Cladribine Tablets: Collaborative Study to Evaluate Impact On Central Nervous System Biomarkers in Multiple Sclerosis

Gregory Wu47 enrolled

Overview

The purpose of this study is to better understand the mechanism of action (MoA) of cladribine tablets by exploring the effect on central nervous system (CNS) and blood biomarkers relevant in the relapsing forms of multiple sclerosis (RMS; to include relapsing-remitting MS \[RRMS\] or active secondary progressive MS).

This is an open label, randomized, multicenter collaborative research Phase 4 biomarker study, designed to generate hypotheses to better understand the MoA of cladribine tablets in RMS (to include RRMS or active secondary progressive MS). The study is designed to generate hypotheses regarding the impact and relevance of cladribine tablet activity in the CNS by assessing the cerebrospinal (CSF) levels of lymphocyte subsets, other immune cells, neuronal injury markers and soluble immunological markers in study participants with RMS before and during treatment with cladribine tablets, and the association of these CSF markers with corresponding blood markers and with clinical outcomes.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

BASIC_SCIENCE

Masking

NONE

Enrollment

Conditions

Multiple Sclerosis Multiple Sclerosis, Relapsing-Remitting

Interventions

CladribineDRUG

All participants will receive cladribine 10 mg tablets at a cumulative dosage of 3.5 mg/kg divided into 2 treatment courses as per the United States Prescribing Information (USPI) (1.75 mg/kg per treatment course; Year 1 and Year 2 treatment). Patients will be randomized 1:2:2:1 to receive a total of 2 Lumbar Punctures at specific time points during the treatment cycle.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Have a relapsing form of multiple sclerosis (RMS; to include RRMS or active secondary progressive MS) 2. Are willing and able to receive at least 2 lumbar punctures 3. Have an EDSS of 0 to ≤ 5.5 during the screening period 4. Had at least 1 relapse or 1 gadolinium-enhancing or 1 new or enlarged T2 lesion in the last 12 months 5. Have absolute lymphocyte count (ALC) within normal range of the local laboratory or assessed as normal by the investigator within the 3 week screening period and meet all other eligibility criteria for cladribine tablet treatment 6. Capable of giving signed informed consent Exclusion Criteria: 1. Have any contraindication for lumbar puncture 2. Have current malignancy 3. Are infected with human immunodeficiency virus (HIV) 4. Have active chronic infections (e.g. hepatitis or tuberculosis) 5. Have signs or symptoms suggestive of progressive multifocal leukoencephalopathy (PML) in MRI 6. Have history of hypersensitivity to cladribine or any of the excipients listed in the cladribine tablets US Prescribing Information 7. Allergy or hypersensitivity to gadolinium and/or any other contraindication to perform a MRI 8. Have any other comorbid conditions that preclude participation 9. Have been previously treated with cladribine 10. Have previously been treated with ocrelizumab, alemtuzumab, rituximab, or daclizumab 11. Have received treatment with natalizumab during the last 6 months 12. Are currently receiving immunosuppressive or myelosuppressive therapy, e.g., methotrexate, cyclophosphamide, cyclosporine or azathioprine, or chronic treatment with systemic corticosteroids 13. Have received treatment with immunosuppressive or myelosuppressive therapy during the last 6 months 14. Have received chronic treatment with systemic corticosteroids during the last 4 weeks 15. Have moderate or severe hepatic impairment (Child-Pugh score \>6) 16. Have moderate or severe renal impairment (creatinine clearance \<60 mL per minute) 17. Are pregnant or unwilling or unable to use effective contraception during cladribine tablets dosing and for 6 months after the last dose in each treatment course 18. Are intending to breastfeed on a cladribine tablet treatment day and/or during the 10 days after the last cladribine tablet dose.

Locations (5)

Washington University School of Medicine

St Louis, Missouri, United States

Oklahoma Medical Research Foundation

Oklahoma City, Oklahoma, United States

University of Pennsylvania

Philadelphia, Pennsylvania, United States

University of Texas Southwestern Medical Center

Dallas, Texas, United States

Outcomes

Primary Outcomes

Change in CD3+ T Cells % From Baseline to Week 5

Change in CSF level of CD3+ T lymphocytes from Baseline to second LP at Week 5, using quality-controlled flow cytometry and assays. Within-group differences from baseline to Week 5 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed. Positive number indicates increase in CD3+ T cell percentage and a negative number indicates decrease in CD3+ T cell percentage.

Time frame: Baseline to Week 5 (5 weeks after first cladribine dose)

Change in CD3+ T Cells % From Baseline to Week 10

Change in CSF level of CD3+ T lymphocytes from Baseline to second LP at Week 10, using quality-controlled flow cytometry and assays. Within-group differences from Baseline to Week 10 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed. Positive number indicates increase in CD3+ T cell percentage and a negative number indicates decrease in CD3+ T cell percentage.

Time frame: Baseline to Week 10 (10 weeks after first cladribine dose)

Change in CD3+ T Cells % From Baseline to Year 1

Change in CSF level of CD3+ T lymphocytes from Baseline to second LP at Year 1, using quality-controlled flow cytometry and assays. Within-group differences from Baseline to Year 1 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed. Positive number indicates increase in CD3+ T cell percentage and a negative number indicates decrease in CD3+ T cell percentage.

Time frame: Baseline to Year 1 (45 weeks after first cladribine dose)

Change in CD3+ T Cells % From Baseline to Year 2

Change in CSF level of CD3+ T lymphocytes from Baseline to second LP at Year 2, using quality-controlled flow cytometry and assays. Within-group differences from Baseline to Year 2 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed. Positive number indicates increase in CD3+ T cell percentage and a negative number indicates decrease in CD3+ T cell percentage.

Data from ClinicalTrials.gov

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Medical College of Wisconsin

Milwaukee, Wisconsin, United States

Time frame: Baseline to Year 2 (45 weeks after last cladribine dose)

Change in CD3+ T Cells Absolute Numbers (Cells/mL) From Baseline to Week 5

Change in CSF level of CD3+ T cells absolute numbers from Baseline to second LP at Week 5, using quality-controlled flow cytometry and assays. Within-group differences from baseline to Week 5 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed. Positive number indicates increase in CD3+ T cells absolute numbers and a negative number indicates decrease in CD3+ T cells absolute numbers.

Time frame: Baseline to Week 5

Change in CD3+ T Cells Absolute Numbers (Cells/mL) From Baseline to Week 10

Change in CSF level of CD3+ T cells absolute numbers from Baseline to second LP at Week 10, using quality-controlled flow cytometry and assays. Within-group differences from Baseline to Week 10 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed. Positive number indicates increase in CD3+ T cells absolute numbers and a negative number indicates decrease in CD3+ T cells absolute numbers.

Time frame: Baseline to Week 10 (10 weeks after first cladribine dose)

Change in CD3+ T Cells Absolute Numbers (Cells/mL) From Baseline to Year 1

Change in CSF level of CD3+ T cells absolute numbers from Baseline to second LP at Year 1, using quality-controlled flow cytometry and assays. Within-group differences from Baseline to Year 1 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed. Positive number indicates increase in CD3+ T cells absolute numbers and a negative number indicates decrease in CD3+ T cells absolute numbers.

Time frame: Baseline to Year 1 (45 weeks after first cladribine dose)

Change in CD3+ T Cells Absolute Numbers (Cells/mL) From Baseline to Year 2

Change in CSF level of CD3+ T cells absolute numbers from Baseline to second LP at Year 2, using quality-controlled flow cytometry and assays. Within-group differences from Baseline to Year 2 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed. Positive number indicates increase in CD3+ T cells absolute numbers and a negative number indicates decrease in CD3+ T cells absolute numbers.

Time frame: Baseline to Year 2 (45 weeks after last cladribine dose)

Change in CD19+ B Cells % From Baseline to Week 5

Change in CSF level of CD19+ B lymphocytes from Baseline to second LP at Week 5, using quality-controlled flow cytometry and assays. Within-group differences from Baseline to Week 5 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed. Positive number indicates increase in CD19+ B cell percentage and a negative number indicates decrease in CD19+ B cell percentage.

Time frame: Baseline to Week 5 (5 weeks after first cladribine dose)

Change in CD19+ B Cells % From Baseline to Week 10

Change in CSF level of CD19+ B lymphocytes from Baseline to second LP at Week 10, using quality-controlled flow cytometry and assays. Within-group differences from Baseline to Week 10 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed. Positive number indicates increase in CD19+ B cell percentage and a negative number indicates decrease in CD19+ B cell percentage.

Time frame: Baseline to Week 10 (10 weeks after first cladribine dose)

Change in CD19+ B Cells % From Baseline to Year 1

Change in CSF level of CD19+ B lymphocytes from Baseline to second LP at Year 1, using quality-controlled flow cytometry and assays. Within-group differences from Baseline to Year 1 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed. Positive number indicates increase in CD19+ B cell percentage and a negative number indicates decrease in CD19+ B cell percentage.

Time frame: Baseline to Year 1 (45 weeks after first cladribine dose)

Change in CD19+ B Cells % From Baseline to Year 2

Change in CSF level of CD19+ B lymphocytes from Baseline to second LP at Year 2, using quality-controlled flow cytometry and assays. Within-group differences from Baseline to Year 2 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed. Positive number indicates increase in CD19+ B cell percentage and a negative number indicates decrease in CD19+ B cell percentage.

Time frame: Baseline to Year 2 (45 weeks after last cladribine dose)

Change in CD19+ B Cells Absolute Numbers (Cells/mL) From Baseline to Week 5

Change in CSF level of CD19+ B cells absolute numbers from Baseline to second LP at Week 5, using quality-controlled flow cytometry and assays. Within-group differences from Baseline to Week 5 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed. Positive number indicates increase in CD19+ B cells absolute numbers and a negative number indicates decrease in CD19+ B cells absolute numbers.

Time frame: Baseline to Week 5 (5 weeks after first cladribine dose)

Change in CD19+ B Cells Absolute Numbers (Cells/mL) From Baseline to Week 10

Change in CSF level of CD19+ B cells absolute numbers from Baseline to second LP at Week 10, using quality-controlled flow cytometry and assays. Within-group differences from Baseline to Week 10 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed. Positive number indicates increase in CD19+ B cells absolute numbers and a negative number indicates decrease in CD19+ B cells absolute numbers.

Time frame: Baseline to Week 10 (10 weeks after first cladribine dose)

Change in CD19+ B Cells Absolute Numbers (Cells/mL) From Baseline to Year 1

Change in CSF level of CD19+ B cells absolute numbers from Baseline to second LP at Year 1, using quality-controlled flow cytometry and assays. Within-group differences from Baseline to Year 1 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed. Positive number indicates increase in CD19+ B cells absolute numbers and a negative number indicates decrease in CD19+ B cells absolute numbers.

Time frame: Baseline to Year 1 (45 weeks after first cladribine dose)

Change in CD19+ B Cells Absolute Numbers (Cells/mL) From Baseline to Year 2

Change in CSF level of CD19+ B cells absolute numbers from Baseline to second LP at Year 2, using quality-controlled flow cytometry and assays. Within-group differences from Baseline to Year 2 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed. Positive number indicates increase in CD19+ B cells absolute numbers and a negative number indicates decrease in CD19+ B cells absolute numbers.

Time frame: Baseline to Year 2 (45 weeks after last cladribine dose)

Change in the Neurofilament Light Chain (NfL) Level From Baseline to Week 5

Change in CSF level NfL (measured in pg/mL) from baseline to week 5 using the highly sensitive Neurology 4-Plex D Advantage Plus (N4PD+) single molecule array (SIMOA) technology. A single batch of samples with duplicates were run at the conclusion of the study. Within-group differences from baseline to Week 5 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed. Positive number indicates increase in NfL value and a negative number indicates decrease in NfL value.

Time frame: Baseline to Week 5 (5 weeks after first cladribine dose)

Change in the Neurofilament Light Chain (NfL) Level From Baseline to Week 10

Change in CSF level NfL (measured in pg/mL) from baseline to Week 10 using the highly sensitive Neurology 4-Plex D Advantage Plus (N4PD+) single molecule array (SIMOA) technology. A single batch of samples with duplicates were run at the conclusion of the study. Within-group differences from baseline to Week 10 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed. Positive number indicates increase in NfL value and a negative number indicates decrease in NfL value.

Time frame: Baseline to Week 10 (10 weeks after first cladribine dose)

Change in the Neurofilament Light Chain (NfL) Level From Baseline to Year 1

Change in CSF level NfL (measured in pg/mL) from baseline to Year 1 using the highly sensitive Neurology 4-Plex D Advantage Plus (N4PD+) single molecule array (SIMOA) technology. A single batch of samples with duplicates were run at the conclusion of the study. Within-group differences from baseline to Year 1 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed. Positive number indicates increase in NfL value and a negative number indicates decrease in NfL value.

Time frame: Baseline to Year 1 (45 weeks after first cladribine dose)

Change in the Neurofilament Light Chain (NfL) Level From Baseline to Year 2

Change in CSF level NfL (measured in pg/mL) from baseline to year 2 using the highly sensitive Neurology 4-Plex D Advantage Plus (N4PD+) single molecule array (SIMOA) technology. A single batch of samples with duplicates were run at the conclusion of the study. Within-group differences from baseline to year 2 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed. Positive number indicates increase in NfL value and a negative number indicates decrease in NfL value.

Time frame: Baseline to Year 2 (45 weeks after last cladribine dose)