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Patients With Relapse Remitting Multiple Sclerosis (RRMS): Candidates for MS Therapy Change

A 6-month, Randomized, Active Comparator, Open-label, Multi-Center Study to Evaluate Patient Outcomes, Safety and Tolerability of Fingolimod (FTY720) 0.5 mg/Day in Patients With Relapsing Remitting Multiple Sclerosis Who Are Candidates for MS Therapy Change From Previous Disease Modifying Therapy (EPOC)

Status
Completed
Phases
Phase 4
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01317004
Acronym
EPOC
Enrollment
61
Registered
2011-03-16
Start date
2011-05-31
Completion date
2014-06-30
Last updated
2015-06-22

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Relapsing Remitting Multiple Sclerosis

Keywords

Multiple sclerosis, Fingolimod, Disease Modifying Therapy, TSQM-9

Brief summary

The purpose of this study is to evaluate the change in patient-reported treatment satisfaction after 6 months of treatment with fingolimod 0.5mg/day vs. DMT standard of care, using the global satisfaction subscale of the Treatment Satisfaction Questionnaire for Medication (TSQM-9).

Interventions

DRUGFingolimod

0.5 mg/day oral capsule

DRUGStandard MS DMT

Interferon beta 1a or interferon beta 1b or Glatiramer Acetate

Sponsors

Novartis Pharmaceuticals
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No

Inclusion criteria

* Patients must be diagnosed with relapsing remitting MS (RRMS) as defined by 2005 revised McDonald criteria. * Patients who explicitly agree to be assigned to a treatment group that may receive fingolimod or DMT after having been informed about their respective benefits and possible adverse events by the investigator. * An Expanded Disability Status Scale (EDSS) score of 0-5.5 inclusive. * Must have received continuous treatment with a single approved and indicated MS DMT for a minimum of 6 months prior to the screening visit. Patients must continue with this MS DMT until the randomization visit. * Naïve to treatment with fingolimod.

Exclusion criteria

* A manifestation of MS other than those defined in the inclusion criteria. * A history of chronic disease of the immune system other than MS or a known immunodeficiency syndrome. * History of malignancy of any organ system (other than localized basal cell carcinoma of the skin), treated or untreated, within the past 5 years, regardless of whether there is evidence of local recurrence or metastases. * Patients with uncontrolled diabetes mellitus (HbA1c \> 7%). * Diagnosis of macular edema during Screening Phase. Other protocol-defined inclusion/

Design outcomes

Primary

MeasureTime frameDescription
Change From Baseline in Patient-reported Treatment Satisfactionbaseline, 6 monthsThe Treatment Satisfaction Questionnaire for Medication (TSQM-9) is a psychometric measure of a patient's satisfaction with medication. It consists of 3 subscales: effectiveness, convenience and global satisfaction. The scores were computed by adding items for each domain, i.e. 1 to 3 for effectiveness, 4 - 6 for convenience and 7 to 9 for global satisfaction. The lowest possible score (1 for each item and 3 for all 3 subscales) was subtracted from the composite score and divided by the greatest possible score range. The greatest range was (7-1) X 3 items = 18 for the effectiveness and convenience, and (5-1) x 3 items = 12 for global satisfaction. This provided a transformed score between 0 and 1 that was then multiplied by 100. A positive change from baseline indicates improvement.

Secondary

MeasureTime frameDescription
Change From Baseline in Patient-reported Fatigue6 monthsThe fatigue Severity Scale (FSS) is a 9-item scale used to assess fatigue. The FSS score was calculated summing the 9 items of the questionnaire and dividing by the number of non-missing items (each item is based on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree)). A negative change from baseline indicates improvement.
Change From Baseline in Patient-Reported Effectiveness and Convenience6 monthsThe Treatment Satisfaction Questionnaire for Medication (TSQM-9) is a psychometric measure of a patient's satisfaction with medication. It consists of 3 subscales: effectiveness, convenience and global satisfaction. The scores were computed by adding items for each domain, i.e. 1 to 3 for effectiveness, 4 - 6 for convenience and 7 to 9 for global satisfaction. The lowest possible score (1 for each item and 3 for all 3 subscales) was subtracted from the composite score and divided by the greatest possible score range. The greatest range was (7-1) X 3 items = 18 for the effectiveness and convenience, and (5-1) x 3 items = 12 for global satisfaction. This provided a transformed score between 0 and 1 that was then multiplied by 100. A positive change from baseline indicates improvement.
Change From Baseline in Patient-reported Activities of Daily Living (ADL)baseline, 6 monthsThe PRIMUS activity measure is a 15-item assessment used to evaluate patient-reported activities of daily living. The PRIMUS activities score was calculated summing the 15 items, after recoding the responses from 1 - 3 to 0 - 2. Therefore, the total score ranged from 0 - 3-, where high scores were indicative of greater function limitation. A negative change from baseline indicates improvement.
Change From Baseline in Patient-reported Health Related Quality of Life (QOL)6 monthsThe SF-36v2 is a validated health-related quality of life instrument used in numerous disease states, including MS. It is a self-administered survey that measures 8 domains of health including: physical functioning, role limitations due to physical health, pain, general health, energy/fatigue, social functioning, role limitations due to emotional problems and emotional well-being. Additionally, two summary scale scores can be calculated: the Physical Component Summary (PCS) and the Mental Component Summary (MCS). If half or more questions within a domain were answered, then a score was calculated for that domain. Otherwise, the patient score for that domain was set to missing. If the patient was missing any 1 of the 8 scale scores, then the physical and mental component scores were set to missing. An algorithm was used to create a score from 0 to 100 for each domain score and component score. A positive change from baseline indicates improvement.
Physician-reported Clinical Global Impression of Improvement (CGI-I)6 monthsThe CGI-I is a rating scale allowing a physician-reported global evaluation of the subject's improvement over time. The Investigator assessed the subject's clinical change relative to the symptoms at baseline on the CGI-I, a seven-point scale, with rating as follows: 1=Very much improved, 2=Much improved, 3=Minimally improved, 4=No change, 5=Minimally worse, 6=Much worse, 7=Very much worse. A lower score and a negative change from baseline indicate improvement.
Change From Baseline in Patient-reported Depression6 monthsThe Beck Depression Inventory Fast Screen (BDI-FS) is a brief, multiple choice, self reported inventory designed to evaluate depression in patients with medical illness. The BDI-FS score was calculated summing the 7 items of the questionnaire. Each item ranged from 0 (not present) to 3 (severe). The total score ranges from 0-3 (minimal depression), 4-8 (mild depression), 9-12 (moderate depression) and 13-21 (severe depression). A negative change from baseline indicates improvement.

Countries

Italy

Participant flow

Recruitment details

Actual enrollment = 61 because 65 participants were randomized to the study, but only 61 participants received at least one dose of study medication. As such, the participant flow captures the 65 participants randomized and the 61 participants who received drug as the safety set.

Participants by arm

ArmCount
Fingolimod
Patients randomized in this arm received Fingolimod 0.5 mg/day oral capsule for 6 months core period.
50
Multiple Sclerosis Disease Modifying Treatment (MS DMT)
Patients randomized in this arm received selected Standard MS DMT such as Interferon beta-1b or Interferon beta-1a or Glatiramer acetate for 6 months.
11
Total61

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event33
Overall StudyProtocol Violation02
Overall StudyWithdrawal by Subject14

Baseline characteristics

CharacteristicFingolimodMultiple Sclerosis Disease Modifying Treatment (MS DMT)Total
Age, Continuous37.96 Years
STANDARD_DEVIATION 8.69
35.82 Years
STANDARD_DEVIATION 7.22
37.57 Years
STANDARD_DEVIATION 8.43
Sex: Female, Male
Female
32 Participants8 Participants40 Participants
Sex: Female, Male
Male
18 Participants3 Participants21 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
13 / 507 / 11
serious
Total, serious adverse events
4 / 501 / 11

Outcome results

Primary

Change From Baseline in Patient-reported Treatment Satisfaction

The Treatment Satisfaction Questionnaire for Medication (TSQM-9) is a psychometric measure of a patient's satisfaction with medication. It consists of 3 subscales: effectiveness, convenience and global satisfaction. The scores were computed by adding items for each domain, i.e. 1 to 3 for effectiveness, 4 - 6 for convenience and 7 to 9 for global satisfaction. The lowest possible score (1 for each item and 3 for all 3 subscales) was subtracted from the composite score and divided by the greatest possible score range. The greatest range was (7-1) X 3 items = 18 for the effectiveness and convenience, and (5-1) x 3 items = 12 for global satisfaction. This provided a transformed score between 0 and 1 that was then multiplied by 100. A positive change from baseline indicates improvement.

Time frame: baseline, 6 months

Population: Participants from the safety set, who had values at both baseline and month 6, were included in the analysis. The safety set included randomized participants who received at least one dose of study medication.

ArmMeasureValue (MEAN)Dispersion
FingolimodChange From Baseline in Patient-reported Treatment Satisfaction19.57 score on a scaleStandard Deviation 21
Multiple Sclerosis Disease Modifying Treatment (MS DMT)Change From Baseline in Patient-reported Treatment Satisfaction5.83 score on a scaleStandard Deviation 16.47
Secondary

Change From Baseline in Patient-reported Activities of Daily Living (ADL)

The PRIMUS activity measure is a 15-item assessment used to evaluate patient-reported activities of daily living. The PRIMUS activities score was calculated summing the 15 items, after recoding the responses from 1 - 3 to 0 - 2. Therefore, the total score ranged from 0 - 3-, where high scores were indicative of greater function limitation. A negative change from baseline indicates improvement.

Time frame: baseline, 6 months

Population: Participants from the safety set, who had values at both baseline and month 6, were included in the analysis. The safety set included randomized participants who received at least one dose of study medication.

ArmMeasureValue (MEAN)Dispersion
FingolimodChange From Baseline in Patient-reported Activities of Daily Living (ADL)0.19 score on a scaleStandard Deviation 2.75
Multiple Sclerosis Disease Modifying Treatment (MS DMT)Change From Baseline in Patient-reported Activities of Daily Living (ADL)0.15 score on a scaleStandard Deviation 1.72
Secondary

Change From Baseline in Patient-reported Depression

The Beck Depression Inventory Fast Screen (BDI-FS) is a brief, multiple choice, self reported inventory designed to evaluate depression in patients with medical illness. The BDI-FS score was calculated summing the 7 items of the questionnaire. Each item ranged from 0 (not present) to 3 (severe). The total score ranges from 0-3 (minimal depression), 4-8 (mild depression), 9-12 (moderate depression) and 13-21 (severe depression). A negative change from baseline indicates improvement.

Time frame: 6 months

Population: Participants from the safety set, who had values at both baseline and month 6, were included in the analysis. The safety set included randomized participants who received at least one dose of study medication.

ArmMeasureValue (MEAN)Dispersion
FingolimodChange From Baseline in Patient-reported Depression-1.15 score on a scaleStandard Deviation 3.59
Multiple Sclerosis Disease Modifying Treatment (MS DMT)Change From Baseline in Patient-reported Depression-0.12 score on a scaleStandard Deviation 3.06
Secondary

Change From Baseline in Patient-Reported Effectiveness and Convenience

The Treatment Satisfaction Questionnaire for Medication (TSQM-9) is a psychometric measure of a patient's satisfaction with medication. It consists of 3 subscales: effectiveness, convenience and global satisfaction. The scores were computed by adding items for each domain, i.e. 1 to 3 for effectiveness, 4 - 6 for convenience and 7 to 9 for global satisfaction. The lowest possible score (1 for each item and 3 for all 3 subscales) was subtracted from the composite score and divided by the greatest possible score range. The greatest range was (7-1) X 3 items = 18 for the effectiveness and convenience, and (5-1) x 3 items = 12 for global satisfaction. This provided a transformed score between 0 and 1 that was then multiplied by 100. A positive change from baseline indicates improvement.

Time frame: 6 months

Population: Participants from the safety set, who had values at both baseline and month 6, were included in the analysis. The safety set included randomized participants who received at least one dose of study medication.

ArmMeasureGroupValue (MEAN)Dispersion
FingolimodChange From Baseline in Patient-Reported Effectiveness and ConvenienceEffectiveness13.53 score on a scaleStandard Deviation 28.39
FingolimodChange From Baseline in Patient-Reported Effectiveness and ConvenienceConvenience24.64 score on a scaleStandard Deviation 18.28
Multiple Sclerosis Disease Modifying Treatment (MS DMT)Change From Baseline in Patient-Reported Effectiveness and ConvenienceConvenience12.78 score on a scaleStandard Deviation 25.26
Multiple Sclerosis Disease Modifying Treatment (MS DMT)Change From Baseline in Patient-Reported Effectiveness and ConvenienceEffectiveness-1.67 score on a scaleStandard Deviation 32.4
Secondary

Change From Baseline in Patient-reported Fatigue

The fatigue Severity Scale (FSS) is a 9-item scale used to assess fatigue. The FSS score was calculated summing the 9 items of the questionnaire and dividing by the number of non-missing items (each item is based on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree)). A negative change from baseline indicates improvement.

Time frame: 6 months

Population: Participants from the safety set, who had values at both baseline and month 6, were included in the analysis. The safety set included randomized participants who received at least one dose of study medication.

ArmMeasureValue (MEAN)Dispersion
FingolimodChange From Baseline in Patient-reported Fatigue-0.18 score on a scaleStandard Deviation 1.46
Multiple Sclerosis Disease Modifying Treatment (MS DMT)Change From Baseline in Patient-reported Fatigue-0.32 score on a scaleStandard Deviation 1.21
Secondary

Change From Baseline in Patient-reported Health Related Quality of Life (QOL)

The SF-36v2 is a validated health-related quality of life instrument used in numerous disease states, including MS. It is a self-administered survey that measures 8 domains of health including: physical functioning, role limitations due to physical health, pain, general health, energy/fatigue, social functioning, role limitations due to emotional problems and emotional well-being. Additionally, two summary scale scores can be calculated: the Physical Component Summary (PCS) and the Mental Component Summary (MCS). If half or more questions within a domain were answered, then a score was calculated for that domain. Otherwise, the patient score for that domain was set to missing. If the patient was missing any 1 of the 8 scale scores, then the physical and mental component scores were set to missing. An algorithm was used to create a score from 0 to 100 for each domain score and component score. A positive change from baseline indicates improvement.

Time frame: 6 months

Population: Participants from the safety set, who had values at both baseline and month 6, were included in the analysis. The safety set included randomized participants who received at least one dose of study medication.

ArmMeasureGroupValue (MEAN)Dispersion
FingolimodChange From Baseline in Patient-reported Health Related Quality of Life (QOL)Physical functioning (n=41,9)1.71 score on a scaleStandard Deviation 23.07
FingolimodChange From Baseline in Patient-reported Health Related Quality of Life (QOL)Role limitations due to physical health (n=42,9)7.14 score on a scaleStandard Deviation 37.97
FingolimodChange From Baseline in Patient-reported Health Related Quality of Life (QOL)Pain (n=45,9)6.56 score on a scaleStandard Deviation 24.32
FingolimodChange From Baseline in Patient-reported Health Related Quality of Life (QOL)General health (n=44,8)4.52 score on a scaleStandard Deviation 19.43
FingolimodChange From Baseline in Patient-reported Health Related Quality of Life (QOL)Energy/fatigue (n=43,9)2.33 score on a scaleStandard Deviation 18.81
FingolimodChange From Baseline in Patient-reported Health Related Quality of Life (QOL)Social functioning (n=45,9)7.78 score on a scaleStandard Deviation 24.9
FingolimodChange From Baseline in Patient-reported Health Related Quality of Life (QOL)Role limitations d/t emotional problems (n=45,9)7.04 score on a scaleStandard Deviation 41.82
FingolimodChange From Baseline in Patient-reported Health Related Quality of Life (QOL)Emotional well-being (n=43,9)2.51 score on a scaleStandard Deviation 16.88
FingolimodChange From Baseline in Patient-reported Health Related Quality of Life (QOL)PCS (n=40,8)4.52 score on a scaleStandard Deviation 18.05
FingolimodChange From Baseline in Patient-reported Health Related Quality of Life (QOL)MCS (n=40,8)5.88 score on a scaleStandard Deviation 18.21
Multiple Sclerosis Disease Modifying Treatment (MS DMT)Change From Baseline in Patient-reported Health Related Quality of Life (QOL)Emotional well-being (n=43,9)4.89 score on a scaleStandard Deviation 28.13
Multiple Sclerosis Disease Modifying Treatment (MS DMT)Change From Baseline in Patient-reported Health Related Quality of Life (QOL)Physical functioning (n=41,9)-1.11 score on a scaleStandard Deviation 20.73
Multiple Sclerosis Disease Modifying Treatment (MS DMT)Change From Baseline in Patient-reported Health Related Quality of Life (QOL)Social functioning (n=45,9)6.94 score on a scaleStandard Deviation 25.85
Multiple Sclerosis Disease Modifying Treatment (MS DMT)Change From Baseline in Patient-reported Health Related Quality of Life (QOL)Role limitations due to physical health (n=42,9)5.56 score on a scaleStandard Deviation 27.32
Multiple Sclerosis Disease Modifying Treatment (MS DMT)Change From Baseline in Patient-reported Health Related Quality of Life (QOL)MCS (n=40,8)7.28 score on a scaleStandard Deviation 24.05
Multiple Sclerosis Disease Modifying Treatment (MS DMT)Change From Baseline in Patient-reported Health Related Quality of Life (QOL)Pain (n=45,9)14.44 score on a scaleStandard Deviation 15.25
Multiple Sclerosis Disease Modifying Treatment (MS DMT)Change From Baseline in Patient-reported Health Related Quality of Life (QOL)Role limitations d/t emotional problems (n=45,9)3.70 score on a scaleStandard Deviation 38.89
Multiple Sclerosis Disease Modifying Treatment (MS DMT)Change From Baseline in Patient-reported Health Related Quality of Life (QOL)General health (n=44,8)6.25 score on a scaleStandard Deviation 14.08
Multiple Sclerosis Disease Modifying Treatment (MS DMT)Change From Baseline in Patient-reported Health Related Quality of Life (QOL)PCS (n=40,8)7.83 score on a scaleStandard Deviation 15.86
Multiple Sclerosis Disease Modifying Treatment (MS DMT)Change From Baseline in Patient-reported Health Related Quality of Life (QOL)Energy/fatigue (n=43,9)6.48 score on a scaleStandard Deviation 33.24
Secondary

Physician-reported Clinical Global Impression of Improvement (CGI-I)

The CGI-I is a rating scale allowing a physician-reported global evaluation of the subject's improvement over time. The Investigator assessed the subject's clinical change relative to the symptoms at baseline on the CGI-I, a seven-point scale, with rating as follows: 1=Very much improved, 2=Much improved, 3=Minimally improved, 4=No change, 5=Minimally worse, 6=Much worse, 7=Very much worse. A lower score and a negative change from baseline indicate improvement.

Time frame: 6 months

Population: Participants from the safety set, who had values at month 6, were included in the analysis. The safety set included randomized participants who received at least one dose of study medication.

ArmMeasureGroupValue (NUMBER)
FingolimodPhysician-reported Clinical Global Impression of Improvement (CGI-I)Much improved13.64 Percentage of participants
FingolimodPhysician-reported Clinical Global Impression of Improvement (CGI-I)Minimally improved36.36 Percentage of participants
FingolimodPhysician-reported Clinical Global Impression of Improvement (CGI-I)No change47.73 Percentage of participants
FingolimodPhysician-reported Clinical Global Impression of Improvement (CGI-I)Minimally worse2.27 Percentage of participants
Multiple Sclerosis Disease Modifying Treatment (MS DMT)Physician-reported Clinical Global Impression of Improvement (CGI-I)Minimally worse11.11 Percentage of participants
Multiple Sclerosis Disease Modifying Treatment (MS DMT)Physician-reported Clinical Global Impression of Improvement (CGI-I)Much improved11.11 Percentage of participants
Multiple Sclerosis Disease Modifying Treatment (MS DMT)Physician-reported Clinical Global Impression of Improvement (CGI-I)No change66.67 Percentage of participants
Multiple Sclerosis Disease Modifying Treatment (MS DMT)Physician-reported Clinical Global Impression of Improvement (CGI-I)Minimally improved11.11 Percentage of participants

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026