A Study to Investigate the Radiological Onset of Action After Treatment Initiation With Subcutaneous (SC) Natalizumab in Participants With Relapsing-Remitting Multiple Sclerosis (RRMS)

Multiple Sclerosis, Relapsing-Remitting Clinical Trial

Official title:

A Prospective, Multicenter, Interventional, Open-Label, Single-arm Phase IV Study Over 24 Weeks to Investigate the Radiological Onset of Action After Treatment Initiation With Subcutaneous Natalizumab in Patients With Relapsing-Remitting Multiple Sclerosis (TYS-ON)

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT05532163
• Other study ID #: DE-TYS-12072
• Secondary ID: 2022-001820-14
• Status: Terminated
• Phase: Phase 4
• Start date: January 23, 2023
• Est. completion date: October 31, 2023

Study information

• Verified date: April 2024
• Source: Biogen
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The primary objective of this study is to evaluate the radiological efficacy of SC natalizumab over time through Week 24 in natalizumab-naïve participants, as measured by brain magnetic resonance imaging (MRI). The secondary objectives of this study are to evaluate additional lesion-related radiological efficacy measures over time, relapse-based clinical efficacy measures, disability improvement and worsening (EDSS), pharmacokinetic and pharmacodynamic parameters, the immunogenicity of repeated doses, and safety in treatment-naïve participants of SC natalizumab.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 1
• Est. completion date: October 31, 2023
• Est. primary completion date: October 31, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 60 Years

Eligibility

Key Inclusion Criteria:

• Diagnosis of RRMS according to the McDonald criteria
• Treatment-naïve in respect to natalizumab as disease modifying monotherapy for RRMS
• No or not more than one prior MS disease-modifying therapy
• Highly active RRMS, as defined by at least one relapse in the previous year and at least one T1 gadolinium-enhancing lesion or =3 new or enlarging T2 lesions
• EDSS score = 5.5 at Screening
• Estimated glomerular filtration rate (eGFR) >30 millilitre per min (mL/min), as estimated using the Cockcroft-Gault formula.

Key Exclusion Criteria:

• Primary- and secondary-progressive MS
• Participants for whom MRI is contraindicated
• History of any clinically significant cardiac, endocrinologic, hematologic, hepatic, immunologic, metabolic (including diabetes), urologic, pulmonary, neurologic (except for RRMS), dermatologic, psychiatric, renal, or other major disease that would preclude participation in a clinical study
• History of severe allergic or anaphylactic reactions or known hypersensitivity to any antibody drug therapy. NOTE: Other protocol defined Inclusion/Exclusion criteria may apply.

Related Conditions & MeSH terms

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

Intervention

Drug:
• Natalizumab
Administered as specified in the treatment arm

Locations

Country	Name	City	State
Germany	Neurologische Praxis Dr. med. Boris-Alexander Kallmann	Bamberg
Germany	Neurologische Studiengesellschaft Bonn GbR	Bonn

Sponsors (1)

Lead Sponsor	Collaborator
Biogen

Country where clinical trial is conducted

Germany, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Cumulative Number of Active Lesions (CUALs) Through Week 24	Cumulative number of active lesions will be calculated as the sum of the number of gadolinium (Gd)-enhancing lesions and new or enlarging T2 hyperintense lesions that are non-enhancing on post-gadolinium T1-weighted (T1w) scans. It is also referred to as combined unique active lesions (CUALs).	Up to Week 24
Secondary	Cumulative Number of CUALs Through Weeks 4, 8, and 12	CUALs will be calculated as the sum of the number of Gd-enhancing lesions and new or enlarging T2 hyperintense lesions that are non-enhancing on post-gadolinium T1w scans.	Weeks 4, 8, and 12
Secondary	Absolute Number of CUALs at Weeks 4, 8, 12, and 24	CUALs will be calculated as the sum of the number of Gd-enhancing lesions and new or enlarging T2 hyperintense lesions that are non-enhancing on post-gadolinium T1w scans.	Weeks 4, 8, 12, and 24
Secondary	Mean Change From Baseline of CUALs at Weeks 4, 8, 12, and 24	CUALs will be calculated as the sum of the number of Gd-enhancing lesions and new or enlarging T2 hyperintense lesions that are non-enhancing on post-gadolinium T1w scans.	Baseline, Weeks 4, 8, 12, and 24
Secondary	Cumulative Number of New Gd-Enhancing Lesions Through Weeks 4, 8, 12, and 24	Cumulative number will be calculated as the sum of the number of Gd-enhancing lesions through Weeks 4, 8, 12, and 24.	Weeks 4, 8, 12, and 24
Secondary	Absolute Number of New Gd-Enhancing Lesions at Weeks 4, 8, 12, and 24		Weeks 4, 8, 12, and 24
Secondary	Absolute Number of Persisting Gd-Enhancing Lesions at Weeks 4, 8, 12, and 24		Weeks 4, 8, 12, and 24
Secondary	Absolute Number of Any (New or Persisting) Gd-Enhancing Lesions at Weeks 4, 8, 12, and 24		Weeks 4, 8, 12, and 24
Secondary	Change From Baseline of Any (New or Persisting) Gd-Enhancing Lesions at Weeks 4, 8, 12, and 24		Baseline, Weeks 4, 8, 12, and 24
Secondary	Cumulative Number of New or Enlarging T2 Lesions at Weeks 4, 8, 12, and 24	Cumulative number will be calculated as the sum of the number of new or enlarging T2 hyperintense lesions through Weeks 4, 8, 12, and 24.	Weeks 4, 8, 12, and 24
Secondary	Absolute Number of New or Enlarging T2 Lesions at Weeks 4, 8, 12, and 24		Weeks 4, 8, 12, and 24
Secondary	Change From Baseline of New or Enlarging T2 Lesions at Weeks 4, 8, 12, and 24		Baseline, Weeks 4, 8, 12, and 24
Secondary	Annualized Relapse Rate	Multiple sclerosis (MS) relapse is defined as the onset of new or recurrent neurological symptoms lasting at least 24 hours, accompanied by new objective abnormalities on a neurological examination, and not explained solely by non-MS processes such as fever, infection, severe stress, or drug toxicity. ARR is defined as the total number of relapses divided by the total participant-time at risk of relapse.	Week 24
Secondary	Time to First Relapse	MS relapse is defined as the onset of new or recurrent neurological symptoms lasting at least 24 hours, accompanied by new objective abnormalities on a neurological examination, and not explained solely by non-MS processes such as fever, infection, severe stress, or drug toxicity. Time to first MS relapse will be calculated as the date from first study drug administration through the date of the first relapse, if applicable.	Up to Week 24
Secondary	Number of Participants With Expanded Disability Status Scale (EDSS) Improvement and Stable Disease and Worsening at Weeks 12, and 24	The EDSS measures the disability status of people with multiple sclerosis on a scale that ranges from 0 to 10. The first levels 1.0 to 4.5 refer to people with a high degree of ambulatory ability and the subsequent levels 5.0 to 9.5 refer to the loss of ambulatory ability. The range of main categories include (0) = normal neurologic exam; to (5) = ambulatory without aid or rest for 200 meters; disability severe enough to impair full daily activities; to (10) = death due to MS. Stable disease is defined as +/- 0.5 change of EDSS. Worsening is > 0.5 increase of EDSS.	Baseline, Weeks 12, and 24
Secondary	Trough Serum Natalizumab Concentration (Ctrough)		Pre dose on Baseline, Weeks 4, 8, 12, and 24
Secondary	Trough alpha 4 (a4) Integrin Saturation		Pre dose on Baseline, Weeks 4, 8, 12, and 24
Secondary	Change From Baseline in Lymphocyte Subsets Count	Lymphocyte subsets include T cells, B cells and natural killer cells (cluster of differentiate 4 [CD4], CD8, CD19, and CD56).	Baseline up to Week 24
Secondary	Change From Baseline in Anti-Natalizumab Antibodies		Pre dose on Baseline, Weeks 12, and 24
Secondary	Persistence of Anti-Natalizumab Antibodies	Re-test will be done for antibodies after 6 weeks of first positive result.	Re-test after 6 weeks of first positive result (up to Week 24)
Secondary	Number of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)	An AE is any untoward medical occurrence in a participant or clinical investigation participant administered a pharmaceutical product and that does not necessarily have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medicinal (investigational) product, whether or not related to the medicinal (investigational) product. SAE is any untoward medical occurrence that at any dose results in death, in the view of the investigator, places the participant at immediate risk of death (a life-threatening event), requires inpatient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, results in a congenital anomaly/birth defect or is a medically important event.	Up to Week 24