cladribine
DrugCladribine tablets were administered until CDMS conversion, whichever occur first.
NCT Number: NCT00725985
A randomized, double-blind, clinical trial to assess the safety and efficacy of two doses of oral cladribine versus placebo in participants who had a first clinical demyelinating event (clinically isolated syndrome). Participants in either the cladribine or placebo group may also enter treatment periods with open-label interferon-beta or open-label cladribine depending upon the disease status. The primary objective of this study is to evaluate the effect of two dosage regimens of oral cladribine versus placebo on the time to conversion to multiple sclerosis (MS) (from randomization) according to the Poser criteria in participants with first clinical demyelinating event at high risk of converting to MS.
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Notify Me18 year–55 year
All sexes
Interventional
Phase 3
Instituto Medico Rodriguez Alfici, Godoy Cruz, Argentina
This will be a randomized, double blind, three-arm, placebo-controlled, multi-center trial to evaluate the safety and efficacy of oral cladribine versus placebo in the treatment of participants who have sustained a first clinical demyelinating event within 75 days prior to the Screening. Participants must have a minimum of 2 clinically silent lesions on the Screening magnetic resonance imaging (MRI).
The study will include a pre-study evaluation period (Screening period: between 10 and 28 days prior to the start of treatment with blinded study medication (oral cladribine or placebo).
Depending upon the clinical course of their MS, participants will then proceed from the ITP to either the Maintenance Treatment Period (with open-label interferon-beta treatment) or LTFU period (with either open-label low-dose cladribine or no additional treatment (if no progression to MS has been noted after the initial treatment period). The single primary endpoint for the overall study, which will be determined during the ITP, is time to conversion to MS (from randomization), according to the Poser criteria.
For every participants, eligibility for study enrollment and entry into each of the study periods, and diagnosis of conversion to either McDonald MS or CDMS must be confirmed and approved by a Sponsor appointed study Adjudication Committee.
Healthy volunteers accepted: No
Only the study team can determine whether someone qualifies for participation.
Inclusion criteria
Exclusion criteria
Cladribine tablets were administered until CDMS conversion, whichever occur first.
Placebo matched to cladribine tablets were administered.
Participants who converted to CDMS during ITP entered in open-label maintenance period (OLMP) and received RNF subcutaneously at a dose of 44 microgram (mcg) three times a week. Participants who converted to CDMS during long-term follow-up (LTFU) period, received RNF subcutaneously at a dose of 44 mcg three times a week.
Time frame: ITP: Baseline up to Week 96
CDMS according to the Poser criteria is defined as the occurrence of a second attack or a sustained increase in the expanded disability status scale (EDSS) Score. EDSS assesses disability in 8 functional systems. An overall score ranging from 0 (normal) to 10 (death due to Multiple Sclerosis [MS]) was calculated. Sustained EDSS progression was defined as an increase in the EDSS score of greater than or equal to (>=) 1 point if baseline EDSS was between >= 1.0 and less than or equal to (=<) 4.5; or >= 1.5 points if baseline EDSS was 0, or >= 0.5 if baseline EDSS >= 5.0 over a period of at least 3 months. Kaplan-Meier estimates were provided for of the cumulative (cum.) percentage (%) of participants with CDMS over time. The probability of patients remaining event-free over time (from randomization) in each of the three treatment groups was displayed in the form of survival curves estimated using the non-parametric Kaplan-Meier method.
Time frame: ITP: Baseline up to Week 96
The McDonald criteria use dissemination in time and space established by magnetic resonance imaging (MRI) findings to provide a clinical diagnosis for MS. Dissemination in time is established by a new time constant 2 (T2) or gadolinium enhanced (Gd+) lesion found on a repeat MRI. Dissemination in space is established by the presence of any 3 of the following: 1 Gd+ lesion or 9 T2 bright lesions if there is no enhancement; greater than or equal to 1 infratentorial lesion; greater than or equal to 1 juxtacortical lesion; greater than or equal to 3 periventricular lesions. Kaplan-Meier estimates were provided for the cum. percentage (%) of participants with McDonald MS over time.
Time frame: ITP: Baseline up to Week 96
Number of CUA lesions, new or enlarging T2 lesions, and new or persisting T1 Gd+ lesions were measured by using magnetic resonance imaging (MRI) scans.
Time frame: OLMP: Day 1, 90, 180, 270, 360, 450, 540, 630, 720 and 810
EDSS progression is based on a standardized neurological exam and focuses on symptoms that commonly occur in Multiple Sclerosis (MS). Overall scores ranges from 0.0 (normal) to 10.0 (death due to MS). A sustained progression on EDSS score was defined as an EDSS progression confirmed into two consecutive assessment. Probability of disability progression at different time points was estimated using Kaplan-Meier method on the time to disability progression defined as the time from randomization to first EDSS increase.
Time frame: Time from Randomization up to 1217 days
The McDonald criteria use dissemination in time and space established by magnetic resonance imaging (MRI) findings to provide a clinical diagnosis for MS. Dissemination in time is established by a new time constant 2 (T2) or gadolinium enhanced (Gd+) lesion found on a repeat MRI.
Time frame: Time from Randomization up to 1217 days
CDMS according to the Poser criteria is defined as the occurrence of a second attack or a sustained increase in the expanded disability status scale (EDSS) Score. EDSS assesses disability in 8 functional systems. An overall score ranging from 0 (normal) to 10 (death due to MS) was calculated. Sustained EDSS progression was defined as an increase in the EDSS score of greater than or equal to (>=) 1 point if baseline EDSS was between >= 1.0 and less than or equal to (=<) 4.5; or >= 1.5 points if baseline EDSS was 0, or >= 0.5 if baseline EDSS >= 5.0 over a period of at least 3 months.
Time frame: Time from Randomization up to 1217 days
CDMS according to the Poser criteria is defined as the occurrence of a second attack or a sustained increase in the expanded disability status scale (EDSS) Score. EDSS assesses disability in 8 functional systems. An overall score ranging from 0 (normal) to 10 (death due to MS) was calculated. Sustained EDSS progression was defined as an increase in the EDSS score of greater than or equal to (>=) 1 point if baseline EDSS was between >= 1.0 and less than or equal to (=<) 4.5; or >= 1.5 points if baseline EDSS was 0, or >= 0.5 if baseline EDSS >= 5.0 over a period of at least 3 months.
Time frame: ITP: Baseline up to week 96
Clinically definite multiple sclerosis (CDMS) according to the Poser criteria is defined as the occurrence of a second attack or a sustained increase in the expanded disability status scale (EDSS) Score. EDSS assesses disability in 8 functional systems. An overall score ranging from 0 (normal) to 10 (death due to MS) was calculated. Sustained EDSS progression was defined as an increase in the EDSS score of greater than or equal to (>=) 1 point if baseline EDSS was between >= 1.0 and less than or equal to (=<) 4.5; or >= 1.5 points if baseline EDSS was 0, or >= 0.5 if baseline EDSS >= 5.0 over a period of at least 3 months. The percentage of participants who converted to CDMS are reported here.
Time frame: ITP: Baseline up to week 96
Percentage of participants converting to mcDonald multiple sclerosis (2005) were reported.
Time frame: ITP: Week 13, 24, 36, 48, 60, 72, 84 and 96
Number of new or persisting Gd-enhanced lesions were measured by using magnetic resonance imaging (MRI) scans.
Time frame: OLMP: Baseline, Week 24, 48, 72 and 96
Number of new or persisting Gd-Enhanced lesions were measured by using magnetic resonance imaging (MRI) scans.
Time frame: LTFU: Baseline, Week 13, 24 and 36
Number of new or persisting Gd-Enhanced lesions were measured by using magnetic resonance imaging (MRI) scans.
Time frame: LTFU: Baseline, Week 13, 24, 36 and 48
Number of new or persisting Gd-Enhanced lesions were measured by using magnetic resonance imaging (MRI) scans.
Time frame: ITP: Week 13, 24, 36, 48, 60, 72, 84 and 96
Number of new or enlarging T2 lesions were measured by using magnetic resonance imaging (MRI) scans.
Time frame: OLMP: Baseline, Week 24, 48, 72 and 96
Number of new or enlarging T2 lesions were measured by using magnetic resonance imaging (MRI) scans.
Time frame: LTFU: Baseline, Week 13, 24 and 36
Number of new or enlarging T2 Lesions were measured by using magnetic resonance imaging (MRI) scans.
Time frame: LTFU: Baseline, Week 13, 24, 36 and 48
Number of new or enlarging T2 lesions were measured by using magnetic resonance imaging (MRI) scans.
Time frame: ITP: Week 13, 24, 36, 48, 60, 72, 84 and 96
Number of CUA lesions were measured by using magnetic resonance imaging (MRI) scans.
Time frame: OLMP: Baseline, Week 24, 48, 72 and 96
Number of combined unique active (CUA) lesions were measured by using magnetic resonance imaging (MRI) scans.
Time frame: LTFU: Baseline, Week 13, 24 and 36
Number of CUA MRI lesions were measured by using magnetic resonance imaging (MRI) scans.
Time frame: LTFU: Baseline, Week 13, 24, 36 and 48
Number of CUA lesions were measured by using magnetic resonance imaging (MRI) scans.
Time frame: ITP: Baseline, Week 96
Change in volume of T1 Gd-Enhanced lesions was measured by using magnetic resonance imaging (MRI) scans.
Time frame: OLMP: Baseline, Week 24, 48, 72 and 96
Volume of T1 Gd-Enhanced lesions was measured by using magnetic resonance imaging (MRI) scans.
Time frame: LTFU: Baseline, Week 13, 24 and 36
Volume of T1 Gd-Enhanced lesions was measured by using magnetic resonance imaging (MRI) scans.
Time frame: LTFU: Baseline, Week 13, 24, 36 and 48
Volume of T1 Gd-Enhanced lesions was measured by using magnetic resonance imaging (MRI) scans.
Time frame: ITP: Baseline, Week 48 and 96
Change in volume of T2 lesions from baseline was measured by using magnetic resonance imaging (MRI) scans.
Time frame: OLMP: Baseline, Week 48 and 96
Volume of T2 lesions was measured by using magnetic resonance imaging (MRI) scans.
Time frame: LTFU: Baseline (Day 1)
Volume of T2 lesions was measured by using magnetic resonance imaging (MRI) scans.
Time frame: Baseline, Week 48
Volume of T2 lesions was measured by using magnetic resonance imaging (MRI) scans.
Time frame: ITP: Baseline, Week 48 and 96
Number of T1 Hypointense lesions were measured by using magnetic resonance imaging (MRI) scans.
Time frame: OLMP: Baseline, Week 48 and 96
Number of T1 Hypointense lesions were measured by using magnetic resonance imaging (MRI) scans.
Time frame: LTFU: Baseline (Day 1)
Number of T1 Hypointense lesions were measured by using magnetic resonance imaging (MRI) scans.
Time frame: LTFU: Baseline, Week 48
Number of T1 Hypointense lesions were measured by using magnetic resonance imaging (MRI) scans.
Time frame: ITP: Baseline up to Week 96
T1 Gd-enhanced lesions were measured by using magnetic resonance imaging (MRI) scans. Percentage of participants with no new or persisting T1 Gd-enhanced lesions were reported.
Time frame: OLMP: Baseline up to Week 96
T1 Gd-enhanced lesions were measured by using magnetic resonance imaging (MRI) scans. Percentage of participants with no new or persisting T1 Gd-enhanced lesions were reported.
Time frame: LTFU: Baseline up to Week 48
T1 Gd-enhanced lesions were measured by using magnetic resonance imaging (MRI) scans. Percentage of participants with no new or persisting T1 Gd-enhanced lesions were reported.
Time frame: Baseline up to Week 48
T1 Gd-enhanced lesions were measured by using magnetic resonance imaging (MRI) scans. Percentage of participants with no new or persisting T1 Gd-enhanced lesions were reported.
Time frame: ITP: Baseline up to Week 96
T2 lesions were measured by using magnetic resonance imaging (MRI) scans. Percentage of participants with no new or enlarging T2 lesions were reported.
Time frame: OLMP: Baseline up to 96
T2 Gd-enhanced lesions were measured by using magnetic resonance imaging (MRI) scans. Percentage of participants with no new or enlarging T2 Lesions were reported.
Time frame: Baseline up to Week 48
Enlarging T2 Lesions were measured by using magnetic resonance imaging (MRI) scans. Percentage of participants with no New or Enlarging T2 Lesions were reported.
Time frame: LTFU: Baseline up to Week 48
Enlarging T2 lesions were measured by using magnetic resonance imaging (MRI) scans. Percentage of participants with no New or Enlarging T2 lesions were reported.
Time frame: ITP: Baseline, Week 48 and 96
Brain volume was measured by using magnetic resonance imaging (MRI) scans. Percent change from baseline in brain volume at Week 48 and 96 was reported.
Time frame: OLMP: Baseline, Week 48 and 96
Brain volume was measured by using magnetic resonance imaging (MRI) scans. Percent change from baseline in brain volume at Week 48 and 96 was reported.
Time frame: Baseline up to Week 96
Relapse was defined as new, worsening or recurrent neurological symptoms attributed to multiple sclerosis that last for at least 24 hours without fever or infection, or adverse reaction to prescribed medication, preceded by a stable or improving neurological status of at least 30 days.
Time frame: Baseline up to Week 48
Relapse was defined as new, worsening or recurrent neurological symptoms attributed to multiple sclerosis that last for at least 24 hours without fever or infection, or adverse reaction to prescribed medication, preceded by a stable or improving neurological status of at least 30 days.
Time frame: Baseline up to Week 48
Relapse was defined as new, worsening or recurrent neurological symptoms attributed to multiple sclerosis that last for at least 24 hours without fever or infection, or adverse reaction to prescribed medication, preceded by a stable or improving neurological status of at least 30 days.
Time frame: Baseline up to Week 96
The annualized relapse rate for each treatment group was the mean of the annualized relapse rates for all the participants in the group, calculated as the total number of confirmed relapses divided by the total number of days on study multiplied by 365.25. Where, Relapse was defined as new, worsening or recurrent neurological symptoms attributed to multiple sclerosis that last for at least 24 hours without fever or infection, or adverse reaction to prescribed medication, preceded by a stable or improving neurological status of at least 30 days.
Time frame: Baseline up to Week 96
Relapse was defined as new, worsening or recurrent neurological symptoms attributed to multiple sclerosis that last for at least 24 hours without fever or infection, or adverse reaction to prescribed medication, preceded by a stable or improving neurological status of at least 30 days. Percentage of relapse-free participants were reported.
Time frame: ITP: Baseline up to Week 96
An AE was defined as any untoward medical occurrence in the form of signs, symptoms, abnormal laboratory findings, or diseases that emerges or worsens relative to baseline during a clinical study with an Investigational Medicinal Product (IMP), regardless of causal relationship and even if no IMP has been administered. SAE: Any AE that resulted in death; was life threatening; resulted in persistent/significant disability/incapacity; resulted in/prolonged an existing in-patient hospitalization; was a congenital anomaly/birth defect; or was a medically important condition. The term TEAE is defined as AEs starting or worsening after the first intake of the study drug. TEAEs include both Serious TEAEs and non-serious TEAEs. Number of Participants with TEAEs and serious TEAEs were reported.
EMD Serono Research & Development Institute, Inc.
Industry
A Phase III, Randomized, Double-blind, Placebo-controlled, Multi-center Clinical Trial of Oral Cladribine in Subjects With a First Clinical Event at High Risk of Converting to MS
Acronym: ORACLE MS
OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.
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