REbif FLEXible Dosing in Early Multiple Sclerosis (MS) (REFLEX)
Primary Purpose
Multiple Sclerosis
Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
RNF
RNF
Placebo
Sponsored by

About this trial
This is an interventional prevention trial for Multiple Sclerosis focused on measuring Rebif New Formulation, Clinical Isolated Syndrome, Multiple Sclerosis
Eligibility Criteria
Inclusion Criteria:
- Single, first clinical event suggestive of MS within 60 days prior to study Day 1, which is the day of randomization (clock starts 24 hours after onset). The event must be a new neurological abnormality present for at least 24 hours, either mono- or polysymptomatic, other than a paresthesia, vegetative or cerebral dysfunction
- At least two clinically silent lesions on the T2-weighted MRI scan, with a size of at least 3 millimeter (mm), at least one of which is ovoid or periventricular or infratentorial
- EDSS 0 - 5.0 at least one time point during the screening period before start of treatment
- 18 and 50 years old, inclusive
- Willing to follow study procedures
- Written informed consent
If female, subject must:
- be neither pregnant nor breast-feeding nor attempting to conceive
- use a highly effective method of contraception. A highly effective method of contraception is defined as those which result in a low failure rate (that is [i.e.] less than 1 percent [%] per year) when used consistently and correctly such as implants, injectables, combined oral contraceptives, some intrauterine devices (IUDs), sexual abstinence or vasectomised partner
Exclusion Criteria:
- Diagnosis of MS (per McDonald criteria 2005)
- Any other disease that could better explain the subject's signs and symptoms
- Complete transverse myelitis or bilateral optic neuritis
- Subject uses or has used any other approved MS disease-modifying drug (DMD)
- Any investigational drug or undergone an experimental procedure within 12 weeks prior to study Day 1
- Oral or systemic corticosteroids or adrenocorticotropic hormone (ACTH) within 30 days prior to study Day 1
- Total bilirubin greater than 2.5 times upper limit of normal (ULN)
- Subject has total aspartate aminotransferase (AST) or alanine aminotransferase (ALT) or alkaline phosphatase (ALP) greater than 2.5 times the ULN
- Inadequate bone marrow reserve, defined as a total white blood cell count less than 3.0 x 109 per liter (/L), platelet count less than 75 x 109/L, hemoglobin less than 100 gram per liter (g/L)
- Current autoimmune disease
- Major medical or psychiatric illness (including history of or current severe depressive disorders and/or suicidal ideation) that in the opinion of the investigator creates undue risk to the subject or could affect compliance with the study protocol
- History of seizures not adequately controlled by treatment
- Cardiac disease, such as angina, congestive heart failure or arrhythmia
- Known allergy to IFN-beta or the excipient(s) of the study medication
- Any condition that could interfere with the MRI evaluation;
- Known allergy to gadolinium-diethylene triamine pentaacetic acid (DTPA)
- Previously participated in this study
- Participated in any clinical trial within the past 6 months
- Any immunomodulatory or immunosuppressive therapy at any time prior to enrollment, including, but not limited to, the following products: any IFN, glatiramer acetate (Copolymer I), cyclophosphamide, cyclosporine, methotrexate, linomide, azathioprine, mitoxantrone, teriflunomide, laquinimod, cladribine, total lymphoid irradiation, anti-lymphocyte monoclonal antibody treatment (e.g. natalizumab, alemtuzumab/Campath, anti-cluster of differentiation 4 [CD4]), intravenous, immunoglobulins (Igs), cytokines or anti-cytokine therapy
- Any experimental MS treatment prior to trial entry, including, but not limited to, any statins (if given to prevent MS) and pentoxyfylline
- History of alcohol or drug abuse
- Intolerance or any contraindication to both paracetamol (acetaminophen) and ibuprofen
- Inability to administer subcutaneous injections either by self or by caregiver
- Moderate to severe renal impairment
Sites / Locations
- Research Site
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Arms of the Study
Arm 1
Arm 2
Arm 3
Arm Type
Active Comparator
Active Comparator
Placebo Comparator
Arm Label
RNF 44 mcg three times weekly
RNF 44 mcg once weekly and placebo twice weekly for blinding
Placebo three times weekly
Arm Description
Outcomes
Primary Outcome Measures
Time to Conversion to Multiple Sclerosis (MS) According to the McDonald Criteria (2005)
The McDonald criteria use dissemination in time and space established by magnetic resonance image (MRI) findings to provide a clinical diagnosis for MS. Dissemination in time is established by a new time constant 2 (T2) or gadolinium-enhancing (Gd+) lesion found on a repeat MRI. Dissemination in space is established by the presence of any 3 of the following: 1 Gd+ lesion or 9 T2 bright lesions if there is no enhancement; greater than or equal to 1 infratentorial lesion; greater than or equal to 1 juxtacortical lesion; greater than or equal to 3 periventricular lesions.
Time to Conversion to Multiple Sclerosis (MS) According to the McDonald Criteria (2005)
The McDonald criteria use dissemination in time and space established by MRI findings to provide a clinical diagnosis for MS. Dissemination in time is established by a T2 or Gd+ lesion found on a repeat MRI. Dissemination in space is established by the presence of any 3 of the following: 1 Gd+ lesion or 9 T2 bright lesions if there is no enhancement; greater than or equal to 1 infratentorial lesion; greater than or equal to 1 juxtacortical lesion; greater than or equal to 3 periventricular lesions.
Secondary Outcome Measures
Time to Conversion to Clinically Definite Multiple Sclerosis (CDMS) Defined by Either a Second Attack or a 3-Month Sustained Increase (Greater Than or Equal to 1.5 Points) in the Expanded Disability Status Scale (EDSS) Score
CDMS was defined by the occurrence of a second exacerbation or relapse over 24 months in participants who presented with first clinical demyelinating event (FCDE) accompanied by an abnormal MRI scan. EDSS assesses disability in 8 functional systems. An overall score ranging from 0 (normal) to 10 (death due to MS) was calculated.
Time to Conversion to Clinically Definite Multiple Sclerosis (CDMS) Defined by Either a Second Attack or a 3-Month Sustained Increase (Greater Than or Equal to 1.5 Points) in the Expanded Disability Status Scale (EDSS) Score
CDMS was defined by the occurrence of a second exacerbation or relapse over 36 months in participants who presented with FCDE accompanied by an abnormal MRI scan. EDSS assesses disability in 8 functional systems. An overall score ranging from 0 (normal) to 10 (death due to MS) was calculated.
Mean Number of Combined Unique Active (CUA) Lesions, New Time Constant 2 (T2) Lesions, Gadolinium Enhanced (Gd+) Lesions and New Time Constant 1 (T1) Hypointense Lesions Per Participant Per Scan
Number of CUA lesions, new T2 lesions, Gd+ lesions and new T1 hypointense lesions were measured by using MRI scans.
Change From Baseline in Time Constant 2 (T2) Lesion Volume , Time Constant 1 (T1) Hypointense Lesion Volume and Gadolinium Enhanced (Gd+) Lesion Volume at Month 36
Change from baseline in lesion volume was measured by using MRI scans for T2 lesions, T1 hypointense lesions and (Gd+) lesions.
Change From Baseline in Expanded Disability Status Score (EDSS) Score at Month 36
EDSS assesses disability in 8 functional systems. An overall score ranging from 0 (normal) to 10 (death due to MS) was calculated. The change in EDSS at Month 36 was calculated as EDSS at Month 36 minus EDSS at baseline.
Full Information
NCT ID
NCT00404352
First Posted
November 27, 2006
Last Updated
December 18, 2013
Sponsor
Merck KGaA, Darmstadt, Germany
1. Study Identification
Unique Protocol Identification Number
NCT00404352
Brief Title
REbif FLEXible Dosing in Early Multiple Sclerosis (MS)
Acronym
REFLEX
Official Title
A Phase III, Randomized, Double-blind, Placebo-controlled, Multicenter Clinical Trial of Rebif New Formulation (44 Microgram [Mcg] Three Times Weekly [Tiw] and 44 Mcg Once Weekly [ow]) in Subjects at High Risk of Converting to Multiple Sclerosis (REFLEX)
Study Type
Interventional
2. Study Status
Record Verification Date
December 2013
Overall Recruitment Status
Completed
Study Start Date
November 2006 (undefined)
Primary Completion Date
August 2010 (Actual)
Study Completion Date
July 2011 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Merck KGaA, Darmstadt, Germany
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The study is a 24 months randomized, double-blind, Placebo-controlled, multi-center clinical trial with an optional 12 months open label extension.
The primary objective of the study is to evaluate the effect of fetal bovine serum [FBS]-free/human serum albumin [HSA]-free formulation of Interferon [IFN] beta-1a (RNF) 44 microgram (three times weekly and once weekly) versus placebo on the time to conversion to McDonald multiple sclerosis (MS) criteria (2005) in subjects with a first clinical demyelinating event at high risk of converting to MS.
The main secondary objective of study is to evaluate the effect of RNF 44 microgram (three times weekly and once weekly) versus placebo on the "Time to conversion to clinically definite MS (CDMS)" in subjects with a first clinical demyelinating event at high risk of converting to MS.
At the end of 24 month double-blind core REFLEX trial, subjects who will not convert to CDMS and decide to receive open-label (OL) treatment will be enrolled into an open-label, 12 month extension period to evaluate the effect of RNF 44 mcg three times weekly treatment on the time to conversion to McDonald MS and time to conversion to CDMS.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Sclerosis
Keywords
Rebif New Formulation, Clinical Isolated Syndrome, Multiple Sclerosis
7. Study Design
Primary Purpose
Prevention
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
517 (Actual)
8. Arms, Groups, and Interventions
Arm Title
RNF 44 mcg three times weekly
Arm Type
Active Comparator
Arm Title
RNF 44 mcg once weekly and placebo twice weekly for blinding
Arm Type
Active Comparator
Arm Title
Placebo three times weekly
Arm Type
Placebo Comparator
Intervention Type
Drug
Intervention Name(s)
RNF
Other Intervention Name(s)
Rebif
Intervention Description
Single dose of RNF administered subcutaneously three times weekly at least 48 hours apart at a starting dose of 8.8 microgram (mcg) for first 2 weeks followed by 22 mcg for next 2 weeks and finally 44 mcg until 24 months, or 36 months for patients enrolled in the OL extension.
Intervention Type
Drug
Intervention Name(s)
RNF
Other Intervention Name(s)
Rebif
Intervention Description
Single dose of RNF administered subcutaneously once weekly at a starting dose of 8.8 mcg for first 2 weeks followed by 22 mcg for next 2 weeks and finally 44 mcg until 24 months.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo was supplied as a transparent, sterile solution for injection in pre-filled syringes matching the RNF pre-filled syringes, each containing 0.5 mL.
Primary Outcome Measure Information:
Title
Time to Conversion to Multiple Sclerosis (MS) According to the McDonald Criteria (2005)
Description
The McDonald criteria use dissemination in time and space established by magnetic resonance image (MRI) findings to provide a clinical diagnosis for MS. Dissemination in time is established by a new time constant 2 (T2) or gadolinium-enhancing (Gd+) lesion found on a repeat MRI. Dissemination in space is established by the presence of any 3 of the following: 1 Gd+ lesion or 9 T2 bright lesions if there is no enhancement; greater than or equal to 1 infratentorial lesion; greater than or equal to 1 juxtacortical lesion; greater than or equal to 3 periventricular lesions.
Time Frame
Various time points from randomization up to 24 months
Title
Time to Conversion to Multiple Sclerosis (MS) According to the McDonald Criteria (2005)
Description
The McDonald criteria use dissemination in time and space established by MRI findings to provide a clinical diagnosis for MS. Dissemination in time is established by a T2 or Gd+ lesion found on a repeat MRI. Dissemination in space is established by the presence of any 3 of the following: 1 Gd+ lesion or 9 T2 bright lesions if there is no enhancement; greater than or equal to 1 infratentorial lesion; greater than or equal to 1 juxtacortical lesion; greater than or equal to 3 periventricular lesions.
Time Frame
Various time points from randomization up to 36 months
Secondary Outcome Measure Information:
Title
Time to Conversion to Clinically Definite Multiple Sclerosis (CDMS) Defined by Either a Second Attack or a 3-Month Sustained Increase (Greater Than or Equal to 1.5 Points) in the Expanded Disability Status Scale (EDSS) Score
Description
CDMS was defined by the occurrence of a second exacerbation or relapse over 24 months in participants who presented with first clinical demyelinating event (FCDE) accompanied by an abnormal MRI scan. EDSS assesses disability in 8 functional systems. An overall score ranging from 0 (normal) to 10 (death due to MS) was calculated.
Time Frame
Various time points from randomization up to 24 months
Title
Time to Conversion to Clinically Definite Multiple Sclerosis (CDMS) Defined by Either a Second Attack or a 3-Month Sustained Increase (Greater Than or Equal to 1.5 Points) in the Expanded Disability Status Scale (EDSS) Score
Description
CDMS was defined by the occurrence of a second exacerbation or relapse over 36 months in participants who presented with FCDE accompanied by an abnormal MRI scan. EDSS assesses disability in 8 functional systems. An overall score ranging from 0 (normal) to 10 (death due to MS) was calculated.
Time Frame
Various time points from randomization up to 36 months
Title
Mean Number of Combined Unique Active (CUA) Lesions, New Time Constant 2 (T2) Lesions, Gadolinium Enhanced (Gd+) Lesions and New Time Constant 1 (T1) Hypointense Lesions Per Participant Per Scan
Description
Number of CUA lesions, new T2 lesions, Gd+ lesions and new T1 hypointense lesions were measured by using MRI scans.
Time Frame
Month 24 up to Month 36
Title
Change From Baseline in Time Constant 2 (T2) Lesion Volume , Time Constant 1 (T1) Hypointense Lesion Volume and Gadolinium Enhanced (Gd+) Lesion Volume at Month 36
Description
Change from baseline in lesion volume was measured by using MRI scans for T2 lesions, T1 hypointense lesions and (Gd+) lesions.
Time Frame
Baseline, Month 36
Title
Change From Baseline in Expanded Disability Status Score (EDSS) Score at Month 36
Description
EDSS assesses disability in 8 functional systems. An overall score ranging from 0 (normal) to 10 (death due to MS) was calculated. The change in EDSS at Month 36 was calculated as EDSS at Month 36 minus EDSS at baseline.
Time Frame
Baseline, Month 36
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Single, first clinical event suggestive of MS within 60 days prior to study Day 1, which is the day of randomization (clock starts 24 hours after onset). The event must be a new neurological abnormality present for at least 24 hours, either mono- or polysymptomatic, other than a paresthesia, vegetative or cerebral dysfunction
At least two clinically silent lesions on the T2-weighted MRI scan, with a size of at least 3 millimeter (mm), at least one of which is ovoid or periventricular or infratentorial
EDSS 0 - 5.0 at least one time point during the screening period before start of treatment
18 and 50 years old, inclusive
Willing to follow study procedures
Written informed consent
If female, subject must:
be neither pregnant nor breast-feeding nor attempting to conceive
use a highly effective method of contraception. A highly effective method of contraception is defined as those which result in a low failure rate (that is [i.e.] less than 1 percent [%] per year) when used consistently and correctly such as implants, injectables, combined oral contraceptives, some intrauterine devices (IUDs), sexual abstinence or vasectomised partner
Exclusion Criteria:
Diagnosis of MS (per McDonald criteria 2005)
Any other disease that could better explain the subject's signs and symptoms
Complete transverse myelitis or bilateral optic neuritis
Subject uses or has used any other approved MS disease-modifying drug (DMD)
Any investigational drug or undergone an experimental procedure within 12 weeks prior to study Day 1
Oral or systemic corticosteroids or adrenocorticotropic hormone (ACTH) within 30 days prior to study Day 1
Total bilirubin greater than 2.5 times upper limit of normal (ULN)
Subject has total aspartate aminotransferase (AST) or alanine aminotransferase (ALT) or alkaline phosphatase (ALP) greater than 2.5 times the ULN
Inadequate bone marrow reserve, defined as a total white blood cell count less than 3.0 x 109 per liter (/L), platelet count less than 75 x 109/L, hemoglobin less than 100 gram per liter (g/L)
Current autoimmune disease
Major medical or psychiatric illness (including history of or current severe depressive disorders and/or suicidal ideation) that in the opinion of the investigator creates undue risk to the subject or could affect compliance with the study protocol
History of seizures not adequately controlled by treatment
Cardiac disease, such as angina, congestive heart failure or arrhythmia
Known allergy to IFN-beta or the excipient(s) of the study medication
Any condition that could interfere with the MRI evaluation;
Known allergy to gadolinium-diethylene triamine pentaacetic acid (DTPA)
Previously participated in this study
Participated in any clinical trial within the past 6 months
Any immunomodulatory or immunosuppressive therapy at any time prior to enrollment, including, but not limited to, the following products: any IFN, glatiramer acetate (Copolymer I), cyclophosphamide, cyclosporine, methotrexate, linomide, azathioprine, mitoxantrone, teriflunomide, laquinimod, cladribine, total lymphoid irradiation, anti-lymphocyte monoclonal antibody treatment (e.g. natalizumab, alemtuzumab/Campath, anti-cluster of differentiation 4 [CD4]), intravenous, immunoglobulins (Igs), cytokines or anti-cytokine therapy
Any experimental MS treatment prior to trial entry, including, but not limited to, any statins (if given to prevent MS) and pentoxyfylline
History of alcohol or drug abuse
Intolerance or any contraindication to both paracetamol (acetaminophen) and ibuprofen
Inability to administer subcutaneous injections either by self or by caregiver
Moderate to severe renal impairment
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Bettina M. Stubinski, MD
Organizational Affiliation
Merck Serono S.A., Geneva
Official's Role
Study Director
Facility Information:
Facility Name
Research Site
City
Mendoza
Country
Argentina
Facility Name
Research Site
City
Sydney
Country
Australia
Facility Name
Research Site
City
Graz
Country
Austria
Facility Name
Research Site
City
Innsbruck
Country
Austria
Facility Name
Research Site
City
B-Leuven
Country
Belgium
Facility Name
Research Site
City
Brugge
Country
Belgium
Facility Name
Research Site
City
Pleven
Country
Bulgaria
Facility Name
Research Site
City
Rousse
Country
Bulgaria
Facility Name
Research Site
City
Shumen
Country
Bulgaria
Facility Name
Research Site
City
Sofia
Country
Bulgaria
Facility Name
Research Site
City
Varna
Country
Bulgaria
Facility Name
Research Site
City
Montreal, Quebec
Country
Canada
Facility Name
Research Site
City
Ontario
Country
Canada
Facility Name
Research Site
City
Victoria British Columbia
Country
Canada
Facility Name
Research Site
City
Karlovac
Country
Croatia
Facility Name
Research Site
City
Osijek
Country
Croatia
Facility Name
Research Site
City
Rijeka
Country
Croatia
Facility Name
Research Site
City
Split
Country
Croatia
Facility Name
Research Site
City
Zagreb
Country
Croatia
Facility Name
Research Site
City
Hradec Kralove
Country
Czech Republic
Facility Name
Research Site
City
Olomouc
Country
Czech Republic
Facility Name
Research Site
City
Prague
Country
Czech Republic
Facility Name
Research Site
City
Tallinn
Country
Estonia
Facility Name
Research Site
City
Tartu
Country
Estonia
Facility Name
Research Site
City
OYS
Country
Finland
Facility Name
Research Site
City
Vantaa
Country
Finland
Facility Name
Research Site
City
Paris
Country
France
Facility Name
Research Site
City
Poissy Cedex
Country
France
Facility Name
Research Site
City
Hannover
Country
Germany
Facility Name
Research Site
City
Henningsdorf
Country
Germany
Facility Name
Research Site
City
Munich
Country
Germany
Facility Name
Research Site
City
Athens
Country
Greece
Facility Name
Research Site
City
Ness Ziona
Country
Israel
Facility Name
Research Site
City
Safed
Country
Israel
Facility Name
Research Site
City
Tel-Hashomer
Country
Israel
Facility Name
Research Site
City
Catania
Country
Italy
Facility Name
Research Site
City
Milano
Country
Italy
Facility Name
Research Site
City
Padova
Country
Italy
Facility Name
Research Site
City
Roma
Country
Italy
Facility Name
Research Site
City
Riga
Country
Latvia
Facility Name
Research Site
City
Beirut
Country
Lebanon
Facility Name
Research Site
City
Rabat
Country
Morocco
Facility Name
Research Site
City
Bialystok
Country
Poland
Facility Name
Research Site
City
Lodz
Country
Poland
Facility Name
Research Site
City
Warsaw
Country
Poland
Facility Name
Research Site
City
Wroclaw
Country
Poland
Facility Name
Research Site
City
Lisboa
Country
Portugal
Facility Name
Research Site
City
Bucharest
Country
Romania
Facility Name
Research Site
City
Iasi
Country
Romania
Facility Name
Research Site
City
Targu-Mures
Country
Romania
Facility Name
Research Site
City
Timisoara
Country
Romania
Facility Name
Research Site
City
Ekaterinburg
Country
Russian Federation
Facility Name
Research Site
City
Moscow
Country
Russian Federation
Facility Name
Research Site
City
Nizhny Novgorod
Country
Russian Federation
Facility Name
Research Site
City
Novosibirsk
Country
Russian Federation
Facility Name
Research Site
City
Saint-Petersburg
Country
Russian Federation
Facility Name
Research Site
City
Samara
Country
Russian Federation
Facility Name
Research Site
City
Saratov
Country
Russian Federation
Facility Name
Research Site
City
Riyadh
Country
Saudi Arabia
Facility Name
Research Site
City
Belgrade
Country
Serbia
Facility Name
Research Site
City
Nis
Country
Serbia
Facility Name
Research Site
City
Presov
Country
Slovakia
Facility Name
Research Site
City
Barcelona
Country
Spain
Facility Name
Research Site
City
Bilbao
Country
Spain
Facility Name
Research Site
City
Madrid
Country
Spain
Facility Name
Research Site
City
Sevilla
Country
Spain
Facility Name
Research Site
City
Istanbul
Country
Turkey
12. IPD Sharing Statement
Citations:
PubMed Identifier
35274413
Citation
Battaglini M, Vrenken H, Tappa Brocci R, Gentile G, Luchetti L, Versteeg A, Freedman MS, Uitdehaag BMJ, Kappos L, Comi G, Seitzinger A, Jack D, Sormani MP, Barkhof F, De Stefano N. Evolution from a first clinical demyelinating event to multiple sclerosis in the REFLEX trial: Regional susceptibility in the conversion to multiple sclerosis at disease onset and its amenability to subcutaneous interferon beta-1a. Eur J Neurol. 2022 Jul;29(7):2024-2035. doi: 10.1111/ene.15314. Epub 2022 Apr 4.
Results Reference
derived
PubMed Identifier
24413638
Citation
Freedman MS, De Stefano N, Barkhof F, Polman CH, Comi G, Uitdehaag BM, Casset-Semanaz F, Hennessy B, Lehr L, Stubinski B, Jack DL, Kappos L. Patient subgroup analyses of the treatment effect of subcutaneous interferon beta-1a on development of multiple sclerosis in the randomized controlled REFLEX study. J Neurol. 2014 Mar;261(3):490-9. doi: 10.1007/s00415-013-7222-6. Epub 2014 Jan 12.
Results Reference
derived
PubMed Identifier
24292999
Citation
De Stefano N, Comi G, Kappos L, Freedman MS, Polman CH, Uitdehaag BM, Hennessy B, Casset-Semanaz F, Lehr L, Stubinski B, Jack DL, Barkhof F. Efficacy of subcutaneous interferon beta-1a on MRI outcomes in a randomised controlled trial of patients with clinically isolated syndromes. J Neurol Neurosurg Psychiatry. 2014 Jun;85(6):647-53. doi: 10.1136/jnnp-2013-306289. Epub 2013 Nov 29.
Results Reference
derived
PubMed Identifier
22146409
Citation
Comi G, De Stefano N, Freedman MS, Barkhof F, Polman CH, Uitdehaag BM, Casset-Semanaz F, Hennessy B, Moraga MS, Rocak S, Stubinski B, Kappos L. Comparison of two dosing frequencies of subcutaneous interferon beta-1a in patients with a first clinical demyelinating event suggestive of multiple sclerosis (REFLEX): a phase 3 randomised controlled trial. Lancet Neurol. 2012 Jan;11(1):33-41. doi: 10.1016/S1474-4422(11)70262-9. Epub 2011 Dec 4. Erratum In: Lancet Neurol. 2012 Feb;11(2):125.
Results Reference
derived
Links:
URL
http://www.mslifelines.com
Description
Full FDA approved prescribing information can be found here
Learn more about this trial
REbif FLEXible Dosing in Early Multiple Sclerosis (MS)
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