Ocrelizumab VErsus Rituximab Off-Label at the Onset of Relapsing MS Disease (OVERLORD-MS)
Relapsing Remitting Multiple Sclerosis
About this trial
This is an interventional treatment trial for Relapsing Remitting Multiple Sclerosis focused on measuring RRMS, MS
Eligibility Criteria
Inclusion Criteria:
- Male and female patients, treatment naïve, and aged between 18 and 60 years included
- Women of childbearing potential1 (WOCBP) able and willing to use highly effective methods of birth control2 per ICH M3 (R2) that result in a low failure rate of less than 1% per year when used consistently and correctly for the duration of the study OR until 3 months after last dose administered.
- A diagnosis of RRMS according to the 2017 revised diagnostic criteria of McDonald (Thompson, Banwell et al. 2018) within the last 12 months.
- Disease activity defined as ≥ 1 relapse3 or ≥ 1 new MRI lesion during the last 12 months
- EDSS score ≤ 4.0
- Absence of comorbidity or drug abuse that preclude study participation
- Able to complete treatment or follow-up visits in the study (e.g. no contraindications for MRI or plans of moving)
- Able to understand written and spoken Norwegian or English
- Capable of giving signed informed consent as described in Appendix 1.2 which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol.
Exclusion Criteria:
- Known hypersensitivity or other known side effects for any of the study medications, including co-medications such as high glucocorticosteroids
- A diagnosis of primary progressive MS according to the revised diagnostic criteria of McDonald (Thompson, Banwell et al. 2018)
- A disease course of secondary progressive MS (Lublin, Reingold et al. 2014)
- Any ongoing infection, including tuberculosis, hepatitis virus or HIV, as well as hepatitis B surface antigen positivity and/or hepatitis C PCR positivity verified at screening visit.
- Prior or current psychiatric illness, mental deficiency or cognitive dysfunction influencing the patient ability to make an informed consent or comply with the treatment and follow-up phases of this protocol.
- Cardiac insufficiency, cardiomyopathy, significant cardiac dysrhythmia, unstable or advanced ischemic heart disease (NYHA III or IV)
- Active malignancy or prior history of malignancy except localized basal cell, squamous skin cancer or carcinoma in situ of the cervix.
- WBC < 1.5 x 109/L if not caused by a reversible effect of documented ongoing medication. If WBC < 1.5 x 109/L is caused by a reversible effect of documented ongoing medication the WBC count must be > 1,5 x 109/L before start of study treatment.
- Platelet (thrombocyte) count < 100 x 109/L
- ALAT and/or ASAT more than 2 times the upper normal reference limit (ULN)
- Serum creatinine > 200 µmol/L
- Serum bilirubin > ULN
- Pregnancy or lactating female patients
- Any disease that can influence the patient safety and compliance, or the evaluation of disability
- History of serious or life-threatening infusion reaction to ocrelizumab or rituximab, if previously treated with these medications for other diseases than MS
- Previous use of MS-therapies such as natalizumab, fingolimod, interferons, glatiramer acetate, dimethyl fumarate, teriflunomide, cladribine, rituximab, alemtuzumab, ocrelizumab, hematopoietic stem cell therapy (HSCT) or other immunosuppression therapies with long lasting effects, or any other disease modifying therapy (DMT) for MS. If any of these medications have been used against other diseases than MS, patients can be included if the medications have not been used the previous year before enrollment.
- Currently enrolled in another investigational device or drug study, or less than 30 days since ending another investigational device or drug study (s), or receiving other investigational treatment(s). Patients participating in a purely observational trial will not be excluded.
- Presence of metallic objects implanted in the body, or allergy to MRI contrast that would preclude the ability of the patient to safely have MRI exams
- Current alcohol or drug dependencies
Sites / Locations
- Haukeland University Hospital
- Nordlandsykehuset HF
- Vestre Viken syekhus
- Sørlandet Sykehus
- Molde sjukehus
- Sykehuset Namsos
- Oslo University Hospital HF
- Akershus University Hospital
- Oslo University Hospital
- Sykehuset Telemark
- Stavanger University Hospital HF
- University Hospital North Norway HF
- University Hospital North Norway
- St. Olavs Hospital
- Karolinska Hospital
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Rituximab
Ocrelizumab
Rituximab will be given as infusion at week 0, week 26, week 52, week 78, and week 104 unless there is a reason for schedule modifications (see Section 6.3). Each infusion is given over approximately 4 hours and follow local guidelines for infusion. Initial dose; 1000 mg Subsequent doses; 500 mg
Ocrelizumab will be given as infusion at week 0, week 26, week 52, week 78, and week 104 unless there is a reason for schedule modifications (see Section 6.3). Each infusion is given over approximately 4 hours and follow local guidelines for infusion. Initial and subsequent doses; 600 mg