Relapsing Multiple Sclerosis, Primary Progressive Multiple Sclerosis
Conditions
Brief summary
This study will evaluate the pharmacokinetics, pharmacodynamics, safety, immunogenicity, and radiological and clinical effects of subcutaneous (SC) administration of ocrelizumab compared with the intravenous (IV) infusion of ocrelizumab in patients with either relapsing multiple sclerosis (RMS) or primary progressive multiple sclerosis (PPMS).
Interventions
DRUGOcrelizumab IV
IV Injection
DRUGOcrelizumab SC
SC Injection
Participants will receive mandatory (corticosteroids and antihistamine) and optional (analgesic) prophylactic treatment before the start of each ocrelizumab infusion
DRUGDiphenhydramine IV
Participants will receive mandatory (corticosteroids and antihistamine) and optional (analgesic) prophylactic treatment before the start of each ocrelizumab infusion
DRUGDexamethasone given orally
Participants will receive mandatory (corticosteroids and antihistamine) and optional (analgesic) prophylactic treatment before the start of each ocrelizumab injection
DRUGDesloratadine given orally
Participants will receive mandatory (corticosteroids and antihistamine) and optional (analgesic) prophylactic treatment before the start of each ocrelizumab injection
Sponsors
Hoffmann-La Roche
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
* Diagnosis of PPMS or RMS according to the revised McDonald 2017 criteria (Thompson et al. 2018) * EDSS score, 0-6.5, inclusive, at screening * Neurological stability for ≥30 days prior to both screening and baseline * Disease duration from onset of MS symptoms of less than 15 years for patients with EDSS score \<2.0 at screening * For females participants, without reproductive potential may be enrolled if post-menopausal, unless receiving a hormonal therapy for menopause or if surgically sterile * For females of childbearing potential, agreement to remain abstinent or use adequate contraceptive methods
Exclusion criteria
* Any known or suspected active infection at screening or baseline (except nailbed infections), or any major episode of infection requiring hospitalization or treatment with IV anti microbials within 8 weeks prior to and during screening or treatment with oral anti microbials within 2 weeks prior to and during screening * History of confirmed or suspected progressive multifocal leukoencephalopathy (PML) * History of cancer, including hematologic malignancy and solid tumors, within 10 years of screening * Immunocompromised state * Receipt of a live-attenuated vaccine within 6 weeks prior to randomization Influenza vaccination is permitted if the inactivated vaccine formulation is administered * Inability to complete an MRI or contraindication to gadolinium administration * Contraindications to mandatory premedications for IRRs, including closed-angle glaucoma for antihistamines * Known presence of other neurologic disorders * Any concomitant disease that may require chronic treatment with systemic corticosteroids or immunosuppressants during the course of the study * Significant, uncontrolled disease, such as cardiovascular, pulmonary, renal, hepatic, endocrine or gastrointestinal, or any other significant disease that may preclude patient from participating in the study * History of or currently active primary or secondary (non-drug-related) immunodeficiency * Pregnant or breastfeeding, or intending to become pregnant during the study and 6 or 12 months * Lack of peripheral venous access * History of alcohol or other drug abuse within 12 months prior to screening * Treatment with any investigational agent within 24 weeks prior to screening or 5 half-lives of the investigational drug (whichever is longer), or treatment with any experimental procedure for MS (e.g., treatment for chronic cerebrospinal venous insufficiency) * Participants who have previously received anti-CD20s if the last treatment was less than 2 years before screening, and/or if B-cell count is below lower limit of normal, and/or the discontinuation of the treatment was due to safety reasons or lack of efficacy * Previous treatment with cladribine, atacicept, and alemtuzumab * Previous treatment with fingolimod, siponimod, ponesimod, or ozanimod within 6 weeks of baseline * Previous treatment with interferons beta (1a or 1b), or glatiramer acetate within 2 weeks of baseline * Previous treatment with natalizumab within 4.5 months of baseline * Treatment with mitoxantrone within 2 years prior to baseline visit or evidence of cardiotoxicity following mitoxantrone use or a cumulative lifetime dose of more than 60 mg/m2 * Previous treatment with any other immunomodulatory or immunosuppressive medication not already listed above without appropriate washout as described in the applicable local label. * If the washout requirements are not described in the applicable local label, then the wash out period must be 5 times the half-life of the medication. The PD effects of the previous medication must also be considered when determining the required time for washout. * Any previous treatment with bone marrow transplantation and hematopoietic stem cell transplantation * Any previous history of transplantation or anti-rejection therapy * Treatment with IV Ig or plasmapheresis within 12 weeks prior to randomization * Systemic corticosteroid therapy within 4 weeks prior to screening * Positive screening tests for active, latent, or inadequately treated hepatitis B * Sensitivity or intolerance to any ingredient (including excipients) of ocrelizumab * Any additional exclusionary criterion as per ocrelizumab (Ocrevus®) local label, if more stringent than the above
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Serum Ocrelizumab Area Under the Concentration-Time Curve Over the First 12 Weeks (AUCW1-12) After SC Administration | Day 1 Week 1 to Week 12 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Maximum Serum Concentration (Cmax) of Ocrelizumab SC | Day 1 Week 1 to Week 24 | — |
| Rate of Gadolinium-enhancing Lesions on T1-weighted (T1Gd+) Lesions as Detected by Brain Magnetic Resonance Imaging (MRI) at Weeks 8 and 24 | At Weeks 8 and 24 | Radiologic evaluation for the total number of T1Gd+ lesions was performed using a standardized MRI at Weeks 8 and 24 to monitor central nervous system (CNS) lesions in participants with MS. Estimand variable (adjusted lesion rate) was modeled by a negative binomial regression that included treatment variable \& was adjusted for covariates: baseline T1Gd+ lesion (present or not), geographical region (United States of America vs. Rest of the world). EE = Efficacy-evaluable. |
| Rate of New or Enlarging T2 Lesions as Detected by Brain MRI at Weeks 12 and 24 | At Weeks 12 and 24 | Radiologic evaluation for the new or enlarging T2 lesions was performed using a standardized MRI at Weeks 12 and 24 to monitor CNS lesions in participants with MS. Estimand variable (adjusted lesion rate) was modeled by a negative binomial regression that included treatment variable \& was adjusted for covariates: baseline T2 lesion count, geographical region (United States of America vs. Rest of the world). |
| Number of Participants With Adverse Events (AEs) | From initiation of study drug until 24 weeks after the final dose of study drug (up to 138.1 weeks) | An AE was any untoward medical occurrence in a clinical investigation participant administered a pharmaceutical product, regardless of causal attribution. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. |
| Number of Participants With Anti-drug Antibodies (ADAs) to Ocrelizumab After SC or IV Administration | Up to 138.1 weeks | Participants who received ocrelizumab were considered to be treatment-emergent ADA-positive if they were ADA-negative or had missing data at baseline but developed an ADA response following ocrelizumab exposure (treatment-induced ADA response), or if they were ADA-positive at baseline and the titer of one or more post-baseline samples was at least 0.60 titer units (t.u.) greater than the titer of the baseline sample (treatment-enhanced ADA response). Participants with a positive post-baseline sample has been reported here. |
| Number of Participants With ADAs to rHuPH20 After Ocrelizumab SC Administration | Up to 138.1 weeks | Ocrelizumab SC formulation is co-formulated with rHuPH20 at a concentration of 1000 units per milliliter (U/mL). Participants who received ocrelizumab SC were considered to be treatment-emergent ADA-positive if they were ADA-negative or had missing data at baseline but developed an ADA response following ocrelizumab SC exposure (treatment-induced ADA response), or if they were ADA-positive at baseline and the titer of one or more post-baseline samples was at least 0.60 titer units (t.u.) greater than the titer of the baseline sample (treatment-enhanced ADA response). Participants with a positive post-baseline sample has been reported here. |
| Percentage of Participants Who Achieved CD19+ B Cell Level of ≤5 Cells/Microliters (µL) at Weeks 12, 24, 48, and/or 96 | At Weeks 12, 24, 48, and 96 | B-cells were assessed in fresh whole blood using flow cytometry. Percentages have been rounded off. |
Countries
Brazil, Czechia, Italy, New Zealand, Poland, Spain, Turkey (Türkiye), United States
Contacts
STUDY_DIRECTORClinical Trials
Hoffmann-La Roche
Participant flow
Recruitment details
A total of 236 participants with primary progressive multiple sclerosis (PPMS) or relapsing multiple sclerosis (RMS) took part in the study at 37 investigative sites across 8 countries from 03 May 2022 to 06 June 2025.
Pre-assignment details
The study consisted of 3 periods: a 24-week controlled period, where participants were randomized in a 1:1 ratio to receive ocrelizumab as either subcutaneous (SC) injection or intravenous (IV) infusion, an ocrelizumab SC treatment period, where participants in both arms received SC treatment, followed by a safety follow-up period where participants who completed the treatment or discontinued from the treatment early were followed for up to 24 weeks after the last ocrelizumab administration.
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Continuous | 40.0 years STANDARD_DEVIATION 11.9 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 8 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 94 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 33 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 1 Participants |
| Race (NIH/OMB) Black or African American | 7 Participants |
| Race (NIH/OMB) More than one race | 3 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 1 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 6 Participants |
| Race (NIH/OMB) White | 211 Participants |
| Sex: Female, Male Female | 147 Participants |
| Sex: Female, Male Male | 48 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 118 | 0 / 118 |
| other Total, other adverse events | 86 / 118 | 99 / 118 |
| serious Total, serious adverse events | 9 / 118 | 7 / 118 |
Outcome results
None listed