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Study to Evaluate the Reduction of Cardiac Problems in Multiple Sclerosis Patients With Mitoxantrone and Dexrazoxane in Combination (MSCardioPro)

Primary Purpose

Multiple Sclerosis

Status
Unknown status
Phase
Phase 2
Locations
Germany
Study Type
Interventional
Intervention
Dexrazoxane (DRZ) plus Mitoxantrone (MX)
Placebo plus Mitoxantrone (MX)
Sponsored by
PD Dr. Andrew Chan
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Sclerosis focused on measuring Multiple Sclerosis, MS, Mitoxantrone, Dexrazoxane, Cardioxane, cardiotoxicity, cardiac toxicity, cardiotoxic side effects, cardiac MRI, cranial MRI, LVEF, neurological outcome

Eligibility Criteria

18 Years - 55 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Written informed consent to participate in the study
  • Male or female subject is 18 years of age to 55 years of age
  • Subject must have one of the below mentioned confirmed diagnoses of Multiple Sclerosis: RRMS or CPMS according to rev. McDonald Criteria (2005)
  • If female of childbearing potential: Will to practice reliable birth control measures during study treatment and for at least 6 months after completion of study medication; not lactating or pregnant; and has a documented negative pregnancy test result within 72 hours prior to study medication administration. Male study participants: Will to practice reliable birth control measures during study treatment and for at least 6 months after completion of study medication
  • Subject is willing to participate in the study, follow protocol study treatment regimen, and comply with all planned assessments
  • Mitoxantrone treatment indication is given according to current guidelines:

    • Relapsing progressive or secondary progressive MS with/without superimposed relapses
    • EDSS 3-6; EDSS deterioration ≥1 point over last 18 months or 2 relapses
    • non-response or non-tolerability of pre-treatment
  • ≥ 48 mg/m² BSA MX dose received up to baseline visit as lifetime dosage before study entry. If the patient is under regular ongoing MX treatment, the infusion interval of 3 months must be obtained (see exclusion criteria)

Exclusion Criteria:

  • Concomitant clinically suspected or confirmed neurologic disorder at study entry that may interfere with the evaluation in this protocol [i.e. EDSS, MSFC, MEP or MRI measurements]
  • Pre-Treatment with DRZ or immunosuppressive drugs of the anthracycline family with cardiotoxic potential other than MX prior to study enrollment
  • Last Treatment with MX within the past 84 days prior to study enrollment (regular 3-monthly intervals must be obtained)
  • History of hypersensitivity to any of the study drugs or to drugs with similar chemical structures
  • Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive HCG laboratory test (>5 mIU/ml)
  • Unwillingness to perform adequate contraception
  • Use of other investigational drugs at the time of enrollment, or within 30 days or 5 half-lives of enrollment, whichever is longer
  • Subjects unable or unwilling to adhere to the study-designated procedures and restrictions
  • Patients not able to perform cardiac/neurological investigations including MRI, e.g. hypersensitivity to MRI contrast agent
  • Other known contraindication for DRZ or MX according to current labelling
  • Subject has a pre-existing cardiac disease interfering with left ventricular ejection fraction, i.e. cardiac insufficience for different reasons (resulting from prior cardial conditions such as myocardial infarction, myocarditis)
  • Routine co-administration of cortisone-pulse therapy (other than for treatment of relapses), intrathecal triamcinolone-therapy or other off-label/ investigational agents (e.g. fampridine, aminopyridine)
  • History of malignancy in the past 5 years (excluding localized basal cell carcinoma of the skin)
  • Pre-Treatment with other immunosuppressive drugs (azathioprine, methotrexate, mycophenolate, cyclophosphamide) within the past 3 months
  • Pre-Treatment with monoclonal antibodies (natalizumab, rituximab) within the past 6 months

Sites / Locations

  • Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Dexrazoxane (DRZ) plus Mitoxantrone (MX)

Placebo plus Mitoxantrone (MX)

Arm Description

DRZ (600 mg/m2) : MX (12 mg/m2) ratio 50:1

Placebo + MX (12 mg/m2)

Outcomes

Primary Outcome Measures

Changes in LVEF in the different treatment arms by cardiac MRI
Assessment of cardiac function by measurement of LVEF in mitoxantrone plus dexrazoxane treatment arm versus mitoxantrone plus placebo treatment arm by cardiac MRI

Secondary Outcome Measures

Changes in LVEF by transthoracic echocardiography and determination of cardiac side effects by ECG and by measurement of CK-MB, Troponin and BNP in mitoxantrone plus dexrazoxane versus mitoxantrone plus placebo treatment arms
Assessment of cardiac function by measurement of LVEF by transthoracic echocardiography, by determination of cardiac side effects by ECG and by measurement of CK-MB, Troponin and BNP in mitoxantrone plus dexrazoxane treatment arm versus mitoxantrone plus placebo treatment arm
Determination of EDSS and relapse rate in mitoxantrone plus dexrazoxane treatment arm versus mitoxantrone plus placebo treatment arm
Comparison of clinical efficacy of mitoxantrone plus dexrazoxane treatment versus mitoxantrone plus placebo treatment on neurological outcome parameters by means of EDSS and relapse rate
Cumulative number of active lesions by cMRI
LVEF in 3D-echocardiography vs. LVEF in cardiac MRI
Clinical efficacy of DRZ+MX vs. MX monotherapy by MSFC
Quality of Life by SF-36 questionnaire
Changes in magnetic evoked potentials: prolongation of TMCT+CMCT, potential configuration
Annual brain atrophy rates in cMRI
Changes in transcranial sonography (abnormal iron deposition AID). AID in cMRI. Comparison of both methods
Analysis of ABD transporter gene polymorphisms as predictor of therapy response and side effect profile via TaqMan PCR

Full Information

First Posted
May 30, 2012
Last Updated
November 4, 2014
Sponsor
PD Dr. Andrew Chan
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1. Study Identification

Unique Protocol Identification Number
NCT01627938
Brief Title
Study to Evaluate the Reduction of Cardiac Problems in Multiple Sclerosis Patients With Mitoxantrone and Dexrazoxane in Combination
Acronym
MSCardioPro
Official Title
A Phase II Proof of Concept Study Evaluating the Reduction of Mitoxantrone-induced Cardiotoxicity and Neurological Outcome in the Combined Use of Mitoxantrone and Dexrazoxane (Cardioxane®) in Multiple Sclerosis (MSCardioPro)
Study Type
Interventional

2. Study Status

Record Verification Date
November 2014
Overall Recruitment Status
Unknown status
Study Start Date
April 2012 (undefined)
Primary Completion Date
April 2015 (Anticipated)
Study Completion Date
April 2016 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
PD Dr. Andrew Chan

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study will primarily address the question whether the combination of Mitoxantrone therapy with dexrazoxane can reduce cardiotoxic side effects in the treatment of Multiple Sclerosis patients in comparison to Mitoxantrone monotherapy.
Detailed Description
It is designed to provide clinical and paraclinical efficacy and safety data for dexrazoxane in Mitoxantrone treatment of Multiple Sclerosis in order to investigate the possible positive influence of dexrazoxane on cardiac function of Mitoxantrone-affected myocardial tissue and on the possible augmented clinical efficacy of Mitoxantrone in combination with dexrazoxane on neurological outcome parameters. The incidence of cardiotoxicity during combined Mitoxantrone/dexrazoxane treatment will be investigated and compared to the standard Mitoxantrone-treatment without dexrazoxane.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Sclerosis
Keywords
Multiple Sclerosis, MS, Mitoxantrone, Dexrazoxane, Cardioxane, cardiotoxicity, cardiac toxicity, cardiotoxic side effects, cardiac MRI, cranial MRI, LVEF, neurological outcome

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
50 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Dexrazoxane (DRZ) plus Mitoxantrone (MX)
Arm Type
Experimental
Arm Description
DRZ (600 mg/m2) : MX (12 mg/m2) ratio 50:1
Arm Title
Placebo plus Mitoxantrone (MX)
Arm Type
Placebo Comparator
Arm Description
Placebo + MX (12 mg/m2)
Intervention Type
Drug
Intervention Name(s)
Dexrazoxane (DRZ) plus Mitoxantrone (MX)
Other Intervention Name(s)
Cardioxane® (Dexrazoxane), Ralenova® (Mitoxantrone)
Intervention Description
Dosage: DRZ (600 mg/m2) : MX (12 mg/m2) ratio 50:1 DRZ infusion / MX infusion once every three months over a period of 12 months, i.e. 5 infusions
Intervention Type
Drug
Intervention Name(s)
Placebo plus Mitoxantrone (MX)
Other Intervention Name(s)
Ralenova ® (Mitoxantrone)
Intervention Description
MX Dosage: 12mg/m2 Placebo infusion / MX infusion once every three months over a period of 12 months, i.e. 5 infusions
Primary Outcome Measure Information:
Title
Changes in LVEF in the different treatment arms by cardiac MRI
Description
Assessment of cardiac function by measurement of LVEF in mitoxantrone plus dexrazoxane treatment arm versus mitoxantrone plus placebo treatment arm by cardiac MRI
Time Frame
Baseline to month 12
Secondary Outcome Measure Information:
Title
Changes in LVEF by transthoracic echocardiography and determination of cardiac side effects by ECG and by measurement of CK-MB, Troponin and BNP in mitoxantrone plus dexrazoxane versus mitoxantrone plus placebo treatment arms
Description
Assessment of cardiac function by measurement of LVEF by transthoracic echocardiography, by determination of cardiac side effects by ECG and by measurement of CK-MB, Troponin and BNP in mitoxantrone plus dexrazoxane treatment arm versus mitoxantrone plus placebo treatment arm
Time Frame
Baseline and month 3,6,9,12, 24
Title
Determination of EDSS and relapse rate in mitoxantrone plus dexrazoxane treatment arm versus mitoxantrone plus placebo treatment arm
Description
Comparison of clinical efficacy of mitoxantrone plus dexrazoxane treatment versus mitoxantrone plus placebo treatment on neurological outcome parameters by means of EDSS and relapse rate
Time Frame
Baseline and month 3,6,9,12 and 24
Title
Cumulative number of active lesions by cMRI
Time Frame
Day1 and month 12
Title
LVEF in 3D-echocardiography vs. LVEF in cardiac MRI
Time Frame
Baseline and month 12
Title
Clinical efficacy of DRZ+MX vs. MX monotherapy by MSFC
Time Frame
Baseline and month 3,6,9,12 and 24
Title
Quality of Life by SF-36 questionnaire
Time Frame
Baseline and month 3,6,9 and month 12
Title
Changes in magnetic evoked potentials: prolongation of TMCT+CMCT, potential configuration
Time Frame
Baseline and month 3,6,9 and month 12
Title
Annual brain atrophy rates in cMRI
Time Frame
Day 1 and month 12
Title
Changes in transcranial sonography (abnormal iron deposition AID). AID in cMRI. Comparison of both methods
Time Frame
Baseline and month 12
Title
Analysis of ABD transporter gene polymorphisms as predictor of therapy response and side effect profile via TaqMan PCR
Time Frame
Baseline and month 12

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Written informed consent to participate in the study Male or female subject is 18 years of age to 55 years of age Subject must have one of the below mentioned confirmed diagnoses of Multiple Sclerosis: RRMS or CPMS according to rev. McDonald Criteria (2005) If female of childbearing potential: Will to practice reliable birth control measures during study treatment and for at least 6 months after completion of study medication; not lactating or pregnant; and has a documented negative pregnancy test result within 72 hours prior to study medication administration. Male study participants: Will to practice reliable birth control measures during study treatment and for at least 6 months after completion of study medication Subject is willing to participate in the study, follow protocol study treatment regimen, and comply with all planned assessments Mitoxantrone treatment indication is given according to current guidelines: Relapsing progressive or secondary progressive MS with/without superimposed relapses EDSS 3-6; EDSS deterioration ≥1 point over last 18 months or 2 relapses non-response or non-tolerability of pre-treatment ≥ 48 mg/m² BSA MX dose received up to baseline visit as lifetime dosage before study entry. If the patient is under regular ongoing MX treatment, the infusion interval of 3 months must be obtained (see exclusion criteria) Exclusion Criteria: Concomitant clinically suspected or confirmed neurologic disorder at study entry that may interfere with the evaluation in this protocol [i.e. EDSS, MSFC, MEP or MRI measurements] Pre-Treatment with DRZ or immunosuppressive drugs of the anthracycline family with cardiotoxic potential other than MX prior to study enrollment Last Treatment with MX within the past 84 days prior to study enrollment (regular 3-monthly intervals must be obtained) History of hypersensitivity to any of the study drugs or to drugs with similar chemical structures Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive HCG laboratory test (>5 mIU/ml) Unwillingness to perform adequate contraception Use of other investigational drugs at the time of enrollment, or within 30 days or 5 half-lives of enrollment, whichever is longer Subjects unable or unwilling to adhere to the study-designated procedures and restrictions Patients not able to perform cardiac/neurological investigations including MRI, e.g. hypersensitivity to MRI contrast agent Other known contraindication for DRZ or MX according to current labelling Subject has a pre-existing cardiac disease interfering with left ventricular ejection fraction, i.e. cardiac insufficience for different reasons (resulting from prior cardial conditions such as myocardial infarction, myocarditis) Routine co-administration of cortisone-pulse therapy (other than for treatment of relapses), intrathecal triamcinolone-therapy or other off-label/ investigational agents (e.g. fampridine, aminopyridine) History of malignancy in the past 5 years (excluding localized basal cell carcinoma of the skin) Pre-Treatment with other immunosuppressive drugs (azathioprine, methotrexate, mycophenolate, cyclophosphamide) within the past 3 months Pre-Treatment with monoclonal antibodies (natalizumab, rituximab) within the past 6 months
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Andrew Chan, PD Dr.
Organizational Affiliation
Department of Neurology, St. Josef-Hospital Bochum, Ruhr-University Bochum
Official's Role
Principal Investigator
Facility Information:
Facility Name
Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum
City
Bochum
ZIP/Postal Code
44791
Country
Germany

12. IPD Sharing Statement

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Study to Evaluate the Reduction of Cardiac Problems in Multiple Sclerosis Patients With Mitoxantrone and Dexrazoxane in Combination

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