Theclinical trial landscape inamyotrophic lateral sclerosis—Past, present, and future

Funding information Amyotrophic Lateral Sclerosis Research Program, Grant/Award Number: W81XWH‐17‐ 1‐0237; Life Extension Foundation; Packard Center for ALS Research; Muscular Dystrophy Association, Grant/Award Number: MDA277268; National Institutes of Health, Grant/Award Numbers: R01GM099836, R21NS090205, R21NS102687; NSF Graduate Research Fellowship, Grant/Award Number: DGE‐1321851; Amyotrophic Lateral Sclerosis Association; Linda Montague Pechenik Research Award; G. Harold and Leila Y. Mathers Charitable Foundation; ALSFAC; Target ALS Abstract Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease marked by progressive loss of muscle function. It is the most common adult‐onset form of motor neuron disease, affecting about 16 000 people in the United States alone. The average survival is about 3 years. Only two interventional drugs, the antiglutamatergic small‐molecule riluzole and the more recent antioxidant edaravone, have been approved for the treatment of ALS to date. Therapeutic strategies under investigation in clinical trials cover a range of different modalities and targets, and more than 70 different drugs have been tested in the clinic to date. Here, we summarize and classify interventional therapeutic strategies based on their molecular targets and phenotypic effects. We also discuss possible reasons for the failure of clinical trials in ALS and highlight emerging preclinical strategies that could provide a breakthrough in the battle against this relentless disease.