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Assessment of Clemastine Fumarate as a Remyelinating Agent in Multiple Sclerosis (ReBUILD)

Primary Purpose

Multiple Sclerosis, Relapsing-Remitting

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Clemastine
Placebo
Sponsored by
University of California, San Francisco
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Sclerosis, Relapsing-Remitting

Eligibility Criteria

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

Inclusion Criteria:

  • Relapsing remitting Multiple Sclerosis by 2010 Revised McDonald Criteria
  • Age 18-60.
  • Latency delay > 125 milliseconds on baseline full-field transient pattern reversal visual evoked potential (VEP) in at least one eye (electrophysiological evidence of demyelination)
  • Retinal nerve fiber layer (RNFL) > 70 microns on Spectralis Domain Optical Coherence Topography (SD-OCT) in the same eye meeting criteria for latency delay (sufficient axons)
  • No optic neuritis in prior 6 months
  • Stable immunomodulatory therapy - no switch or planned switch in > 6 months and no change in doses in 30 days prior to screening
  • Use of appropriate contraception during period of trial (females of child bearing potential)
  • Understand and sign informed consent.
  • Expanded disability status scale (EDSS) 0-6.0 (inclusive)

Exclusion Criteria:

  • Major ophthalmologic disease / Concomitant ophthalmologic disorders (e.g. diabetes, macular degeneration, glaucoma, severe myopia , etc).
  • Myopia > -7 Diopters (Severe myopia)
  • History of significant cardiac conduction block
  • History of cancer
  • Known optic neuritis in involved eye > 5 years ago OR disease duration > 15 years
  • Suicidal ideation or behaviour in 6 months prior to screening
  • Pregnancy, breastfeeding, or planning to become pregnant.
  • Involved with other study protocol simultaneously without prior approval. 9. Concomitant use of Dalfampridine (4AP or diamino4AP) or any other formulation of 4AP or diamino4AP.
  • Concomitant use of any other putative remyelinating therapy as determined by investigator.
  • Treatment with corticosteroids within 30 days prior to screening
  • Prior treatment with total lymphoid irradiation, T cell or T cell receptor vaccination
  • Prior treatment with alemtuzumab, mitoxantrone, or cyclophosphamide
  • Serum creatinine > 1.5 mg/dL; aspartate aminotransferase (AST), alanine aminotransferase (ALT) or alkaline phosphatase > 2 times the upper limit of normal
  • History of drug or alcohol abuse within the past year
  • Untreated vitamin B12 deficiency (as determined by B12 serological assessments and metabolites including methylmalonic acid (MMA) and homocysteine) or untreated hypothyroidism
  • Clinically significant cardiac, metabolic, hematologic, hepatic, immunologic, urologic, endocrinologic, neurologic, pulmonary, psychiatric, dermatologic, psychiatric allergic, renal or other major diseases that in the PI's judgment may affect interpretation of study results or patient safety.
  • History of or presence of clinically significant medical illness or laboratory abnormality that, in the opinion of the investigator would preclude participation in the study

Sites / Locations

  • UCSF Multiple Sclerosis Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

3 months Clemastine, 2 months Placebo

3 months Placebo , 2 months Clemastine

Arm Description

4mg clemastine twice daily for first 3 months -- crossover -- equivalent quantity/frequency of placebo for last 2 months

Placebo for first 3 months -- crossover -- 4mg clemastine twice daily for last 2 months.

Outcomes

Primary Outcome Measures

Full Field Visual Evoked Potential (VEP)
The primary objective is to evaluate the efficacy of Clemastine relative to placebo for reducing P100 latencies on full field transient pattern reversal visual evoked potentials.Visual evoked potentials (VEP) are used primarily to measure the functional integrity of the visual pathways from the retina to the visual cortex of the brain. VEP latencies were collected at Baseline, Month 1, Month 3, and Month 5.

Secondary Outcome Measures

Tolerability of Clemastine in Multiple Sclerosis (MS) Patients
Will demonstrate the tolerability of Clemastine in this population. This will include special focus with regards to fatigue as this is a major symptom for patients suffering from multiple sclerosis.This will be assessed by administering a fatigue questionnaire called the Multidimensional Assessment of Fatigue (MAF) at all four visits throughout the study. MAF scale range is 0-50. Lower scores indicate lower levels of fatigue and higher scores indicate higher levels of fatigue.
Myelin Water Fraction (MWF) and Magnetization Transfer Ratios (MTR)
To evaluate the efficacy of Clemastine relative to placebo in increasing magnetization transfer ratios derived from magnetic resonance imaging (MRI) of the brain during the period of exposure to active treatment. To evaluate the efficacy of Clemastine relative to placebo at reducing radial diffusivity derived from diffusion tensor imaging as assessed by magnetic resonance imaging (MRI) during the period of exposure to active medication.
Expanded Disability Status Scale (EDSS) Score
To evaluate the efficacy of Clemastine relative to placebo in reducing the EDSS score at 90 days compared to placebo (Group A) & at 150 days compared to day 90 (Group B). EDSS is an ordinal scale for assessing neurological impairment of MS based on a neurological examination. It consists of scores in each of seven functional systems (FS) & an ambulation score that are then combined to determine the EDSS [ranging from 0 (normal) to 10 (death due to MS)]. The FSs are the Visual, Brain Stem, Pyramidal, Cerebellar, Sensory, Bowel & Bladder, & Cerebral functions. FSs & EDSS steps assessed in a standardized manner. EDSS is a widely used &accepted instrument to evaluate disability status at a given time & longitudinally, to assess disability progression in clinical studies in MS.

Full Information

First Posted
January 10, 2014
Last Updated
September 22, 2021
Sponsor
University of California, San Francisco
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1. Study Identification

Unique Protocol Identification Number
NCT02040298
Brief Title
Assessment of Clemastine Fumarate as a Remyelinating Agent in Multiple Sclerosis
Acronym
ReBUILD
Official Title
A Phase II Randomized, Double-Blind, Parallel-Group, Placebo Controlled Crossover Trial to Assess the Efficacy, Safety, Tolerability, and Pharmacokinetics of Clemastine Fumarate as a Remyelinating Agent in Multiple Sclerosis
Study Type
Interventional

2. Study Status

Record Verification Date
September 2021
Overall Recruitment Status
Completed
Study Start Date
January 2014 (undefined)
Primary Completion Date
September 2015 (Actual)
Study Completion Date
April 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of California, San Francisco

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The main purpose of this study is to assess clemastine as a remyelinating agent in patients with relapsing forms of multiple sclerosis. The study will also evaluate the tolerability of clemastine, originally approved as first-generation antihistamine, in patients with multiple sclerosis. Study procedures will include assessments for evidence of remyelination in the anterior visual pathway and in the brain using electrophysiologic techniques and magnetic resonance imaging. The study will also assess the robustness and stability of this clinical effect in patients taking clemastine for up to 3 months. Patients in this study can remain on their standard disease modifying treatment during the course of the study. However, patients cannot participate in any other investigational new drug research study concurrently.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Sclerosis, Relapsing-Remitting

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
3 months Clemastine, 2 months Placebo
Arm Type
Active Comparator
Arm Description
4mg clemastine twice daily for first 3 months -- crossover -- equivalent quantity/frequency of placebo for last 2 months
Arm Title
3 months Placebo , 2 months Clemastine
Arm Type
Active Comparator
Arm Description
Placebo for first 3 months -- crossover -- 4mg clemastine twice daily for last 2 months.
Intervention Type
Drug
Intervention Name(s)
Clemastine
Other Intervention Name(s)
Clemastine Fumarate,, Tavist -1
Intervention Description
4mg tablet twice daily
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo tablet twice daily
Primary Outcome Measure Information:
Title
Full Field Visual Evoked Potential (VEP)
Description
The primary objective is to evaluate the efficacy of Clemastine relative to placebo for reducing P100 latencies on full field transient pattern reversal visual evoked potentials.Visual evoked potentials (VEP) are used primarily to measure the functional integrity of the visual pathways from the retina to the visual cortex of the brain. VEP latencies were collected at Baseline, Month 1, Month 3, and Month 5.
Time Frame
Treatment start to treatment end, up to 3 months.
Secondary Outcome Measure Information:
Title
Tolerability of Clemastine in Multiple Sclerosis (MS) Patients
Description
Will demonstrate the tolerability of Clemastine in this population. This will include special focus with regards to fatigue as this is a major symptom for patients suffering from multiple sclerosis.This will be assessed by administering a fatigue questionnaire called the Multidimensional Assessment of Fatigue (MAF) at all four visits throughout the study. MAF scale range is 0-50. Lower scores indicate lower levels of fatigue and higher scores indicate higher levels of fatigue.
Time Frame
Treatment start to treatment end, up to 3 months.
Title
Myelin Water Fraction (MWF) and Magnetization Transfer Ratios (MTR)
Description
To evaluate the efficacy of Clemastine relative to placebo in increasing magnetization transfer ratios derived from magnetic resonance imaging (MRI) of the brain during the period of exposure to active treatment. To evaluate the efficacy of Clemastine relative to placebo at reducing radial diffusivity derived from diffusion tensor imaging as assessed by magnetic resonance imaging (MRI) during the period of exposure to active medication.
Time Frame
Treatment start to treatment end, up to 3 months.
Title
Expanded Disability Status Scale (EDSS) Score
Description
To evaluate the efficacy of Clemastine relative to placebo in reducing the EDSS score at 90 days compared to placebo (Group A) & at 150 days compared to day 90 (Group B). EDSS is an ordinal scale for assessing neurological impairment of MS based on a neurological examination. It consists of scores in each of seven functional systems (FS) & an ambulation score that are then combined to determine the EDSS [ranging from 0 (normal) to 10 (death due to MS)]. The FSs are the Visual, Brain Stem, Pyramidal, Cerebellar, Sensory, Bowel & Bladder, & Cerebral functions. FSs & EDSS steps assessed in a standardized manner. EDSS is a widely used &accepted instrument to evaluate disability status at a given time & longitudinally, to assess disability progression in clinical studies in MS.
Time Frame
Start of treatment to end of treatment, up to 3 months
Other Pre-specified Outcome Measures:
Title
Serum Creatinine Level
Description
Blood sample will be collected at each visit to evaluate health status...
Time Frame
Baseline, 1 month, 3 month, 5 month
Title
Serum Triglyceride Level
Description
Blood sample will be collected at each visit to evaluate health status.
Time Frame
Baseline, 1 month, 3 month, 5 month
Title
Vitamin B-12 Level
Description
Blood sample will be collected at each visit to evaluate health status.
Time Frame
Baseline, 1 month, 3 month, 5 month
Title
Human Chorionic Gonadotropin (hCG) Level in Female Patients of Childbearing Potential
Description
Blood and urine sample will be collected to assess pregnancy status of all female participants of child bearing potential.
Time Frame
Baseline, 1 month, 3 month, 5 month

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: Relapsing remitting Multiple Sclerosis by 2010 Revised McDonald Criteria Age 18-60. Latency delay > 125 milliseconds on baseline full-field transient pattern reversal visual evoked potential (VEP) in at least one eye (electrophysiological evidence of demyelination) Retinal nerve fiber layer (RNFL) > 70 microns on Spectralis Domain Optical Coherence Topography (SD-OCT) in the same eye meeting criteria for latency delay (sufficient axons) No optic neuritis in prior 6 months Stable immunomodulatory therapy - no switch or planned switch in > 6 months and no change in doses in 30 days prior to screening Use of appropriate contraception during period of trial (females of child bearing potential) Understand and sign informed consent. Expanded disability status scale (EDSS) 0-6.0 (inclusive) Exclusion Criteria: Major ophthalmologic disease / Concomitant ophthalmologic disorders (e.g. diabetes, macular degeneration, glaucoma, severe myopia , etc). Myopia > -7 Diopters (Severe myopia) History of significant cardiac conduction block History of cancer Known optic neuritis in involved eye > 5 years ago OR disease duration > 15 years Suicidal ideation or behaviour in 6 months prior to screening Pregnancy, breastfeeding, or planning to become pregnant. Involved with other study protocol simultaneously without prior approval. 9. Concomitant use of Dalfampridine (4AP or diamino4AP) or any other formulation of 4AP or diamino4AP. Concomitant use of any other putative remyelinating therapy as determined by investigator. Treatment with corticosteroids within 30 days prior to screening Prior treatment with total lymphoid irradiation, T cell or T cell receptor vaccination Prior treatment with alemtuzumab, mitoxantrone, or cyclophosphamide Serum creatinine > 1.5 mg/dL; aspartate aminotransferase (AST), alanine aminotransferase (ALT) or alkaline phosphatase > 2 times the upper limit of normal History of drug or alcohol abuse within the past year Untreated vitamin B12 deficiency (as determined by B12 serological assessments and metabolites including methylmalonic acid (MMA) and homocysteine) or untreated hypothyroidism Clinically significant cardiac, metabolic, hematologic, hepatic, immunologic, urologic, endocrinologic, neurologic, pulmonary, psychiatric, dermatologic, psychiatric allergic, renal or other major diseases that in the PI's judgment may affect interpretation of study results or patient safety. History of or presence of clinically significant medical illness or laboratory abnormality that, in the opinion of the investigator would preclude participation in the study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ari J. Green, MD, MCR
Organizational Affiliation
University of California, San Francisco
Official's Role
Principal Investigator
Facility Information:
Facility Name
UCSF Multiple Sclerosis Center
City
San Francisco
State/Province
California
ZIP/Postal Code
94518
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
10467384
Citation
Fischer JS, LaRocca NG, Miller DM, Ritvo PG, Andrews H, Paty D. Recent developments in the assessment of quality of life in multiple sclerosis (MS). Mult Scler. 1999 Aug;5(4):251-9. doi: 10.1177/135245859900500410.
Results Reference
background
PubMed Identifier
29029896
Citation
Green AJ, Gelfand JM, Cree BA, Bevan C, Boscardin WJ, Mei F, Inman J, Arnow S, Devereux M, Abounasr A, Nobuta H, Zhu A, Friessen M, Gerona R, von Budingen HC, Henry RG, Hauser SL, Chan JR. Clemastine fumarate as a remyelinating therapy for multiple sclerosis (ReBUILD): a randomised, controlled, double-blind, crossover trial. Lancet. 2017 Dec 2;390(10111):2481-2489. doi: 10.1016/S0140-6736(17)32346-2. Epub 2017 Oct 10.
Results Reference
result
PubMed Identifier
35710320
Citation
Abdelhak A, Cordano C, Boscardin WJ, Caverzasi E, Kuhle J, Chan B, Gelfand JM, Yiu HH, Oertel FC, Beaudry-Richard A, Condor Montes S, Oksenberg JR, Lario Lago A, Boxer A, Rojas-Martinez JC, Elahi FM, Chan JR, Green AJ. Plasma neurofilament light chain levels suggest neuroaxonal stability following therapeutic remyelination in people with multiple sclerosis. J Neurol Neurosurg Psychiatry. 2022 Jun 16:jnnp-2022-329221. doi: 10.1136/jnnp-2022-329221. Online ahead of print.
Results Reference
derived
Links:
URL
http://multiplesclerosis.ucsf.edu/research/rebuild
Description
ReBUILD trial description University of California, San Francisco Multiple Sclerosis Center

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Assessment of Clemastine Fumarate as a Remyelinating Agent in Multiple Sclerosis

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