Evaluation of Safety, Tolerability and Preliminary Efficacy of EHP-101 in Relapsing Forms of Multiple Sclerosis
Primary Purpose
Relapsing Forms of Multiple Sclerosis
Status
Suspended
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
EHP-101 25 mg OD
EHP-101 25 mg BID
EHP-101 50 mg OD
EHP-101 50 mg BID
Sponsored by
About this trial
This is an interventional treatment trial for Relapsing Forms of Multiple Sclerosis focused on measuring Multiple Sclerosis, Nervous System Diseases, Demyelinating Autoimmune Diseases, Autoimmune Diseases of the Nervous System, Relapsing Forms of Multiple Sclerosis, Relapsing Remitting Multiple Sclerosis, Relapsing Secondary Progressive Multiple Sclerosis
Eligibility Criteria
Inclusion Criteria:
- Male and female adults aged 18 to 55 years at the time of consent;
- Confirmed diagnosis of MS according to the revised 2017 McDonald criteria;
- Relapsing forms of MS (RMS) including Relapsing-Remitting MS (RRMS) and active Secondary Progressive MS (SPMS);
- Patients must have experienced at least 1 of the following within 12 months prior to Visit 1: an acute clinical relapse, gadolinium-enhancing T1 lesions on brain or spinal cord magnetic resonance imaging (MRI), or new T2 lesion(s) on brain or spinal cord MRI;
- Neurologically stable with no evidence of clinical relapse of MS or corticosteroid treatment within 28 days prior to the first investigational product administration;
- Naïve to prior MS treatment or discontinuing current MS treatment due to (1) intolerability, (2) laboratory abnormalities, (3) current treatment perceived by the patient to be ineffective, (4) patient preference, or (5) based on investigator judgement to switch MS therapy;
- An EDSS score of 0 to 6.0 (inclusive) at screening and enrolment visit;
- Willing and able to provide informed consent and capable of understanding and complying with the protocol.
Exclusion Criteria:
- Primary progressive MS (PPMS) or non-active secondary progressive MS (SPMS);
- Relapse during the 28 days prior to first investigational product administration;
- Total lymphoid irradiation, T-cell or T-cell receptor vaccination, total body irradiation, or total lymphoid irradiation at any time;
- Treatment with alemtuzumab, mitoxantrone, cyclophosphamide or cladribine at any time;
MS treatment that may impact the efficacy or safety assessment defined as follows:
- 52 weeks or less prior to first investigational product administration: Immunosuppressant agents (e.g., cyclosporine, methotrexate, mycophenolate)
- 36 weeks or less prior to first investigational product administration: CD20 depletion therapies such as rituximab, ocrelizumab, ofatumumab or others. Condition for inclusion of patients who had CD20 depletion therapies more than 36 weeks prior to the first investigational product administration: may only be included if there is no clinically relevant B cell depletion and possible safety risk to patients based on the Investigator's opinion.
- 12 weeks or less prior to first investigational product administration: natalizumab
- 8 weeks or less prior to first investigational product administration: dimethyl-fumarate fingolimod
- 4 weeks or less prior to first investigational product administration: corticosteroids intravenous immunoglobulin (IVIG) ozanimod, siponimod, or ponesimod glatiramer acetate interferons
- 2 weeks or less prior to first investigational product administration: teriflunomide. Subject must exhibit no active agent in serum levels; cholestyramine or activated charcoal washout may be used to achieve this;
Any one of the following values for laboratory test at screening:
- Haemoglobin < 9 g/dL;
- Neutrophils < 1.0 x 10^9/L;
- Platelets < 75 x 10^9/L;
- Serum transaminases > 2.0 x upper limit of normal;
- Total bilirubin ≥ 1.5 x upper limit of normal;
- Thyroid-stimulating hormone level >10% above of the upper limit of normal;
- Estimated glomerular filtration rate ≤60 mL/min/1.73m2 (using the Cockcroft-Gault equation);
- Lymphocytes < 1 × 10^9/L;
Sites / Locations
- North Central Neurology Associates
- Fullerton Neurology and Headache Center
- Accel Research Sites - Brain and Spine Institute of Port Orange
- St. Vincent's Hospital
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Experimental
Arm Label
EHP-101 Once a day (OD)
EHP-101 Twice a day (BID)
Arm Description
Outcomes
Primary Outcome Measures
Incidence and severity of Treatment Emergent Adverse Events
This safety outcome combines the measure of the number of subjects experiencing adverse events (AEs), the nature and severity of those AEs and their relationship to the study treatments
Secondary Outcome Measures
Brain lesion activity measured by MRI
Disease progression measured by MS Functional Composite (MSFC)
The MSFC consists of three assessments of walking speed, processing speed and finger dexterity. The scores are combined to provide a Z-score (number of standard deviations away from mean of a normal population) with lower scores representing greater abnormality
Disease progression measured by Expanded Disability Status Scale (EDSS)
The EDSS is an ordinal scale used for assessing neurological impairment of MS based on a neurological examination. It consists of scores in each of seven functional systems (FS) and 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, and Cerebral functions. The FSs and EDSS steps will be assessed in a standardized manner
Disease progression measured by Symbol Digit Modalities Test (SDMT)
The SDMT measures the time to pair abstract symbols with specific numbers. The test requires elements of attention, visuoperceptual processing, working memory, and psychomotor speed. The score is the number of correctly coded items from 0-110 in 90 seconds. The total score provides a measure of the speed and accuracy of symbol-digit substitution
Disability status measured by MS Functional Composite (MSFC)
The MSFC consists of three assessments of walking speed, processing speed and finger dexterity. The scores are combined to provide a Z-score (number of standard deviations away from mean of a normal population) with lower scores representing greater abnormality
Disability status measured by Expanded Disability Status Scale (EDSS)
The EDSS is an ordinal scale used for assessing neurological impairment of MS based on a neurological examination. It consists of scores in each of seven functional systems (FS) and 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, and Cerebral functions. The FSs and EDSS steps will be assessed in a standardized manner
Disability status measured by Symbol Digit Modalities Test (SDMT)
The SDMT measures the time to pair abstract symbols with specific numbers. The test requires elements of attention, visuoperceptual processing, working memory, and psychomotor speed. The score is the number of correctly coded items from 0-110 in 90 seconds. The total score provides a measure of the speed and accuracy of symbol-digit substitution
Time to first relapse
Preliminary Annualized Relapse Rate (ARR)
Percent of patients who experience a relapse
Proportion of patients who remain qualified as relapse-free
Change in blood levels of neurofilament light chain (NfL)
Full Information
NCT ID
NCT04909502
First Posted
May 14, 2021
Last Updated
October 19, 2022
Sponsor
Emerald Health Pharmaceuticals
1. Study Identification
Unique Protocol Identification Number
NCT04909502
Brief Title
Evaluation of Safety, Tolerability and Preliminary Efficacy of EHP-101 in Relapsing Forms of Multiple Sclerosis
Official Title
A Phase IIa, Open-label, Multicentre Dose-Finding Trial in Patients With Relapsing Forms of Multiple Sclerosis (RMS) to Evaluate the Safety, Tolerability and Preliminary Efficacy of EHP-101
Study Type
Interventional
2. Study Status
Record Verification Date
April 2022
Overall Recruitment Status
Suspended
Why Stopped
Temporary recruitment pause to re-assess the protocol design, specifically the eligibility criteria
Study Start Date
October 19, 2021 (Actual)
Primary Completion Date
December 2023 (Anticipated)
Study Completion Date
April 2024 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Emerald Health Pharmaceuticals
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
5. Study Description
Brief Summary
The purpose of this trial is to evaluate the safety, tolerability, pharmacokinetics, and preliminary efficacy of EHP-101 in adult subjects with Relapsing Forms of Multiple Sclerosis (RMS).
Detailed Description
An interventional, open label, randomized design will be used to test safety, tolerability, pharmacokinetics, and preliminary efficacy of EHP-101 in 50 patients ≥ 18 and ≤ 55 years of age with documented RMS. There will be a screening period of up to 28 days, 168 days treatment period, and 28 days follow-up.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Relapsing Forms of Multiple Sclerosis
Keywords
Multiple Sclerosis, Nervous System Diseases, Demyelinating Autoimmune Diseases, Autoimmune Diseases of the Nervous System, Relapsing Forms of Multiple Sclerosis, Relapsing Remitting Multiple Sclerosis, Relapsing Secondary Progressive Multiple Sclerosis
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
The study will initially be conducted with 2 treatment arms starting in parallel. Patients will initially receive a 25 mg OD or a 25 mg BID dose. After 28 days, each patient will increase to a 50 mg OD or 50mg BID dose level, respectively, if deemed to be safe by the investigator.
Masking
None (Open Label)
Masking Description
Open Label design
Allocation
Non-Randomized
Enrollment
50 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
EHP-101 Once a day (OD)
Arm Type
Experimental
Arm Title
EHP-101 Twice a day (BID)
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
EHP-101 25 mg OD
Intervention Description
25 mg OD during the first 28 Days of the trial
Intervention Type
Drug
Intervention Name(s)
EHP-101 25 mg BID
Intervention Description
25 mg BID during the first 28 Days of the trial
Intervention Type
Drug
Intervention Name(s)
EHP-101 50 mg OD
Intervention Description
After 28 Days of treatment with 25 mg OD, patients will escalate to 50 mg OD up to the end of the trial
Intervention Type
Drug
Intervention Name(s)
EHP-101 50 mg BID
Intervention Description
After 28 Days of treatment with 25 mg BID, patients will escalate to 50 mg BID up to the end of the trial
Primary Outcome Measure Information:
Title
Incidence and severity of Treatment Emergent Adverse Events
Description
This safety outcome combines the measure of the number of subjects experiencing adverse events (AEs), the nature and severity of those AEs and their relationship to the study treatments
Time Frame
168 days (24 weeks)
Secondary Outcome Measure Information:
Title
Brain lesion activity measured by MRI
Time Frame
168 days (24 weeks)
Title
Disease progression measured by MS Functional Composite (MSFC)
Description
The MSFC consists of three assessments of walking speed, processing speed and finger dexterity. The scores are combined to provide a Z-score (number of standard deviations away from mean of a normal population) with lower scores representing greater abnormality
Time Frame
168 days (24 weeks)
Title
Disease progression measured by Expanded Disability Status Scale (EDSS)
Description
The EDSS is an ordinal scale used for assessing neurological impairment of MS based on a neurological examination. It consists of scores in each of seven functional systems (FS) and 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, and Cerebral functions. The FSs and EDSS steps will be assessed in a standardized manner
Time Frame
168 days (24 weeks)
Title
Disease progression measured by Symbol Digit Modalities Test (SDMT)
Description
The SDMT measures the time to pair abstract symbols with specific numbers. The test requires elements of attention, visuoperceptual processing, working memory, and psychomotor speed. The score is the number of correctly coded items from 0-110 in 90 seconds. The total score provides a measure of the speed and accuracy of symbol-digit substitution
Time Frame
168 days (24 weeks)
Title
Disability status measured by MS Functional Composite (MSFC)
Description
The MSFC consists of three assessments of walking speed, processing speed and finger dexterity. The scores are combined to provide a Z-score (number of standard deviations away from mean of a normal population) with lower scores representing greater abnormality
Time Frame
168 days (24 weeks)
Title
Disability status measured by Expanded Disability Status Scale (EDSS)
Description
The EDSS is an ordinal scale used for assessing neurological impairment of MS based on a neurological examination. It consists of scores in each of seven functional systems (FS) and 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, and Cerebral functions. The FSs and EDSS steps will be assessed in a standardized manner
Time Frame
168 days (24 weeks)
Title
Disability status measured by Symbol Digit Modalities Test (SDMT)
Description
The SDMT measures the time to pair abstract symbols with specific numbers. The test requires elements of attention, visuoperceptual processing, working memory, and psychomotor speed. The score is the number of correctly coded items from 0-110 in 90 seconds. The total score provides a measure of the speed and accuracy of symbol-digit substitution
Time Frame
168 days (24 weeks)
Title
Time to first relapse
Time Frame
168 days (24 weeks)
Title
Preliminary Annualized Relapse Rate (ARR)
Time Frame
168 days (24 weeks)
Title
Percent of patients who experience a relapse
Time Frame
168 days (24 weeks)
Title
Proportion of patients who remain qualified as relapse-free
Time Frame
168 days (24 weeks)
Title
Change in blood levels of neurofilament light chain (NfL)
Time Frame
Baseline, 28 Days, 56 Days, 84 Days, 112 Days, 140 Days, 168 Days
Other Pre-specified Outcome Measures:
Title
Microstructural analysis and assessment of potential remyelination measured by Magnetization Transfer Ratio (MTR)
Time Frame
168 days (24 weeks)
Title
Assessment of white matter diffusivity and integrity measured by Diffusion Tensor Imaging (DTI)
Time Frame
168 days (24 weeks)
Title
VCE-004.8 plasma trough levels for all patients
Time Frame
197 Days (28 weeks)
Title
Pharmacokinetic profile of VCE-004.8 in terms of maximum observed plasma concentration (Cmax)
Time Frame
Day 1 (pre-dose) and at 0.5, 1, 2, 3, 4 and 6 hours post-dose on Day 1 and Day 28
Title
Pharmacokinetic profile of VCE-004.8 in terms of area under the plasma concentration-time curve (AUC)
Time Frame
Day 1 (pre-dose) and at 0.5, 1, 2, 3, 4 and 6 hours post-dose on Day 1 and Day 28
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:
Male and female adults aged 18 to 55 years at the time of consent;
Confirmed diagnosis of MS according to the revised 2017 McDonald criteria;
Relapsing forms of MS (RMS) including Relapsing-Remitting MS (RRMS) and active Secondary Progressive MS (SPMS);
Patients must have experienced at least 1 of the following within 12 months prior to Visit 1: an acute clinical relapse, gadolinium-enhancing T1 lesions on brain or spinal cord magnetic resonance imaging (MRI), or new T2 lesion(s) on brain or spinal cord MRI;
Neurologically stable with no evidence of clinical relapse of MS or corticosteroid treatment within 28 days prior to the first investigational product administration;
Naïve to prior MS treatment or discontinuing current MS treatment due to (1) intolerability, (2) laboratory abnormalities, (3) current treatment perceived by the patient to be ineffective, (4) patient preference, or (5) based on investigator judgement to switch MS therapy;
An EDSS score of 0 to 6.0 (inclusive) at screening and enrolment visit;
Willing and able to provide informed consent and capable of understanding and complying with the protocol.
Exclusion Criteria:
Primary progressive MS (PPMS) or non-active secondary progressive MS (SPMS);
Relapse during the 28 days prior to first investigational product administration;
Total lymphoid irradiation, T-cell or T-cell receptor vaccination, total body irradiation, or total lymphoid irradiation at any time;
Treatment with alemtuzumab, mitoxantrone, cyclophosphamide or cladribine at any time;
MS treatment that may impact the efficacy or safety assessment defined as follows:
52 weeks or less prior to first investigational product administration: Immunosuppressant agents (e.g., cyclosporine, methotrexate, mycophenolate)
36 weeks or less prior to first investigational product administration: CD20 depletion therapies such as rituximab, ocrelizumab, ofatumumab or others. Condition for inclusion of patients who had CD20 depletion therapies more than 36 weeks prior to the first investigational product administration: may only be included if there is no clinically relevant B cell depletion and possible safety risk to patients based on the Investigator's opinion.
12 weeks or less prior to first investigational product administration: natalizumab
8 weeks or less prior to first investigational product administration: dimethyl-fumarate fingolimod
4 weeks or less prior to first investigational product administration: corticosteroids intravenous immunoglobulin (IVIG) ozanimod, siponimod, or ponesimod glatiramer acetate interferons
2 weeks or less prior to first investigational product administration: teriflunomide. Subject must exhibit no active agent in serum levels; cholestyramine or activated charcoal washout may be used to achieve this;
Any one of the following values for laboratory test at screening:
Haemoglobin < 9 g/dL;
Neutrophils < 1.0 x 10^9/L;
Platelets < 75 x 10^9/L;
Serum transaminases > 2.0 x upper limit of normal;
Total bilirubin ≥ 1.5 x upper limit of normal;
Thyroid-stimulating hormone level >10% above of the upper limit of normal;
Estimated glomerular filtration rate ≤60 mL/min/1.73m2 (using the Cockcroft-Gault equation);
Lymphocytes < 1 × 10^9/L;
Facility Information:
Facility Name
North Central Neurology Associates
City
Cullman
State/Province
Alabama
ZIP/Postal Code
35058
Country
United States
Facility Name
Fullerton Neurology and Headache Center
City
Fullerton
State/Province
California
ZIP/Postal Code
92835
Country
United States
Facility Name
Accel Research Sites - Brain and Spine Institute of Port Orange
City
Port Orange
State/Province
Florida
ZIP/Postal Code
32127
Country
United States
Facility Name
St. Vincent's Hospital
City
Melbourne
State/Province
Victoria
ZIP/Postal Code
3065
Country
Australia
12. IPD Sharing Statement
Learn more about this trial
Evaluation of Safety, Tolerability and Preliminary Efficacy of EHP-101 in Relapsing Forms of Multiple Sclerosis
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