Sodium Phenylbutyrate and Tauroursodeoxycholic Acid: A Story of Hope Turned to Disappointment in Amyotrophic Lateral Sclerosis Treatment.


Journal

Clinical drug investigation
ISSN: 1179-1918
Titre abrégé: Clin Drug Investig
Pays: New Zealand
ID NLM: 9504817

Informations de publication

Date de publication:
23 Jun 2024
Historique:
accepted: 26 05 2024
medline: 23 6 2024
pubmed: 23 6 2024
entrez: 23 6 2024
Statut: aheadofprint

Résumé

The absence of a definitive cure for amyotrophic lateral sclerosis (ALS) emphasizes the crucial need to explore new and improved treatment approaches for this fatal, progressive, and disabling neurodegenerative disorder. As at the end of 2023, five treatments - riluzole, edaravone, dextromethorphan hydrobromide + quinidine sulfate (DHQ), tofersen, and sodium phenylbutyrate-tauroursodeoxycholic acid (PB-TUDCA) - were FDA approved for the treatment of patients with ALS. Among them PB-TUDCA has been shown to impact DNA processing impairments, mitochondria dysfunction, endoplasmic reticulum stress, oxidative stress, and pathologic folded protein agglomeration defects, which have been associated with ALS pathophysiology. The Phase 2 CENTAUR trial demonstrated significant impact of PB-TUDCA on the ALS Functional Rating Scale-Revised (ALSFRS-R) risk of death, hospitalization, and the need for tracheostomy or permanent assisted ventilation in patients with ALS based on post hoc analyses. More recently, contrasting with the CENTAUR trial results, results from the Phase 3 PHOENIX trial (NCT05021536) showed no change in ALSFRS-R total score at 48 weeks. Consequently, the sponsor company initiated the process with the US FDA and Health Canada to voluntarily withdraw the marketing authorizations for PB-TUDCA. In the present article, we review ALS pathophysiology, with a focus on PB-TUDCA's proposed mechanisms of action and recent clinical trial results and discuss the implications of conflicting trial data for ALS and other neurological disorders.

Identifiants

pubmed: 38909349
doi: 10.1007/s40261-024-01371-1
pii: 10.1007/s40261-024-01371-1
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.

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Auteurs

Arsh Ketabforoush (A)

NextGen Precision Health, University of Missouri, 1030 Hitt St., Columbia, MO, 65211, USA.
Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO, USA.

Faezeh Faghihi (F)

Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran.

Fereshteh Azedi (F)

Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran.
Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran.

Armin Ariaei (A)

School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Mohamad Amin Habibi (MA)

Clinical Research Development Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran.

Maryam Khalili (M)

School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Bahram Haghi Ashtiani (BH)

Department of Neurology, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran.

Mohammad Taghi Joghataei (MT)

Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran.
Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran.

W David Arnold (WD)

NextGen Precision Health, University of Missouri, 1030 Hitt St., Columbia, MO, 65211, USA. wdavidarnold@health.missouri.edu.
Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO, USA. wdavidarnold@health.missouri.edu.
Department of Neurology, University of Missouri, Columbia, MO, USA. wdavidarnold@health.missouri.edu.
Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO, USA. wdavidarnold@health.missouri.edu.

Classifications MeSH