MND-SMART

Motor neurone disease systematic multi-arm adaptive randomised trial (MND-SMART)

UK Chief Investigator

Professor Siddharthan Chandran

Research summary

MND-SMART stands for Motor Neuron Disease – Systematic Multi-arm Adaptive Randomised Trial. 

Multi-arm means that, unlike typical clinical trials which test a single treatment, MND-SMART will test more than one at the same time. Trial participants taking the different treatments will be compared with a single group who receive a dummy drug, called a placebo. This means that people in MND-SMART are more likely to receive an active treatment when compared to standard clinical trials where half of participants receive the placebo and half the active treatment.

The trial is also adaptive so that researchers can change the drugs being tested according to emerging results. This means that new medicines can be added once a trial has started, while treatments that do not prove effective can be dropped. This is a phase 2 / 3 trial which means if drugs appear to be effective, they will seamlessly transition into phase 3 without the need for additional permissions or trial participants needing to complete a phase 2 trial and join a separate phase 3 trial. 

Current status

Open to recruitment

Recruitment target

Up to 800 participants

Click here to see how many patients have been recruited into this study to date (external link to the NIHR public study search) 

Recruitment group(s)

Patients with MND

Locations

Scotland:

• Aberdeen (Principal Investigator: Callum Duncan) 

• Dundee (Principal Investigator: Ian Morrison)

• Edinburgh (Principal Investigator: Suvankar Pal)

• Glasgow (Principal Investigator: George Gorrie)

• Inverness (Principal Investigator: Javier Carod Artal)

England:

• Birmingham (Principal Investigator: Venkatamaran Srinivasan)

• Brighton (Principal Investigator: Andrew Barritt) (site in set-up, opening shortly)

• Bury St Edmunds (Principal Investigator: Francesca Crawley)

• Cambridge (Principal Investigator: Rhys Roberts)

• Exeter (Principal Investigator: Tim Harrower)

• Ipswich (Principal Investigator: Clare Galton)

• London - St George's Hospital (Principal Investigator: Pablo Garcia Reitboeck)

• London - Royal London Hospital (Principal Investigator: Aleks Radunovic)

• London - University College Hospital (Principal Investigator: Andrea Malaspina) (site in set-up, opening shortly)

• Newcastle (Principal Investigator: Tim Williams)

• Norwich (Principal Investigator: Godwin Mamutse)

• Poole (Principal Investigator: Charles Hillier)

• Salford (Principal Investigator: Hisham Hamdalla)

• Sheffield (Principal Investigator: Chris McDermott)

• Southampton (Principal Investigator: Ashwin Pinto)

Wales:

• Cardiff (Principal Investigator: Ken Dawson)

Northern Ireland:

• Craigavon Area Hospital (Principal Investigator: Raeburn Forbes)

Information about study sites

Contact details

Website: www.mnd-smart.org

Email: loth.mndsmart@nhslothian.scot.nhs.uk 

Telephone: 0131 242 9122

Key dates

Recruitment open date: 20 February 2020

Planned recruitment end date: 02 November 2026

Inclusion / exclusion criteria

Inclusion criteria

• Confirmed diagnosis of MND including the following subtypes: ALS by El Escorial Criteria (possible, probable, and definite), primary lateral sclerosis, and progressive muscular atrophy.

• Over 18.

• Women of childbearing potential according to Clinical Trials Facilitation and coordination Group (CTFG) guidelines. Must have a negative pregnancy test within seven days prior to the baseline visit.

• Women of childbearing potential and fertile men (according to CTFG guidelines) must be using an appropriate method of contraception to avoid any unlikely teratogenic effects of the selected drugs from time of consent, to four weeks after treatment inclusive.

• Willing and able to comply with the trial protocol and ability to understand and complete questionnaires.

• Written informed consent (this can be signed by a proxy in the case of limb dysfunction).

Exclusion criteria

• Patients diagnosed with fronto-temporal dementia (FTD-MND) or any other significant psychiatric disorder that prevents informed consent being given.

• Patients in the manic phase of bipolar disorder.

• Alcoholism (self-reported).

• Active suicide ideation assessed using the Columbia Suicide Severity Rating Scale  (C-SSRS).

• On concurrent investigational medication (including biological therapy).

• Known hypersensitivity, including hereditary fructose intolerance, or adverse reaction to the active substances and their excipients or any past medical history contraindicating use of any of the IMPs.

• Pregnancy or breast-feeding females.

• If ALT, ALP, bilirubin or GGT >3 times the upper limit of normal.

• If creatinine clearance (creatinine clearance or eGFR) <35 ml/min.

• If Serum free T4 >25pmol/l or TSH <0.2mU/l.

• If corrected QT interval on 12 lead ECG >500 ms.

• Patient's diagnosed with ventricular arrhythmias, heart block or in the immediate recovery period after myocardial infarction (< 6 weeks).

• Already taking any of the IMPs in this protocol.

• Patient's contraindicated to any of the IMPs.

• Taking a medication that interacts with the active substances and their excipients, including but not limited to: Dextromethorphan, Amantadine; Ketamine, Monoamine-oxidase inhibitors – (MAOIs), Rasagiline, Selegiline, Safinamide, Tranylcypromine, Phenelzine, Isocarboxazid, Moclobemide.

• Patients with active epilepsy.

• Patients with history of proven peptic ulcer confirmed on endoscopy.

Funders

• MND Scotland

• Euan MacDonald Centre for MND Research

• My Name'5 Doddie Foundation

Sponsor

NHS Lothian

Study design

Interventional; multi-arm, multi-stage, adaptive, randomised controlled trial

Current interventions

• Drug: Amantadine

• Placebo

Phase

2/3

Outcome measures

Co-primary outcome measures

• Slope of decline in Amyotrophic Lateral Sclerosis Functional Rating Scale (Revised) (ALS-FRS(R)) over 18 months.

• Survival.

Secondary outcomes

• Time to King's stage 4a (nutritional failure).

• Time to King's stage 4b (respiratory failure).

• Cognitive function and behaviour assessed by the Edinburgh Cognitive and Behavioural ALS Screen (ECAS).

• Respiratory function measured by forced vital capacity (FVC) and sniff nasal inspiratory pressure (SNIP).

• Anxiety and depression measured by the Hospital Anxiety and Depression Scale (HADS).

• Quality of life evaluation – EQ-5D-5L.