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Impact of Ocrelizumab on Cerebrospinal Fluid Biomarkers at Multiple Sclerosis Onset (IMPACT MS)

Primary Purpose

Relapsing Multiple Sclerosis, Clinically Isolated Syndrome

Status
Active
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Ocrelizumab
Sponsored by
University of California, San Francisco
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Relapsing Multiple Sclerosis

Eligibility Criteria

18 Years - 50 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Patients must meet the following criteria to be included in this study:

  • Signed Consent Form
  • High-risk clinically isolated syndrome or relapsing MS Diagnosis (based on 2017 International Panel Criteria)
  • Age 18-50 inclusive
  • Screening within 90 days of first clinical demyelinating event typical of MS with 1 or more inactive lesions typical of MS
  • No prior MS disease modifying therapy
  • No corticosteroids within 7 days of first ocrelizumab treatment
  • EDSS < 4.0
  • A negative urine or serum pregnancy test must be available for premenopausal women and for women <12 months after the onset of menopause, unless they have undergone surgical sterilization.
  • Women of childbearing potential must agree to remain abstinent (refrain from heterosexual intercourse) or use one method of contraception with a failure rate of <1% per year or a barrier method supplemented with spermicide. Contraception must continue for the duration of study treatment and for at least 24 weeks after the last dose of study treatment. A woman is considered to be of childbearing potential if she is postmenarcheal, has not reached a postmenopausal state (≥ 12 continuous months of amenorrhea with no identified cause of other than menopause), and has not undergone surgical sterilization (removal of the ovaries and/or uterus).

    • Examples of contraceptive methods with a failure rate of <1% per year include bilateral tube ligation, male sterilization, established hormonal contraceptives that inhibit ovulation, hormone-releasing intrauterine devices, and copper intrauterine devices.
    • The reliability of sexual abstinence should be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the patient. Periodic abstinence and withdrawal are not acceptable methods of contraception.
    • Examples of barrier methods supplemented with the use of spermicide include male or female condom, cap, diaphragm, or sponge.

Exclusion Criteria:

Patients will be excluded from the study based on the following criteria:

  • Pregnancy, lactation, or intention to become pregnant during the study
  • Progressive MS (primary or secondary)
  • Disease other than MS to explain the first demyelinating event; including AQP4 IgG seropositivity
  • Unwilling or unsafe to proceed with CSF exams based on coagulopathy or anatomy or other considerations in the judgment of the study investigator
  • Unwilling or unsafe to proceed with MRI
  • Active hepatitis B virus infection
  • Untreated latent or active tuberculosis
  • Active hepatitis C virus infection
  • HIV infection
  • Hypersensitivity to trial medications
  • History of life-threatening infusion reaction to MAbs

Sites / Locations

  • University of California San Francisco

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

No Intervention

Arm Label

Ocrelizumab treated

Observational study cohort

Arm Description

Participants age 18-50 with a first clinical presentation of MS or high-risk CIS diagnosed within 90 days of screening will be treated with ocrelizumab (300 mg IV x 2 doses given 2 weeks apart) at disease origin and with maintenance ocrelizumab 600 mg every 6 months through 30 months with a final study visit at 3 years

Subjects enrolled into an observational study matched for the same disease duration and who are either untreated or treated with alternate MS disease modifying therapies will serve as a parallel reference group

Outcomes

Primary Outcome Measures

Comparison of intrathecal synthesis of gammaglobulins in treatment-naïve relapsing MS and clinically isolated syndrome participants before and after treatment with ocrelizumab
Comparison of intrathecal synthesis of gammaglobulins in treatment-naïve relapsing MS and clinically isolated syndrome participants before and after 3 years of treatment with ocrelizumab. Intrathecal synthesis is measured by either a) normalization of the IgG Index (0.6 is the upper limit of normal) or b) eradication of oligoclonal bands

Secondary Outcome Measures

Full Information

First Posted
July 7, 2020
Last Updated
September 19, 2023
Sponsor
University of California, San Francisco
Collaborators
Genentech, Inc., Valhalla Foundation
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1. Study Identification

Unique Protocol Identification Number
NCT04466150
Brief Title
Impact of Ocrelizumab on Cerebrospinal Fluid Biomarkers at Multiple Sclerosis Onset
Acronym
IMPACT MS
Official Title
Impact of Ocrelizumab on Cerebrospinal Fluid Biomarkers at Multiple Sclerosis Onset
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
August 30, 2020 (Actual)
Primary Completion Date
December 2026 (Anticipated)
Study Completion Date
July 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of California, San Francisco
Collaborators
Genentech, Inc., Valhalla Foundation

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.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Newly diagnosed relapsing multiple sclerosis (MS) and high risk clinically isolated syndrome (CIS) patients will be treated with ocrelizumab at disease onset to see if treatment favorably alters CSF markers of chronic inflammation.
Detailed Description
Newly diagnosed relapsing multiple sclerosis (MS) and high risk clinically isolated syndrome (CIS) patients age 18-50 will be treated with ocrelizumab within 90 days of first clinical MS/CIS presentation and re-dosed as maintenance therapy every 6 months for 3 years to see if treatment favorably alters CSF markers of chronic inflammation Investigators hope data that will provide a foundation for further studies that treating relapsing MS patients at clinical onset (using a B-cell depleting therapy) may improve longer-term outcomes.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Relapsing Multiple Sclerosis, Clinically Isolated Syndrome

7. Study Design

Primary Purpose
Basic Science
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Model Description
This is a nested case-controlled study. By nesting this ocrelizumab interventional treatment arm within an observational study, the investigators will be able to compare treatment with ocrelizumab to usual care for patients who are matched for the same disease duration. Because the same clinical and biomarker assessments will be acquired for both the ocrelizumab interventional arm and the usual care observational cohort, this study will allow direct comparison of ocrelizumab with a usual care control group.
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
30 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Ocrelizumab treated
Arm Type
Active Comparator
Arm Description
Participants age 18-50 with a first clinical presentation of MS or high-risk CIS diagnosed within 90 days of screening will be treated with ocrelizumab (300 mg IV x 2 doses given 2 weeks apart) at disease origin and with maintenance ocrelizumab 600 mg every 6 months through 30 months with a final study visit at 3 years
Arm Title
Observational study cohort
Arm Type
No Intervention
Arm Description
Subjects enrolled into an observational study matched for the same disease duration and who are either untreated or treated with alternate MS disease modifying therapies will serve as a parallel reference group
Intervention Type
Drug
Intervention Name(s)
Ocrelizumab
Other Intervention Name(s)
Ocrevus
Intervention Description
open label biomarker study
Primary Outcome Measure Information:
Title
Comparison of intrathecal synthesis of gammaglobulins in treatment-naïve relapsing MS and clinically isolated syndrome participants before and after treatment with ocrelizumab
Description
Comparison of intrathecal synthesis of gammaglobulins in treatment-naïve relapsing MS and clinically isolated syndrome participants before and after 3 years of treatment with ocrelizumab. Intrathecal synthesis is measured by either a) normalization of the IgG Index (0.6 is the upper limit of normal) or b) eradication of oligoclonal bands
Time Frame
3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must meet the following criteria to be included in this study: Signed Consent Form High-risk clinically isolated syndrome or relapsing MS Diagnosis (based on 2017 International Panel Criteria) Age 18-50 inclusive Screening within 90 days of first clinical demyelinating event typical of MS with 1 or more inactive lesions typical of MS No prior MS disease modifying therapy No corticosteroids within 7 days of first ocrelizumab treatment EDSS < 4.0 A negative urine or serum pregnancy test must be available for premenopausal women and for women <12 months after the onset of menopause, unless they have undergone surgical sterilization. Women of childbearing potential must agree to remain abstinent (refrain from heterosexual intercourse) or use one method of contraception with a failure rate of <1% per year or a barrier method supplemented with spermicide. Contraception must continue for the duration of study treatment and for at least 24 weeks after the last dose of study treatment. A woman is considered to be of childbearing potential if she is postmenarcheal, has not reached a postmenopausal state (≥ 12 continuous months of amenorrhea with no identified cause of other than menopause), and has not undergone surgical sterilization (removal of the ovaries and/or uterus). Examples of contraceptive methods with a failure rate of <1% per year include bilateral tube ligation, male sterilization, established hormonal contraceptives that inhibit ovulation, hormone-releasing intrauterine devices, and copper intrauterine devices. The reliability of sexual abstinence should be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the patient. Periodic abstinence and withdrawal are not acceptable methods of contraception. Examples of barrier methods supplemented with the use of spermicide include male or female condom, cap, diaphragm, or sponge. Exclusion Criteria: Patients will be excluded from the study based on the following criteria: Pregnancy, lactation, or intention to become pregnant during the study Progressive MS (primary or secondary) Disease other than MS to explain the first demyelinating event; including AQP4 IgG seropositivity Unwilling or unsafe to proceed with CSF exams based on coagulopathy or anatomy or other considerations in the judgment of the study investigator Unwilling or unsafe to proceed with MRI Active hepatitis B virus infection Untreated latent or active tuberculosis Active hepatitis C virus infection HIV infection Hypersensitivity to trial medications History of life-threatening infusion reaction to MAbs
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Bruce Cree, MD, PhD, MAS
Organizational Affiliation
University of California, San Francisco
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of California San Francisco
City
San Francisco
State/Province
California
ZIP/Postal Code
94158
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Outcome data (biomarker, genotypic) as well as study data related to diagnosis, disease presentation, and date of birth, along with biological specimens collected as part of the study, may be shared (in coded form) in the future with other qualified researchers, government data registries, and/or commercial entities on a case by case basis at the discretion of the PI and Co-PIs. Any such investigator/entity will be required to provide appropriate documentation that the research being conducted has been approved by an Institutional Review Board and demonstrate that it will be of scientific value.
IPD Sharing Time Frame
Clinical study report to Sponsor estimated May 2025. Other data/samples will be shared after initial results are published and on a case by case basis.
IPD Sharing Access Criteria
Collaborators, other scientific Investigators, Government Health and research agencies, Commercial Companies may request data and/or samples. The request process includes submitting a research proposal, having necessary IRB approval and material transfer agreements.
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Impact of Ocrelizumab on Cerebrospinal Fluid Biomarkers at Multiple Sclerosis Onset

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