Comparative Study of High-Efficacy Disease Modifying Treatment of Relapsing Multiple Sclerosis
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Relapsing Remitting Multiple Sclerosis
- Sponsor
- University of Aarhus
- Enrollment
- 200
- Locations
- 1
- Primary Endpoint
- Changes in B cell populations
- Status
- Recruiting
- Last Updated
- 2 years ago
Overview
Brief Summary
The goal of this prospective, multi-center, non-blinded, non-randomized, non-intervention clinical trial is to compare immunologic, virologic and epigenetic factors in patients with active multiple sclerosis in standard 2.line treatment with ocrelizumab, rituximab, ofatumumab or natalizumab in Region Midt, Denmark. It aims to answer how the immunologic, virologic and epigenetic response in these patients are compared to healthy controls, and analyze their treatment effect in relation to this response. Participants will get an extra blood sample, when they have their routine blood samples taken.
Detailed Description
The CoSHED RMS study will include patients with active multiple sclerosis aged 18-65 years fulfilling the criteria for 2. line treatment and starting treatment with one of the four high-efficacy disease modifying treatments ocrelizumab, rituximab, ofatumumab or natalizumab. Researchers will compare immunologic, virologic and epigenetic parameters in the four treatment groups to a age and gender matched healthy control group. The study duration is 12 months, and patients can continue in an extension phase for additional 12 month. The primary endpoint is changes in B cell populations between the four treatments within 12 months. The study will evaluate a number of efficacy and safety endpoints using clinical, MRI, routine blood samples and research biomarkers.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Multiple sclerosis diagnosis and definition of disease course according to the 2017 McDonald criteria
- •Expanded disability status scale (EDSS) ≤6.5
- •Signed written informed consent
- •Fulfilling criteria for active MS: Treatment naïve relapsing remitting multiple sclerosis (RRMS) patients (never treated, or no DMT the previous 2 years):
- •2 relapse previous 12 months OR
- •1 relapse previous 12 months with severe residual symptoms and EDSS ≥ 3.0 OR
- •1 relapse previous 12 months AND ≥9 T2 lesions on brain and/or spinal cord MRI AND
- •contrast-enhancing lesion or ≥1 new or enlarging T2 lesion on brain and/or spinal cord MRI previous 12 month
- •Previously treated RRMS patients:
- •1 relapse previous 12 months OR
Exclusion Criteria
- •Pregnancy or breast feeding
- •Lack of effective contraception for women of child-bearing potential (effective contraception include oral contraception, intrauterine devices and other forms of contraception with failure rate \<1%)
- •Receipt of a live or live-attenuated vaccine within 6 weeks prior to randomization
- •Known active malignant disease
- •Severe heart failure (New York Heart Association Class IV) or severe, uncontrolled cardiac disease
- •Positive test for HIV, hepatitis B or C, or tuberculosis
- •Negative test for varicella zoster
- •Lymphopenia grade 2 (0.5 to 0.8 × 10\^9/L) or higher grades of lymphopenia (in case of switching from fingolimod lymphopenia grade 2 can be accepted if lymphocytes are rising markedly compared to on treatment levels)
- •Neutropenia grade 2 (1.0 to 1.5 × 10\^9/L) or higher grades
- •Thrombocytopenia grade 2 (50 to 75 × 10\^9/L) or higher grades
Outcomes
Primary Outcomes
Changes in B cell populations
Time Frame: 1 year
Changes in B cell populations in the four treatment groups