Advanced MRI Measures of Repair in Alemtuzumab Treated Patients

Relapsing Remitting Multiple Sclerosis Clinical Trial

— iCAMMS-IST  

Official title:

Advanced Magnetic Resonance Imaging Measures of Repair in Alemtuzumab Treated Patients

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01307332
• Other study ID #: H10-02482
• Secondary ID: 142402
• Status: Completed
• Phase: Phase 3
• Start date: March 2011
• Est. completion date: September 28, 2018

Study information

• Verified date: October 2018
• Source: University of British Columbia
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

There are two parts to this investigator sponsored trial (IST):

1. To perform advanced serial MRI studies on patients initiating alemtuzumab therapy.

2. To provide serum samples for the University of Southern California (USC) ICAM125 lymphocyte recovery study.

Description:

Multiple Sclerosis (MS) is an inflammatory demyelinating disease of the Central Nervous System (CNS). There are many forms of MS; although the majority are Relapsing Remitting (RRMS) representing approximately 80% of the cases. The disease appears to be more inflammatory in RRMS as manifested by an increase in Gadolinium (Gd) enhancement on MRI and an increase in inflammatory bio-assay markers.

Alemtuzumab; a humanized monoclonal antibody that targets the CD52 molecule present on T and B lymphocytes, natural killer (NK) cells, and monocytes and macrophages; effects rapid and sustained lymphocyte depletion and is approved for the treatment of B-cell chronic lymphocytic leukemia in many countries under the names CAMPATH or MabCAMPATH.

There are two parts to this Investigator Sponsored Trial (IST):

1. To perform advanced serial MRI studies on patients initiating alemtuzumab therapy.

2. To provide serum samples for the University of Southern California (USC) ICAM125 lymphocyte recovery study.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 27
• Est. completion date: September 28, 2018
• Est. primary completion date: September 28, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 50 Years

Eligibility

Inclusion Criteria:

• Signed, informed consent form

• Age 18 to 50 years old (inclusive)

• Diagnosis of MS per update of McDonald criteria, and cranial MRI scan demonstrating white matter lesions attributable to MS within 10 years of screening

• Onset of MS symptoms within 15 years of screening

• Neurostatus (EDSS) score 0.0 to 5.0 (inclusive)

• 2 MS attacks (first episode or relapse) occurring in the 24 months prior to screening, with 1 attack in the 12 months prior to screening, with objective neurological signs confirmed by a physician.

Exclusion Criteria:

• Received prior therapy for MS other than corticosteroids within 28 days of screening; e.g., interferon's, IV immunoglobulin, and glatiramer acetate

• Exposure to natalizumab within 6 months of screening

• Any prior exposure to mitoxantrone, mycophenolate mofetil, azathioprine, cladribine, cyclophosphamide, cyclosporine A, methotrexate, rituximab, or any other immunosuppressive agent other than systemic corticosteroid treatment

• Has any progressive form of MS

• History of malignancy (exception for basal cell skin carcinoma)

• Previous hypersensitivity reaction to other immunoglobulin product

• Intolerance of pulsed corticosteroids, especially a history of steroid psychosis

• CD4+, CD8+, or CD19+ (i.e., absolute CD3+CD4+, CD3+CD8+, or CD19+/mm3) count <LLN at Screening; if abnormal cell count(s) return to within normal limits, eligibility may be reassessed

• Seropositivity for human immunodeficiency virus (HIV)

• Significant autoimmune disease (e.g, immune cytopenias, rheumatoid arthritis, systemic lupus erythematosus, other connective tissue disorders; vasculitis; inflammatory bowel disease; severe psoriasis)

• Presence of anti-thyroid stimulating hormone (TSH) receptor (TSHR) antibodies

• Active infection

• Latent tuberculosis unless effective anti-tuberculosis therapy has been completed, or active tuberculosis.

• Infection with hepatitis B virus or hepatitis C virus

• Of childbearing potential with a positive serum pregnancy test

• Unwilling to agree to use a reliable and acceptable contraceptive method throughout the study period

• Major psychiatric disorder that is not adequately controlled by treatment

• Epileptic seizures that are not adequately controlled by treatment

• Major systemic disease or other illness that would, in the opinion of the Investigator, compromise patient safety or interfere with the interpretation of study results

• Medical, psychiatric, cognitive, or other conditions

• Confirmed platelet count the lower limit of normal (LLN) of the evaluating laboratory at Screening or documented at 100,000/L within the past year on a sample without clumping

• Prior history of invasive fungal infections

• Cervical high risk human papilloma virus (HPV) positivity or abnormal cervical cytology other than abnormal squamous cells of undetermined significance (ASCUS).

• Seropositive for Trypanosoma cruzi or the Human T-lymphotropic virus type I or type II (HTLV-I/II) (testing required in endemic regions only)

• Any other illness or infection (latent or active) that, in the Investigator's opinion, could be exacerbated by alemtuzumab treatment

• Any hepatic or renal function value grade 2 or higher at Screening, with the exception of hyperbilirubinemia due to Gilbert's syndrome.

Related Conditions & MeSH terms

• Multiple Sclerosis
• Multiple Sclerosis, Relapsing-Remitting
• Relapsing Remitting Multiple Sclerosis
• Sclerosis

Intervention

Drug:
• MabCampath-1h
Drug:10 mg/mL alemtuzumab intravenous infusion. Form: Sterile, clear, colorless solution. Dosage: 2 cycles. Month 0 dosed over 5 consecutive days; month 12 dosed over 3 consecutive days.

Locations

Country	Name	City	State
Canada	University of British Columbia Hospital	Vancouver	British Columbia

Sponsors (2)

Lead Sponsor	Collaborator
University of British Columbia	Genzyme, a Sanofi Company

Country where clinical trial is conducted

Canada, 

References & Publications (2)

CAMMS223 Trial Investigators, Coles AJ, Compston DA, Selmaj KW, Lake SL, Moran S, Margolin DH, Norris K, Tandon PK. Alemtuzumab vs. interferon beta-1a in early multiple sclerosis. N Engl J Med. 2008 Oct 23;359(17):1786-801. doi: 10.1056/NEJMoa0802670. — View Citation

Coles AJ, Cox A, Le Page E, Jones J, Trip SA, Deans J, Seaman S, Miller DH, Hale G, Waldmann H, Compston DA. The window of therapeutic opportunity in multiple sclerosis: evidence from monoclonal antibody therapy. J Neurol. 2006 Jan;253(1):98-108. Epub 2005 Jul 27. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Changes in normal appearing white matter from baseline through month 24.	The MRI study is designed to identify possible mechanisms by which alemtuzumab acts to protect the brain from inflammation and how it may enhance repair through remyelination.	24 months
Secondary	To identify specific changes in T cell subsets and functions in Relapsing Remitting Multiple Sclerosis from baseline through month 48.	Analyzing changes is immune responsiveness may reveal critical information about the mechanisms by which alemtuzumab acts, confirm the importance of specific immune cell types or molecules as targets for alemtuzumab treatment or may also be useful for monitoring drug effectiveness and safety.	48 months