A randomized trial of long-term dosage of rituximab in multiple sclerosis
This is a prospective randomized phase 3 study comparing two dosing regimens of Rituximab in long-term treatment of MS. Primary endpoint is no evidence of disease activity (NEDA) in a non-inferiority analysis between 12-months dosing interval of 500 mg rituximab with 6-months dosing interval. The endpoint is a compound of being free from release, new or enlarging MRI lesions and sustained progression of disability measured by EDSS. Each patient will have one treating physician responsible for all ongoing medical questions and decisions regarding continuation in the study and one examining physician performing the blinded Expanded Disability Status Scale examination and assessments of exacerbations. The coordinating nurse will administer the study-related tests and administer the rituximab infusions. MRI investigations will be performed blinded for the dosing arm allocation. Randomization will be performed via a randomization module in the national Swedish MS registry. The patients will be randomized in a 1:1 ratio and receive their treatments in accordance with clinical practice. Thus, the study will mimic the real-life situation in which the treatments will be administered. This will lead to a high degree of validity in relation to expected outcome in clinical practice.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
200
After one year in the trial, the patients are split in the two dosing-arms described above. The dose-comparison phase continues four years.
Anders Svenningsson
Danderyd, Stockholm County, Sweden
South Älvsborg Hospital
Borås, Sweden
Falun Hospital
Falun, Sweden
No evidence of disease activity (NEDA)
The proportion of patients maintaining No Evidence of Disease Activity-3 (NEDA-3) during year 2 - 4 of the trial: No relapse, no new T2 lesions (\> 3 mm), no EDSS progression in either dose arm
Time frame: 3 years
No evidence of disease activity (NEDA) in subgroups
The proportion of patients maintaining NEDA-3 comparing the previous rituximab arm with the previous DMF arm from the RIFUND trial
Time frame: 4 years
Time to first relapse
Time to first relapse for the two dose arms
Time frame: 3 yeas
Freedom of new or enlarged lesions on MRI
Proportion of patients in each dosing arm without new/enlarging T2 lesions
Time frame: 3 years
Development of brain atrophy
Evolution of brain atrophy measured as brain parenchymal fraction (BPF) and corpus callosum area or -volume
Time frame: 3 years
Development of confirmed sustained disability
Proportion of patient with confirmed progression in EDSS according to pre-specified criteria
Time frame: 3 years
Mean progression of disability
The mean change in EDSS over the trial period in the two dosing arms
Time frame: 3 years
Neurodegeneration
The mean change of s-NFL concentration between the two dosing arms
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Gävle Hospital
Gävle, Sweden
Saghlgrenska Hospital
Gothenburg, Sweden
Helsingborg Hospital
Helsingborg, Sweden
Karlstad Hospital
Karlstad, Sweden
Halland Hospital Kungsbacka
Kungsbacka, Sweden
Linköping University Hospital
Linköping, Sweden
Nyköping Hospital
Nyköping, Sweden
...and 7 more locations
Time frame: 3 years
Dose persistence
Time to discontinuation of dosing regimen allocation
Time frame: 3 years
Development of hypogammaglobulinaemia
The occurrence of hypogammaglobulinaemia in the two dosing arms
Time frame: 3 years
Development of neutropenia
The occurrence of neutropenia in the two dosing arms
Time frame: 3 years
Development of infections
The occurrence of infections in the two dosing arms
Time frame: 3 years