REbif FLEXible Dosing in Early Multiple Sclerosis (MS) (REFLEX)

Merck KGaA (EMD Serono)

Status and phase: Completed; Phase 3

Conditions: Multiple Sclerosis

Treatments: Drug: RNF; Drug: Placebo

Study type: Interventional

Funder types: Industry

Identifiers

NCT00404352

2006-002982-38 (EudraCT Number)

IMP27025

Details and patient eligibility

About

The study is a 24 months randomized, double-blind, Placebo-controlled, multi-center clinical trial with an optional 12 months open label extension.

The primary objective of the study is to evaluate the effect of fetal bovine serum [FBS]-free/human serum albumin [HSA]-free formulation of Interferon [IFN] beta-1a (RNF) 44 microgram (three times weekly and once weekly) versus placebo on the time to conversion to McDonald multiple sclerosis (MS) criteria (2005) in subjects with a first clinical demyelinating event at high risk of converting to MS.

The main secondary objective of study is to evaluate the effect of RNF 44 microgram (three times weekly and once weekly) versus placebo on the "Time to conversion to clinically definite MS (CDMS)" in subjects with a first clinical demyelinating event at high risk of converting to MS.

At the end of 24 month double-blind core REFLEX trial, subjects who will not convert to CDMS and decide to receive open-label (OL) treatment will be enrolled into an open-label, 12 month extension period to evaluate the effect of RNF 44 mcg three times weekly treatment on the time to conversion to McDonald MS and time to conversion to CDMS.

Enrollment: 517 patients

Sex: All

Ages: 18 to 50 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Single, first clinical event suggestive of MS within 60 days prior to study Day 1, which is the day of randomization (clock starts 24 hours after onset). The event must be a new neurological abnormality present for at least 24 hours, either mono- or polysymptomatic, other than a paresthesia, vegetative or cerebral dysfunction

• At least two clinically silent lesions on the T2-weighted MRI scan, with a size of at least 3 millimeter (mm), at least one of which is ovoid or periventricular or infratentorial

• EDSS 0 - 5.0 at least one time point during the screening period before start of treatment

• 18 and 50 years old, inclusive

• Willing to follow study procedures

• Written informed consent

• If female, subject must:

  • be neither pregnant nor breast-feeding nor attempting to conceive
  • use a highly effective method of contraception. A highly effective method of contraception is defined as those which result in a low failure rate (that is [i.e.] less than 1 percent [%] per year) when used consistently and correctly such as implants, injectables, combined oral contraceptives, some intrauterine devices (IUDs), sexual abstinence or vasectomised partner

Exclusion criteria

• Diagnosis of MS (per McDonald criteria 2005)
• Any other disease that could better explain the subject's signs and symptoms
• Complete transverse myelitis or bilateral optic neuritis
• Subject uses or has used any other approved MS disease-modifying drug (DMD)
• Any investigational drug or undergone an experimental procedure within 12 weeks prior to study Day 1
• Oral or systemic corticosteroids or adrenocorticotropic hormone (ACTH) within 30 days prior to study Day 1
• Total bilirubin greater than 2.5 times upper limit of normal (ULN)
• Subject has total aspartate aminotransferase (AST) or alanine aminotransferase (ALT) or alkaline phosphatase (ALP) greater than 2.5 times the ULN
• Inadequate bone marrow reserve, defined as a total white blood cell count less than 3.0 x 109 per liter (/L), platelet count less than 75 x 109/L, hemoglobin less than 100 gram per liter (g/L)
• Current autoimmune disease
• Major medical or psychiatric illness (including history of or current severe depressive disorders and/or suicidal ideation) that in the opinion of the investigator creates undue risk to the subject or could affect compliance with the study protocol
• History of seizures not adequately controlled by treatment
• Cardiac disease, such as angina, congestive heart failure or arrhythmia
• Known allergy to IFN-beta or the excipient(s) of the study medication
• Any condition that could interfere with the MRI evaluation;
• Known allergy to gadolinium-diethylene triamine pentaacetic acid (DTPA)
• Previously participated in this study
• Participated in any clinical trial within the past 6 months
• Any immunomodulatory or immunosuppressive therapy at any time prior to enrollment, including, but not limited to, the following products: any IFN, glatiramer acetate (Copolymer I), cyclophosphamide, cyclosporine, methotrexate, linomide, azathioprine, mitoxantrone, teriflunomide, laquinimod, cladribine, total lymphoid irradiation, anti-lymphocyte monoclonal antibody treatment (e.g. natalizumab, alemtuzumab/Campath, anti-cluster of differentiation 4 [CD4]), intravenous, immunoglobulins (Igs), cytokines or anti-cytokine therapy
• Any experimental MS treatment prior to trial entry, including, but not limited to, any statins (if given to prevent MS) and pentoxyfylline
• History of alcohol or drug abuse
• Intolerance or any contraindication to both paracetamol (acetaminophen) and ibuprofen
• Inability to administer subcutaneous injections either by self or by caregiver
• Moderate to severe renal impairment

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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517 participants in 3 patient groups, including a placebo group

RNF 44 mcg three times weekly

Active Comparator group

Treatment:

Drug: RNF

Drug: RNF

RNF 44 mcg once weekly and placebo twice weekly for blinding

Active Comparator group

Treatment:

Drug: RNF

Drug: Placebo

Drug: RNF

Placebo three times weekly

Placebo Comparator group

Treatment:

Drug: Placebo