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Phase II Cladribine Add-on to Inteferon-Beta (IFN-b) Therapy in MS Subjects With Active Disease (ONWARD)
This study is currently recruiting participants.
Verified by EMD Serono, March 2009
First Received: February 15, 2007   Last Updated: March 21, 2009   History of Changes
Sponsored by: EMD Serono
Information provided by: EMD Serono
ClinicalTrials.gov Identifier: NCT00436826
  Purpose

The goal of this study is to evaluate the safety, tolerability and effectiveness of oral cladribine when taken in combination with Interferon-beta therapy for the treatment of MS.

This study will randomize 200 subjects from approximately 50 sites located world-wide, who have experienced at least one relapse while taking Interferon-beta therapy within 48 weeks prior to Screening, irrespective of disability progression. Secondary progressive multiple sclerosis (SPMS) patients, who are still experiencing relapses, and patients who have received disease modifying drugs (DMDs), other than Interferon-beta therapy, during their MS treatment history, but are currently on Interferon-beta therapy and have experienced active MS symptoms (at least 1 relapse) during the 48 weeks prior to Screening, may also be enrolled.

Subjects will be randomised in a 2:1 fashion to receive up to 4 cycles of oral cladribine or matching placebo in combination with Interferon-beta therapy. Total subject participation is 104 weeks.


Condition Intervention Phase
Multiple Sclerosis
Drug: Cladribine
Other: Placebo
Phase II

MedlinePlus related topics: Multiple Sclerosis
Drug Information available for: Interferon beta Interferon-beta Cladribine Interferons
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Randomized, Double Blind (Subject, Investigator, Outcomes Assessor), Placebo Control, Parallel Assignment, Safety/Efficacy Study
Official Title: A Phase II, Multi-Center, Randomized, Double-Blind, Placebo-Controlled, Safety, Tolerability and Efficacy Study of Add-on Cladribine Tablet Therapy With Interferon-Beta (IFN-b) Treatment in Multiple Sclerosis Subjects With Active Disease

Further study details as provided by EMD Serono:

Primary Outcome Measures:
  • To evaluate the safety and tolerability of oral cladribine compared to placebo as an add-on therapy to injectable IFN-b treatments in MS subjects with active disease. [ Time Frame: Quarterly safety review. Efficacy measure at 96 weeks ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • To explore the efficacy of oral cladribine as an add-on to IFN-b treatments compared to placebo as an add-on to IFN-b treatments in MS subjects with active disease on: Lesion activity [MRI]; Qualifying relapse rate; Progression of disability [ Time Frame: At 96 weeks ] [ Designated as safety issue: No ]

Estimated Enrollment: 200
Study Start Date: December 2006
Estimated Study Completion Date: November 2013
Estimated Primary Completion Date: October 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
1: Experimental Drug: Cladribine

Cladribine will be administered in the form of a pill. Subjects will receive up to 4 cycles of cladribine in combination with their interferon therapy over a period of 2 years. A cycle is defined as daily administration given consecutively over 4 to 5 days. Subjects will receive 0.875 mg/kg/cycle.

Cycles will be administered on Study Day 1, Weeks 5, 48 and 52 of the study.

2: Placebo Comparator Other: Placebo
This treatment arm is identical to treatment arm #1 with the exception that subjects will receive placebo instead of cladribine.

  Eligibility

Ages Eligible for Study:   18 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Be male or female, 18-65 years of age (inclusive);
  • Weigh between 40-120 kg, inclusive;
  • Have definite MS, as confirmed by the revised McDonald criteria (Polman, et al. 2005), and have relapsing forms of MS, such as relapsing-remitting or secondary progressive type of disease with superimposed relapses forms (See Appendix I);
  • Have experienced at least one relapse while receiving IFN-b treatments (Rebif® 44 mcg tiw, sc; AvonexÒ 30 mcg qw, im; or BetaseronÒ 250 mcg qod, sc) for at least 48 weeks (prior to Screening);
  • Minimum aggregate time on IFN-b therapy is 48-consecutive weeks prior to Screening. Subjects who switched from one IFN-b therapy to another in the 48 weeks preceding Screening may be entered into the study if they have been on a stable regimen of their current IFN-b therapy for a minimum of 3 months prior to Screening.
  • Be clinically stable (other than MS relapse) during the 28 days preceding Screening;
  • The following hematological parameters must be normal (as defined below, inclusively) within 28 days of first dosing of blinded study medication at

SD 1 (see also Section Error! Reference source not found. for further Hematological Testing and Entry Guidelines):

  • Hemoglobin = 11.6 - 16.2 G/DL
  • Leukocytes (total white blood cells [WBC]) = 4.1 - 12.3 x10E3/UL
  • Absolute lymphocytes = = 1.02 - 3.36 x10E3/UL
  • Absolute neutrophil count (ANC) = 2.03 - 8.36 x10E3/UL
  • Platelet count = 140 - 450 x10E3/UL

    • Have no medical history or evidence of latent tuberculosis infection (LTBI) or active tubercular disease (TB), as evidenced by TB skin test or chest X-ray (see Appendices O, P);
    • Have an EDSS from 1.0-5.5, inclusive (See Appendix D);
    • Have no prior exposure to immunosuppressive or cytotoxic agents (with the exception of steroids for MS flare management, or intravenous immunoglobulin-G [IVIG] after allowed wash-out periods (see Exclusion Criteria);
    • If female, must either:
  • be neither pregnant nor breast-feeding, nor attempting to conceive, and
  • use a highly effective method of contraception throughout the entire duration of the study and for 90 days following completion of the last dose of study medication. A highly effective method of contraception is defined as those which result in a low failure rate (i.e. less than 1% per year) when used consistently and correctly such as implants, injectables, combined oral contraceptives, some IUDs, sexual abstinence or vasectomized partner; or
  • be post-menopausal or surgically sterilized.

    • If male, he must be willing to use contraception to avoid pregnancies throughout the entire duration of the study and for 90 days following the last dose of study medication.
    • Be willing and able to comply with study procedures for the duration of the study;
    • Have not met any of the exclusion criteria outlined in this protocol; and
    • Voluntarily provide written informed consent, including, for USA, subject authorization under Health Insurance Portability and Accountability Act (HIPAA), prior to any study-related procedure that is not part of normal medical care, and with the understanding that the subject may withdraw consent at any time without prejudice to their future medical care. Confirmation that the subject is not pregnant must be established by a negative serum human chorionic gonadotropin (hCG) pregnancy test within 28 days prior to Study Day 1 and a negative urine pregnancy test on Study Day 1. A pregnancy test is not required if the subject is post-menopausal or surgically sterilized.

Exclusion Criteria:

  • Have primary progressive MS or secondary progressive MS without relapses forms;
  • Have prior or current malignancy other than medically documented complete excision of basal cell skin cancer no less than 5 years prior to Screening;
  • Have a history of chronic or clinically significant hematological abnormalities;
  • Prior use of cladribine, mitoxantrone, campath-1h, cyclophosphamide, azathioprine, methotrexate, daclizumab, natalizumab, lymphoid irradiation, bone marrow transplantation or myelosuppressive/cytotoxic therapy;
  • Use of cytokine or anti-cytokine therapy or plasmapheresis within 3 months prior to Study Day 1;
  • Treatment with intravenous immunoglobulin-G (IVIG) within 30 days of Screening;
  • Treatment with oral or parenteral corticosteroids within 2 weeks of Screening;
  • Treatment with adrenocorticotropic hormone within 28 days prior to Study Day 1;
  • Use of any investigational drug (other than Rebif® New Formulation [RNF]) or experimental procedure within 6 months prior to Study Day 1;
  • Subject has inadequate liver function, defined by a total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT) or alkaline phosphatase > 2.5 times the upper limit of the normal values;
  • Subject suffers from major medical illness such as cardiac, endocrinologic, hepatic, immunologic (other than MS), metabolic, renal, pulmonary, gastrointestinal, dermatologic, or other major disease that would preclude the administration of oral cladribine.
  • Subject suffers from major 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 active or chronic infectious disease or any disease which compromises immune function (e.g. HIV+, HTLV-1, Lyme disease, LTBI or TB);
  • Have an allergy or hypersensitivity to gadolinium, to cladribine or any of its excipients, or IFN-b or any of its excipient(s);
  • Have any renal condition that would preclude the administration of gadolinium (e.g. acute or chronic severe renal insufficiency (GFR < 30mL/min/1.73m2);
  • Have a positive stool heme-occult test at Screening (see also Section Error! Reference source not found. for further Heme-Occult Testing and Entry Guidelines);
  • Subject has a history of seizures not adequately controlled by treatment.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00436826

Locations
United States, Massachusetts
US Medical Information Recruiting
Rockland, Massachusetts, United States, 02370
Contact: US Medical Information     888-275-7376        
Sponsors and Collaborators
EMD Serono
Investigators
Study Director: Steven Greenberg, MD EMD Serono, Inc
  More Information

No publications provided

Responsible Party: EMD Serono ( Steven Greenberg, MD, Global Clinical Development Unit, Neurology )
Study ID Numbers: 26593
Study First Received: February 15, 2007
Last Updated: March 21, 2009
ClinicalTrials.gov Identifier: NCT00436826     History of Changes
Health Authority: United States: Food and Drug Administration

Keywords provided by EMD Serono:
Multiple Sclerosis
Relapsing forms
Interferon-beta therapy

Study placed in the following topic categories:
Cladribine
Autoimmune Diseases
Multiple Sclerosis
Immunologic Factors
Demyelinating Diseases
Interferons
Interferon-beta
Demyelinating Autoimmune Diseases, CNS
Sclerosis
Immunosuppressive Agents
Antiviral Agents
Autoimmune Diseases of the Nervous System

Additional relevant MeSH terms:
Cladribine
Anti-Infective Agents
Autoimmune Diseases
Immunologic Factors
Demyelinating Diseases
Immune System Diseases
Antineoplastic Agents
Physiological Effects of Drugs
Nervous System Diseases
Interferons
Interferon-beta
Sclerosis
Immunosuppressive Agents
Antiviral Agents
Pharmacologic Actions
Multiple Sclerosis
Pathologic Processes
Therapeutic Uses
Demyelinating Autoimmune Diseases, CNS
Autoimmune Diseases of the Nervous System

ClinicalTrials.gov processed this record on May 07, 2009