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AFQ056

Phase 2

Cocaine-related Disorder | Small molecule | Psychiatry |Novartis AG|Last Updated: Oct 10, 2023

Success Probability

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Trial Design

RandomizedDouble-BlindPLACEBO_CONTROLLED
Total Trials1
Total Enrollment68

FDA Designations

No designations recorded

Clinical trial landscape

AFQ056 · 13 trials · 13 indications

Phase 2 9Phase 1 4
NCT03242928Study to Investigate Whether AFQ056 Reduces Cocaine Use in Patients Diagnosed With Cocaine Use Disorder (CUD)Cocaine-related Disorder
COMPLETED68 Analytics
NCT02920892AFQ056 for Language Learning in Children With FXSFragile X Syndrome
COMPLETED110 Analytics
NCT01491529Evaluation of the Efficacy and Safety of Modified Release AFQ056 in Parkinson's Patients With L-dopa Induced DyskinesiasDyskinesias
COMPLETED154 Analytics
NCT01491932Open-label, Long-term Safety Extension Study of AFQ056 in Parkinson's Patients With L-dopa Induced DyskinesiasDyskinesias
COMPLETED129 Analytics
NCT01385592Evaluation of the Efficacy and Safety of AFQ056 in Parkinson's Patients With L-dopa Induced DyskinesiasDyskinesias
COMPLETED78 Analytics
NCT01357239Safety and Efficacy of AFQ056 in Adolescent Patients With Fragile X SyndromeFragile X Syndrome
COMPLETED139 Analytics
NCT01253629Safety and Efficacy of AFQ056 in Adult Patients With Fragile X SyndromeFragile X Syndrome
COMPLETED175 Analytics
NCT01173731Open Label, Safety, Tolerability and Efficacy of AFQ056 in Parkinson's Patients With L-dopa Induced DyskinesiasParkinson Disease
COMPLETED66 Analytics
NCT00986414Evaluation of the Efficacy and Safety of AFQ056 in Reducing Moderate to Severe L-dopa Induced Dyskinesias in Patients With Parkinson's DiseaseParkinson Disease
COMPLETED260 Analytics
PHASE2COMPLETED
Study to Investigate Whether AFQ056 Reduces Cocaine Use in Patients Diagnosed With Cocaine Use Disorder (CUD)
Cocaine-related DisorderUnlock trial analytics
PHASE2COMPLETED
AFQ056 for Language Learning in Children With FXS
Fragile X SyndromeUnlock trial analytics
PHASE2COMPLETED
Evaluation of the Efficacy and Safety of Modified Release AFQ056 in Parkinson's Patients With L-dopa Induced Dyskinesias
DyskinesiasUnlock trial analytics
PHASE2COMPLETED
Open-label, Long-term Safety Extension Study of AFQ056 in Parkinson's Patients With L-dopa Induced Dyskinesias
DyskinesiasUnlock trial analytics
PHASE2COMPLETED
Evaluation of the Efficacy and Safety of AFQ056 in Parkinson's Patients With L-dopa Induced Dyskinesias
DyskinesiasUnlock trial analytics
PHASE2COMPLETED
Safety and Efficacy of AFQ056 in Adolescent Patients With Fragile X Syndrome
Fragile X SyndromeUnlock trial analytics
PHASE2COMPLETED
Safety and Efficacy of AFQ056 in Adult Patients With Fragile X Syndrome
Fragile X SyndromeUnlock trial analytics
PHASE2COMPLETED
Open Label, Safety, Tolerability and Efficacy of AFQ056 in Parkinson's Patients With L-dopa Induced Dyskinesias
Parkinson DiseaseUnlock trial analytics
PHASE2COMPLETED
Evaluation of the Efficacy and Safety of AFQ056 in Reducing Moderate to Severe L-dopa Induced Dyskinesias in Patients With Parkinson's Disease
Parkinson DiseaseUnlock trial analytics

Study Endpoints

Primary Endpoints

Proportion of Cocaine Use Days
Day 1 up to day 98

The cocaine consumption was recorded once daily (Yes/No) by the subject using the Timeline Follow-Back (TLFB) cocaine assessment tool during the treatment period. For each patient, the proportion of cocaine use days was calculated by dividing the number of days of cocaine use during the treatment period, i.e. 98 days for completers and number of days between Day 1 and day of last dose in case of premature discontinuation of study treatment.

Change in Weighted Child Intentional Communication Score
Baseline through Month 8

The Weighted Child Intentional Communication Score is derived from a 22 minute semi-structured examiner/child play session. Structured and unstructured component scores are found by multiplying each intentional communication act by the following weights: nonverbal = 1; single symbol = 2; and multiple symbols = 3. The two scores are summed together to obtain the total. Higher scores indicate more child-initiated communication. There is no maximum score. The scale was administered at Baseline, Month 2, Month 4, Month 6, and Month 8. A composite score representing the average of the estimated change scores calculated at months 2, 4, 6, and 8 was recorded. A higher least squares mean value indicates a greater increase in WCS score from baseline.

Change in modified AIMS (Abnormal Involuntary Movement Scale) total score from baseline to Week 12
12 weeks

The modified AIMS is a scale used to assess dyskinesia. It focuses on six different parts of the body and rates abnormal movements from 0 (absence of dyskinesia to 4 (severe) (maximal score, 24). Change from baseline to Week 12 will be analyzed using the mixed effect repeated measures model (MMRM) including treatment, pooled center, week, treatment by week interaction as fixed effects and baseline total score as covariate with an unstructured covariance structure.

The incidence rate of adverse events
Monitored for the duration of the study which is 13 weeks

The occurrence of adverse events would be sought by non-directive questioning of the patient. Adverse events may also be detected when they are volunteered by the patient or through physical examination, laboratory test, or other assessments. AEs will be summarized by presenting, for each treatment group the number and percentage of patients having any adverse event, having an adverse event in each system organ class and having each individual adverse event by system organ class and preferred term.

Time to onset of adverse events
Monitored for the duration of the study which is 13 weeks

The occurrence of adverse events (AEs) would be sought by non-directive questioning of the patient. Adverse events may also be detected when they are volunteered by the patient or through physical examination, laboratory test, or other assessments. AEs will be summarized by presenting, for each treatment group the number and percentage of patients having any adverse event, having an adverse event in each system organ class and having each individual adverse event by system organ class and preferred term.

The percentage of patients reaching and maintaining the target dose during the fixed dose treatment period
Assessed during the fixed dose treatment period of 6 weeks

Randomized patients will be up titrated to the target dose and remain on the target dose for the duration of the fixed dose treatment period. AEs will be summarized by presenting, for each treatment group the number and percentage of patients having any adverse event, having an adverse event in each system organ class and having each individual adverse event by system organ class and preferred term.

The percentage of patients discontinued during the up titration period due to AE
Assessed during the up titration period of 6 weeks

Patients randomized will be up titrated to the target doses at regular intervals during the up titration period. AEs will be summarized by presenting, for each treatment group the number and percentage of patients having any adverse event, having an adverse event in each system organ class and having each individual adverse event by system organ class and preferred term.

Incidence rate of adverse events including serious adverse events
Monitored for the duration of the study (anticipated to be an average of 3 years)

The occurrence of adverse events would be sought by non-directive questioning of the patient at each visit. Adverse events may also be detected when they are volunteered by the patient during or between visits or through physical examination, laboratory test, or other assessment.

Severity of adverse events including serious adverse events
Monitored for the duration of the study (anticipated to be an average of 3 years)

The occurrence and severity of adverse events would be sought by non-directive questioning of the patient at each visit. Adverse events may also be detected when they are volunteered by the patient during or between visits or through physical examination, laboratory test, or other assessment.

Change in vital signs from baseline to Weeks 1, 2, 4, 8, 12, Months 6, 9, 12, every 6 months thereafter.
Assessed at Day -14 to -3, Day 1, Weeks 1, 2, 4, 8, 12, Months 6, 9, 12, every 6 months thereafter

Pulse and blood pressure at each visit as indicated above. If a patient discontinues in between these visits, this will be assessed at the time of discontinuation.

Changes in hematology/blood chemistry and urinalysis laboratory evaluations from baseline to Weeks 4, 8, 12, Months 6, 9, 12, every 6 months thereafter
Assessed at Day -14 to -3, Day 1(only urinalysis and only done if abnormalities), Weeks 4, 8, 12, Months 6, 9, 12, every 6 months thereafter

Standard hematology with differential, aPTT, PT/INR;, clinical chemistry consists of albumin, alkaline phosphatase, amylase, total bilirubin, calcium, cholesterol, creatinine, CK, γ-GT, glucose, lipase, lactate dehydrogenase, inorganic phosphorus, magnesium, potassium, total protein, AST, ALT, sodium, triglycerides, urea and uric acid, FSH, LH, oxytocin, prolactin, TBG, TSH, and T4; urinalysis (specific gravity, protein, glucose and blood) If a patient discontinues in between these visits, these will be assessed at the time of discontinuation.

Change in ECGs from baseline to Weeks 4, 8, 12, Months 6, 9, 12, every 6 months thereafter
Assessed at Day -14 to -3, Day 1, (repeated if abnormalities seen), Weeks 4, 8, 12, Months 6, 9, 12, every 6 months thereafter

A standard 12-lead ECG will be performed. A central facility will be used for interpretation and analysis of the ECGs. If a patient discontinues in between these visits, this will be assessed at the time of discontinuation.

Change in Unified Parkinson's Disease Rating Scale (UPDRS) part III scores from baseline to Weeks 4, 8, 12, Months 6, 9, 12, every 6 months thereafter
Assessed at Day 1, Weeks 4, 8, 12, Months 6, 9, 12, every 6 months thereafter

Part III of the UPDRS (items 18-31; total score 0-56), has been proven to be a reliable instrument in assessing the anti-parkinsonian effect in PD patients. This scale measures 14 items such as speech, facial expression, tremor, action or postural tremor, rigidity, finger taps, hand movement, alternating movement, leg agility, arising from a chair, posture, gait, postural stability, and bradykinesia. A higher score is indicative of worsening of symptoms. If a patient discontinues in between these visits, this will be assessed at the time of discontinuation.

Incidence of AEs related to an exacerbation of the underlying movement disorder Parkinson's disease
Monitored for the duration of the study (anticipated to be an average of 3 years)

The occurrence of adverse events relating to the underlying movement disorder Parkinson's disease would be sought by non-directive questioning of the patient at each visit. Adverse events may also be detected when they are volunteered by the patient during or between visits or through physical examination, laboratory test, or other assessment.

Anti-dyskinetic efficacy as measured by the modified AIMS (Abnormal Involuntary Movement Scale) total score. To assess how titration of AFQ056 at 2-week intervals affects tolerability profile
12 weeks
Change From Baseline in Behavioral Symptoms of Fragile X Syndrome Using the Aberrant Behavior Checklist-Community Edition (ABC-CFX) Total Score in Stratum I Patients Exposed to AFQ056 100 mg Bid
Baseline to week 12

The Aberrant Behavior Checklist-Community edition (ABC-C) is a 58-item, caregiver-rated symptom checklist for assessing problem behaviors of children and adults with mental retardation at home, in residential facilities, and work training centers. The assessment was done by attributing to each item a score from 0 ("not at all a problem") to 3 ("problem is severe in degree") and the total score ranks from 0 to 174. The data collected from the full, 58-item ABC-C were analyzed according to the modified FXS ABC-C algorithm (ABC-CFX) for which 55 items and six subscales (irritability, lethargy/withdrawal, stereotypic behavior, hyperactivity, inappropriate speech and social avoidance) plus the total score were considered, and for which the total score ranks from 0 to 165. Stratum I included patients whose Fragile X Mental Retardation 1 (FMR1) gene was fully methylated

Change from baseline in behavioral symptoms of Fragile X Syndrome using the Aberrant Behavior Checklist - Community (ABC-C) Total score in Stratum I
12 weeks

The ABC-C is a 58-item questionnaire that should have been completed as much as possible by the same rater. It is comprised of five subscales (irritability, lethargy/social withdrawal, stereotypic behavior, hyperactivity and inappropriate speech) plus the total score which ranks from 0 to 174 in patients who were fully methylated (FM)

Incidence and severity of AEs/SAEs, changes in vital signs, lab assessments and ECGs, in cognitive function (MMSE), psychiatric symptoms (SCOPA-PC), and underlying symptoms of PD (UPDRS part III, CGIC, PGIC).
3.5 years
Change from baseline to endpoint in the modified AIMS (Abnormal Involuntary Movement Scale) total score
12 weeks
The area under the plasma (or serum or blood) concentration-time curve from time zero to infinity [mass x time / volume] (AUCinf)
Time Frame: Day 1 (period 1): 0.5, 2, 4, 8, 12, 24 hours post-dose; Day 7 (period 2): pre-dose; 0.5, 2, 4, 8 hours post dose
The area under the plasma (or serum or blood) concentration-time curve from time zero to the time of the last quantifiable concentration [mass x time / volume] (AUClast)
Time Frame: Day 1 (period 1): 0.5, 2, 4, 8, 12, 24 hours post-dose; Day 7 (period 2): pre-dose; 0.5, 2, 4, 8 hours post dose
Maximum observed plasma concentration (Cmax)
Time Frame: Day 1 (period 1): 0.5, 2, 4, 8, 12, 24 hours post-dose; Day 7 (period 2): pre-dose; 0.5, 2, 4, 8 hours post dose
Measure: Profile of Pharmacokinetics of AFQ056 in each subjects groups
pre-dose, 0.5, 1, 1.5, 2, 3, 4, 6, 12, 24, 36, 48, 72, 96, 120 hours post-dose

AUClast, AUCinf, Cmax, Tmax, T1/2, CL/F, Vz/F

Measure: Area under the plasma concentration-time curve from time zero to infinity (AUCinf)
0, 0.5, 1, 2, 3, 4, 6, 12, 24, 36, 48, 72 hours post dose
Measure: Area under the curve from time zero to the last measurable concentration sampling time (Tlast) [mass x time x volume-1] (AUClast)
0, 0.5, 1, 2, 3, 4, 6, 12, 24, 36, 48, 72 hours post dose
Measure: Maximum observed plasma concentration (Cmax)
0, 0.5, 1, 2, 3, 4, 6, 12, 24, 36, 48, 72 hours post dose
Measure: Time to Reach Maximum Observed Plasma Concentration (Tmax)
0, 0.5, 1, 2, 3, 4, 6, 12, 24, 36, 48, 72 hours post dose
Measure: Terminal elimination half-life (T1/2)
0, 0.5, 1, 2, 3, 4, 6, 12, 24, 36, 48, 72 hours post dose
Measure: The apparent systemic (or total body) clearance from plasma following extravascular administration [volume / time] (CL/F)
0, 0.5, 1, 2, 3, 4, 6, 12, 24, 36, 48, 72 hours post dose
Measure: The apparent volume of distribution during the terminal elimination phase following oral administration [volume] (Vz/F)
0, 0.5, 1, 2, 3, 4, 6, 12, 24, 36, 48, 72 hours post dose
Measure: Amount of drug excreted into the urine from time zero to time't' where t is a defined time point after administration [mass units or % of dose] (Ae0-t)
4 days
Measure: The renal clearance from plasma [volume / time] (CLr)
4 days
Gastroesophageal reflux episodes as assessed by impedance measurements in the 4-hour period following a standardized high-fat meal in patients with GERD.

Secondary Endpoints

Proportion of Positive Urine Measurements of Benzoylecgonine (BE)
Day 1 up to day 98
Proportion of Days of Alcohol Consumption
Day 1 up to day 98
AFQ056 Plasma Concentrations
Day 15 (0h, 2h), Day 29 (0, 2h), Day 57 (0h, 2h), Day 98 (0h,2h)
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Study Design & Arms

AllocationRANDOMIZED
MaskingDOUBLE
ModelPARALLEL
PurposeTREATMENT

Treatment Arms

ArmTypeDescription
PlaceboPLACEBO_COMPARATORMatching tablet of placebo taken orally BID
AFQ056EXPERIMENTALMavoglurant was up titrated on a bid regimen followed by fixed-dose bid regimen: 50 mg bid from Day 1 to Day 7, 100 mg bid from Day 8 to Day 14, and then fixed-dose 200 mg bid for 84 days
Double-Blind AFQ056 with language interventionEXPERIMENTALAfter a 4-month single-blind placebo lead-in period, subjects with FXS were randomized to receive AFQ056 suspension by mouth twice per day in an 8 month double-blind treatment period. During the double-blind treatment period, subjects in the AFQ056 treatment group began with a dose of 25 mg AFQ056 twice per day and titrated to their maximum tolerated dose over the course of 7 weeks. After 7 weeks the dose was fixed, and at the 2 month visit, the intensive language intervention was initiated. Subjects continued the language intervention while remaining on a stable dose of AFQ056 (ranging from 12.5 mg BID to 100 mg BID), for the next 6 months. Safety and efficacy assessments were performed throughout.
Double-Blind Placebo with language interventionPLACEBO_COMPARATORAfter a 4-month single-blind placebo lead-in period, subjects with FXS were randomized to receive a placebo suspension by mouth twice per day in an 8 month double-blind treatment period. During the double-blind treatment period, dose titration to maximum tolerated dose of matching placebo occurred over 7 weeks. After 7 weeks, the dose was fixed, and at the 2 month visit, the intensive language intervention was initiated. Subjects continued the language intervention while remaining on placebo for the next 6 months. Safety and efficacy assessments were performed throughout.
Open-Label AFQ056 with language interventionEXPERIMENTALAfter 8 months of treatment in the placebo-controlled phase, all subjects had assessments completed and were given the opportunity to enter the open-label extension (OLE) in which all subjects received AFQ056. The OLE began with 2 months of flexible dose titration to each subject's maximum tolerated dose followed by a period of stable treatment. Subjects also continued the language intervention through the extension phase. The duration of the stable treatment depended on when the subject was enrolled into the study. Those enrolled prior to June 15-30, 2019 received a 6-month period of stable treatment. Those enrolled after June 15, 2019 had their period of stable treatment shortened on a sliding scale, such that their treatment including weaning, if necessary, ended before August 31, 2021 (study drug expiration).
AFQ056 150 mgEXPERIMENTALPatients randomized to the AFQ056 150 mg arm will receive AFQ056 oral tablets to be titrated until reaching the target dose of 150 mg twice daily.
AFQ056 200 mgEXPERIMENTALPatients randomized to the AFQ056 200 mg arm will receive AFQ056 oral tablets to be titrated until reaching the target dose of 200 mg twice daily. Patients will be randomized in two groups by amantadine status. * Group 1: Patients are not permitted to take amantadine within 2 weeks prior to the BL1 visit. * Group 2: Patients must be on a stable and well tolerated dose of amantadine for at least 4 weeks prior to BL1 and must maintain the stable dose of amantadine during the remainder of the study.)
AFQ056 100 mgEXPERIMENTAL -
25 mg bidEXPERIMENTAL -
50 mg bidEXPERIMENTAL -
100 mg bidEXPERIMENTAL -
25 mg bid AFQ056EXPERIMENTAL1 capsule of 25 mg and 1 capsule of placebo per intake
50 mg bid AFQ056EXPERIMENTAL2 capsules of 25 mg per intake
100 mg bid AFQ056EXPERIMENTAL1 capsule of 100 mg and 1 capsule of placebo per intake
AFQ056-10mgEXPERIMENTAL -
AFQ056-25mgEXPERIMENTAL -
AFQ056-50mgEXPERIMENTAL -
AFQ056-75mgEXPERIMENTAL -
AFQ056-100mgEXPERIMENTAL -
All Study subjectsEXPERIMENTAL -

Interventions

NameTypeDescription
AFQ056DRUG50 mg and 100 mg tablets taken orally
PlaceboDRUGMatching placebo tablets taken orally BID
Language InterventionOTHERAll subjects will begin an intensive language intervention 2 months after starting treatment with AFQ056 or placebo and will continue the intervention through the end of the study. The language intervention will be administered by a trained language specialist through a combination of in clinic visits and at home synchronous video conferencing sessions. The intervention will subsequently be delivered to the parent by a speech-language clinician through weekly clinician coaching, homework, and feedback sessions. The language intervention is designed to help parents learn and use verbally responsive interactional strategies more frequently and effectively throughout the course of their daily interactions with their children.
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Eligibility Criteria

Age Range18 Years to 65 Years
SexALL
Healthy VolunteersNo
Study Sites8

Inclusion Criteria: * Understand the study procedures and provide written informed consent before any assessment is performed. * Subjects diagnosed with Cocaine Use Disorder according to DSM 5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Ed.). * Must use cocaine through snorting (int...

Countries:ArgentinaSpainSwitzerlandUnited StatesAustriaCanadaFranceGermanyHungaryItalySlovakiaAustraliaBelgiumDenmarkIndonesiaIsraelNetherlandsSwedenTurkey (Türkiye)United KingdomFinlandJapan
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Frequently asked questions about AFQ056

What is AFQ056 used for?

AFQ056 is an investigational small molecule being studied for multiple conditions, including L-dopa induced dyskinesias in Parkinson's disease, hepatic impairment, cocaine use disorder, and Fragile X syndrome. It has been evaluated in clinical trials for these indications, though it remains in development and is not approved.

Who makes AFQ056?

AFQ056 is being developed by Novartis AG, a global pharmaceutical company traded on the New York Stock Exchange under the ticker symbol NVS. Novartis has sponsored multiple clinical trials of AFQ056 across various indications and phases of development.

What phase is AFQ056 in?

AFQ056 has been studied in Phase 1 and Phase 2 clinical trials. The most advanced trials are Phase 2 studies for Parkinson's disease with L-dopa induced dyskinesias and cocaine use disorder. All four completed trials are finished, and the drug remains investigational.

What clinical trials is AFQ056 in?

AFQ056 has completed four clinical trials. NCT00986414 and NCT01173731 are Phase 2 studies in Parkinson's disease with L-dopa induced dyskinesias. NCT01456663 is a Phase 1 pharmacokinetic study in hepatic impairment. NCT03242928 is a Phase 2 study in cocaine use disorder.

Is AFQ056 the same as other names?

AFQ056 is the primary identifier for this investigational drug in clinical trial registries. No alternative names have been reported in the available data. Researchers and investors should refer to it as AFQ056 when searching for information about this compound.