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Randomized Controlled Trial
. 2023 May;67(5):378-386.
doi: 10.1002/mus.27807. Epub 2023 Mar 14.

Randomized trial of inosine for urate elevation in amyotrophic lateral sclerosis

David Walk  1 , Katharine Nicholson  2 , Eduardo Locatelli  3 , James Chan  2 , Eric A Macklin  2 , Valerie Ferment  1 , Georgios Manousakis  1 , Marianne Chase  2 , Mariah Connolly  4 , Derek Dagostino  2 , Meghan Hall  4 , Joseph Ostrow  2 , Lindsay Pothier  2 , Cassandra Lieberman  2 , Dario Gelevski  2 , Rebecca Randall  4 , Alexander V Sherman  2 , Erin Steinhart  2 , Daniela Grasso Walker  2 , Jason Walker  2 , Hong Yu  2 , Anne-Marie Wills  2 , Michael A Schwarzschild  5 , Anna L Beukenhorst  6 , Jukka-Pekka Onnela  6 , James D Berry  2 , Merit E Cudkowicz  2 , Sabrina Paganoni  2   7
Affiliations
Randomized Controlled Trial

Randomized trial of inosine for urate elevation in amyotrophic lateral sclerosis

David Walk et al. Muscle Nerve. 2023 May.

Abstract

Introduction/aims: Higher urate levels are associated with improved ALS survival in retrospective studies, however whether raising urate levels confers a survival advantage is unknown. In the Safety of Urate Elevation in Amyotrophic Lateral Sclerosis (SURE-ALS) trial, inosine raised serum urate and was safe and well-tolerated. The SURE-ALS2 trial was designed to assess longer term safety. Functional outcomes and a smartphone application were also explored.

Methods: Participants were randomized 2:1 to inosine (n = 14) or placebo (n = 9) for 20 weeks, titrated to serum urate of 7-8 mg/dL. Primary outcomes were safety and tolerability. Functional outcomes were measured with the Amyotrophic Lateral Sclerosis Functional Rating Scale Revised (ALSFRS-R). Mobility and ALSFRS-R were also assessed by a smartphone application.

Results: During inosine treatment, mean urate ranged 5.68-6.82 mg/dL. Treatment-emergent adverse event (TEAE) incidence was similar between groups (p > .10). Renal TEAEs occurred in three (21%) and hypertension in one (7%) of participants randomized to inosine. Inosine was tolerated in 71% of participants versus placebo 67%. Two participants (14%) in the inosine group experienced TEAEs deemed related to treatment (nephrolithiasis); one was a severe adverse event. Mean ALSFRS-R decline did not differ between groups (p = .69). Change in measured home time was similar between groups. Digital and in-clinic ALSFRS-R correlated well.

Discussion: Inosine met pre-specified criteria for safety and tolerability. A functional benefit was not demonstrated in this trial designed for safety and tolerability. Findings suggested potential utility for a smartphone application in ALS clinical and research settings.

Keywords: amyotrophic lateral sclerosis; clinical trial; inosine; oxidative stress; smartphone application.

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References

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