Relapsing Remitting Multiple Sclerosis
Conditions
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
0.5 mg/day oral capsule
Interferon beta 1a or interferon beta 1b or Glatiramer Acetate
Sponsors
Study design
Eligibility
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
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Patient-reported Treatment Satisfaction | baseline, 6 months | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Patient-reported Fatigue | 6 months | 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. |
| Change From Baseline in Patient-Reported Effectiveness and Convenience | 6 months | 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. |
| Change From Baseline in Patient-reported Activities of Daily Living (ADL) | baseline, 6 months | 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. |
| Change From Baseline in Patient-reported Health Related Quality of Life (QOL) | 6 months | 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. |
| Physician-reported Clinical Global Impression of Improvement (CGI-I) | 6 months | 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. |
| Change From Baseline in Patient-reported Depression | 6 months | 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. |
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
| Arm | Count |
|---|---|
| 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 |
| Total | 61 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 3 | 3 |
| Overall Study | Protocol Violation | 0 | 2 |
| Overall Study | Withdrawal by Subject | 1 | 4 |
Baseline characteristics
| Characteristic | Fingolimod | Multiple Sclerosis Disease Modifying Treatment (MS DMT) | Total |
|---|---|---|---|
| Age, Continuous | 37.96 Years STANDARD_DEVIATION 8.69 | 35.82 Years STANDARD_DEVIATION 7.22 | 37.57 Years STANDARD_DEVIATION 8.43 |
| Sex: Female, Male Female | 32 Participants | 8 Participants | 40 Participants |
| Sex: Female, Male Male | 18 Participants | 3 Participants | 21 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 13 / 50 | 7 / 11 |
| serious Total, serious adverse events | 4 / 50 | 1 / 11 |
Outcome results
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.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Fingolimod | Change From Baseline in Patient-reported Treatment Satisfaction | 19.57 score on a scale | Standard Deviation 21 |
| Multiple Sclerosis Disease Modifying Treatment (MS DMT) | Change From Baseline in Patient-reported Treatment Satisfaction | 5.83 score on a scale | Standard Deviation 16.47 |
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.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Fingolimod | Change From Baseline in Patient-reported Activities of Daily Living (ADL) | 0.19 score on a scale | Standard 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 scale | Standard Deviation 1.72 |
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.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Fingolimod | Change From Baseline in Patient-reported Depression | -1.15 score on a scale | Standard Deviation 3.59 |
| Multiple Sclerosis Disease Modifying Treatment (MS DMT) | Change From Baseline in Patient-reported Depression | -0.12 score on a scale | Standard Deviation 3.06 |
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.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Fingolimod | Change From Baseline in Patient-Reported Effectiveness and Convenience | Effectiveness | 13.53 score on a scale | Standard Deviation 28.39 |
| Fingolimod | Change From Baseline in Patient-Reported Effectiveness and Convenience | Convenience | 24.64 score on a scale | Standard Deviation 18.28 |
| Multiple Sclerosis Disease Modifying Treatment (MS DMT) | Change From Baseline in Patient-Reported Effectiveness and Convenience | Convenience | 12.78 score on a scale | Standard Deviation 25.26 |
| Multiple Sclerosis Disease Modifying Treatment (MS DMT) | Change From Baseline in Patient-Reported Effectiveness and Convenience | Effectiveness | -1.67 score on a scale | Standard Deviation 32.4 |
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.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Fingolimod | Change From Baseline in Patient-reported Fatigue | -0.18 score on a scale | Standard Deviation 1.46 |
| Multiple Sclerosis Disease Modifying Treatment (MS DMT) | Change From Baseline in Patient-reported Fatigue | -0.32 score on a scale | Standard Deviation 1.21 |
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.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Fingolimod | Change From Baseline in Patient-reported Health Related Quality of Life (QOL) | Physical functioning (n=41,9) | 1.71 score on a scale | Standard Deviation 23.07 |
| Fingolimod | Change 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 scale | Standard Deviation 37.97 |
| Fingolimod | Change From Baseline in Patient-reported Health Related Quality of Life (QOL) | Pain (n=45,9) | 6.56 score on a scale | Standard Deviation 24.32 |
| Fingolimod | Change From Baseline in Patient-reported Health Related Quality of Life (QOL) | General health (n=44,8) | 4.52 score on a scale | Standard Deviation 19.43 |
| Fingolimod | Change From Baseline in Patient-reported Health Related Quality of Life (QOL) | Energy/fatigue (n=43,9) | 2.33 score on a scale | Standard Deviation 18.81 |
| Fingolimod | Change From Baseline in Patient-reported Health Related Quality of Life (QOL) | Social functioning (n=45,9) | 7.78 score on a scale | Standard Deviation 24.9 |
| Fingolimod | Change 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 scale | Standard Deviation 41.82 |
| Fingolimod | Change From Baseline in Patient-reported Health Related Quality of Life (QOL) | Emotional well-being (n=43,9) | 2.51 score on a scale | Standard Deviation 16.88 |
| Fingolimod | Change From Baseline in Patient-reported Health Related Quality of Life (QOL) | PCS (n=40,8) | 4.52 score on a scale | Standard Deviation 18.05 |
| Fingolimod | Change From Baseline in Patient-reported Health Related Quality of Life (QOL) | MCS (n=40,8) | 5.88 score on a scale | Standard 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 scale | Standard 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 scale | Standard 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 scale | Standard 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 scale | Standard 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 scale | Standard 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 scale | Standard 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 scale | Standard 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 scale | Standard 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 scale | Standard 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 scale | Standard Deviation 33.24 |
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.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Fingolimod | Physician-reported Clinical Global Impression of Improvement (CGI-I) | Much improved | 13.64 Percentage of participants |
| Fingolimod | Physician-reported Clinical Global Impression of Improvement (CGI-I) | Minimally improved | 36.36 Percentage of participants |
| Fingolimod | Physician-reported Clinical Global Impression of Improvement (CGI-I) | No change | 47.73 Percentage of participants |
| Fingolimod | Physician-reported Clinical Global Impression of Improvement (CGI-I) | Minimally worse | 2.27 Percentage of participants |
| Multiple Sclerosis Disease Modifying Treatment (MS DMT) | Physician-reported Clinical Global Impression of Improvement (CGI-I) | Minimally worse | 11.11 Percentage of participants |
| Multiple Sclerosis Disease Modifying Treatment (MS DMT) | Physician-reported Clinical Global Impression of Improvement (CGI-I) | Much improved | 11.11 Percentage of participants |
| Multiple Sclerosis Disease Modifying Treatment (MS DMT) | Physician-reported Clinical Global Impression of Improvement (CGI-I) | No change | 66.67 Percentage of participants |
| Multiple Sclerosis Disease Modifying Treatment (MS DMT) | Physician-reported Clinical Global Impression of Improvement (CGI-I) | Minimally improved | 11.11 Percentage of participants |