Multiple Sclerosis
Conditions
Brief summary
Alemtuzumab is a highly effective therapy in relapse remitting multiple sclerosis (RRMS). The aim of this study is to elucidate the mechanism of action of the neuroprotective potential of alemtuzumab in RRMS. Therefore, the investigators will semi-annually analyse blood samples of RRMS patients treated with alemtuzumab up to 36 months. Using in vitro/ ex vivo assays the investigators aim to detect and characterize immune cells including their functional activity. Furthermore, the study aims to combine this analysis with clinical data (MRI, EDSS: Expanded Disability Status Scale, MSFC: Multiple Sclerosis Functional Composite) to reveal the underlining mechanism of action of alemtuzumab to further improve its efficacy and safety for present and future patients.
Interventions
DRUGAlemtuzumab Injection [Lemtrada]
Administration of 2 courses of alemtuzumab at an interval of 1 year. Course 1: Intravenous infusion of 12 mg alemtuzumab per day on 5 consecutive days. Course 2: Intravenous infusion of 12 mg alemtuzumab per day on 3 consecutive days.
Sponsors
University Hospital Muenster
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Diagnosis of MS according to the McDonald criteria 2010 and cranial MRI scan demonstrating white matter lesions attributable to MS within 5 years before prior to signing the informed consent form (ICF) * Age \> 18 years * Written informed consent to study participation
Exclusion criteria
* Medical, psychiatric, cognitive, or other conditions that, in the Investigator's opinion, compromise the patient's ability to understand the patient information, to give informed consent, or to complete the study * Any progressive form of MS * Any condition that serves as a contraindication for alemtuzumab treatment * Any disability acquired from trauma or another illness that could interfere with the evaluation of disability due to MS * Major systemic disease or other illness that would, in the opinion of the Investigator, compromise patient safety or interfere with the interpretation of study results, e.g., current peptic ulcer disease or other conditions that may predispose to hemorrhage * Significant autoimmune disease including but not limited to immune cytopenias, rheumatoid arthritis, systemic lupus erythematosus, other connective tissue disorders, vasculitis, inflammatory bowel disease, severe psoriasis * Inability to undergo MRI with gadolinium administration
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Absolute and relative change of cell-counts compared to baseline of T cell subsets in the peripheral blood (every 6 months) | 36 month | • T cell subsets: * CD (cluster of differentiation) 4 and CD8 positive T cells: naïve T cells, T effector cells, T memory cells, regulatory T cells * T-helper subsets: Th1, Th2, Th17 |
| Absolute and relative change of cell-counts compared to baseline of B-cell subsets in the peripheral blood (every 6 months) | 36 month | • B cell subsets: * Recent bone marrow emigrants, mature naïve, memory B cells * Plasma cells |
| Absolute and relative change of cell-counts compared to baseline of natural killer cells in the peripheral blood (every 6 months) | 36 month | • Natural killer cells: * CD56bright, CD56dim * Natural killer T cells |
| Absolute and relative change of cell-counts compared to baseline of antigen-presenting cells in the peripheral blood (every 6 months) | 36 month | • Antigen-presenting cells: * Dendritic cells: CD303+ plasmacytoid, CD11c+ and CD141+ myeloid dendritic cells * Monocytes and macrophages |
| Absolute and relative change of cell-counts compared to baseline of myeloid-derived suppressor cells in the peripheral blood (every 6 months) | 36 month | • Myeloid-derived suppressor cells |
| Change from baseline in levels of markers of autoimmunity (ANA, cANCA and pANCA) in the serum (every 6 months): | 36 month | \- IFT (immunoflescence-test) of ANA, cANCA and pANCA |
| Change from baseline in levels of markers of autoimmunity (anti-dsDNA) in the serum (every 6 months): | 36 month | \- RIA (radioimmunoassay) of anti-dsDNA |
| Change from baseline in levels of markers of autoimmunity (anti-TSH-Receptor) in the serum (every 6 months): | 36 month | \- Levels of anti-TSH-Receptor (U/ml) |
| Change from baseline in levels of markers of autoimmunity(anti-TPO) in the serum (every 6 months): | 36 month | \- Levels of anti-TPO (U/ml) |
| Change from baseline in levels of markers of autoimmunity (Rheumatoid factor) in the serum (every 6 months): | 36 month | \- Levels of Rheumatoid factor (U/ml) |
| Change from baseline in levels of markers of autoimmunity (anti-CCP) in the serum (every 6 months): | 36 month | \- Levels of anti-CCP (U/ml) |
| Change from baseline in levels of markers of autoimmunity (anti-GBM) in the serum (every 6 months): | 36 month | \- Levels of anti-GBM (U/ml) |
| Change from baseline in levels of markers of autoimmunity (antiplatelet antibodies) in the serum (every 6 months): | 36 month | \- Levels of antiplatelet antibodies (U/ml) |
Secondary
| Measure | Time frame |
|---|---|
| Functional characterization of T-cells and B cells in the peripheral blood (every 6 months) | 36 month |
Other
| Measure | Time frame | Description |
|---|---|---|
| Clinical related data: Analysis of MRI scans | 36 month | \- Number and location of lesions in MRI scans will be count |
| Clinical related data: Evaluation of disease activity and manifestation (EDSS) in comparison to baseline (every 6 months) | 36 month | • Expanded Disability Status Scale (EDSS): * Scoring will be performed using standard scoring test from www.neurostatus.net. * EDSS is an ordinal clinical rating scale which ranges from 0 (normal neurologic examination) to 10 (death due to MS) in half-point increments. EDSS steps 1.0 to 4.5 refer to people with MS who are fully ambulatory, while EDSS steps 5.0 to 9.5 are defined by the impairment to ambulation. |
| Clinical related data: Evaluation of disease activity and manifestation (MSFC) in comparison to baseline (every 6 months) | 36 month | • Multiple Sclerosis Functional Composite (MSFC): * MSFC will be administered according to the MSFC manual of the National MS Society. * In brief measurements on the impact of MS in three key clinical dimensions: leg function and ambulation, arm and hand function, and cognitive function are done. Raw scores in different measurement scales are transformed into standard comparable scores (z-scores) and an overall composite score is calculated. |
| Clinical related data: Observation of relapse rates | 36 month | \- Number and time of relapses will be counted |
Countries
Germany
Contacts
Primary ContactTobias Ruck, Dr.med.
Outcome results
None listed