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EARLY IFNB-1a and Simvastatin Combination Therapy in Clinically Isolated Syndrome Suggestive of Multiple Sclerosis

Primary Purpose

Multiple Sclerosis

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Avonex/Zocor
Sponsored by
University of North Carolina
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Sclerosis focused on measuring Clinically Isolated Syndrome

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Subject has a diagnosis of CIS suggestive of MS involving optic nerve (unilateral optic neuritis), spinal cord (incomplete transverse myelitis), brain stem or cerebellum syndrome confirmed by ophthalmologic or neurological examinations. (Onset of CIS symptoms must occur within twelve months of randomization). At baseline, subject will be between the ages of 18 and 60, inclusive. Subject has a baseline EDSS score between 0.0 and 5.5, inclusive. MRI findings on the brain scan should reveal at least three out the four following findings: one Gd-enhancing lesion or nine T2 hyperintense lesions; or at least one infratentorial lesion; or at least one juxtacortical lesion and or at least three periventricular lesions. Subject has signed informed consent and HIPAA forms. Exclusion Criteria: Subject has a diagnosis of CD RRMS according to Poser criteria, definitive MS according McDonald criteria, secondary progressive, or primary progressive MS. Subject has been treated with statins in the previous three months. Subject has history of severe side effects related to statin therapy. Subject has had a clinically significant infectious illness (e.g., cellulitis, abscess, pneumonia, septicemia) within 30 days prior to randomization. Subject has a history of, or abnormal laboratory results indicative of, any significant cardiac, endocrinologic, hematologic, hepatic, immunologic, metabolic, urologic, pulmonary, gastrointestinal, dermatologic, psychiatric, renal, and/or other major disease. Subject has a history of severe allergic or anaphylactic reactions or known drug hypersensitivity. Subject has an abnormal screening blood test, performed at the screening visit, exceeding any of the limits defined below: alanine transaminase (ALT) or aspartate transaminase (AST) > 1.5 times the upper limit of normal (1.5x ULN) total white blood cell count < 2,300/mm^3 CPK level > 2 x ULN on two consecutive occasions tested at least one week apart. Platelets less than 150,00/mm3 Creatinine > 1.5mg/dl. prothrombin time (PT) > ULN Subject has history of treatment with either interferon-beta 1a or 1b, or glatiramer acetate. Subject has had any prior treatment with any of the following medications: total lymphoid irradiation intravenous immunoglobulins IVIg, or plasma exchange natalizumab or any other therapeutic monoclonal antibody Subject has had treatment with any of the following medications within 1 year prior to randomization: mitoxantrone cyclophosphamide Subject has had treatment with any of the following medications: cyclosporine azathioprine methotrexate glatiramer acetate interferon beta-1b or INF beta-1a intravenous immunoglobulin (IVIG) plasmapheresis or cytapheresis Subject has had treatment with any of the following medications within 50 days prior to randomization: intravenous corticosteroid treatment oral corticosteroid treatment Subject has a history of alcohol abuse within 2 years prior to randomization. Subject is a female who is not postmenopausal for at least one year, surgically sterile, or willing to practice effective contraception (as defined by the investigator) during the study. The rhythm method is not to be used as the sole method of contraception. Subject is a nursing mother, pregnant woman, or planning to become pregnant while on study. Subject has had participation in any other investigational study within 6 months prior to randomization. Subject is unwilling or is unable to comply with the requirements of this protocol including the presence of any condition (physical, mental, or social) that is likely to affect the subject's ability to comply with the study protocol. Subject is determined unsuitable for enrollment into this study for any other reason in the opinion of the Investigator and/or the Sponsor.

Sites / Locations

  • University of North Carolina-Chapel Hill MS clinic within the Neuroscience Hospital

Outcomes

Primary Outcome Measures

The primary objective of this study is to determine whether combination therapy with IFNb-1a plus simvastatin, when compared to IFNb-1a plus placebo decreases or delays additional clinical or MRI activity.
We will use the following outcome measures:
Relapse rates, Time to first relapse,Number of new T2 lesions, Number of new Gd-enhancing lesions

Secondary Outcome Measures

Full Information

First Posted
September 1, 2005
Last Updated
February 28, 2008
Sponsor
University of North Carolina
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1. Study Identification

Unique Protocol Identification Number
NCT00146068
Brief Title
EARLY IFNB-1a and Simvastatin Combination Therapy in Clinically Isolated Syndrome Suggestive of Multiple Sclerosis
Official Title
Phase IV Double-Blind Randomized Study to Evaluate Safety and Efficacy of Interferon Beta-1a (Avonex) Plus Simvastatin (Zocor) Combination Therapy in Clinically Isolated Syndrome Suggestive of Multiple Sclerosis Over a One Year Period
Study Type
Interventional

2. Study Status

Record Verification Date
February 2008
Overall Recruitment Status
Completed
Study Start Date
September 2004 (undefined)
Primary Completion Date
December 2007 (Actual)
Study Completion Date
December 2007 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
University of North Carolina

4. Oversight

5. Study Description

Brief Summary
The purpose of this study is to determine the safety, tolerability and efficacy of a combination therapy interferon beta-1a(Avonex) plus simvastatin (Zocor) vs. interferon beta-1a plus placebo in patients with clinically isolated syndrome suggestive of Multiple Sclerosis.
Detailed Description
Interferon beta-1a (IFNB-1a), a FDA approved therapy for relapsing-remitting (RR) MS has several mechanisms of action. It lowers proinflammatory cytokine production and inhibits antigen presentation by class II major histocompatibility complex (MHC) molecule. It also reduces metalloproteinase activity, which all lead to decreased migration of T-lymphocytes into the central nervous system (CNS), and subsequent inhibition of inflammatory lesion formation. We propose that combination therapy during early stages of the disease with second immunomodulatory agent that targets different steps in the pathogenesis of the disease may add to the effectiveness of IFNB-1a. IFNB-1a administered intramuscularly at 30 mg per week is particularly suitable for combination therapy due to its proven efficacy in Clinically Isolated Syndrome (CIS),favorable safety profile and low frequency of neutralizing antibodies (NABs) against IFNB-1a in comparison to other forms of IFNB-1a. Recent studies have reported a significant anti-inflammatory and neuroprotective effects of statins, cholesterol-lowering agents. Statins disrupt cellular membrane lipid rafts, which inhibit the clustering of T-cell receptor (TCR), co-stimulatory, and adhesion molecules, required for optimal T-cell activation. Along with inhibiting T-cell activation, statins decrease IFNB inducible MHC class II expression, suppressing an effective antigen presentation. They block migration of activated mononuclear cells from peripheral circulation into the CNS by blocking LFA-1 adhesion molecule and by reducing metalloproteinase type 9 secretion. While their anti-inflammatory effects at tolerable oral doses may not justify their use as monotherapy for RR MS, their pleiotropic mechanisms of action showed synergistic effects with IFNB-1a in studies in vitro. We propose that simvastatin may enhance the immunomodulatory effects of INFB-1a in patients with CIS suggestive of MS and that this combination may even more effectively prevent further disease activity if administered early in the course of the disease.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Sclerosis
Keywords
Clinically Isolated Syndrome

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
Double
Allocation
Randomized
Enrollment
30 (false)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
Avonex/Zocor
Primary Outcome Measure Information:
Title
The primary objective of this study is to determine whether combination therapy with IFNb-1a plus simvastatin, when compared to IFNb-1a plus placebo decreases or delays additional clinical or MRI activity.
Title
We will use the following outcome measures:
Title
Relapse rates, Time to first relapse,Number of new T2 lesions, Number of new Gd-enhancing lesions

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject has a diagnosis of CIS suggestive of MS involving optic nerve (unilateral optic neuritis), spinal cord (incomplete transverse myelitis), brain stem or cerebellum syndrome confirmed by ophthalmologic or neurological examinations. (Onset of CIS symptoms must occur within twelve months of randomization). At baseline, subject will be between the ages of 18 and 60, inclusive. Subject has a baseline EDSS score between 0.0 and 5.5, inclusive. MRI findings on the brain scan should reveal at least three out the four following findings: one Gd-enhancing lesion or nine T2 hyperintense lesions; or at least one infratentorial lesion; or at least one juxtacortical lesion and or at least three periventricular lesions. Subject has signed informed consent and HIPAA forms. Exclusion Criteria: Subject has a diagnosis of CD RRMS according to Poser criteria, definitive MS according McDonald criteria, secondary progressive, or primary progressive MS. Subject has been treated with statins in the previous three months. Subject has history of severe side effects related to statin therapy. Subject has had a clinically significant infectious illness (e.g., cellulitis, abscess, pneumonia, septicemia) within 30 days prior to randomization. Subject has a history of, or abnormal laboratory results indicative of, any significant cardiac, endocrinologic, hematologic, hepatic, immunologic, metabolic, urologic, pulmonary, gastrointestinal, dermatologic, psychiatric, renal, and/or other major disease. Subject has a history of severe allergic or anaphylactic reactions or known drug hypersensitivity. Subject has an abnormal screening blood test, performed at the screening visit, exceeding any of the limits defined below: alanine transaminase (ALT) or aspartate transaminase (AST) > 1.5 times the upper limit of normal (1.5x ULN) total white blood cell count < 2,300/mm^3 CPK level > 2 x ULN on two consecutive occasions tested at least one week apart. Platelets less than 150,00/mm3 Creatinine > 1.5mg/dl. prothrombin time (PT) > ULN Subject has history of treatment with either interferon-beta 1a or 1b, or glatiramer acetate. Subject has had any prior treatment with any of the following medications: total lymphoid irradiation intravenous immunoglobulins IVIg, or plasma exchange natalizumab or any other therapeutic monoclonal antibody Subject has had treatment with any of the following medications within 1 year prior to randomization: mitoxantrone cyclophosphamide Subject has had treatment with any of the following medications: cyclosporine azathioprine methotrexate glatiramer acetate interferon beta-1b or INF beta-1a intravenous immunoglobulin (IVIG) plasmapheresis or cytapheresis Subject has had treatment with any of the following medications within 50 days prior to randomization: intravenous corticosteroid treatment oral corticosteroid treatment Subject has a history of alcohol abuse within 2 years prior to randomization. Subject is a female who is not postmenopausal for at least one year, surgically sterile, or willing to practice effective contraception (as defined by the investigator) during the study. The rhythm method is not to be used as the sole method of contraception. Subject is a nursing mother, pregnant woman, or planning to become pregnant while on study. Subject has had participation in any other investigational study within 6 months prior to randomization. Subject is unwilling or is unable to comply with the requirements of this protocol including the presence of any condition (physical, mental, or social) that is likely to affect the subject's ability to comply with the study protocol. Subject is determined unsuitable for enrollment into this study for any other reason in the opinion of the Investigator and/or the Sponsor.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Silva Markovic-Plese
Organizational Affiliation
University of North Carolina, Chapel Hill
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of North Carolina-Chapel Hill MS clinic within the Neuroscience Hospital
City
Chapel Hill
State/Province
North Carolina
ZIP/Postal Code
27599
Country
United States

12. IPD Sharing Statement

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EARLY IFNB-1a and Simvastatin Combination Therapy in Clinically Isolated Syndrome Suggestive of Multiple Sclerosis

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