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Study to Assess Whether GSK239512 Can Remyelinate Lesions in Subjects With Relapsing Remitting Multiple Sclerosis

Information source: GlaxoSmithKline
ClinicalTrials.gov processed this data on August 20, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Multiple Sclerosis, Relapsing-Remitting

Intervention: GSK239512 (Drug); Placebo (Drug)

Phase: Phase 2

Status: Completed

Sponsored by: GlaxoSmithKline

Official(s) and/or principal investigator(s):
GSK Clinical Trials, Study Director, Affiliation: GlaxoSmithKline

Summary

This is a randomized, parallel group, placebo-controlled study designed to assess whether GSK239512 can enhance lesion remyelination in subjects with Relapsing Remitting Multiple Sclerosis (RRMS). Subjects with RRMS on stable background treatment with either Avonex (Interferon-beta1a) or Copaxone (Glatiramer Acetate) are eligible to participate. Subjects will be randomized in a 1: 1 ratio between placebo and GSK239512, and will continue to be managed with their current standard of care therapy (Copaxone or Avonex). The total treatment period is 48 weeks, including a standard 4 week titration period and 44 week maintenance treatment period (which could be adapted to a 5-week titration and 43 week maintenance period, if needed). Titration doses start at 10 micrograms (mcg) and increase up to 80 mcg (10 mcg first week, 20 mcg second week, 40 mcg third week, 80 mcg fourth week). Subjects will be titrated to the maximum tolerated dose with the objective of titrating to the highest dose (80 mcg GSK239512), whenever possible, based on investigator judgement of tolerability. The post-treatment follow-up period will be a minimum of 2 weeks in duration following the end of treatment at Week 48 or early withdrawal, as appropriate.

Clinical Details

Official title: Proof of Mechanism Study to Assess the Potential of GSK239512 to Remyelinate Lesions in Subjects With Relapsing Remitting Multiple Sclerosis

Study design: Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment

Primary outcome:

Mean change in gadolinium (Gd) enhanced (GdE) lesion magnetization transfer ratio (MTR) differences (calibrated to reference scan) from before enhancement to stable recovery (>=3 months post new GdE lesion)

Mean change in Delta MTR lesion MTR differences (calibrated to reference scan) from before lesion appearance to stable recovery (>=3 months post lesion appearance)

Secondary outcome:

Change from baseline in T2 lesion MTR at Week 48

Cumulative new and enlarging Gd enhancing, T2 and Combined Unique Active lesions comparing placebo to GSK239512 treated subjects

Change from baseline at Week 48 in total brain volume, white matter volume and grey matter volume comparing placebo to GSK239512 treated subjects

Cumulative number of persistent black holes and new unenhancing T1 lesion counts comparing placebo to GSK239512 treated subjects over treatment duration up to Week 48

Proportion of new GdE lesions evolving into chronic (unenhancing) T1 lesions (black holes) comparing placebo to GSK239512 treated subjects over treatment duration up to Week 48

Mean change from baseline in overall cognitive impairment and cognitive domains comparing placebo to GSK239512 treated subjects

Comparison of Relapse Rates between placebo and GSK239512 treated subjects

Comparison of Time to First Relapse between placebo and GSK239512

Comparison of the proportion of subjects Relapse Free between placebo and GSK239512 treated subjects

Proportion of subjects with sustained worsening of Expanded Disability Severity Scale (EDSS) over 3 months comparing placebo to GSK239512 treated subjects

Mean change from baseline in the EDSS functional systems and a subset of component assessments comparing placebo to GSK239512 treated subjects

Safety and tolerability as assessed by frequency and severity of Adverse Events (AEs) and Serious Adverse Events (SAEs)

Safety and tolerability as assessed by percentage of subjects withdrawing due to AEs

Safety and tolerability as assessed by summary of suicide behavior and ideation risk as assessed by the electronic Columbia Suicide Severity Rating Scale (eC-SSRS)

Safety and tolerability as assessed by summary of suicide behavior and ideation risk as assessed by Possible Suicidality Related Adverse Event (PSRAE)

Safety and tolerability as assessed by change from baseline in clinical chemistry, hematology, and urinalysis parameters

Safety and tolerability as assessed by frequency of clinical chemistry, hematology, and urinalysis parameters of potential clinical concern

Safety and tolerability as assessed by change from baseline in blood pressure

Safety and tolerability as assessed by change from baseline in heart rate

Safety and tolerability as assessed by change from baseline in Electrocardiogram (ECG) parameters

Safety and tolerability as assessed by frequency of vital signs and ECG parameters of potential clinical concern

Trough concentration of GSK239512 at Week 4, Week 24, Week 36 and Week 48

Sparse Pharmacokinetics (PK) sampling for concentration of GSK239512 at Week 8

Eligibility

Minimum age: 18 Years. Maximum age: 50 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- 18 to 50 years of age

- Diagnosed with a relapsing-remitting course of multiple sclerosis as defined by the

appropriate McDonald criteria at the time of diagnosis.

- Diagnosis of RRMS made within approximately 10 years prior to the screening visit (as

documented by year of diagnosis or duration of disease), and No physical manifestations of other forms of Multiple Sclerosis (MS) including signs of progression to secondary progressive MS (SPMS)

- Currently compliant with a stable dose regimen of Avonex (Interferon Beta1a) or

Copaxone (Glatiramer Acetate) for management of MS for >= 1 year prior to the screening visit

- The occurrence of at least one of the following (within the year preceding the screen

visit AND after >=2 months of stable treatment with Avonex OR Copaxone): a) 1 reported and/or documented relapse, OR b) 1 Gadolinium Enhanced (GdE) lesion on MRI

- Currently neurologically stable, in the investigator's judgment, and not actively

experiencing or recovering from a recent relapse at the screening visit

- A Kurtzke Expanded Disability Status Scale (EDSS) score of 1 to 4. 5 (inclusive) at

the screening visit.

- Must agree not to participate in a clinical study involving another investigational

drug or device throughout their participation in this study. Non-interventional study participation is allowed if the time involvement and scheduling will not interfere with compliance in this study in the opinion of the investigator

- A female subject is eligible to enter the study if she is a) Not pregnant or nursing,

b) Of non-childbearing potential (i. e. women who have had a hysterectomy, are postmenopausal, which is defined as >2 years without menses [female subjects who have been post-menopausal for <2 years must be confirmed with Follicle Stimulating Hormone and estradiol levels], have both ovaries surgically removed or have current documented tubal ligation); or, c) Of childbearing potential and agrees to use the acceptable methods of birth control, for one month prior to the start of investigational product to 1 month after the last dose of investigational product.

- Informed Consent: Must be competent to understand the information given in the

Institutional Review Board (IRB) or Independent Ethics Committee (IEC) approved Informed Consent Form (ICF) and must sign the form prior to the initiation of any study procedures Exclusion Criteria:

- MRI: Unable to undergo MRI scans (e. g. due to pacemaker, severe claustrophobia,

hypersensitivity to contrast media), Lacks adequate venous access for administration of Gd-enhancing agent, or Findings on brain MRI scan indicating any clinically significant brain abnormality other than MS (e. g. damage associated with prior traumatic brain injury)

- Past and Concurrent Medical Conditions: a) History of severe and clinically

significant CNS trauma with current sequelae (e. g. traumatic brain injury, spinal cord compression), b) Significant concurrent, uncontrolled medical condition or disease which in the opinion of the investigator could (e. g. significant psychiatric disorder, etc), affect the subjects' safety, impair the subject's reliable participation in the trial, impair the evaluation of the endpoints, or necessitate the use of medication not allowed by this protocol, c) History or presence of myelopathy due to spinal cord compression by disk or vertebral disease or chronic progressive myelopathy, d) Diagnosis of any type epilepsy, e) At risk of suicide, as indicated by: A documented history of attempted suicide or significant suicidal ideation during the 6 months preceding the screening visit, OR If in the investigator's judgment the subject is at risk of a suicide attempt based on the screen visit assessment, including the eC-SSRS, f) Presence of significant and routine sleep disturbance (severe insomnia, nocturnal wandering, confusion, disorientation, agitation, or vivid dreams) that has a negative impact on quality of life that, in the judgement of the investigator, may increase the risk of tolerability issues during dose escalation, g) Presence or history of hallucinations that, in the judgement of the investigator, may increase the safety risk to the subject, h) Known diagnosis or history consistent with positive human immunodeficiency virus (HIV)

- Past and Current Medications and Therapies: Have had treatment with the following to

manage their MS: a) Within 1 year: fingolimod (e. g. Gilenya), Rebif (interferon beta1a), interferon beta1b (e. g. Betaseron), mycophenolate mofetil (e. g. CellCept), or Recently approved medication or formulation indicated for the management of MS. Consult with GlaxoSmithKline (GSK) Medical Monitor if there are specific questions regarding eligible treatments b) Within 2 years: natalizumab (e. g. Tysabri), alemtuzumab (e. g. Campath), daclizumab (e. g. Zenapax), rituximab (e. g. Rituxan), mitoxantrone (e. g. Novantrone), cladribine (e. g. Leustatin), or azathioprine (e. g. Imuran)

- Have used corticotropin to manage a relapse within 6 months prior to Screen Visit.

- Have had treatment with the following and were unable to discontinue and refrain from

treatment for the specified time period and are not able to discontinue use throughout participation in the clinical trial: dalfampridine /fampridine (e. g.

Ampyra) - 1 month prior to Screen Visit, nabiximols (e. g. Sativex) - 1 month prior to

Screen Visit, amantadine (e. g. Symmetrel) - 3 months prior to Screen Visit, or

leflunomide (e. g. Arava) - 1 year prior to Screen Visit

- Have used the following medications within the last 30 days or 5 half-lives

(whichever is longer) prior to screening and are not able to discontinue use throughout participation in the clinical trial: Any CNS stimulants (e. g., modafinil, dexamphetamine, methylphenidate), Known potent P-glycoprotein inhibitors (e. g. itraconazole, ketoconazole, cyclosporin, loperamide, diltiazem, verapamil, spironolactone, quinidine, bepridil, quinine, carvedilol), Known potent inhibitors or inducers of the CYP3A4 enzyme (e. g., verapamil, ketoconazole, cimetidine, rifampin, modafinil), CNS-penetrant antihistamines (e. g. bromopheniramine, chlorpheniramine, clemastine, diphenhydramine, hyrdoxyzine),

- History of medically significant adverse effects (including allergic reactions and

hypersensitivities) following treatment with: Histamine H3 receptor antagonist or inverse agonist, Gadolinium enhancing agent, Relapse medication: glucocorticoids (e. g., methylprednisolone) OR A known hypersensitivity to components of the investigational product, relapse medication, or Gadolinium enhancing agent.

- Electrocardiogram (ECG) showing a clinically significant abnormality at screening.

Including a QT interval corrected using Bazett's and Fridericia's formulas (QTcB or QTcF) interval of >=450 msec or >=480 msec for patients with a Bundle Branch Block.

- Infectious Disease Status at Screening a) Subjects with no documented record of

vaccination against Hepatitis B (primary and secondary immunization and booster) AND a positive test for hepatitis B surface antigen (HBsAg and Hepatitis B Core Antibody [IgM anti-HBc]), b) Subjects with serologic evidence of active Hepatitis C, as indicated by a positive Hepatitis C Virus(HCV) RNA test and anti-HCV antibody test

- Laboratory Values at Screening: Hematology: Total white cell count <2. 0 x 109/L,

Neutrophils <1. 0 x 109/L, Platelets <75 x 109/L (If out of range, platelet count can be repeated to exclude platelet clumping), or Haemoglobin < 80 g/L.

- Screening clinical chemistry liver function test: Alanine aminotransferase (ALT) >2. 0

x upper limit of normal (ULN), Aspartate aminotransferase (AST) >2. 0 x ULN, Alkaline phosphatise (ALP) >1. 5 x ULN, or Bilirubin >1. 5 x ULN.

- Documented renal insufficiency or laboratory results indicative of renal

insufficiency (due to risks associated with administration of Gadolinium based contrast agents to subjects with moderate to severe kidney disease): Estimated Creatinine Clearance (Cockroft-Gault) <60 mL/minute

- If known, or according to investigator judgement, subject is suspected of not being

able to comply with the study protocol requirements. Contributing factors to this assessment by the investigator could be, but not limited to: job demands, substance abuse, alcoholism, drug dependency or psychological disorder

- Prior participation in a clinical trial or use of an investigational product for a

non approved intervention: Prior use of an investigational drug for MS or a condition other than MS within 4 weeks or 5 half-lives (whichever is longer) prior to screening. The GSK Medical Monitor should be consulted to confirm eligibility

Locations and Contacts

GSK Investigational Site, Sofia 1113, Bulgaria

GSK Investigational Site, Sofia 1309, Bulgaria

GSK Investigational Site, Sofia 1431, Bulgaria

GSK Investigational Site, Jihlava 586 33, Czech Republic

GSK Investigational Site, Olomouc 775 20, Czech Republic

GSK Investigational Site, Teplice 415 29, Czech Republic

GSK Investigational Site, Berlin 10961, Germany

GSK Investigational Site, Berlin 12163, Germany

GSK Investigational Site, Hamburg 20249, Germany

GSK Investigational Site, Hamburg 22083, Germany

GSK Investigational Site, Barcelona 08035, Spain

GSK Investigational Site, Barcelona 08036, Spain

GSK Investigational Site, Madrid 28040, Spain

GSK Investigational Site, Madrid 28046, Spain

GSK Investigational Site, Madrid 28034, Spain

GSK Investigational Site, Majadahonda (Madrid) 28222, Spain

GSK Investigational Site, Malaga 29010, Spain

GSK Investigational Site, Sevilla 41009, Spain

GSK Investigational Site, Stockholm SE-141 86, Sweden

GSK Investigational Site, Donetsk 83099, Ukraine

GSK Investigational Site, Ivano-Frankivsk 76008, Ukraine

GSK Investigational Site, Kharkiv 61068, Ukraine

GSK Investigational Site, Kyiv 04107, Ukraine

GSK Investigational Site, Lutsk 43005, Ukraine

GSK Investigational Site, Lviv 79010, Ukraine

GSK Investigational Site, Poltava 36024, Ukraine

GSK Investigational Site, Vinnitsa 21005, Ukraine

GSK Investigational Site, London NW1 2BU, United Kingdom

GSK Investigational Site, London SE5 9RS, United Kingdom

GSK Investigational Site, Romford RM7 0AG, United Kingdom

GSK Investigational Site, Sheffield S10 2JF, United Kingdom

GSK Investigational Site, Calgary, Alberta T2N 2T9, Canada

GSK Investigational Site, Edmonton, Alberta T6G 1Z1, Canada

GSK Investigational Site, Ulm, Baden-Wuerttemberg 89073, Germany

GSK Investigational Site, Alzenau, Bayern 63755, Germany

GSK Investigational Site, Unterhaching, Bayern 82008, Germany

GSK Investigational Site, Koeln, Nordrhein-Westfalen 50935, Germany

GSK Investigational Site, Muenster, Nordrhein-Westfalen 48149, Germany

GSK Investigational Site, Ottawa, Ontario K1H 8L6, Canada

GSK Investigational Site, Gatineau, Quebec J9J 0A5, Canada

GSK Investigational Site, Montreal, Quebec H3A 2B4, Canada

GSK Investigational Site, Dresden, Sachsen 01069, Germany

GSK Investigational Site, Leipzig, Sachsen 04103, Germany

Additional Information

Starting date: February 2013
Last updated: January 15, 2015

Page last updated: August 20, 2015

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