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A Prospective, Open-label, Non-randomized, Clinical Trial to Determine if Natalizumab (Tysabri®) Improves Ambulatory Measures in Relapsing-remitting Multiple Sclerosis (RRMS) Patients (TIMER)

Primary Purpose

Relapsing Remitting Multiple Sclerosis (RRMS)

Status
Completed
Phase
Phase 4
Locations
International
Study Type
Interventional
Intervention
BG00002 (natalizumab)
Sponsored by
Biogen
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Relapsing Remitting Multiple Sclerosis (RRMS) focused on measuring TYSABRI naive, Relapsing-remitting multiple sclerosis (RRMS)

Eligibility Criteria

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

Key Inclusion Criteria:

  • Must give written informed consent and provide all authorizations required by local law (for example, Protected Health Information [PHI])
  • Men or women between 18 and 60 years of age, inclusive
  • Must have Expanded Disability Status Scale (EDSS) less than or equal to 5.5 at baseline
  • Must be able to walk at least 100 m without assistive devices
  • Must be natalizumab-naïve
  • Must have a documented diagnosis of a relapsing remitting form of multiple sclerosis (MS0 as defined by the revised McDonald Committee criteria (Polman et al., 2005)
  • Must have had a recent (within 3 months from baseline) magnetic resonance imaging (MRI)
  • Must have had at least 1 relapse in the previous year and must satisfy the locally approved therapeutic indications for Tysabri. If Tysabri is not yet approved in a specific country, patients must fulfill the following criteria:

    • Patients with high disease activity despite treatment with a beta-interferon defined as patients who have failed to respond to a full and adequate course of a beta-interferon
    • Patients must have had at least 1 relapse in the previous year while on therapy, and have at least 9 T2 hyperintense lesions in cranial MRI or at least 1 gadolinium (Gd)-enhancing lesion
    • Patients with rapidly evolving severe relapsing remitting multiple sclerosis defined as patients who have had 2 or more disabling relapses in one year and 1 or more Gd-enhancing lesions on brain MRI or significant increase in T2 lesions as compared to a previous MRI
  • Must be stable in disability for at least 30 days prior to enrollment to the study
  • Must be stable in symptomatic management of the disease, specifically spasticity, depression and fatigue for at least 30 days prior to enrollment to the study
  • Must be considered by the Investigator to be free of signs and symptoms suggestive of progressive multifocal leukoencephalopathy (PML) based on medical history, physical examination, or laboratory testing
  • Must be willing to discontinue and remain free from concomitant immunosuppressive or immunomodulatory treatment (including interferon [IFN] and glatiramer acetate [GA]) while being treated with natalizumab during the study.

Key Exclusion Criteria:

Unless otherwise specified, candidates will be excluded from study entry if any of the following exclusion criteria exist at the time of the Screening Visit:

  • Onset of a relapse within 50 days prior to first infusion
  • Considered by the Investigator to be immunocompromised, based on medical history, physical examination, or laboratory testing or due to prior immunosuppressive treatment
  • History of, or available abnormal laboratory results indicative of, any significant cardiac, endocrinologic, hematologic, hepatic, immunologic, metabolic, urologic, pulmonary, gastrointestinal, dermatologic, psychiatric (including major depression), renal, and/or other major disease that would preclude the administration of a recombinant humanized antibody immunomodulating agent. The Investigator must re-review the subject's medical fitness for participation and consider any diseases that would preclude treatment
  • History of malignancy (subjects with basal cell carcinoma that has been completely excised prior to study entry remain eligible)
  • Known history of human immunodeficiency virus infection or hematological malignancy
  • History of organ transplantation (including anti-rejection therapy)
  • A clinically significant infectious illness (cellulitis, abscess, pneumonia, septicemia) within 30 days prior to the Screening Visit
  • Treatment with immunosuppressant medications (mitoxantrone, cyclophosphamide, cyclosporine, azathioprine, methotrexate) within 6 months prior to Screening
  • Female subjects who are not postmenopausal for at least 1 year, surgically sterile (does not include tubal ligation), or willing to practice effective contraception (as defined by the Investigator) during the study
  • Women who are breastfeeding, pregnant, or planning to become pregnant while on study
  • Current enrollment in any other study treatment or disease study
  • Unwillingness or inability to comply with the requirements of this protocol, including the presence of any condition (physical, mental, or social) that is likely to affect the subject's ability to comply with the study protocol
  • Subjects with walking impairment due to causes other than MS
  • Other unspecified reasons that, in the opinion of the Investigator and/or Biogen Idec, make the subject unsuitable for enrollment into this study

NOTE: Other eligibility criteria may apply.

Sites / Locations

  • Biogen Idec Investigative Site
  • Biogen Idec Investigative Site
  • Biogen Idec Investigative Site
  • Biogen Idec Investigative Site
  • Biogen Idec Investigative Site
  • Biogen Idec Investigative Site
  • Biogen Idec Investigative Site
  • Biogen Idec Investigative Site
  • Biogen Idec Investigative Site
  • Biogen Idec Investigative Site
  • Biogen Idec Investigative Site
  • Biogen Idec Investigative Site
  • Biogen Idec Investigative Site
  • Biogen Idec Investigative Site
  • Biogen Idec Investigative Site

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Natalizumab

Arm Description

natalizumab 300 mg IV every 4 weeks for 48 weeks

Outcomes

Primary Outcome Measures

Change From Baseline in the Timed 100-meter Walk Test (T100T)
In the T100T, the participant is instructed to walk as fast as possible for a distance of 100 meters.
Change From Baseline in the Timed 25-foot Walk Test (T25FW)
In the T25FW, the participant is instructed to walk as fast as possible for a distance of 25 feet.
Change From Baseline in Maximum Walking Distance (MWD)
Change From Baseline in Expanded Disability Status Scale (EDSS)
EDSS assesses disability in 8 functional systems. An overall score ranging from 0 (normal) to 10 (death due to MS) was calculated.

Secondary Outcome Measures

Correlation Between the EDSS and MWD (Pearson Correlation Coefficient)
Pearson correlation coefficient is a measure of the linear correlation (dependence) between 2 variables, giving a value between +1 and -1 inclusive, where 1 is total positive correlation, 0 is no correlation, and -1 is total negative correlation.
Correlation Between the EDSS and MWD (Spearman Correlation Coefficient)
Spearman correlation coefficient is a non-parametric measure of the correlation (dependence) between 2 variables, giving a value between +1 and -1 inclusive, where 1 is total positive correlation, 0 is no correlation, and -1 is total negative correlation.
Correlation Between the T100T and T25FW (Pearson Correlation Coefficient)
Pearson correlation coefficient is a measure of the linear correlation (dependence) between 2 variables, giving a value between +1 and -1 inclusive, where 1 is total positive correlation, 0 is no correlation, and -1 is total negative correlation.
Correlation Between the T100T and T25FW (Spearman Correlation Coefficient)
Spearman correlation coefficient is a non-parametric measure of the correlation (dependence) between 2 variables, giving a value between +1 and -1 inclusive, where 1 is total positive correlation, 0 is no correlation, and -1 is total negative correlation.
Correlation Between the EDSS and T25FW (Pearson Correlation Coefficient)
Pearson correlation coefficient is a measure of the linear correlation (dependence) between 2 variables, giving a value between +1 and -1 inclusive, where 1 is total positive correlation, 0 is no correlation, and -1 is total negative correlation.
Correlation Between the EDSS and T25FW (Spearman Correlation Coefficient)
Spearman correlation coefficient is a non-parametric measure of the correlation (dependence) between 2 variables, giving a value between +1 and -1 inclusive, where 1 is total positive correlation, 0 is no correlation, and -1 is total negative correlation.
Correlation Between the EDSS and T100T (Pearson Correlation Coefficient)
Pearson correlation coefficient is a measure of the linear correlation (dependence) between 2 variables, giving a value between +1 and -1 inclusive, where 1 is total positive correlation, 0 is no correlation, and -1 is total negative correlation.
Correlation Between the EDSS and T100T (Spearman Correlation Coefficient)
Spearman correlation coefficient is a non-parametric measure of the correlation (dependence) between 2 variables, giving a value between +1 and -1 inclusive, where 1 is total positive correlation, 0 is no correlation, and -1 is total negative correlation.
Improvement in Timed 25FT Walk Speed and T100T Speed at Week 24 and 48
To determine how well each of the walking tests, T100T or T25FW, predicts walking limitations, participants were stratified by baseline EDSS scores, and walking tests at Weeks 24 and 48 were analyzed. A 15% or 20% improvement indicates that, when compared with baseline walking speed (meters per second), there is at least 15% or 20% improvement at the corresponding timepoint, e.g. (speed at Week 24 - speed at baseline)/speed at baseline*100% ≥ 15% or 20%. Confirmed (conf) improvement at Week 48 indicates that the participant has at least 15% (or 20%) improvement in walking speed at both Week 24 and Week 48.

Full Information

First Posted
March 26, 2009
Last Updated
February 14, 2017
Sponsor
Biogen
Collaborators
Elan Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT00871780
Brief Title
A Prospective, Open-label, Non-randomized, Clinical Trial to Determine if Natalizumab (Tysabri®) Improves Ambulatory Measures in Relapsing-remitting Multiple Sclerosis (RRMS) Patients
Acronym
TIMER
Official Title
A Prospective, Open-label, Non-randomized, Clinical Trial to Determine if Natalizumab (Tysabri®) Improves Ambulatory Measures in Relapsing-remitting Multiple Sclerosis (RRMS) Patients "TIMER" Study
Study Type
Interventional

2. Study Status

Record Verification Date
February 2017
Overall Recruitment Status
Completed
Study Start Date
August 2009 (undefined)
Primary Completion Date
July 2012 (Actual)
Study Completion Date
July 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Biogen
Collaborators
Elan Pharmaceuticals

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The primary objective of the study is to evaluate the evolution of walking capacity as measured by the timed 100-meter walk test (T100T), timed 25-foot walk test (T25FW), maximum walking distance (MWD), and Expanded Disability Status Scale (EDSS) during the first year of therapy with natalizumab. The secondary objectives of this study are as follows: To evaluate the correlation between the MWD and EDSS and both walking tests, the T100T and the T25FW at Baseline, at Week 24 and at Week 48 of therapy. To determine how well each of the walking tests, T100T or T25FW, predicts walking limitations in all participants and in the subgroups of participants stratified by baseline EDSS.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Relapsing Remitting Multiple Sclerosis (RRMS)
Keywords
TYSABRI naive, Relapsing-remitting multiple sclerosis (RRMS)

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
224 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Natalizumab
Arm Type
Experimental
Arm Description
natalizumab 300 mg IV every 4 weeks for 48 weeks
Intervention Type
Drug
Intervention Name(s)
BG00002 (natalizumab)
Other Intervention Name(s)
Tysabri®
Primary Outcome Measure Information:
Title
Change From Baseline in the Timed 100-meter Walk Test (T100T)
Description
In the T100T, the participant is instructed to walk as fast as possible for a distance of 100 meters.
Time Frame
Baseline, Week 24, Week 48
Title
Change From Baseline in the Timed 25-foot Walk Test (T25FW)
Description
In the T25FW, the participant is instructed to walk as fast as possible for a distance of 25 feet.
Time Frame
Baseline, Week 24, Week 48
Title
Change From Baseline in Maximum Walking Distance (MWD)
Time Frame
Baseline, Week 24, Week 48
Title
Change From Baseline in Expanded Disability Status Scale (EDSS)
Description
EDSS assesses disability in 8 functional systems. An overall score ranging from 0 (normal) to 10 (death due to MS) was calculated.
Time Frame
Baseline, Week 24, Week 48
Secondary Outcome Measure Information:
Title
Correlation Between the EDSS and MWD (Pearson Correlation Coefficient)
Description
Pearson correlation coefficient is a measure of the linear correlation (dependence) between 2 variables, giving a value between +1 and -1 inclusive, where 1 is total positive correlation, 0 is no correlation, and -1 is total negative correlation.
Time Frame
Baseline, Week 24, Week 48
Title
Correlation Between the EDSS and MWD (Spearman Correlation Coefficient)
Description
Spearman correlation coefficient is a non-parametric measure of the correlation (dependence) between 2 variables, giving a value between +1 and -1 inclusive, where 1 is total positive correlation, 0 is no correlation, and -1 is total negative correlation.
Time Frame
Baseline, Week 24, Week 48
Title
Correlation Between the T100T and T25FW (Pearson Correlation Coefficient)
Description
Pearson correlation coefficient is a measure of the linear correlation (dependence) between 2 variables, giving a value between +1 and -1 inclusive, where 1 is total positive correlation, 0 is no correlation, and -1 is total negative correlation.
Time Frame
Baseline, Week 24, Week 48
Title
Correlation Between the T100T and T25FW (Spearman Correlation Coefficient)
Description
Spearman correlation coefficient is a non-parametric measure of the correlation (dependence) between 2 variables, giving a value between +1 and -1 inclusive, where 1 is total positive correlation, 0 is no correlation, and -1 is total negative correlation.
Time Frame
Baseline, Week 24, Week 48
Title
Correlation Between the EDSS and T25FW (Pearson Correlation Coefficient)
Description
Pearson correlation coefficient is a measure of the linear correlation (dependence) between 2 variables, giving a value between +1 and -1 inclusive, where 1 is total positive correlation, 0 is no correlation, and -1 is total negative correlation.
Time Frame
Baseline, Week 24, Week 48
Title
Correlation Between the EDSS and T25FW (Spearman Correlation Coefficient)
Description
Spearman correlation coefficient is a non-parametric measure of the correlation (dependence) between 2 variables, giving a value between +1 and -1 inclusive, where 1 is total positive correlation, 0 is no correlation, and -1 is total negative correlation.
Time Frame
Baseline, Week 24, Week 48
Title
Correlation Between the EDSS and T100T (Pearson Correlation Coefficient)
Description
Pearson correlation coefficient is a measure of the linear correlation (dependence) between 2 variables, giving a value between +1 and -1 inclusive, where 1 is total positive correlation, 0 is no correlation, and -1 is total negative correlation.
Time Frame
Baseline, Week 24, Week 48
Title
Correlation Between the EDSS and T100T (Spearman Correlation Coefficient)
Description
Spearman correlation coefficient is a non-parametric measure of the correlation (dependence) between 2 variables, giving a value between +1 and -1 inclusive, where 1 is total positive correlation, 0 is no correlation, and -1 is total negative correlation.
Time Frame
Baseline, Week 24, Week 48
Title
Improvement in Timed 25FT Walk Speed and T100T Speed at Week 24 and 48
Description
To determine how well each of the walking tests, T100T or T25FW, predicts walking limitations, participants were stratified by baseline EDSS scores, and walking tests at Weeks 24 and 48 were analyzed. A 15% or 20% improvement indicates that, when compared with baseline walking speed (meters per second), there is at least 15% or 20% improvement at the corresponding timepoint, e.g. (speed at Week 24 - speed at baseline)/speed at baseline*100% ≥ 15% or 20%. Confirmed (conf) improvement at Week 48 indicates that the participant has at least 15% (or 20%) improvement in walking speed at both Week 24 and Week 48.
Time Frame
Baseline, Week 24, Week 48

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Key Inclusion Criteria: Must give written informed consent and provide all authorizations required by local law (for example, Protected Health Information [PHI]) Men or women between 18 and 60 years of age, inclusive Must have Expanded Disability Status Scale (EDSS) less than or equal to 5.5 at baseline Must be able to walk at least 100 m without assistive devices Must be natalizumab-naïve Must have a documented diagnosis of a relapsing remitting form of multiple sclerosis (MS0 as defined by the revised McDonald Committee criteria (Polman et al., 2005) Must have had a recent (within 3 months from baseline) magnetic resonance imaging (MRI) Must have had at least 1 relapse in the previous year and must satisfy the locally approved therapeutic indications for Tysabri. If Tysabri is not yet approved in a specific country, patients must fulfill the following criteria: Patients with high disease activity despite treatment with a beta-interferon defined as patients who have failed to respond to a full and adequate course of a beta-interferon Patients must have had at least 1 relapse in the previous year while on therapy, and have at least 9 T2 hyperintense lesions in cranial MRI or at least 1 gadolinium (Gd)-enhancing lesion Patients with rapidly evolving severe relapsing remitting multiple sclerosis defined as patients who have had 2 or more disabling relapses in one year and 1 or more Gd-enhancing lesions on brain MRI or significant increase in T2 lesions as compared to a previous MRI Must be stable in disability for at least 30 days prior to enrollment to the study Must be stable in symptomatic management of the disease, specifically spasticity, depression and fatigue for at least 30 days prior to enrollment to the study Must be considered by the Investigator to be free of signs and symptoms suggestive of progressive multifocal leukoencephalopathy (PML) based on medical history, physical examination, or laboratory testing Must be willing to discontinue and remain free from concomitant immunosuppressive or immunomodulatory treatment (including interferon [IFN] and glatiramer acetate [GA]) while being treated with natalizumab during the study. Key Exclusion Criteria: Unless otherwise specified, candidates will be excluded from study entry if any of the following exclusion criteria exist at the time of the Screening Visit: Onset of a relapse within 50 days prior to first infusion Considered by the Investigator to be immunocompromised, based on medical history, physical examination, or laboratory testing or due to prior immunosuppressive treatment History of, or available abnormal laboratory results indicative of, any significant cardiac, endocrinologic, hematologic, hepatic, immunologic, metabolic, urologic, pulmonary, gastrointestinal, dermatologic, psychiatric (including major depression), renal, and/or other major disease that would preclude the administration of a recombinant humanized antibody immunomodulating agent. The Investigator must re-review the subject's medical fitness for participation and consider any diseases that would preclude treatment History of malignancy (subjects with basal cell carcinoma that has been completely excised prior to study entry remain eligible) Known history of human immunodeficiency virus infection or hematological malignancy History of organ transplantation (including anti-rejection therapy) A clinically significant infectious illness (cellulitis, abscess, pneumonia, septicemia) within 30 days prior to the Screening Visit Treatment with immunosuppressant medications (mitoxantrone, cyclophosphamide, cyclosporine, azathioprine, methotrexate) within 6 months prior to Screening Female subjects who are not postmenopausal for at least 1 year, surgically sterile (does not include tubal ligation), or willing to practice effective contraception (as defined by the Investigator) during the study Women who are breastfeeding, pregnant, or planning to become pregnant while on study Current enrollment in any other study treatment or disease study Unwillingness or inability to comply with the requirements of this protocol, including the presence of any condition (physical, mental, or social) that is likely to affect the subject's ability to comply with the study protocol Subjects with walking impairment due to causes other than MS Other unspecified reasons that, in the opinion of the Investigator and/or Biogen Idec, make the subject unsuitable for enrollment into this study NOTE: Other eligibility criteria may apply.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Medical Director
Organizational Affiliation
Biogen
Official's Role
Study Director
Facility Information:
Facility Name
Biogen Idec Investigative Site
City
Liege
Country
Belgium
Facility Name
Biogen Idec Investigative Site
City
Puebla
Country
Mexico
Facility Name
Biogen Idec Investigative Site
City
Bialystok
Country
Poland
Facility Name
Biogen Idec Investigative Site
City
Bydgoszcz
Country
Poland
Facility Name
Biogen Idec Investigative Site
City
Lotz
Country
Poland
Facility Name
Biogen Idec Investigative Site
City
Poznan
Country
Poland
Facility Name
Biogen Idec Investigative Site
City
Warszawa
Country
Poland
Facility Name
Biogen Idec Investigative Site
City
Bucharest
Country
Romania
Facility Name
Biogen Idec Investigative Site
City
Mures
Country
Romania
Facility Name
Biogen Idec Investigative Site
City
Riyadh
Country
Saudi Arabia
Facility Name
Biogen Idec Investigative Site
City
Dnipropetrovsk
Country
Ukraine
Facility Name
Biogen Idec Investigative Site
City
Kharkiv
Country
Ukraine
Facility Name
Biogen Idec Investigative Site
City
Kyiv
Country
Ukraine
Facility Name
Biogen Idec Investigative Site
City
Lviv
Country
Ukraine
Facility Name
Biogen Idec Investigative Site
City
Simferopol
Country
Ukraine

12. IPD Sharing Statement

Citations:
PubMed Identifier
25511792
Citation
Voloshyna N, Havrdova E, Hutchinson M, Nehrych T, You X, Belachew S, Hotermans C, Paes D. Natalizumab improves ambulation in relapsing-remitting multiple sclerosis: results from the prospective TIMER study and a retrospective analysis of AFFIRM. Eur J Neurol. 2015 Mar;22(3):570-7. doi: 10.1111/ene.12618. Epub 2014 Dec 15.
Results Reference
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A Prospective, Open-label, Non-randomized, Clinical Trial to Determine if Natalizumab (Tysabri®) Improves Ambulatory Measures in Relapsing-remitting Multiple Sclerosis (RRMS) Patients

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