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Non-inferiority Study of Rituximab Compared to Ocrelizumab in Relapsing MS (Noisy Rebels)

Primary Purpose

Multiple Sclerosis, Multiple Sclerosis, Relapsing-Remitting, Demyelinating Autoimmune Diseases, CNS

Status
Recruiting
Phase
Phase 3
Locations
Netherlands
Study Type
Interventional
Intervention
Rituximab
Sponsored by
Amsterdam UMC, location VUmc
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Sclerosis focused on measuring ocrelizumab, rituximab, non-inferiority

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Men and women aged 18 years and older A diagnosis of relapsing MS according to the 2017 revised diagnostic criteria Indication to start treatment with anti-CD20 therapy according to the treating neurologist and the relevant label in the Netherlands for treatment of relapsing MS Able to understand written and spoken Dutch or English Capable of giving signed informed consent including compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol. Screening EDSS score ≤ 6.5 . Exclusion Criteria: Medical Conditions A known allergy or other intolerability to RTX, OCR, gadolinium-based MRI contrast agents, or corticosteroids. A diagnosis of primary progressive MS according to the diagnostic criteria. A diagnosis of not-active secondary progressive MS. Chronic infectious diseases such as tuberculosis, VZV, hepatitis virus or HIV, as well as hepatitis B surface antigen positivity and/or hepatitis C PCR positivity verified at screening visit. A history of proven inflammatory bowel disease such as M. Crohn or ulcerative colitis 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 disease that makes treatment with OCR or RTX contra-indicated as stated by the most recent SmPC Active malignancy or prior history of malignancy that makes treatment with OCR or RTX contra-indicated as stated by the most recent SmPC. WBC < 1.5 x 109/L if not caused by a reversible effect of documented ongoing medication. If 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 Serum IgG < LLN Pregnant or breast-feeding women Women of childbearing potential (WOCBP) not able or willing to use highly effective methods of birth control per ICH M3 (R2) that result in failure rate of ≤ 1% per year when used consistently and correctly for the duration of the study OR until 3 months after last dose administered. History of serious or life-threatening infusion reaction to OCR or RTX Treatment with glucocorticoids or ACTH within one month prior to start of study treatment Prior/Concomitant Therapy Previous use of second line MS-therapies cladribine, RTX, alemtuzumab, OCR, ofatumumab, hematopoietic stem cell therapy (HSCT) or other immunosuppression therapies with long lasting effects. Mitoxantrone is allowed if used > 1 year before enrolment. If any of these medications have been used for indications other than MS, patients can be included if the medications have not been used the year before enrolment. Previous treatment with natalizumab is allowed if the reason to switch was disease activity (so not allowed in for example cases that switch from natalizumab to anti-CD20 therapy because of JCV positivity). Concomitant use of systemic immunosuppressive medication (except corticosteroids for symptomatic treatment of relapses). Prior/Concurrent Clinical Study Experience Currently enrolled in another investigational device or drug study, or less than 30 days since ending of another investigational device or drug study (s), or receiving other investigational treatment(s). Patients participating in a purely observational studies will be allowed to participate. Lifestyle Current alcohol or drug dependencies. Diagnostic assessments Presence of metallic objects implanted in the body, that would preclude the ability of the patient to safely have MRI exams. Not willing to undergo MRI scans with i.v. gadolinium injections

Sites / Locations

  • Amsterdam UMC, location VUmcRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

No Intervention

Experimental

Arm Label

Ocrelizumab

Rituximab

Arm Description

The standard group will receive ocrelizumab (600 mg, the first dosage given in two infusion of 300 mg with a two week interval) following the current treatment protocol

The experimental group will receive rituximab (1000 mg). Rituximab will be given intravenously. To ensure blinding of treatment allocation two dosages of 500 mg with a two week interval will be given instead of one initial dosage of 1000 mg of rituximab to mimic the ocrelizumab protocol

Outcomes

Primary Outcome Measures

Proportion of patients free of inflammatory disease activity
Proportion of patients with no new or enlarged T2 lesions on brain MRI between month 6 and month 24

Secondary Outcome Measures

Presence and number of clinical relapses
Clinical relapses during treatment
Contrast enhancing lesions
Proportion of patients with no contrast enhancing lesions on brain MRI
Average number of T2 lesions on brain MRI
The average number of new/enlarged T2 lesions between baseline, month 6 and month 24 on brain MRI
Disability progression during follow-up
Disability progression measured on the Expanded Disability Status Scale (EDSS)
Disability progression during follow-up
Disability progression measured on the timed 25 foot walk test (T25FW)
Disability progression during follow-up
Disability progression measured on the Nine Hole Peg Test (9HPT)
Disability progression during follow-up
Disability progression measured on the Symbol Digit Modalities Test(SDMT)

Full Information

First Posted
April 3, 2023
Last Updated
April 17, 2023
Sponsor
Amsterdam UMC, location VUmc
Collaborators
Stichting Treatmeds
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1. Study Identification

Unique Protocol Identification Number
NCT05834855
Brief Title
Non-inferiority Study of Rituximab Compared to Ocrelizumab in Relapsing MS
Acronym
Noisy Rebels
Official Title
Non-inferiority Study of Rituximab Compared to Ocrelizumab in Relapsing Multiple Sclerosis
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Recruiting
Study Start Date
April 2023 (Anticipated)
Primary Completion Date
May 2027 (Anticipated)
Study Completion Date
May 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Amsterdam UMC, location VUmc
Collaborators
Stichting Treatmeds

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Rationale: Ocrelizumab is widely and effectively used to treat relapsing multiple sclerosis (RMS). Phase II studies and data from large patient cohorts indicate that rituximab, another anti-CD20 monoclonal antibody, is probably equally effective and safe as ocrelizumab in the treatment of RMS. An advantage of rituximab is a considerably lower price. Therefore we will start a study aimed at demonstrating non-inferiority of rituximab compared to ocrelizumab in RMS. If non-inferiority of rituximab can be shown, important reductions in the cost of treatment of RMS will be possible, without loss of efficacy. Objective: Evaluating the efficacy and safety of ritixumab compared to ocrelizumab in the treatmens of RMS. Study design: Randomized double blind multi-centre non-inferiority study of rituximab compared to ocrelizumab in 200 patients with RMS. The trial duration will be 30 months Study population: The study population consists of 200 adult RMS patiens with an indication to start anti-CD20 monoclonal antibody treatment. Intervention: Patients will be randomized 1:1 into the standard group (ocrelizumab treatment) or the experimental group (rituximab treatment). Main study parameters: To conclude non-inferiority of rituximab there will be one primary endpoint: the proportion of patients free of inflammatory disease activity (defined as: new or enlarged T2 lesions) between week 24 (M6) and week 96 (M24) of treatment in each arm. Secondary trial endpoints are presence and number of clinical relapses,T2 and contrast enhancing lesion volumes, brain volume and brain volume changes, disease progression (defined as clinically relevant change on any of the measures: EDSS, T25FW, 9HPT, SDMT), biochemical parameters such as lipidomics and neurofilament light (NfL), immunological parameters, safety as measured by the number of (serious) adverse events ((S)AE), quality of life (EQ-5D-L) and treatment satisfaction (TSQM) and patient reported measures of MS impact (MSIS-29) and well-being (questionnaire on physical complaints) Nature and extent of the burden and risk: Patients included in this study will be treated and monitored by MRI, clinical tests and laboratory tests according to existing protocols and will not be exposed to extra or unknown risks. They will have extra annual questionnaires and larger blood samples at some time points. There is extensive experience with both rituximab and ocrelizumab as efficacious and safe treatments of RMS.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Sclerosis, Multiple Sclerosis, Relapsing-Remitting, Demyelinating Autoimmune Diseases, CNS, Autoimmune Diseases of the Nervous System, Nervous System Diseases, Demyelinating Diseases
Keywords
ocrelizumab, rituximab, non-inferiority

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Model Description
Multicenter randomized controlled double-blind non-inferiority trial in The Netherlands
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
The patient, site personnel administrating infusions, and the treating and evaluating neurologist and study nurse will all be blinded
Allocation
Randomized
Enrollment
200 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Ocrelizumab
Arm Type
No Intervention
Arm Description
The standard group will receive ocrelizumab (600 mg, the first dosage given in two infusion of 300 mg with a two week interval) following the current treatment protocol
Arm Title
Rituximab
Arm Type
Experimental
Arm Description
The experimental group will receive rituximab (1000 mg). Rituximab will be given intravenously. To ensure blinding of treatment allocation two dosages of 500 mg with a two week interval will be given instead of one initial dosage of 1000 mg of rituximab to mimic the ocrelizumab protocol
Intervention Type
Drug
Intervention Name(s)
Rituximab
Other Intervention Name(s)
MabThera, Truxima, Ruxience, Rixathon
Intervention Description
Treatment with rituximab
Primary Outcome Measure Information:
Title
Proportion of patients free of inflammatory disease activity
Description
Proportion of patients with no new or enlarged T2 lesions on brain MRI between month 6 and month 24
Time Frame
between month 6 and month 24
Secondary Outcome Measure Information:
Title
Presence and number of clinical relapses
Description
Clinical relapses during treatment
Time Frame
Baseline, month 6, month 24
Title
Contrast enhancing lesions
Description
Proportion of patients with no contrast enhancing lesions on brain MRI
Time Frame
Baseline, month 6, month 24
Title
Average number of T2 lesions on brain MRI
Description
The average number of new/enlarged T2 lesions between baseline, month 6 and month 24 on brain MRI
Time Frame
Baseline, month 6, month 24
Title
Disability progression during follow-up
Description
Disability progression measured on the Expanded Disability Status Scale (EDSS)
Time Frame
Baseline, month 6, month 24
Title
Disability progression during follow-up
Description
Disability progression measured on the timed 25 foot walk test (T25FW)
Time Frame
Baseline, month 6, month 24
Title
Disability progression during follow-up
Description
Disability progression measured on the Nine Hole Peg Test (9HPT)
Time Frame
Baseline, month 6, month 24
Title
Disability progression during follow-up
Description
Disability progression measured on the Symbol Digit Modalities Test(SDMT)
Time Frame
Baseline, month 6, month 24
Other Pre-specified Outcome Measures:
Title
Anti-drug antibodies
Description
Proportion of patients with anti-drug-antibodies during 30 months of treatment
Time Frame
30 months
Title
Infusion reactions
Description
Proportion of patients with immediate and delayed infusion reactions during 30 months of treatment
Time Frame
30 months
Title
Infections
Description
Proportion of patients with infections during 30 months of treatment
Time Frame
30 months
Title
Malignancies
Description
Proportion of patients with malignancies during 30 months of treatment
Time Frame
30 months
Title
Adverse events
Description
Proportion of patients with any SAE/SAR and AESI during 30 months of treatment
Time Frame
30 months
Title
Burden of physical senstations during treatment
Description
Burden of physical sensations prior to, after, and between infusions as measured with wearing-off questionnaire and question 5 of the RAPID3-HAQ2 questionnaire
Time Frame
Baseline, month 6, month 12, month 18, month 24, month 30
Title
Quality of life questionnaires
Description
Quality of life as measured by multiple sclerosis impact scale-29 (MSIS-29)
Time Frame
Baseline, month 6, month 12, month 18, month 24, month 30
Title
Quality of life questionnaires
Description
Quality of life as measured by EuroQol-5 Dimension (EQ-5D)
Time Frame
Baseline, month 6, month 12, month 18, month 24, month 30
Title
Treatment satisfaction
Description
Treatment satisfaction as measured with the Treatment Satisfaction Questionnaire Measurement (TSQM)
Time Frame
Baseline, month 6, month 12, month 18, month 24, month 30
Title
Lymphocytes
Description
Absolute numbers of different lymphocyte subsets prior to infusion during 30 months of treatment
Time Frame
30 months
Title
Neurofilament
Description
Serum levels of neurofilament during 30 months of treatment
Time Frame
30 months
Title
Dynamics of B-cell depletion
Description
B-cell count (thousand/ml) (normal range: 100-300 thousand/ml)
Time Frame
Baseline, week 2, month 6, month 12, month 18, month 24, month 30
Title
Dynamics of B-cell repopulation
Description
B-cell count (thousand/ml) (normal range: 100-300 thousand/ml)
Time Frame
Baseline, week 2, month 6, month 12, month 18, month 24, month 30
Title
Dynamics of ocrelizumab drug concentrations
Description
Dynamics of ocrelizumab drug concentrations (microgram/mL)
Time Frame
Baseline, week 2, month 6, month 12, month 18, month 24, month 30
Title
Immunoglobulins
Description
Serum levels of immunoglobulins
Time Frame
Baseline, week 2, month 6, month 12, month 18, month 24, month 30
Title
Serum levels
Description
Serum levels of chemokines and cytokines, protectins, resolvins, maresins, and lipoxins during 30 months of treatment
Time Frame
30 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Men and women aged 18 years and older A diagnosis of relapsing MS according to the 2017 revised diagnostic criteria Indication to start treatment with anti-CD20 therapy according to the treating neurologist and the relevant label in the Netherlands for treatment of relapsing MS Able to understand written and spoken Dutch or English Capable of giving signed informed consent including compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol. Screening EDSS score ≤ 6.5 . Exclusion Criteria: Medical Conditions A known allergy or other intolerability to RTX, OCR, gadolinium-based MRI contrast agents, or corticosteroids. A diagnosis of primary progressive MS according to the diagnostic criteria. A diagnosis of not-active secondary progressive MS. Chronic infectious diseases such as tuberculosis, VZV, hepatitis virus or HIV, as well as hepatitis B surface antigen positivity and/or hepatitis C PCR positivity verified at screening visit. A history of proven inflammatory bowel disease such as M. Crohn or ulcerative colitis 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 disease that makes treatment with OCR or RTX contra-indicated as stated by the most recent SmPC Active malignancy or prior history of malignancy that makes treatment with OCR or RTX contra-indicated as stated by the most recent SmPC. WBC < 1.5 x 109/L if not caused by a reversible effect of documented ongoing medication. If 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 Serum IgG < LLN Pregnant or breast-feeding women Women of childbearing potential (WOCBP) not able or willing to use highly effective methods of birth control per ICH M3 (R2) that result in failure rate of ≤ 1% per year when used consistently and correctly for the duration of the study OR until 3 months after last dose administered. History of serious or life-threatening infusion reaction to OCR or RTX Treatment with glucocorticoids or ACTH within one month prior to start of study treatment Prior/Concomitant Therapy Previous use of second line MS-therapies cladribine, RTX, alemtuzumab, OCR, ofatumumab, hematopoietic stem cell therapy (HSCT) or other immunosuppression therapies with long lasting effects. Mitoxantrone is allowed if used > 1 year before enrolment. If any of these medications have been used for indications other than MS, patients can be included if the medications have not been used the year before enrolment. Previous treatment with natalizumab is allowed if the reason to switch was disease activity (so not allowed in for example cases that switch from natalizumab to anti-CD20 therapy because of JCV positivity). Concomitant use of systemic immunosuppressive medication (except corticosteroids for symptomatic treatment of relapses). Prior/Concurrent Clinical Study Experience Currently enrolled in another investigational device or drug study, or less than 30 days since ending of another investigational device or drug study (s), or receiving other investigational treatment(s). Patients participating in a purely observational studies will be allowed to participate. Lifestyle Current alcohol or drug dependencies. Diagnostic assessments Presence of metallic objects implanted in the body, that would preclude the ability of the patient to safely have MRI exams. Not willing to undergo MRI scans with i.v. gadolinium injections
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Lisa Schoof, Msc
Phone
650087853
Ext
+31
Email
l.g.schoof@amsterdamumc.nl
First Name & Middle Initial & Last Name or Official Title & Degree
Eva Strijbis, Dr.
Phone
204442182
Ext
+31
Email
e.strijbis@amsterdamumc.nl
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Bob van Oosten, Dr
Organizational Affiliation
Amsterdam UMC, location VUmc
Official's Role
Principal Investigator
Facility Information:
Facility Name
Amsterdam UMC, location VUmc
City
Amsterdam
ZIP/Postal Code
1081 HV
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
B. van Oosten, Dr.
First Name & Middle Initial & Last Name & Degree
E. Strijbis, Dr.

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Time Frame
After medical ethical commitee approved the study protocol

Learn more about this trial

Non-inferiority Study of Rituximab Compared to Ocrelizumab in Relapsing MS

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