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Completed

NCT Number: NCT02937285

National Multicenter, Controlled, Single-blind Study With Two Parallel Groups Evaluating the Safety and Efficacy of Sequential Treatment With Mitoxantrone and Interferon Versus Interferon Alone in Patients With Strong Risk of Progression in the Initial Phase of Multiple Sclerosis

The relative effectiveness of current treatments and their different mechanisms of action yield to consider more and more that the multiple sclerosis (MS) therapeutic approach must use multiple molecules, both combined and sequential.

In this sense, one can assume that the combination of two molecules with different but complementary mechanisms of action, can delay progression of the disease. Mitoxantrone has a powerful action, immediate and total, whereas interferon a selective action, immunomodulatory and delayed.

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Key information

Age range

18 year–50 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 3

Primary location

CHU Rennes

Rennes, France

About this study

This study is based on the hypothesis that there is a synergistic effect of both increasing the dose of interferon and also the use of mitoxantrone, allowing to further reduce the conversion rate MS.

Because mitoxantrone decreases the rate of relapses 2 times more than interferon beta, a (at least) 2 times higher benefit on the disease activity is expected with interferon mitoxantrone combination than with interferon alone.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Patients should have a MS according to the McDonald criteria:
  • One relapse with time dissemination shown by an MRI performed less than 2 months before inclusion, with at least one of these criteria:
  • multifocal presentation
  • relapse determining a severe disability (EDSS greater than 3.5)
  • at least 2 lesions taking contrast on MRI
  • at least 9 T2 lesions with contrast enhancement.
  • Patients must be 18 to 50 years.
  • The duration of disease progression should be less than one year.
  • Women of childbearing age must have an effective contraception.
  • Patients have to be able to give their own informed consent before inclusion in the study.

Exclusion criteria

  • presence of another disease that could explain the symptoms / signs of the patient.
  • Any other condition / disability that may interfere with the clinical state.
  • Prior treatment with immunosuppressive (mitoxantrone, azathioprine, cyclophosphamide) or immunomodulator.
  • Treatment with corticosteroids in the previous 2 weeks, regardless of the dose.
  • Corticosteroids for over a month.
  • Pregnancy and lactation.
  • Patient whose antecedents may contra-indicate the use of immunosuppressive therapy.
  • Hypersensitivity to mitoxantrone or one of the excipients.
  • Clinical cardiac disease with reduced ejection fraction of the left ventricle.
  • Patient suffering from myelodysplasia.
  • Abnormalities of Complete Blood Count.
  • History of hematologic malignancy.
  • Hepatic impairment.
  • Vaccination against yellow fever.
  • Vaccination with an attenuated vaccine assets.
  • Treatment with phenytoin or fosphenytoin.
  • Hypersensitivity to interferon beta-1a natural or recombinant or any of the excipients.
  • Current severe depression and / or suicidal thoughts.
  • Uncontrolled epilepsy.
  • History of addiction.
  • A history of hypersensitivity to gadolinium, history of severe renal impairment
  • Inability to undergo MRI (claustrophobia, tics, involuntary movements, tremor, etc.).
  • Participation in another trial in the preceding 6 months or during the study.
  • Minors, protected adults and persons deprived of their liberty.

Treatment and study plan

Interferon beta 1a

Drug

Subcutaneous injection of 44µg 3 times a week

Other names: REBIF

Mitoxantrone

Drug

10 mg / m² monthly infusion for 6 months

Other names: ELSEP

Primary outcomes

  1. Treatment efficacy

    Time frame: Four years after inclusion

    Efficacy is judged based on

    • the absence of relapse within the 2 first years; AND
    • a disease progression as determined by an increase in the Expanded Disability Status Scale (EDSS) not greater than 1 during the 4 years treatment.

Secondary outcomes

  1. Time to first relapse

    Time frame: From date of randomization until the date of first documented progression, assessed up to 4 years

  2. Frequency of relapses in 2 years

    Time frame: Within two years following randomization

  3. Frequency of relapses in 4 years

    Time frame: Within four years following randomization

  4. Changes in the level of disability in 2 years

    Time frame: Two years following randomization

    EDSS score

  5. Changes in the level of disability in 4 years

    Time frame: Four years following randomization

    EDSS score

  6. Patients in progression

    Time frame: Four years following randomization

    Rate of patients who progressed to a clinically definite MS (according to the criteria of Mc Donald) in the subgroup of patients who had only one clinical event.

  7. Disease activity on MRI at 6 months

    Time frame: 6 months following randomization

    To compare in the two arms, the rate of patients without radiological (MRI) sign of disease activity

  8. Patients without disease activity on MRI at 12 months

    Time frame: 12 months following randomization

    To compare in the two arms, the rate of patients without radiological (MRI) sign of disease activity

  9. Patients without disease activity on MRI at 24 months

    Time frame: 24 months following randomization

    To compare in the two arms, the rate of patients without radiological (MRI) sign of disease activity

  10. Patients without disease activity on MRI at 48 months

    Time frame: 48 months following randomization

    To compare in the two arms, the rate of patients without radiological (MRI) sign of disease activity

  11. Number of visible lesions on MRI at 6 months

    Time frame: 6 months following randomization

    To compare in the two arms, the number of lesions taking contrast

  12. Number of visible lesions on MRI at 12 months

    Time frame: 12 months following randomization

    To compare in the two arms, the number of lesions taking contrast

  13. Number of visible lesions on MRI at 24 months

    Time frame: 24 months following randomization

    To compare in the two arms, the number of lesions taking contrast

  14. Number of visible lesions on MRI at 48 months

    Time frame: 48 months following randomization

    To compare in the two arms, the number of lesions taking contrast

  15. Lesion load on evaluated T2 weighted MRI at 12 months

    Time frame: 12 months following randomization

  16. Lesion load on evaluated T2 weighted MRI at 24 months

    Time frame: 24 months following randomization

  17. Lesion load on evaluated T2 weighted MRI at 48 months

    Time frame: 48 months following randomization

  18. Brain atrophy

    Time frame: 24 and 48 months following randomization

    To assess the presence and progression of brain atrophy, changes in the total brain volume after 24 and 48 months will be automatically measured from MR images with dedicated software and expressed as percent change, from a standardized estimation of cerebral volume.

Sponsors and collaborators

Lead sponsor

Rennes University Hospital

Other

Registry information

Official study title

National Multicenter, Controlled, Single-blind Study With Two Parallel Groups Evaluating the Safety and Efficacy of Sequential Treatment With Mitoxantrone and Interferon Beta-1a (REBIF 44mg 3 Times / Week) Versus Interferon Alone in Patients With Strong Risk of Progression in the Initial Phase of Multiple Sclerosis

Acronym: MITOX-REBIF

Important dates

Study start
2010
Primary completion
2020
Study completion
2020
First posted
Oct 18, 2016
Registry last updated
Mar 29, 2023

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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