In adults with primary mitochondrial myopathy, the highest dose of elamipretide increased 6-minute walk distance by a mean of 64.5 m compared to 20.4 m with placebo after 5 days (p=0.053).
RCT (n=36)
double-blind
randomized
Yes
Does intravenous elamipretide improve distance walked in the 6-minute walk test in adults with primary mitochondrial myopathy?
Elamipretide improves short-term exercise performance in adults with primary mitochondrial myopathy without significant safety concerns.
Absolute Event Rate: 64.5% vs 20.4%
p-value: p=0.053
Objective To assess the safety and efficacy of elamipretide, an aromatic-cationic tetrapeptide that readily penetrates cell membranes and transiently localizes to the inner mitochondrial membrane where it associates with cardiolipin, in adults with primary mitochondrial myopathy (PMM). Methods A Study Investigating the Safety, Tolerability, and Efficacy of MTP-131 for the Treatment of Mitochondrial Myopathy (MMPOWER) was a phase I/II multicenter, randomized, double-blind, placebo-controlled trial of elamipretide in 36 participants with genetically confirmed PMM. Participants were randomized to intravenous elamipretide (0.01, 0.1, and 0.25 mg/kg/h or placebo for 2 hours in a dose-escalating sequence). The primary efficacy measure was the change in distance walked in the 6-minute walk test (6MWT) after 5 days of treatment. Other efficacy measures included changes in cardiopulmonary exercise testing parameters, in participant-reported symptoms, and in serum and urinary biomarkers. Safety, tolerability, and pharmacokinetics were also measured. Results Participants who received the highest dose of elamipretide walked a mean of 64.5 m farther at day 5 compared to a change of 20.4 m in the placebo group (p = 0.053). In addition, there was a dose-dependent increase in distance walked on the 6MWT with elamipretide treatment (p = 0.014). In a model that adjusted for additional covariates possibly affecting response, the adjusted change for the highest dose of elamipretide was 51.2 vs 3.0 m in the placebo group (p = 0.0297). No significant differences were observed in other efficacy and safety endpoints. Conclusions Elamipretide increased exercise performance after 5 days of treatment in patients with PMM without increased safety concerns. These findings, as well as additional functional and patient-reported measures, remain to be tested in larger trials with longer treatment periods to detect other potential therapeutic benefits in individuals affected by this condition. Classification of evidence This trial provides Class I evidence that for patients with PMM, elamipretide improved the distance walked on the 6MWT.
Karaa et al. (Fri,) conducted a rct in primary mitochondrial myopathy (n=36). elamipretide vs. placebo was evaluated on change in distance walked in the 6-minute walk test (6MWT) after 5 days of treatment (p=0.053). In adults with primary mitochondrial myopathy, the highest dose of elamipretide increased 6-minute walk distance by a mean of 64.5 m compared to 20.4 m with placebo after 5 days (p=0.053).