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Webinar: Breaking Down Enrollment Barriers in ALS Research Through Advocacy
Posted by: ALS Trial Expert February 16, 2012
ALS Trial Expert
This week Richard Bedlack MD, PhD, spoke about strategies to overcome enrollment barriers in an ALS Association/NEALS webinar presentation titled, “Breaking Down Enrollment Barriers in ALS Research Through Advocacy.”  If you missed it, be sure to view it here.  

While there are many new exciting areas being delved into in ALS research, significant barriers, in particular low enrollment rates, still impede progress towards finding a cure.  In the most recent NEALS / ALS Association Webinar, Dr. Bedlack describes the important determinants of clinical trial enrollment.  He provides detailed examples of steps researchers are taking to not only promote enrollment, but to improve the design of clinical trials to make clinical research more appealing to patients.  Dr. Bedlack outlines “why”, “what”, and “how” PALS advocacy efforts can help foster new clinical research.  The webinar ended with several questions from the attendees.

To leave a comment, please click here.
ALS Association Efforts
Posted by: Tom Kettler February 15, 2012
I want to share some of the efforts I have been able to participate in through the National ALS Association. In mid January, the National ALS Association held the Annual Leadership Meetings in Nashville, TN. The purpose is to formulate strategic planning and policy designed to better the Associations ability to provide Care Services, Research funding and Public Policy. One of the events enjoyed by the entire group of participants was a Lunch to Honor our Heroes Living with ALS. One of the three honorees at that luncheon I first met at the NEALS CRLI Conference in October. She did a magnificent job of telling her story and finished to a standing ovation. Well done!

Another facet of the meetings was that the Chapter Relations Administrator invited chapter representatives to participate in a panel discussion entitled "Growing The Association's Research Program: How Can Chapters Make the Case?". A great amount of information was shared offering different approaches, philosophies and theories of how research is part of the "three legged stool" along with care services and advocacy needed to marry each Chapter's purpose and goals. I was able to share the CRLI experience in Clearwater Beach as an example of the need to advocate and fund research for our dedicated scientists and PALS. The panel generated a lot of positive questions and discussion as well as interest in the CRLI.  

The end of January was our National ALS Fly-In to Washington, D.C. where we were instructed on our Advocacy Priorities followed by visits to key legislative directors on the Hill. These meetings were preparatory to our visits to the Hill on National ALS Advocacy Day coming up in May. The three priorities presented to our legislators are:
(1) Appropriate 10 Million to continue the National ALS Registry At The Centers For Disease Control and Prevention;
(2) Appropriate 10 Million to continue the ALS Research Program (ALSRP) At the Department of Defense (DOD); and
(3) Enact the Moddern Cures Act, H.R. 3497.

For more information on each of these priorities please go here.  I will probably see some of you in Washington in May.



The following comments have been received in response to this blog post. To leave your own comments, please click here.
Thanks Tom! Keep us updated about your trip in May. It is also exciting to know that Clinical Research Learning Institute was so well received at these meetings. There seems to be a lot of interest out there in taking part.
Comment left by ALS Trial Expert on 02/15/2012
It was great to see you in DC 2 weeks ago. Hope to see you in May.
Comment left by Rob Tison on 02/16/2012
Thank you very much for the updates. This site has bloomed into a great resource! I hope that in the next couple of months that we can learn some specifics of how the MODDERN Cures act would directly help those with ALS. When I try to read it http://thomas.loc.gov/cgi-bin/query/z?c112:H.R.3497: , I see a big focus on implementation of diagnostics, and that doesn't seem to me like a front-burner issue for the disease without good biomarkers. I understand how it could be attractive to the broader National Health Council membership, but I wonder if it's the most urgent legislation to chase specifically for ALS. Thanks for any insights.
Comment left by rkn on 02/17/2012
Exciting News Re. Another Phase 2 Trial for ALS
Posted by: Rob Tison February 14, 2012
Rob Tisonhttp://www.als.net/Media/5409/News/ The ALS Therapy Development Institute to Launch Phase II Clinical Trial of TDI 132 in ALS Patients
The following comments have been received in response to this blog post. To leave your own comments, please click here.
See this also: http://online.wsj.com/article/SB10001424052970204062704577221220332840952.html?KEYWORDS=ALS
Comment left by Rob Tison on 02/14/2012
Thanks! Also, at http://www.alsconsortium.org/news_gilenya.php
Comment left by ALS Trial Expert on 02/15/2012
Is there a good reason that NEALS is stressing safety and tolerability, but ignoring the efficacy aspect of this planned phase II trial? Quote: "This Phase II clinical trial will determine safety and tolerability of TDI 132 in patients with ALS.  It will yield important information on dosing and safety for a subsequent efficacy study.  NEALS is working with ALSTDI to design and conduct the clinical trial trial." Yet, we know that phase II trials are aimed at early efficacy review and continued safety. FDA Description of phase II: "Phase 2 includes the early controlled clinical studies conducted to obtain some preliminary data on the effectiveness of the drug for a particular indication or indications in patients with the disease or condition. This phase of testing also helps determine the common short-term side effects and risks associated with the drug. Phase 2 studies are typically well-controlled, closely monitored, and conducted in a relatively small number of patients, usually involving several hundred people." There are multiple instances of FDA approvals of drugs for life threatening confound based on phase II efficacy (e.g. HIV and cancer). ALS is certainly life threatening and in desperate need of an effective therapy. Urgency should cause ALS phase II trials to be designed for the same potential, IMHO.
Comment left by Rob Tison on 02/16/2012
ALS TDI / NEALS Gilenya webinar has been scheduled for March 12 and people may register here: http://www.als.net/ALS-Events/ALS-Webinars/Register/?wid=03122012
Comment left by Rob Tison on 02/16/2012
Thank you for your questions Rob. In drug development there are often several phase II type questions that need to be answered prior to embarking on larger phase III, long term efficacy studies. These phase II questions include safety, dose selection and assessment for preliminary efficacy. We are working closely with ALSTDI to develop the Phase II program for TDI 132. This Phase II program will assess safety, dosing, biological effect and preliminary efficacy. We recognize the urgency behind finding an effective therapy.
Comment left by ALS Trial Expert on 02/17/2012
I see here, http://www.alzforum.org/new/detail.asp?id=3065, that two phase trials are being discussed.
Comment left by Rob Tison on 02/21/2012
CALBIO2012: Driven by Patients
Posted by: Rob Tison February 13, 2012
Rob TisonThis seems like a relevant conference for some of our ALS clinician researchers looking for ways to improve and accelerate clinical trials and/or share knowledge:

http://www.baybio.org/baybio-sites/calbio2012/program/

CALBIO2012 is a statewide conference produced by BayBio and BIOCOM that brings together the life sciences sector in California and beyond: company executives and innovators, government, medical research and disease foundations, university transfer offices, philanthropists and investors.

Built on the synergy between two leading life sciences clusters, CALBIO2012 identifies best practices and new models and fosters collaborations in research, development and product commercialization.


Especially these tracks & sessions:

http://www.baybio.org/baybio-sites/calbio2012/tracks/clinical-development/
Track 2
Clinical Development
Thursday, March 8, 2012

Session 1
Patient Advocacy: The Key to the Next Evolution of Clinical Development

The sleeping giant in clinical development is the patient, both as the crucial resource in clinical trials and as a previously under-utilized source of clinical/molecular data and biospecimens. Increasingly, product innovators are viewing patients as full partners. Novel collaborations with patient advocacy groups – who have access to large numbers of patients with a particular disease, who are motivated to drive and accelerate research, and who can bridge the silos of academe and industry – are emerging. Patient groups can also be supportive to the development of new models, such as adaptive clinical trials, that have the potential to produce better clinical outcomes in a shorter time frame. This session will explore the pro-active role of advocacy groups, how these types of collaborations are taking shape, how they might fuel a new generation of clinical development, what is needed to harness the potential of all the data, and how to avoid some of the common pitfalls.

Session 2
Ten Tips to Accelerate Clinical Trials and Do Them Well

In order to expedite the speed with which clinical trials are completed, it is critical to have a solid foundation for measuring and tracking where key improvements in process and efficiency can be made. There are general areas where sponsors can improve the speed of clinical trial completion, for example: decreasing time for subject enrollment and recruitment, decreasing site contracting time and speeding up site initiations. In this cost constrained environment, however, there is a cost benefit sponsors are willing to accept in order to save time and improve clinical trial performance. Due to the cost of making improvements, it is important to have key processes in place for identifying where changes can have the biggest bang for the buck. Processes for identifying key changes include: -Developing a balanced scorecard for selecting the right sites and investigators -Key criteria for streamlining the feasibility process -Establishing enrollment forecasting methodology -Optimal incorporation of feasibility and subject enrollment Once processes such as these are established, key areas can be identified for improvement. This approach has the benefit of decreasing sponsor expense by honing in on specific areas of improvement while accelerating trial performance and efficiency.

Session 4
Modernizing our Industry: Developing the Clinical Trials of the Future

The average drug costs over a billion dollars to develop, and takes more than ten years to get from the bench to the patient. Without question, the costliest, most time-consuming part of drug development is the process of clinical testing, however, most clinical trials are conducted in much the same way that they have been for the last 50 years. Could the cost of conducting clinical trials be reduced? Could we speed up the time in which it takes to get a drug through clinical testing? And, is it possible to design better clinical trials so as to avoid costly late-stage failures? New technologies and approaches now make the answers to all of these questions a resounding “yes”. This panel will focus on the future of clinical trials and what is being done to modernize the process of drug development. Panelists will discuss new recruiting techniques, mobile health technologies for remote patient monitoring, innovative trial designs and industry-wide consortiums that will ultimately revolutionize the way we conduct clinical trials, reducing costs and speeding drug development.
---------

http://www.baybio.org/baybio-sites/calbio2012/tracks/patients/
Patients
Track 3
Friday, March 9, 2012

Session 1
Taking Matters into Their Own Hands: The Role of Patients in Drug Development 

In major world markets, patients have emerged as a significant power in drug development, approval, reimbursement and communication. Patient organizations are playing a critical role in many cases, from co-creation of innovative therapies and delivery systems, to faster approval and wider reimbursement. For biopharma companies, a successful business model now relies on involving patients and advocacy groups in each stage of development: joint drug development and testing (injectable biologics such as Novo Nordisk’s insulin reached global success due in part to patient-friendly pens); collaboration in speeding approval from regulators, such as the role of patient groups in the fast approval of Novartis’s leukemia drug, Gleevec; understanding of patients’ experience of disease, such as Sanofi Genzyme’s close links with families of patients with Gaucher disease and other orphan diseases. This panel representing innovating biopharma companies, leading foundations/advocacy groups and key industry experts will explore the role that disease foundations and patient advocacy groups can and should play and discuss current best practices in successful company-patient collaborations throughout the value chain.

Session 2
Patient Access to Developmental Drugs

This session explores proposed regulatory innovation in the area of life-threatening diseases that have unmet medical need. Since the 1962 tightening of evidentiary standards for safety and efficacy, FDA has struggled to balance benefit and risk in a way that helps patients in need of treatment. Our one size fits all approach to drug approval has not allowed individuals to express their own preferences for risk versus potential health improvement, especially in deadly diseases for which no approved treatments are effective and the only chance at survival may lie with new investigational drugs. The panel session considers the effectiveness of FDAMA’s Accelerated Approval provisions and whether they have produced a net benefit to terminally-ill patients over the last 15 years. In the last 10 years, several initiatives for more meaningful progressive regulatory approval have been argued in Congress and in the Judiciary, including parallel-track and class-level authorization. We will examine these initiatives and discuss new draft legislation proposed by BIO and by Senator Kay Hagen (D-NC). The implications are not just human lives, but also dramatic reduction in regulatory risk for companies considering development in deadly unsolved diseases.

Session 3
Social Media and Life Sciences: Hearing a Patient’s Voice

700 million of anything is hard to ignore. The exponential growth of social media, with nearly 700 million Facebook users, is well documented with increasing numbers of life sciences companies looking at ways to interact with healthcare providers, patients and consumers through social media. The key question, however, is how do you connect the right people with the right message at the right time? During this panel discussion you will hear about latest social media developments and trends, limitations and major pitfalls. Learn about key innovators and what experiences might be relevant for your company.

To leave a comment, please click here.
National ALS Registry
Posted by: ALS Trial Expert February 09, 2012
ALS Trial Expert

I want to share an example of what PALS are doing to advocate for ALS research.  

This YouTube video promotes the National ALS Registry, supported by the Centers for Disease Control.  The ALS registry can play a vital role in learning more about ALS, such as risk factors for the disease or patterns over time.  The more PALS who enroll, the more valuable the information derived from it.  Registration is easy and gives access to surveys, which family members and caregivers are encouraged to get involved with.  By registering, you will be contributing to ALS research and potentially helping PALS in the future. 

Listen to Rick as he talks about why the registry is so important and about benefits for PALS.  Thank you Rick!

YouTube ALS Video

CDC Registry

 

To leave a comment, please click here.
ALS Biomarker Efforts
Posted by: Bob Murray January 30, 2012
We all know how important biomarkers are to research generally, and how helpful it could be for ALS research in particular if there were reliable signposts for clinicians, scientists and and pharmas to use in their work. There are secure repositories at many ALS clinics that store blood and other types of samples donated by both PALS and non-PALS folks (the non-PALS for controls).  So we thought we'd do our bit at MGH. I've donated skin and blood, and have signed up for spinal fluid.  As a PALS, Mary has donated skin and blood.  The more folks who choose to support such work, the better the chance to discover some reliable biomarkers for ALS.
Bob Murray (may I respectfully add Go Patriots!)
The following comments have been received in response to this blog post. To leave your own comments, please click here.
Biorepositories and biomarker trials are of the utmost importance. These samples can be used to speed diagnosis and begin to learn about the causes of ALS. Any PALS and non-PALS interested in giving samples should contact their local ALS clinic to see about opportunities, or take a look at recruiting observational studies in the NEALS database. You can also contact the ALS trial expert at (877) 458-0631. Thank you for sharing Bob!
Comment left by ALS Trial Expert on 02/01/2012
In addition to blood and spinal fluid type donation opportunities, which I ALS find incredibly valuable, I've recently realized there is no summary to be found for institutions accepting brain and spinal cord donations upon death for ALS research. I feel there is an unmet need there, as more people would participate if knowledge was more prevalent. These do not appear at clinicaltrial.gov or the new NEALS study search tools. Sorry for a morbid topic, but a summary of opportunities is needed for PALS.
Comment left by Rob Tison on 02/04/2012
Thanks Rob, you bring up a very good point about the need for this information. It is clearly a very sensitive topic, but does need consideration. There is a shortage of brain and spinal cord tissue for ALS research; a reason for this MAY have to do with lack of knowledge. There is now a list on the NEALS website of facilities that accept postmortem tissue donation. Thanks to the ALS Association, you can find this list at http://www.alsconsortium.org/trials.php. It is reviewed and updated as needed to ensure that it remains current. I will be working to get this information out in other formats as well. Thank you for bringing this up.
Comment left by ALS Trial Expert on 02/07/2012
The ALS Research Pipeline
Posted by: ALS Trial Expert January 18, 2012
ALS Trial Expert
As Dr. Merit Cudkowicz stated in a recent lecture to colleagues, patients, and caregivers, “the pace of (ALS) discovery is increasing.”  While Riluzole is currently the only approved drug for ALS, many other treatments are being investigated for their potential roles in ALS treatment.  Researchers are improving upon clinical trial design and dosage; they are learning from past trials and using this information to design trials that are faster, more precise, and more appealing to participants.  What is coming down the ALS research pipeline?

Interventional Drug Trials
Cytokinetics has two actively enrolling trials continuing to investigate CK-2017357, a drug that enhances muscle contraction, one for two weeks and another for four weeks with the goal of arriving at an appropriate dosing schedule to use in a planned Phase 3 trial:

Enrolling Study #1
The phase II, randomized, double-blind, placebo-controlled trial is seeking to change the previous dose by including low, mid, and high dosage both without (Cohort A) and with (Cohort B) concurrent use of Riluzole.  Results from Cohort A show that CK-2017356 was well-tolerated when dosed daily in ALS patients.  Cohort B is currently enrolling; patients will reduce their Riluzole dosage to 50 mg for seven days before taking daily oral doses of either placebo, 125 mg, 250 mg, or 375 mg of CK-2017357 for fourteen days, and to remain at that dose of Riluzole while randomized.  
Enrolling Study #2
Cytokinetic’s titration study is a three week dose escalation study to see if subjects can tolerate 500 mg CK-2017357 in daily divided doses. Participants reduce their use of Riluzole to 50 mg for seven days before being randomized to receive twice daily doses of CK-2017357, or placebo, for seven days, totaling 250 mg, 375 mg, and 500 mg daily.  Researchers are examining the optimal dosage to display maximum tolerability and clinical effects.

Nuedexta is a drug approved by the FDA for improving emotional lability in ALS and other disorders.  Based on patient experience, a new NEALS trial will be starting soon to evaluate whether this drug improves bulbar functions such as swallowing and speaking.  Information regarding inclusion criteria and study sites will be posted soon.

The University of Kansas is investigating Rasagiline in a phase II, open-label trial to determine if it is safe in ALS patients and if it has the potential to slow ALS disease progression.  Rasagiline has possible neuroprotective properties.  Participants are being enrolled at 3 US sites: California Pacific Medical Center in San Francisco, CA, the University of Pennsylvania, and at the coordinating center, the University of Kansas.

Stem Cell Trials
Sponsored by NeuralStem, 12 participants received injections of human spinal cord-derived neural stem cells in the lumbar spinal cord at Emory University in Atlanta, GA. The next participants will receive injections into the cervical (neck region) spinal cord. This phase I trial is primarily designed to investigate safety in patients with ALS. Participants must live in close proximity to Atlanta.

The Northeast ALS consortium is working with Brainstorm Cell Therapeutics to design a Phase II clinical trial in the United States.  Brainstorm Cell Therapeutics is performing a Phase I/II clinical trial at the Hadassah Medical Organization in Israel, and is currently enrolling ALS participants in a trial of autologous transplantation of Mesenchymal Stromal Stem cells secreting Neurotrophic factors (MSC-NTF), taken from the patient’s own bone marrow.  The cells are delivered into the muscles or into the spinal fluid.
 
Other Interventional Trials
Phoenix Neurological Associates is investigating Zinc in a phase I/II, open-label trial to determine tolerability and safety of zinc at high doses in conjunction with copper, used concurrently with Riluzole for treating ALS.  Zinc may play a role in pathological processes associated with ALS.

Research is not only delving into drug treatment, but symptomatic treatment through exercise.  Until now, a randomized, controlled, large study evaluating the potential benefits of resistance and endurance exercise in ALS has not been systematically undertaken.  The purpose of this ALSA-funded trial titled “Trial of Resistance and Endurance Exercise in Amyotrophic Lateral Sclerosis” is to evaluate the safety and tolerability of resistance or endurance exercise in research participants with ALS. In this pilot study, 60 participants with ALS will be enrolled at 4 clinical centers.  Each subject will be assigned to treatment in 1 of 3 arms:  resistance exercise, endurance exercise, stretching and range of motion exercise.  Each participant will complete 6 months of this exercise regimen. Primary outcome will be tolerability of exercise regimen.

Enrollment Closures
Ceftriaxone, a phase III, randomized, double-blind, placebo-controlled trial investigating efficacy and long-term safety of Ceftriaxone, has closed enrollment.  Five hundred and thirteen participants were enrolled at 62 centers across the US and Canada. The study will close when the last enrolled participant has been in the trial for one year.  Ceftriaxone is an intravenous antibiotic that has several neuroprotective properties.  

The NP001 trial, a randomized, double-blind, placebo-controlled Phase II trial examining the effects of NP001 administered intravenously on clinical function at two dose levels, has also concluded enrollment.  The trial enrolled 136 patients at multiple study centers.  NP001 is a novel regulator of macrophage activation and a regulator of neuroinflammation.

Study Closures
In Cytokinetics’ completed phase II trial “A Study of CK-2017357 in Patients with ALS,” the effect of a single dose of CK-2017357 was measured in terms of safety and skeletal muscle function or fatigability.  Results were promising, in that a single dose of study medication reduced measures of muscle fatigue and was associated with perceived improvement by patients.  
CK-2017357 is now being investigated for optimal dosage in two other phase II trials.

NEALS is in discussions with several companies and foundations about potential therapies and will post study specific criteria and results of trials as soon as they are available to us.  NEALS promises to keep the ALS community at the forefront through its:

•Newly launched NEALS website, which contains a searchable ALS trial database that is monitored and kept up-to-date at all times.
•Clinical trial news and findings posted on the NEALS Clinical Trial News page.
•Introduction of a clinical trials expert, who is available for questions and response in a timely manner.



The following comments have been received in response to this blog post. To leave your own comments, please click here.
Thanks for the summary. Are you able to provide a forecasted start date for the second phase III trial of Dexpramipexole (Endeavor)? How about confirming another phase II trial of NP001 soon?
Comment left by Rob Tison on 01/12/2012
Thanks Rob, Information has not yet been released for either of those trials. As soon as it is, I will post it in the NEALS news.
Comment left by ALS Trials Expert on 01/12/2012
you could give us further information about new phases or possible dates for the second phase III trial of dexpramipexole? Thanks.
Comment left by koke on 01/17/2012
At this time, nothing has been released about dates for the second phase III dexpramipexole (Endeavor) trial. When this, and other trial information, is announced, it will be posted on the NEALS website.
Comment left by ALS Trial Expert on 01/17/2012
In reference to the Brainstorm information shared earlier in this blog, I read Brainstorm's January 17, 2012 comments on the status of their adult stem cell ALS safety trial. I found it interesting and potentially promising, albeit very early days, and the evidence is based on the study of only 4 ALS patients to date. Here is Brainstorm's announcement, January 17, 2012 BrainStorm Announces Clinical Data Supporting Safety and Efficacy of NurOwn™ Based on Initial Patient Results Business Wire | 1/17/2012 BrainStorm Cell Therapeutics Inc. BCLI, an innovative developer of adult stem cell technologies and Central Nervous System (CNS +1.31%, news) therapeutics, today announced that the data from the initial patients in its ALS Phase I/II human clinical trial treated with its NurOwn™ technology did not present any significant side effects and that the NurOwn™ treatment has so far proven to be safe. Prof. Dimitrios Karussis, who is leading the clinical trial at Hadassah Medical Center, stated, “There have been no significant side effects in the initial patients we have treated with BrainStorm’s NurOwn™ technology. In addition, even though we are conducting a safety trial, the early clinical follow up of the patients treated with the stem cells shows indications of beneficial clinical effects, such as an improvement in breathing and swallowing ability as well as in muscular power. I am very excited about the safety results, as well as these indications of efficacy, we are seeing. This may represent the biggest hope in this field of degenerative diseases, like ALS.” After reviewing the safety data from the first four patients, the Hadassah Medical Center ethical committee granted approval for the trial to advance to transplanting the next patients. “We are happy to report that the first patients treated with our NurOwn™ technology did not present any significant side effects. This supports and strengthens our belief and trust in our technology. Based on the interim safety report, the hospital ethical and safety committee granted the company approval to proceed with treating the next patients. We are pleased with the progress we are making and look forward to continuing to demonstrate the safety of NurOwn™ in the future,” said Chaim Lebovits, BrainStorm’s President. The ALS Phase I/II human clinical trial is being performed at Hadassah Medical Center in Israel in collaboration with BrainStorm and is utilizing BrainStorm’s NurOwn™ technology for growing and modifying autologous adult human stem cells to treat ALS, often referred to as Lou Gehrig's Disease. The study is headed by Prof. Karussis, M.D., Ph.D., who is the head of Hadassah's Multiple Sclerosis Center and a member of the International Steering Committees for Bone Marrow and Mesenchymal Stem Cells Transplantation in Multiple Sclerosis (MS +5.97%, news), and a scientific team from BrainStorm headed by Prof. Eldad Melamed. The initial phase of the study is designed to establish the safety of NurOwn™ and will later be expanded to assess efficacy.
Comment left by Mary Murray on 01/19/2012
Thanks to Legislators
Posted by: Bob Murray January 04, 2012
As we know, HR 2055, a comprehensive bill passed on December 17, 2011, included over  12,000,000 dollars for continued funding of ALS research related to veterans, and for the ALS National Registry for all PALS.  I did a little quick research and was happy to see that Mary's and my US rep, Steven Lynch, and US senators, John Kerry and Scott Brown, voted for the appropriation. We had spoken to Lynch at a local "Congress on your corner," and to Brown at an ALS walk in the fall.  [Not saying that tipped the scales :)] I called all three legislators this morning, talked to their aides, and asked them to insure that the principals were aware of our gratitude.  Just a drop,  of course, but we live in hope that lots of "drops" can add up!
The following comments have been received in response to this blog post. To leave your own comments, please click here.
Those “drops” are just as much a part of ALS advocacy as all your other efforts. Well done.
Comment left by ALS Trial Expert on 01/05/2012
Searching for Clinical Trials - Great New Tools!
Posted by: Rob Tison December 24, 2011
Rob TisonI am honored to been invited to be an ALS clinical research ambassador.  Even beforehand, I have realized the great importance of clinical trial participation to advance potential therapies, and even knowledge if trials should be unsuccessful.

Slow enrollment delays progress towards important answers, costs trial sponsors more money and may effect future trial sizes as sponsors size trials based on timing goals and historic participation rates.  Smaller trials may reject beneficial drugs due to lack of statistical significance. And, there are likely more drug candidates than the eligible, aware and willing patient population can support by filling trials.

Having been an active participant in multiple ALS forums for about 2 years, I've realized most PALS are very unaware of all recruiting trials, and this is a major factor regarding participation, among the willing and eligible.

The recently launched NEALS advanced trial search tool is a huge advancement.  It is user-friendly and powerful, with disease specific filters (e.g. fALS vs. sALS, no placebos, stem cells only, only active and recruiting, time since onset limit, FVC limit, etc.).  The www.clinicaltrials.gov site was the 'gold standard'.  It is complete, but is NOT user friendly and returned a daunting number of trials to sort through, making it impractical unless one wanted details about a trial they were already aware of and searched by keywords.  The new tool has the power of complete data, but allows 'intelligent' and practical filtering impossible elsewhere.  It empowers PALS!

The link to the advanced trial search tool is:  http://www.alsconsortium.org/search.php?v=a

Check it out and spread the word!  Increased trial awareness will result in increased participation.  Increased participation will lead to effective therapies sooner.

If you have a specific trial in mind, the basic trial search tool is also useful, using keywords: http://www.alsconsortium.org/search.php

And, if one is not confident in their search abilties or simply wants to interact with an expert, another terrific option is calling or emailing a NEALS Clinical Trial Expert with your questions about clinical research at (877) 458-0631 or alstrials@partners.org
rial Expert
The following comments have been received in response to this blog post. To leave your own comments, please click here.
Rob, thank you for your post. Please be sure to let other participants in your forums know as well. You are right; clinicaltrials.gov has a wealth of information, but can be overwhelming, especially if you are looking to minimize your results by looking for certain criteria. We truly hope that visitors to the NEALS site will use the trial search function and will find it to be a helpful tool. If anyone needs additional assistance, I am available over the phone to walk people through as they use the search tool. Any feedback about this feature or misinformation can be directed to me so that I may better assist you. Any trial question at all, please call me!
Comment left by ALS Trial Expert on 12/27/2011
I agree with Rob that the NEALS site is really a big step forward in making the trials clearer for potential participants. I have been participating in the Empower trial by Biogen Idec of dexpramipexole since April and I thought it might be of some interest to someone considering participation If I told what it has been like for me. Far from feeling like an experimental object, I have felt welcomed as a co-participant in an important research project that may help many future ALS patients. I take a pill morning and evening(with applesauce since I have Bulbar onset ALS and have trouble swallowing) that may be either 150 mg. of depramipexole or a placebo. The trial requires monthly meetings with the team for checkups and blood draws (painless in the hands of experienced clinicians) and every three months, a more extensive physical by a doctor to determine how I am doing overall. Regularly, I have the FRS(questions that are used to scale ALS progression of symptoms) and the breathing test familiar to PALS. Some blood draws had to be taken at specific times after or before the pill was taken, but the team is very helpful in scheduling these to be as little of a burden as possible. Overall, the experience has been very positive for me. I may be on a placebo or the real 'dex' tablet, but time will tell. Either way, I feel I am contributing to the body of knowledge about ALS and its thus far unpredictable progression. Anyone considering participation in a trial should read all the material available on the trial and understand the risks and benefits. We need to find new treatments for ALS and we can only do that if we work together with those willing to do the hard science.
Comment left by Mary Murray on 01/04/2012
Mary, what you’ve said is so important. For many PALS, their lack of awareness may be what is stopping them from enrolling in trials. For others, just having the information may not be enough. Hearing and internalizing clinical trial experiences of other PALS can be a catalyst for change. That being said, you are right about reading all material first, because one trial might not be right for everyone. Thank you! I ask others who have been enrolled in trials, what positive experiences do you have to share?
Comment left by ALS Trial Expert on 01/05/2012
Trials are terribly important, equally important is allowing early access to treatments that are in trial and demonstrating safe dramatic improvement. PALS are dying each day and early access is the humane step to take. 1800 of us have signed this petition. To learn more email: treat.us.now@gmail.com, or edjohnson@alumni.duke.eduem http://www.change.org/petitions/corporate-citizens-authorize-and-make-available-compassionate-use-drugs-for-als-patients-now
Comment left by ed johnson on 01/10/2012
Emergency Data Base
Posted by: Thurza and James Campbell December 15, 2011
I'm Chair of our town's disAbility Advisory Committee. We worked with Police and Fire on establishing and maintaining a confidential data base of all residents with any special needs. In power outages, they contact anyone on the list, giving the power company a heads up too, regarding those on oxygen, a bipap or respirator. If needed they deliver and hook up a generator or take the resident to a shelter. Every city and town needs such a data base. Police worked with the Council on Aging to compile the lists then Police visited each person to help them fill out the forms. We used schools to determine kids.  we publicized the project to the entire community, as all ALSers and others with special needs aren't seniors. Of course pride and HIPPA prevent any data base  being 100% complete.
i have the forms, but don't know how to attach them.
Thurza Campbell, PLS
Sherborn, MA
The following comments have been received in response to this blog post. To leave your own comments, please click here.
GOOD WORK THURZA!
Comment left by Marilyn and Larry Sanford on 12/14/2011
Thanks Thurza! It is important to remember that advocacy can go beyond research to include the crucial issue of safety such as this.
Comment left by ALS Trials Expert on 12/16/2011
Thanks Thurza! On a related note, it occurred to me the other day that my wife, Mary, with advanced bulbar ALS, can no longer speak - and how would she reach E911 for an emergency (and not limited to ALS related of course). I've started some research, early days, and a TTY device seems one reliable way forward (for a PALs who can type). It's essentially a keyboard that allows messages to be typed over an ordinary phone line, and E911 in Massachusetts has TTY devices that allow the E911 agent to read the "caller's" emergency description. The devices can cost 300 or more from what I see on line - insurance, Medicare, Medicaid, etc may cover some of the cost as a piece of durable medical equipment. And the need applies not only to the PALS own emergency (if the CALS is not at hand e.g.), but suppose a CALS needs an E911 response, and the PALS cannot speak to get help. As I say, early days. One final thought - if a PALS can dial E911, the agent is expected to dispatch a responder if the line remains connected though no one speaks. But it might be a police officer rather than a medical unit.
Comment left by Bob Murray on 01/04/2012
More info - I realize this blog site is essentially regarding clinical research, but along Thurza's line, safety is important of course, and I wanted to add what I've just learned regarding E911 in MASSACHUSETTS - helpful for non speaking PALS who can type. The state's Office of Public Safety outlines what's called MASSACHUSETTS SILENT CALL PROCEDURE: Dial 911, wait for agent to answer, then press 1 for Police, or 2 for Fire, or 3 for Ambulance from a touch tone land line. See http://www.mass.gov/eopss/agencies/state-911/massachusetts-silent-call-procedure.html In addition, the MASSACHUSETTS E911 staff can source assistance devices (TTY and others) for "disabled" folks who need them to reach E911; an income means test determines how much folks might pay. See MassEDP http://www.mass.gov/eopss/agencies/massedp/
Comment left by Bob Murray on 01/04/2012
Use What You Got
Posted by: Richard Bedlack, MD, PhD November 29, 2011
Richard Bedlack, MD, PhD
People think I’m nuts.  They say that doctors aren’t supposed to have hair that looks like they just rolled out of bed, or loud clothes, or tattoos, or a purple car.  But this is who I am. Thankfully, it turns out that these eccentricities can be effective weapons in my fight against ALS as well.  

For example, I am sometimes asked if my hair is for real, and how it stays that way.  I tell people it is from a combination of cheap mousse and great surprise…the latter due to the fact that less than 10% of patients with ALS ever enroll in research studies!  To me this means that our studies cost more, take longer to complete, may end without an answer and may not be generalizable to all patients with ALS…in short that it will take longer to find the cure for this terrible disease.   This would make anybody’s hair stand on end!

I am sometimes asked why I wear such brightly colored suits.  Well, these reflect my optimism:  I know we can fix this enrollment problem. NEALS research that shows that the major determinants of enrollment are doctor factors and patient factors…things like lack of awareness of studies, time and money burdens, and surprising misconceptions about research in general and about alternative and off label therapeutic options.  Initiatives are underway to address these issues, including a clinical trials concierge service, expanding the numbers of sites that offer trials, educational materials such as webinars and video-assisted consent, studies that have home-based outcome measures, and ALSUntangled, (alsuntangled.org) which helps patients and their families use social networking to investigate alternative and off label treatment options.

Most often I am asked about my swallow tattoo; this opens the door for me to talk about Tim.  When this talented videographer and musician’s mom died from ALS, she left him a book full of hand-drawn swallows; later he had these tattooed onto his arm.  When Tim got the disease his family and friends got their own swallow tattoos, and came together to create the Often Awesome Army (oftenawesome.org).  Turns out the swallow is a very old tattoo that sailors used to get; it was the first bird they saw when land was approaching and thus let them know they were not lost at sea.  What a perfect symbol for all of us fighting ALS!  Over the past 2 years, Tim’s Often Awesome Army held numerous highly publicized and well-attended concerts, art shows and tattoo marathons, and they created a series of You Tube Videos that have been watched more than 10,000 people.  Tim showed me the power individuals have when they direct their energy and unique talents toward their fight.   To similarly empower others, NEALS recently held the first ALS Clinical Research Learning Institute.  We helped educate a small group of incredibly talented patients and families about ALS research and advocacy; we look forward to seeing how these new “research ambassadors” meld their unique skills and newfound knowledge to help us improve enrollment in ALS research.

Readers, I am sure you have your own unique talents.  What makes you special or different?  Can you think of a way to use what you got to educate and advocate for some aspect of ALS research?  Remember the words of Margaret Meade: “Never doubt that a small group of thoughtful committed citizens can work together to make a difference.  Indeed that is the only thing that ever does.”  Celebrate your eccentricities, make them work for your own fight against ALS…these individual efforts are not only fun, but when added together they will sum to a powerful force.

Oh yeah…and my purple car?  Well if that turns your head, you can’t miss my license plate:



The following comments have been received in response to this blog post. To leave your own comments, please click here.
As simple as it sounds, talking and listening go a long way. Patients who enroll in clinical trials want to know the value of their contribution. Perhaps if we increase communication with patients not only before and during, but after trials, participants can help shape understanding of ALS trials to other patients. You asked what I got…well, I’ve got the concerns and questions of pALS and caregivers. I’ve got clear, relevant, accurate information to give back to them. I hope to make navigating the ALS clinical trial world a lot less daunting. And a big thank you to our new research ambassadors. Without you, the field of ALS advocacy would not be moving at the rate it is. Keep up your amazing work!
Comment left by ALS Trial Expert on 12/13/2011
Enjoyed meeting you in Clearwater. LOVE the license plate!!
Comment left by Marilyn & Larry Sanford on 12/14/2011
Welcome
Posted by: ALS Trial Expert November 28, 2011
ALS Trial Expert
Welcome to the NEALS Clinical Research Blog!  One of the new features on the NEALS website, the blog is an interactive tool written by ALS Association / NEALS representatives and research advocates to report on clinical research advocacy efforts and other clinical trial information.
The following comments have been received in response to this blog post. To leave your own comments, please click here.
As of 1/1/12 there are over 30 new Treatments for ALS (not counting Stem Cell treatment) undergoing FDA trial. We are dedicated to having some of these made available as soon as they meet the FDA minimum requirement for Compassionate use..... The drug companies and the FDA are being asked to Treat Us Now! As soon as efficacy becomes apparent during Phase II begin taking the necessary manufacturing steps to have available supply for those PALS willing to sign off on accepting potential risk. Assure that Drug companies understand the Public Relations benefit from supporting early access. PALS will have to arrange funding and monitoring for access to early treatment. http://www.change.org/petitions/corporate-citizens-authorize-and-make-available-compassionate-use-drugs-for-als-patients-now email:treat.us.now@gmail.com, or edjohnson@alumni.duke.edu
Comment left by edjohnson on 01/10/2012
 
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