Relapsing-Remitting Multiple Sclerosis
Conditions
Brief summary
The primary study objective is to test the superiority of Daclizumab High Yield Process (DAC HYP) compared to interferon β 1a (IFN β-1a) in preventing multiple sclerosis (MS) relapse in participants with relapsing remitting multiple sclerosis. The secondary study objectives are to test the superiority of DAC HYP compared to IFN β-1a in slowing functional decline and disability progression and maintaining quality of life in this participant population.
Interventions
Daclizumab High Yield Process for subcutaneous injection
Placebo to interferon beta-1a intramuscular injection
Interferon beta-1a for intramuscular injection
Placebo to Daclizumab High Yield Process subcutaneous injection
Sponsors
Study design
Eligibility
Inclusion criteria
Key Inclusion Criteria: * Must have a confirmed diagnosis of Relapsing Remitting Multiple Sclerosis (RRMS), and a cranial magnetic resonance imaging (MRI) demonstrating lesion(s) consistent with MS * Must have a baseline Expanded Disability Status Scale (EDSS) between 0.0 and 5.0, inclusive * Male subjects and female subjects of childbearing potential must be willing to practice effective contraception during the study and be willing and able to continue contraception for 4 months after their last dose of study treatment Key
Exclusion criteria
* Known intolerance, contraindication to, or history of non-compliance with Avonex® 30 µg * History of treatment with Daclizumab High Yield Process (Dac HYP) * History of malignancy * History of severe allergic or anaphylactic reactions * Known hypersensitivity to study drugs or their excipients * History of abnormal laboratory results indicative of any significant disease * History of human immunodeficiency virus (HIV) or other immunodeficient conditions * History of drug or alcohol abuse (as defined by the Investigator) within the 2 years prior to randomization * History of seizure disorder or unexplained blackouts OR history of a seizure within 6 months prior to Baseline * History of suicidal ideation or an episode of clinically severe depression (as determined by the Investigator) within 3 months prior to Day 1 * An MS relapse that has occurred within the 50 days prior to randomization AND/OR the subject has not stabilized from a previous relapse prior to randomization * Known history of, or positive screening test result for hepatitis C virus or hepatitis B virus * Varicella or herpes zoster virus infection or any severe viral infection within 6 weeks before screening * Exposure to varicella zoster virus within 21 days before screening NOTE: Other protocol-defined Inclusion/
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Adjusted Annualized Relapse Rate (ARR) | Up to 144 weeks | Relapses are defined as new or recurrent neurological symptoms not associated with fever or infection, lasting at least 24 hours, and accompanied by new objective neurological findings upon examination by the examining neurologist. Only relapses confirmed by Independent Neurology Evaluation Committee (INEC) are included in this analysis. Adjusted ARR was estimated from a negative binomial regression model adjusted for the baseline relapse rate, history of prior IFN beta use, baseline Expanded Disability Status Scale score (EDSS; ≤ 2.5 vs \> 2.5) and baseline age (≤ 35 vs \> 35 years). Data after participants switched to alternative MS medications are excluded. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Adjusted Mean Number of New or Newly Enlarging T2 Hyperintense Lesions up to Week 96 | up to 96 weeks | The quantity of lesions is assessed by brain magnetic resonance imaging (MRI). The adjusted mean number is estimated from a negative binomial regression model, adjusted for baseline volume of T2 from a negative binomial regression model, adjusted for baseline volume of T2 hyperintense lesions, history of prior IFN beta use and baseline age (≤ 35 vs \> 35 years). To account for the timing of the MRI measurement, the logarithmic transformation of the scan number of the MRI assessment is included in the model as the 'offset' parameter. Observed data after participants switched to alternative MS medications are excluded. Missing data are not imputed. Only observed new or newly enlarging T2 lesions at the last visit of the participant up to Week 96 visit are used in this analysis. |
| Proportion of Participants With Sustained Disability Progression at 144 Weeks | Baseline through 144 weeks | Sustained disability progression is defined as: at least a 1.0-point increase on the EDSS from Baseline EDSS ≥ 1.0 that is sustained for 12 weeks, or at least a 1.5-point increase on the EDSS from baseline EDSS = 0 that is sustained for 12 weeks. The EDSS measures the disability status of people with MS on a scale that ranges from 0 to 10, with higher scores indicating more disability. Estimated proportion of participants with progression is based on the Kaplan-Meier product limit method. Participants were censored at the time of withdrawal/switch if they withdrew from study or switched to alternative MS medication without a progression. Participants with a tentative progression at the End of Treatment Period Visit (or the last EDSS assessment prior to alternative MS start date) and no confirmation assessment were censored at their last EDSS assessment. |
| Proportion of Participants Relapse-free at Week 144 | 144 weeks | Relapses are defined as new or recurrent neurological symptoms not associated with fever or infection, lasting at least 24 hours, and accompanied by new objective neurological findings upon examination by the examining neurologist. Only relapses confirmed by INEC are included in this analysis. Data after participants switched to alternative MS medications are excluded. The estimated proportion of subjects relapse-free at Week 144 is based on the Kaplan-Meier product limit method. |
| Percentage of Participants With a ≥ 7.5 Point Worsening From Baseline in the Multiple Sclerosis Impact Scale (MSIS-29) Physical Impact Score at 96 Weeks | Baseline and 96 weeks | The MSIS-29 is a 29-item disease-specific patient-reported outcome measure that has been developed and validated to examine the physical and psychological impact of MS from a patient's perspective; it measures physical and psychological items. Worsening in the MSIS-29 physical score is defined as an increase of ≥ 7.5 points in the MSIS-29 physical score at 96 weeks compared to baseline. If a participant was missing data for less than 10 of the 20 items that make up the physical score, then the mean of the non-missing items were used for the missing items. If a participant was missing 10 or more of the 20 items that make up the physical score, or missing the questionnaire entirely, or if the questionnaire was completed after the participant switched to alternative MS medication, a random effects model was used to estimate the MSIS-29 physical score. |
Countries
Argentina, Australia, Brazil, Canada, Czechia, Denmark, Finland, France, Georgia, Germany, Greece, Hungary, India, Ireland, Israel, Italy, Mexico, Moldova, Poland, Romania, Russia, Serbia, Spain, Sweden, Switzerland, Ukraine, United Kingdom, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Interferon Beta-1a IFN β-1a 30 µg IM injection once weekly plus placebo to DAC HYP SC once every 4 weeks for 96 to 144 weeks | 922 |
| Daclizumab High Yield Process DAC HYP 150 mg SC injection once every 4 weeks plus placebo to IFN β-1a IM injection once weekly for 96 to 144 weeks | 919 |
| Total | 1,841 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 47 | 56 |
| Overall Study | Consent Withdrawn | 98 | 80 |
| Overall Study | Death | 4 | 0 |
| Overall Study | Investigator Decision | 4 | 6 |
| Overall Study | Lack of Efficacy | 46 | 23 |
| Overall Study | Lost to Follow-up | 12 | 9 |
| Overall Study | Noncompliance | 7 | 8 |
| Overall Study | Other | 2 | 1 |
| Overall Study | Pregnancy | 4 | 7 |
| Overall Study | Site Closure | 4 | 5 |
Baseline characteristics
| Characteristic | Interferon Beta-1a | Daclizumab High Yield Process | Total |
|---|---|---|---|
| Age, Continuous | 36.2 years STANDARD_DEVIATION 9.32 | 36.4 years STANDARD_DEVIATION 9.36 | 36.3 years STANDARD_DEVIATION 9.34 |
| Age, Customized 18 to 19 years | 25 participants | 14 participants | 39 participants |
| Age, Customized 20 to 29 years | 227 participants | 236 participants | 463 participants |
| Age, Customized 30 to 39 years | 327 participants | 322 participants | 649 participants |
| Age, Customized 40 to 49 years | 256 participants | 250 participants | 506 participants |
| Age, Customized 50 to 55 years | 86 participants | 96 participants | 182 participants |
| Age, Customized > 55 years | 1 participants | 1 participants | 2 participants |
| Sex: Female, Male Female | 627 Participants | 625 Participants | 1252 Participants |
| Sex: Female, Male Male | 295 Participants | 294 Participants | 589 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 783 / 922 | 731 / 919 |
| serious Total, serious adverse events | 194 / 922 | 221 / 919 |
Outcome results
Adjusted Annualized Relapse Rate (ARR)
Relapses are defined as new or recurrent neurological symptoms not associated with fever or infection, lasting at least 24 hours, and accompanied by new objective neurological findings upon examination by the examining neurologist. Only relapses confirmed by Independent Neurology Evaluation Committee (INEC) are included in this analysis. Adjusted ARR was estimated from a negative binomial regression model adjusted for the baseline relapse rate, history of prior IFN beta use, baseline Expanded Disability Status Scale score (EDSS; ≤ 2.5 vs \> 2.5) and baseline age (≤ 35 vs \> 35 years). Data after participants switched to alternative MS medications are excluded.
Time frame: Up to 144 weeks
Population: participants with a relapse
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Interferon Beta-1a | Adjusted Annualized Relapse Rate (ARR) | 0.393 relapses per person-years |
| Daclizumab High Yield Process | Adjusted Annualized Relapse Rate (ARR) | 0.216 relapses per person-years |
Adjusted Mean Number of New or Newly Enlarging T2 Hyperintense Lesions up to Week 96
The quantity of lesions is assessed by brain magnetic resonance imaging (MRI). The adjusted mean number is estimated from a negative binomial regression model, adjusted for baseline volume of T2 from a negative binomial regression model, adjusted for baseline volume of T2 hyperintense lesions, history of prior IFN beta use and baseline age (≤ 35 vs \> 35 years). To account for the timing of the MRI measurement, the logarithmic transformation of the scan number of the MRI assessment is included in the model as the 'offset' parameter. Observed data after participants switched to alternative MS medications are excluded. Missing data are not imputed. Only observed new or newly enlarging T2 lesions at the last visit of the participant up to Week 96 visit are used in this analysis.
Time frame: up to 96 weeks
Population: participants with baseline and at least one post-baseline MRI measurement
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Interferon Beta-1a | Adjusted Mean Number of New or Newly Enlarging T2 Hyperintense Lesions up to Week 96 | 9.44 lesions |
| Daclizumab High Yield Process | Adjusted Mean Number of New or Newly Enlarging T2 Hyperintense Lesions up to Week 96 | 4.31 lesions |
Percentage of Participants With a ≥ 7.5 Point Worsening From Baseline in the Multiple Sclerosis Impact Scale (MSIS-29) Physical Impact Score at 96 Weeks
The MSIS-29 is a 29-item disease-specific patient-reported outcome measure that has been developed and validated to examine the physical and psychological impact of MS from a patient's perspective; it measures physical and psychological items. Worsening in the MSIS-29 physical score is defined as an increase of ≥ 7.5 points in the MSIS-29 physical score at 96 weeks compared to baseline. If a participant was missing data for less than 10 of the 20 items that make up the physical score, then the mean of the non-missing items were used for the missing items. If a participant was missing 10 or more of the 20 items that make up the physical score, or missing the questionnaire entirely, or if the questionnaire was completed after the participant switched to alternative MS medication, a random effects model was used to estimate the MSIS-29 physical score.
Time frame: Baseline and 96 weeks
Population: participants with a baseline and Week 96 assessment
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Interferon Beta-1a | Percentage of Participants With a ≥ 7.5 Point Worsening From Baseline in the Multiple Sclerosis Impact Scale (MSIS-29) Physical Impact Score at 96 Weeks | 23 percentage of participants |
| Daclizumab High Yield Process | Percentage of Participants With a ≥ 7.5 Point Worsening From Baseline in the Multiple Sclerosis Impact Scale (MSIS-29) Physical Impact Score at 96 Weeks | 19 percentage of participants |
Proportion of Participants Relapse-free at Week 144
Relapses are defined as new or recurrent neurological symptoms not associated with fever or infection, lasting at least 24 hours, and accompanied by new objective neurological findings upon examination by the examining neurologist. Only relapses confirmed by INEC are included in this analysis. Data after participants switched to alternative MS medications are excluded. The estimated proportion of subjects relapse-free at Week 144 is based on the Kaplan-Meier product limit method.
Time frame: 144 weeks
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Interferon Beta-1a | Proportion of Participants Relapse-free at Week 144 | 0.508 proportion of participants |
| Daclizumab High Yield Process | Proportion of Participants Relapse-free at Week 144 | 0.673 proportion of participants |
Proportion of Participants With Sustained Disability Progression at 144 Weeks
Sustained disability progression is defined as: at least a 1.0-point increase on the EDSS from Baseline EDSS ≥ 1.0 that is sustained for 12 weeks, or at least a 1.5-point increase on the EDSS from baseline EDSS = 0 that is sustained for 12 weeks. The EDSS measures the disability status of people with MS on a scale that ranges from 0 to 10, with higher scores indicating more disability. Estimated proportion of participants with progression is based on the Kaplan-Meier product limit method. Participants were censored at the time of withdrawal/switch if they withdrew from study or switched to alternative MS medication without a progression. Participants with a tentative progression at the End of Treatment Period Visit (or the last EDSS assessment prior to alternative MS start date) and no confirmation assessment were censored at their last EDSS assessment.
Time frame: Baseline through 144 weeks
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Interferon Beta-1a | Proportion of Participants With Sustained Disability Progression at 144 Weeks | 0.203 proportion of participants |
| Daclizumab High Yield Process | Proportion of Participants With Sustained Disability Progression at 144 Weeks | 0.162 proportion of participants |