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Imatinib for Multiple Sclerosis (MS) Relapses

Primary Purpose

Multiple Sclerosis

Status
Unknown status
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Imatinib Mesylate
Methylprednisolone
Sponsored by
Tomas Olsson
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Sclerosis focused on measuring Multiple Sclerosis relaps, Imatinib, Methylprednisolone

Eligibility Criteria

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

Inclusion Criteria:

  • An acute exacerbation, relapse, in persons with RRMS, either newly diagnosis or on treatment with one of the long-term immunomodulatory drugs, or possible MS where the diagnosis is supported by typical MRI or cerebrospinal fluid changes typical of MS (this enables inclusion of persons with a first neuroinflammatory bout, with high risk of developing MS before fulfilling the McDonald criteria for definite MS, or high risk for developing MS in the category clinically isolated syndrome (CIS)/possible MS with supporting MRI lesions and/or cerebrospinal fluid aberrations suggesting intra-thecal immunoglobulin synthesis with oligoclonal bands/and/or increased free Kappa Light chains. The relapse should be deemed to require relapse treatment by the investigator and affect a functional domain with a minimum of grade 2.
  • 18-55 years of age
  • Affection of any of the following EDSS sub-domains representing the targeted neurological deficit: 1. Visual function. grade 0-6, 2. Brain stem function grade 0-5. 3. Pyramidal function, grade 0-6. 4. Cerebellar function, grade 0-5. 5. Sensory function grade 0-6, and deterioration at least one step in any of these EDSS domains
  • EDSS ≤ 6 before the acute exacerbation
  • Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, if they are using effective methods of contraception during the study. Acceptable birth control methods are those with a failure rate of less than 1% per year when used consistently and correctly according to CTFG, September 2014 "Recommendations related to contraception and pregnancy testing in clinical trials". Such methods include:

    1. Combined (estrogen and progestogen containing hormonal contraception associated with inhibition of ovulation.

      • oral
      • intravaginal
      • transdermal
    2. progestogen-only hormonal contraception associated with inhibition of ovulation

      • oral
      • injectable
      • implantable
    3. intrauterine device (IUD)
    4. intrauterine hormone-releasing system (IUS)
    5. bilateral tubal occlusion
    6. total abstinence or vasectomized partner.

Exclusion Criteria:

  • A pseudo-relapse should be excluded, as deemed by the experienced treating neurologist, and as evidenced by an active infection, likely with fever, with reappearing new signs and symptoms in a previously affected neurological function.
  • Inability to provide informed consent
  • Concomitant medication with drugs which may increase the plasma concentration of Imatinib - ketoconazole, itraconazole , erythromycin and clarithromycin
  • Concomitant medication with drugs which may decrease the plasma concentration of Imatinib: dexamethasone, phenytoin, carbamazepin, rifampicin, phenobarbital, fosphenytoin, primidon, Hypericum perforatum (St John's wort).
  • Female patients with childbearing potential, if pregnancy cannot be excluded by pregnancy test (urine point-of-care pregnancy test).
  • Patient is participating in other interventional study
  • General infection or any other condition judged by the treating neurologist to contra-indicate Imatinib
  • Any laboratory deviation of general bodily functions such as kidney, or renal function judged to be of clinical significance by the treating neurologist constitutes an exclusion criteria.
  • Patients with a positive Hepatitis B-DNA test result or serology indicating latent infection.

Sites / Locations

  • Rigshospitalet
  • Hamburg-EppendorfRecruiting
  • UKSH Campus KielRecruiting
  • Uniklinik KölnRecruiting
  • Haukeland sjukhus
  • Akershus University Hospital
  • Rikshospitalet, Oslo
  • Ullevåls sjukhus
  • Karolinska Universityhospital, HuddingeRecruiting
  • Neurology Sahlgrenska HospitalRecruiting
  • Linköping University HospitalRecruiting
  • Akademiskt specialistcentrumRecruiting
  • Karolinska Universitetssjukhuset, SolnaRecruiting
  • Uppsala University HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Imatinib

Methylprednisolone

Arm Description

Imatinib will be administered orally one tablet (400mg) twice daily, 800mg per day for 14 consecutive days.

Methylprednisolone will be administered once a day either in tablets; Medrol 1g per day or iv; Solumedrol 1000 mg per day, both for three consecutive days.

Outcomes

Primary Outcome Measures

Functional system score (FSS) change in the most worsened FSS after 28 days due to the acute relapse
The primary endpoint is mean change between baseline and day 28 in the most worsened FSS due to the acute relapse comparing MP and Imatinib. In case more than one domain is affected, priority of selected FSS should be in the following order: 1) Pyramidal, 2) Brain stem, 3) Cerebellar, 4) Visual, 5) Sensory. At least a two step deterioration due to neuroinflammatory bout should have occurred. Bowel and Cerebral domains will not be considered in the primary endpoints. The FSS is graded accordingly: 1. Visual function. Grade 0-6 2. Brain stem function grade 0-5 3. Pyramidal function, grade 0-6 4. Cerebellar function, grade 0-5 5. Sensory function grade 0-6 6. bowel/bladder function 7. Cerebral functions

Secondary Outcome Measures

Functional system score (FSS) change between baseline and week 12 in the most worsened FSS due to the acute relapse
In case more than one domain is affected, priority of selected FSS should be in the following order: 1) Pyramidal, 2) Brain stem, 3) Cerebellar, 4) Visual, 5) Sensory. At least a two step deterioration due to neuroinflammatory bout should have occurred.
Mean expanded disability status scale (EDSS) change between baseline and day 28
Calculation of EDSS summary score is based on the FSS score, from 0-5 with 0 representing normal neurological exam and 10 representing death by MS
Mean change in 9-hole peg test (evaluates upper limb function) between baseline and day 28
Evaluates upper limb function
Mean change in timed 25- walk between baseline and day 28
Mean change in symbol digital modality test (SDMT) between baseline and day 28
Evaluates cognitive function, with a score range of 0 to 110, with 110 representing the best cognitive function
Mean change in Multiple Sclerosis Impact Scale (MSIS-29; MS-specific quality of life (QoL) scale) between baseline and day 28
The MISIS-29 consists of 29 items (composed of 20- item physical scale and a 9-item psychological scale), graded from 1-5 points with 5 indicating the most severe impact. The points for the two scales are individually summarized. The physical scale results in a sum with a range 20-100 , where 100 indicates the worse health. The psychological scale is similarly resulting in a range between to 9- 45, where 9 is the least and 45 is the worst.
Mean change in EQ5D (EuroQol 5 dimensions) (general QoL) between baseline and day 28.
EQ-5D is a standardized instrument developed by the EuroQol Group as a measure of health-related quality of life comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression
Any difference in number of new brain MRI lesions at day 14 with regards to the baseline, comparing the two drugs
Any difference in number of new brain MRI lesions at day 28 with regards to the baseline, comparing the two drugs

Full Information

First Posted
September 14, 2018
Last Updated
July 30, 2021
Sponsor
Tomas Olsson
Collaborators
The Swedish Research Council
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1. Study Identification

Unique Protocol Identification Number
NCT03674099
Brief Title
Imatinib for Multiple Sclerosis (MS) Relapses
Official Title
Imatinib for Multiple Sclerosis (MS) Relapses - a Phase II, Randomised Study
Study Type
Interventional

2. Study Status

Record Verification Date
July 2021
Overall Recruitment Status
Unknown status
Study Start Date
October 1, 2018 (Actual)
Primary Completion Date
December 31, 2022 (Anticipated)
Study Completion Date
July 30, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Tomas Olsson
Collaborators
The Swedish Research Council

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
To investigate if treatment with Imatinib results in a better outcome than standard care in form of Methylprednisolone(MP) after MS-associated relapses.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Sclerosis
Keywords
Multiple Sclerosis relaps, Imatinib, Methylprednisolone

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Randomized, single-blinded, controlled.
Masking
Outcomes Assessor
Masking Description
Treating physician not blinded, evaluating physician blinded.
Allocation
Randomized
Enrollment
200 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Imatinib
Arm Type
Experimental
Arm Description
Imatinib will be administered orally one tablet (400mg) twice daily, 800mg per day for 14 consecutive days.
Arm Title
Methylprednisolone
Arm Type
Active Comparator
Arm Description
Methylprednisolone will be administered once a day either in tablets; Medrol 1g per day or iv; Solumedrol 1000 mg per day, both for three consecutive days.
Intervention Type
Drug
Intervention Name(s)
Imatinib Mesylate
Intervention Description
Tablets 400 mg
Intervention Type
Drug
Intervention Name(s)
Methylprednisolone
Intervention Description
1 g tablets or infusion
Primary Outcome Measure Information:
Title
Functional system score (FSS) change in the most worsened FSS after 28 days due to the acute relapse
Description
The primary endpoint is mean change between baseline and day 28 in the most worsened FSS due to the acute relapse comparing MP and Imatinib. In case more than one domain is affected, priority of selected FSS should be in the following order: 1) Pyramidal, 2) Brain stem, 3) Cerebellar, 4) Visual, 5) Sensory. At least a two step deterioration due to neuroinflammatory bout should have occurred. Bowel and Cerebral domains will not be considered in the primary endpoints. The FSS is graded accordingly: 1. Visual function. Grade 0-6 2. Brain stem function grade 0-5 3. Pyramidal function, grade 0-6 4. Cerebellar function, grade 0-5 5. Sensory function grade 0-6 6. bowel/bladder function 7. Cerebral functions
Time Frame
28 days
Secondary Outcome Measure Information:
Title
Functional system score (FSS) change between baseline and week 12 in the most worsened FSS due to the acute relapse
Description
In case more than one domain is affected, priority of selected FSS should be in the following order: 1) Pyramidal, 2) Brain stem, 3) Cerebellar, 4) Visual, 5) Sensory. At least a two step deterioration due to neuroinflammatory bout should have occurred.
Time Frame
12 weeks
Title
Mean expanded disability status scale (EDSS) change between baseline and day 28
Description
Calculation of EDSS summary score is based on the FSS score, from 0-5 with 0 representing normal neurological exam and 10 representing death by MS
Time Frame
28 days
Title
Mean change in 9-hole peg test (evaluates upper limb function) between baseline and day 28
Description
Evaluates upper limb function
Time Frame
28 days
Title
Mean change in timed 25- walk between baseline and day 28
Time Frame
28 days
Title
Mean change in symbol digital modality test (SDMT) between baseline and day 28
Description
Evaluates cognitive function, with a score range of 0 to 110, with 110 representing the best cognitive function
Time Frame
28 days
Title
Mean change in Multiple Sclerosis Impact Scale (MSIS-29; MS-specific quality of life (QoL) scale) between baseline and day 28
Description
The MISIS-29 consists of 29 items (composed of 20- item physical scale and a 9-item psychological scale), graded from 1-5 points with 5 indicating the most severe impact. The points for the two scales are individually summarized. The physical scale results in a sum with a range 20-100 , where 100 indicates the worse health. The psychological scale is similarly resulting in a range between to 9- 45, where 9 is the least and 45 is the worst.
Time Frame
28 days
Title
Mean change in EQ5D (EuroQol 5 dimensions) (general QoL) between baseline and day 28.
Description
EQ-5D is a standardized instrument developed by the EuroQol Group as a measure of health-related quality of life comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression
Time Frame
28 days
Title
Any difference in number of new brain MRI lesions at day 14 with regards to the baseline, comparing the two drugs
Time Frame
14 days
Title
Any difference in number of new brain MRI lesions at day 28 with regards to the baseline, comparing the two drugs
Time Frame
28 days

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: An acute exacerbation, relapse, in persons with RRMS, either newly diagnosis or on treatment with one of the long-term immunomodulatory drugs, or possible MS where the diagnosis is supported by typical MRI or cerebrospinal fluid changes typical of MS (this enables inclusion of persons with a first neuroinflammatory bout, with high risk of developing MS before fulfilling the McDonald criteria for definite MS, or high risk for developing MS in the category clinically isolated syndrome (CIS)/possible MS with supporting MRI lesions and/or cerebrospinal fluid aberrations suggesting intra-thecal immunoglobulin synthesis with oligoclonal bands/and/or increased free Kappa Light chains. The relapse should be deemed to require relapse treatment by the investigator and affect a functional domain with a minimum of grade 2. 18-55 years of age Affection of any of the following EDSS sub-domains representing the targeted neurological deficit: 1. Visual function. grade 0-6, 2. Brain stem function grade 0-5. 3. Pyramidal function, grade 0-6. 4. Cerebellar function, grade 0-5. 5. Sensory function grade 0-6, and deterioration at least one step in any of these EDSS domains EDSS ≤ 6 before the acute exacerbation Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, if they are using effective methods of contraception during the study. Acceptable birth control methods are those with a failure rate of less than 1% per year when used consistently and correctly according to CTFG, September 2014 "Recommendations related to contraception and pregnancy testing in clinical trials". Such methods include: Combined (estrogen and progestogen containing hormonal contraception associated with inhibition of ovulation. oral intravaginal transdermal progestogen-only hormonal contraception associated with inhibition of ovulation oral injectable implantable intrauterine device (IUD) intrauterine hormone-releasing system (IUS) bilateral tubal occlusion total abstinence or vasectomized partner. Exclusion Criteria: A pseudo-relapse should be excluded, as deemed by the experienced treating neurologist, and as evidenced by an active infection, likely with fever, with reappearing new signs and symptoms in a previously affected neurological function. Inability to provide informed consent Concomitant medication with drugs which may increase the plasma concentration of Imatinib - ketoconazole, itraconazole , erythromycin and clarithromycin Concomitant medication with drugs which may decrease the plasma concentration of Imatinib: dexamethasone, phenytoin, carbamazepin, rifampicin, phenobarbital, fosphenytoin, primidon, Hypericum perforatum (St John's wort). Female patients with childbearing potential, if pregnancy cannot be excluded by pregnancy test (urine point-of-care pregnancy test). Patient is participating in other interventional study General infection or any other condition judged by the treating neurologist to contra-indicate Imatinib Any laboratory deviation of general bodily functions such as kidney, or renal function judged to be of clinical significance by the treating neurologist constitutes an exclusion criteria. Patients with a positive Hepatitis B-DNA test result or serology indicating latent infection.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Tomas Olsson, MD, Prof
Phone
+46707213598
Email
Tomas.Olsson@ki.se
Facility Information:
Facility Name
Rigshospitalet
City
Copenhagen
ZIP/Postal Code
2100
Country
Denmark
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
FinnThorup Sellebjerg, MD
Email
finn.thorup.sellebjerg@regionh.dk
Facility Name
Hamburg-Eppendorf
City
Hamburg
ZIP/Postal Code
20246
Country
Germany
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Christoph Heesen
Email
heesen@uke.de
First Name & Middle Initial & Last Name & Degree
Christoph Heesen
Facility Name
UKSH Campus Kiel
City
Kiel
ZIP/Postal Code
24105
Country
Germany
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Klarissa Hanja Stürner, MD
Email
Klarissa.Stuerner@uksh.de
Facility Name
Uniklinik Köln
City
Köln
ZIP/Postal Code
50937
Country
Germany
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Clemens Warnke, MD
Email
clemens.warnke@uk-koeln.de
Facility Name
Haukeland sjukhus
City
Bergen
ZIP/Postal Code
5021
Country
Norway
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kjell Morten Myhr, MD
Email
kjell-morten.myhr@helse-bergen.no
Facility Name
Akershus University Hospital
City
Lørenskog
ZIP/Postal Code
1478
Country
Norway
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Trygve Holmöy, MD
Email
trygve.holmoy@medisin.uio.no
Facility Name
Rikshospitalet, Oslo
City
Oslo
ZIP/Postal Code
0372
Country
Norway
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Hanne Flinstad Harbo, MD
Email
h.f.harbo@medisin.uio.no
Facility Name
Ullevåls sjukhus
City
Oslo
ZIP/Postal Code
0424
Country
Norway
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Elisabeth G Celius, MD
Email
uxelgu@ous-hf.no
Facility Name
Karolinska Universityhospital, Huddinge
City
Huddinge
State/Province
Stockholm
ZIP/Postal Code
14186
Country
Sweden
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Katharina Fink, MD
Email
Katharina.Fink@sll.se
Facility Name
Neurology Sahlgrenska Hospital
City
Göteborg
ZIP/Postal Code
41345
Country
Sweden
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jan Lycke, MD
Email
jan.lycke@neuro.gu.se
Facility Name
Linköping University Hospital
City
Linköping
ZIP/Postal Code
58185
Country
Sweden
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Charlotte Dahle, MD
Email
Charlotte.Dahle@regionostergotland.se
Facility Name
Akademiskt specialistcentrum
City
Stockholm
ZIP/Postal Code
11341
Country
Sweden
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Fredrik Piehl, MD
Phone
+46-851779840
Email
Fredrik.Piehl@ki.se
Facility Name
Karolinska Universitetssjukhuset, Solna
City
Stockholm
ZIP/Postal Code
17176
Country
Sweden
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Tomas Olsson, MD
Phone
+46707213598
Email
Tomas.Olsson@ki.se
Facility Name
Uppsala University Hospital
City
Uppsala
ZIP/Postal Code
75185
Country
Sweden
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Joachim Burman, MD
Email
joachim.burman@akademiska.se

12. IPD Sharing Statement

Plan to Share IPD
No

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Imatinib for Multiple Sclerosis (MS) Relapses

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