A newly launched phase 4 open-label study will investigate the potential benefits of transitioning clinically stable multiple sclerosis patients from anti-CD20 medications to ozanimod (Zeposia), marking a significant step in exploring treatment de-escalation strategies. The trial, identified as NCT06529406, is currently initiating at multiple tertiary MS referral centers across the United States.
Dr. Enrique Alvarez, associate professor of neurology at the University of Colorado School of Medicine, leads this ambitious research effort that aims to enroll at least 500 participants. The study targets patients with a minimum three-year history of MS symptoms who have maintained disease stability, specifically showing no inflammatory disease activity for at least two years while on continuous anti-CD20 therapy.
Study Design and Treatment Protocol
The treatment protocol involves a carefully structured titration phase for ozanimod administration. Patients will begin with 0.23 mg taken orally once daily for the first four days, followed by 0.46 mg daily on days 5-7. The maintenance phase commences on day 8 with a daily dose of 0.92 mg, which will continue throughout the 36-month follow-up period.
Primary endpoints focus on two critical measures: the count of new T2 lesions and the occurrence of serious infections over the three-year follow-up period. Secondary endpoints encompass a comprehensive range of measures, including:
- Adverse events monitoring
- Infection rates
- Immunoglobulin G and IgM levels
- Relapse frequency
- No evidence of disease activity (NEDA-3) status
Comprehensive Assessment of Patient Outcomes
The trial incorporates extensive exploratory endpoints to evaluate various aspects of patient function and quality of life. These include:
- Cognitive function assessment using the Symbol Digit Modalities Test
- Hand function evaluation via the 9-Hole Peg Test
- Walking ability measurement through the 25-Foot Walk Test
- Patient-reported outcomes on treatment satisfaction
- Impact on fatigue levels and overall quality of life
- Changes in employment status
Context in MS Treatment Landscape
This research emerges amid growing interest in de-escalation strategies for MS treatment. Previous studies have explored similar approaches with other medications. The STRATEGY study, which examined transitioning from natalizumab to dimethyl fumarate across 45 US centers, reported a 19.6% relapse rate after one year, with 8% of patients discontinuing due to adverse events.
Ozanimod's once-daily oral administration and high tolerability profile may offer advantages over alternatives such as fumarates, which require twice-daily dosing and often cause gastrointestinal issues. The researchers also suggest potential safety benefits compared to fingolimod, the first approved S1P receptor modulator for MS treatment.
The study represents a significant effort to address the challenges of long-term MS treatment, particularly the risks associated with extended use of high-efficacy therapies. Results from this trial could provide valuable insights for clinicians making treatment decisions for stable MS patients, potentially offering a safer long-term management strategy while maintaining disease control.
