
The ALSFRS-R is used to measure the progression and severity of disease; it consists of 12 questions, assessing a patient's capability and independence in functional activities relevant to ALS, categorized in 4 domains: gross motor tasks, fine motor tasks, bulbar functions, and respiratory function. Each question is scored from 0 (indicating incapable or dependent) to 4 (normal). The total score ranges from 0 to 48, with higher scores reflecting more normal function and lower scores reflecting more impaired function.
Safety and tolerability of CK-2017357 after multiple oral doses to steady state in patients with ALS
Heel raises will be monitored by an electrogoniometer placed on the index leg and performed once every other second until onset of claudication pain or fatigue as determined by electrogoniometry
Heel raises will be monitored by an electrogoniometer placed on the index leg and performed once every other second until limited by intolerable claudication pain or fatigue as determined by electrogoniometry
Patient's self-paced walking distance over 6 minutes
An instrument for evaluating the functional status of patients with ALS. Minimum score is 0 and maximum score is 40. The higher the score the more function is retained.
Measured using the DynEx Electronic Hand Dynamometer. Patients asked to squeeze the device with the maximum possible force to establish the maximum voluntary contraction.
Handgrip fatigue is measured using the DynEx Electronic Hand Dynamometer. Patient is asked to squeeze the device until they can no longer stay above 60% of target or 120 seconds.
Patient is asked to hold one arm outstretched in front of them at a 90 degree angle. The time the arm falls below 90 degrees for \> 2 seconds will be recorded, up to a total evaluation time of 2 minutes. This is then repeated with the other arm.
SVC is measured using the Puritan Bennett Renaissance II Spirometry System and accessories.
MVV is the volume of air that can be exhaled during 12 seconds of rapid deep breathing. The actual volume is extrapolated to one minute. the Puritan Bennett Renaissance II Spirometry System and accessories is used for this measurement.
SNIP is measured at Functional Residual Capacity, the bottom of the tidal breathing cycle, through one plugged nostril while the other remains open using the Micro Medical MicroRPM Respiratory Pressure Meter
MVC is measured using the MicroFET 2 HHD.
Sub-Maximum Grip Strength Fatigability is measured using the DynEx Electronic Hand. Dynamometer
| Arm | Type | Description |
|---|---|---|
| Delayed Start Treatment | EXPERIMENTAL | The Delayed Start Treatment group consisted of patients who received placebo in CY 4031 and tirasemtiv in CY 4033. |
| Early Start Treatment | EXPERIMENTAL | The Early Start Treatment group consisted of patients who received tirasemtiv in both CY 4031 and CY 4033. |
| Group 1 - Placebo | PLACEBO_COMPARATOR | Day 1 through Week 48: 2 placebo tablets twice daily |
| Group 2 - 250 mg tirasemtiv | EXPERIMENTAL | Day 1 through Week 48: 1 tablet of tirasemtiv (125 mg) and 1 tablet of matching placebo in the AM and 1 tablet of tirasemtiv (125 mg) and 1 tablet of matching placebo in the PM |
| Group 3 - 375 mg tirasemtiv | EXPERIMENTAL | Day 1 through Week 2: 1 tablet of tirasemtiv (125 mg) and 1 tablet of matching placebo in the AM and 1 tablet of tirasemtiv (125 mg) and 1 tablet of matching placebo in the PM; Weeks 3 through 48: 1 tablet of tirasemtiv (125 mg) and 1 tablet of matching placebo in the AM and 2 tablets of tirasemtiv (250 mg) in the PM |
| Group 4 - 500 mg tirasemtiv | EXPERIMENTAL | Day 1 through Week 2: 1 tablet of tirasemtiv (125 mg) and 1 tablet of matching placebo in the AM and 1 tablet of tirasemtiv (125 mg) and 1 tablet of matching placebo in PM; Weeks 3 and 4: 1 tablet of tirasemtiv (125 mg) and 1 tablet of matching placebo in the AM and 2 tablets of tirasemtiv (250 mg) in the PM; Weeks 5 through 48: 2 tablets of tirasemtiv (250 mg) in the AM and 2 tablets of tirasemtiv (250 mg) in the PM |
| CK-2017357 | EXPERIMENTAL | 125 mg tablets |
| Placebo | PLACEBO_COMPARATOR | Placebo tablets |
| Dose Titration of CK-2017357 (Group 1) | EXPERIMENTAL | Dose titration of active drug as add-on therapy to riluzole |
| Matching Placebo (Group 2) | PLACEBO_COMPARATOR | Placebo as add-on therapy to riluzole |
| Matching Placebo | PLACEBO_COMPARATOR | - |
| Active Drug Low Dose (CK-2017357 125 mg) | EXPERIMENTAL | - |
| Active Drug Mid Dose (CK-2017357 250 mg) | EXPERIMENTAL | - |
| Active Drug High Dose (CK-2017357 375 mg) | EXPERIMENTAL | - |
| Treatment Sequence 1 | EXPERIMENTAL | Dosing Period 1 - Placebo; Dosing Period 2 - 375 mg CK-2017357; Dosing Period 3 - 500 mg CK-2017357 |
| Treatment Sequence 2 | EXPERIMENTAL | Dosing Period 1 - Placebo; Dosing Period 2 - 500 mg CK-2017357; Dosing Period 3 - 375 mg CK-2017357 |
| Treatment Sequence 3 | EXPERIMENTAL | Dosing Period 1 - 375 mg CK-2017357; Dosing Period 2 - Placebo; Dosing Period 3 - 500 mg CK-2017357 |
| Treatment Sequence 4 | EXPERIMENTAL | Dosing Period 1 - 375 mg CK-2017357; Dosing Period 2 - 500 mg CK-2017357; Dosing Period 3 - Placebo |
| Treatment Sequence 5 | EXPERIMENTAL | Dosing Period 1 - 500 mg CK-2017357; Dosing Period 2 - Placebo; Dosing Period 3 - 375 mg CK-2017357 |
| Treatment Sequence 6 | EXPERIMENTAL | Dosing Period 1 - 500 mg CK-2017357; Dosing Period 2 - 375 mg CK-2017357; Dosing Period 3 - Placebo |
| Name | Type | Description |
|---|---|---|
| tirasemtiv | DRUG | Oral |
| Placebo tablets | DRUG | - |
| CK-2017357 | DRUG | CK-2017357 125 mg tablets twice daily |
| Riluzole | DRUG | Tablets |
| Placebo | DRUG | Matching placebo tablets BID for 21 days |
| Riluzole 50 MG | DRUG | - |
| Placebo (Part A) | DRUG | Placebo tablets once daily for 14 days (Part A) |
| CK-2017357 (Part A) | DRUG | One 125 mg CK-2017357 tablet once daily for 14 days (Part A) |
| Riluzole 50 MG (Part B) | DRUG | One 50 mg tablet once daily for 14 days (Part B) |
| Placebo (Part B) | DRUG | Placebo tablets once daily for 14 days (Part B) |
| CK-2017357 (Part B) | DRUG | One 125 mg tablet once daily for 14 days (Part B) |
| 375 mg CK-2017357 | DRUG | 375 mg CK-2017357 in capsules administered as a single oral dose. |
| 500 mg CK-2017357 | DRUG | 500 mg CK-2017357 in capsules administered as a single oral dose. |
| 250 mg CK-2017357 | DRUG | 250 mg CK-2017357 in capsules administered as a single oral dose. |
Inclusion Criteria: * Able to comprehend and willing to sign an Informed Consent Form (ICF). If verbal consent is given, a Legal Designee of the patient must sign the ICF form * Completed participation on study drug and the Follow-Up Visit in the CY 4031 study * Male patients, who have not had a va...
Tirasemtiv was developed as a treatment for amyotrophic lateral sclerosis, also known as ALS, a progressive neurological disease that causes loss of muscle function. It was studied in adults aged 18 years and older with ALS. It is an investigational small molecule and is not an approved therapy.
Tirasemtiv targets the fast skeletal muscle troponin complex, specifically the proteins TNNI2, TNNT3, and TNNC2. It acts as an activator of these troponin proteins, which are involved in regulating skeletal muscle contraction. This mechanism was intended to improve muscle function in people with ALS.
Tirasemtiv was developed by Cytokinetics, Incorporated, which trades on the Nasdaq under the ticker CYTK. Cytokinetics is a biopharmaceutical company focused on muscle biology and related therapeutics. The company sponsored the Phase 3 clinical program for tirasemtiv in ALS.
Tirasemtiv reached Phase 3 clinical development for amyotrophic lateral sclerosis. It is an investigational drug and is not approved for marketing. Both of its Phase 3 trials have been completed, and no trials are currently active.
Tirasemtiv was studied in two completed Phase 3 trials. NCT02496767, known as VITALITY-ALS, enrolled 744 participants with ALS. NCT02936635 was a follow-on study for patients who completed VITALITY-ALS and enrolled 280 participants. Both trials were randomized, double-blind, and controlled, and ran across the United States and Europe.
The tirasemtiv Phase 3 program enrolled 1,024 participants in total across its two completed trials. NCT02496767 enrolled 744 patients with ALS, and NCT02936635 enrolled 280 patients who had completed the earlier study. Both trials enrolled adults aged 18 years and older and included male and female participants.