Diaphragm Pacing System (DPS) In Participants With Amyotrophic Lateral Sclerosis (ALS) (DPS in ALS)

March 7, 2023 updated by: Jeremy Shefner, Barrow Neurological Institute

Multi-Center, Randomized Controlled Study of the NeuRx® Diaphragm Pacing System™ (DPS)In Participants With Amyotrophic Lateral Sclerosis (ALS)

The study is being conducted to determine if DPS treatment for people with ALS and hypoventilation is associated with improved survival or diaphragm function.

The primary objective of the study is to conduct a multi-center, randomized controlled clinical trial comparing standard of care (control) to diaphragm stimulator treatment with the NeuRx® Diaphragm Pacing System™ (DPS) with respect to survival.

The secondary objective of the study is to conduct a multi-center, randomized controlled clinical trial to compare standard of care treatment (control) to DPS in ALS subjects with hypoventilation.

Study Overview

Detailed Description

The study is a randomized controlled study to compare standard of care (control) to DPS (diaphragm stimulator named The NeuRx® Diaphragm Pacing System™). Although it remains uncertain if DPS is efficacious for the ALS subject, given the preliminary studies performed by the device manufacturer, it has received FDA humanitarian device exemption (HDE) approval as a humanitarian use device (HUD). This study will utilize a 2:1 randomization schedule such that eligible ALS subjects will have a 2/3 chance of receiving DPS and 1/3 chance of standard of care (control) treatment.

The NeuRx® Diaphragm Pacing System™ (DPS) is a four channel, implanted percutaneous diaphragm muscle stimulation system. Under general anesthesia, the intramuscular electrodes are laparoscopically implanted in the diaphragm. The ends of the implanted electrodes are tunneled subcutaneously to an exit site on the chest or abdominal wall and connected to an external stimulator.

Study Type

Interventional

Enrollment (Actual)

52

Phase

  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

    • Arizona
      • Phoenix, Arizona, United States
        • Barrow Neurological Institute
    • California
      • Los Angeles, California, United States
        • Cedars-Sinai Medical Center
      • San Diego, California, United States
        • California Pacific Medical Center
      • Stanford, California, United States
        • Stanford University
    • Connecticut
      • New Britain, Connecticut, United States
        • Hospital for Special Care
    • Florida
      • Jacksonville, Florida, United States
        • Mayo Clinic Florida
      • Jacksonville, Florida, United States
        • University of Florida, Jacksonville
    • Iowa
      • Iowa City, Iowa, United States
        • University of Iowa
    • Massachusetts
      • Boston, Massachusetts, United States
        • Massachusetts General Hospital
    • Michigan
      • Detroit, Michigan, United States
        • Henry Ford Health Systems
    • Missouri
      • Saint Louis, Missouri, United States
        • St Louis University
    • Nebraska
      • Lincoln, Nebraska, United States
        • Neurology Associates P.C.
    • New York
      • New York, New York, United States
        • Hospital for Special Surgery
      • Syracuse, New York, United States
        • SUNY Upstate Medical University
    • North Carolina
      • Charlotte, North Carolina, United States
        • Carolinas Health Care
      • Winston-Salem, North Carolina, United States
        • Wake Forest University
    • Ohio
      • Cleveland, Ohio, United States
        • Cleveland Clinic
      • Columbus, Ohio, United States
        • Ohio State University
    • Oregon
      • Portland, Oregon, United States
        • Providence ALS Center
    • Pennsylvania
      • Philadelphia, Pennsylvania, United States
        • Drexel University
      • Pittsburgh, Pennsylvania, United States
        • University of Pittsburgh
    • Texas
      • Dallas, Texas, United States
        • University of Texas Southwestern
      • San Antonio, Texas, United States
        • University of Texas
    • Vermont
      • Burlington, Vermont, United States
        • University of Vermont
    • Washington
      • Seattle, Washington, United States
        • Virginia Mason Medical Center

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

21 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Age 21 years or older.
  2. Sporadic or familial ALS diagnosed as definite, probable or possible ALS as defined by revised El Escorial criteria.
  3. Evidence of hypoventilation at Screening with at least one of the following:

    1. Maximal static inspiratory pressure (MIP) <60 cm H20.
    2. Upright or supine forced vital capacity (FVC) <50% predicted for gender, age, and height.
  4. A phrenic nerve potential should be recordable bilaterally.
  5. Subjects must not have taken riluzole for at least 30 days, or be on a stable dose of riluzole for at least 30 days, prior to randomization (riluzole-naïve subjects are permitted in the study).
  6. Capable of providing informed consent and following trial procedures.
  7. Geographically accessible to the site.
  8. Negative urine pregnancy test at Screening in women of child bearing potential (WOCBP). (Women who are post-menopausal or who have had a hysterectomy are deemed not of child bearing potential).
  9. Women of child bearing potential must use an adequate form of contraception: abstinence, hormonal contraception (oral contraception, implanted contraception, injected contraception or other hormonal (patch or contraceptive ring, for example) contraception), intrauterine device (IUD) in place for ≥ 3 months, barrier method in conjunction with spermicide, or another adequate method.

Exclusion Criteria:

  1. Upright forced vital capacity (FVC) ≤ 45% of predicted for gender, age, and height.
  2. Any prior use of non-invasive ventilation (NIV) outside of sleep (nighttime or naps).
  3. Any pulmonary or cardiac disorder or other medical disorder that would be a contraindication for general anesthesia or DPS hardware implantation in the chest.
  4. Implanted electrical device such as a pacemaker or cardiac defibrillator.
  5. Known diaphragm abnormality such as hiatal hernia or para-esophageal hernia of abdominal contents into the thoracic cavity.
  6. Participation in another treatment research study for people with ALS.
  7. Exposure to any other agent currently under investigation for the treatment of people with ALS (off-label use or investigational) within 30 days of the Screening Visit.
  8. Clinically significant history of unstable or severe cardiac, oncologic, hepatic, psychiatric, renal disease, or other medically significant illness.
  9. Pregnant women or women currently breastfeeding.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: NeuRx® Diaphragm Pacing System™ (DPS)
Patients randomized to the experimental arm will receive The NeuRx® Diaphragm Pacing System™ (DPS) device. Under general anesthesia, the intramuscular electrodes are surgically implanted in the diaphragm.
The NeuRx® Diaphragm Pacing System™ (DPS) is a four channel, implanted percutaneous diaphragm muscle stimulation system. Pictures of the device are provided in the Clinician's Manual for the NeuRx® DPS procedure and technique guide from the manufacture Synapse Biomedical, Inc. Under general anesthesia, the intramuscular electrodes are laparoscopically implanted in the diaphragm. The ends of the implanted electrodes are tunneled subcutaneously to an exit site on the chest or abdominal wall and connected to an external stimulator.
No Intervention: Standard of Care
patients randomized to the standard of care arm will not have the Diaphragm Pacing System surgically implanted but will receive standard medical care.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Survival
Time Frame: Subjects will be assessed on a monthly basis for an 18 month period.
Subjects will be assessed on a monthly basis for an 18 month period.

Secondary Outcome Measures

Outcome Measure
Time Frame
quality of life
Time Frame: Subjects will be assessed on a monthly basis for an 18 month period.
Subjects will be assessed on a monthly basis for an 18 month period.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Jeremy Shefner, MD, PhD, Barrow Neurological Institute
  • Principal Investigator: Jonathan Katz, MD, California Pacific Medical Center

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

August 1, 2013

Primary Completion (Actual)

January 1, 2017

Study Completion (Actual)

April 1, 2017

Study Registration Dates

First Submitted

August 23, 2013

First Submitted That Met QC Criteria

September 4, 2013

First Posted (Estimate)

September 10, 2013

Study Record Updates

Last Update Posted (Estimate)

March 9, 2023

Last Update Submitted That Met QC Criteria

March 7, 2023

Last Verified

March 1, 2023

More Information

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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