The investigators propose a multi-center pilot study, which aims to evaluate safety and efficacy of fumarates as de-escalation therapy in clinically stable MS patients previously treated with anti-CD20 therapy.
Ten patients \>18 years of age with a minimum of 2 years of MS disease stability (no relapse or new magnetic resonance imaging lesions) and at least one year of experience on an anti-CD20 agent prior to initiating de-escalation with diroximel fumarate (Vumerity®) or dimethyl fumarate (Tecfidera®) will be followed for 24 months post de-escalation. To account for screen failures and withdrawals, up to 15 may be enrolled.
Study Type
OBSERVATIONAL
Enrollment
11
Titration starting with 231 mg twice a day, orally, for 7 days (per United States Product information). Then continue with 462 mg orally (administered as two 231 mg capsules) twice a day.
Titration will start with 120mg twice a day, orally, for 7 days (per United States product information) and then continue with 240mg twice a day orally.
University of Colorado, Denver
Aurora, Colorado, United States
Components of No Evidence of Disease Activity (NEDA-3) components (of which are no relapse activity, no MRI disease activity and no confirmed disability progression).
Number of subjects not meeting NEDA defined as: 1. Evidence of Relapse activity - collected via monthly phone calls and study visits. OR 2. MRI disease activity - presence of new lesions (T2 or Gd enhancing) on scans done at baseline, months 12 and 24. OR 3. 6 months Confirmed Disability progression (CDP6): measured by EDSS done at baseline and every 6 months. CDP6 is defined as an increase in EDSS score of ≥1.5 if baseline EDSS was 0; or ≥1.0 points if baseline EDSS was ≥0.5-≤5; or by ≥0.5 points if baseline EDSS ≥6, sustained over two consecutive visits for ≥6 months. The time with NEDA (primary outcome) will be described using product-limit estimates (Kaplan-Meier plots). With 20 patients, if there is no evidence of disease activity in any patients in 24 months, we are 90% confident that the true rate is below 17%. Similarly with 1, 2, and 3 patients with observable disease activity in 24 months, the true rates are between 0.1-25%, 1-32% and 3-38% respectively.
Time frame: From baseline to 24 months
Neurofilament light levels
Neurofilament light levels: Neurofilament light chain is a biomarker of neuroaxonal injury measured in serum or plasma. Unit: pg/mL (picograms per milliliter). Range: Continuous, with higher values indicating greater neuroaxonal damage.
Time frame: From baseline to 24 Months
Brain parenchymal volume loss (using Icometrix)
Brain parenchymal volume loss (using iCOMETRIX): Volume is quantified from serial MRI scans using the FDA-cleared iCOMETRIX (icobrain) software platform. Unit: Percentage change in brain parenchymal volume from baseline. Range: Continuous Negative values indicate brain volume loss; larger negative percentages reflect greater tissue loss.
Time frame: From baseline to 24 Months
Multiple Sclerosis Functional Composite (MSFC)
Assessment of MS-related disability that evaluates ambulation (Timed 25-Foot Walk), upper extremity function (9-Hole Peg Test), and cognitive processing speed. Continuous composite score calculated as the mean of standardized z-scores from the three component tests. Positive scores indicate better function and negative scores indicate worse function.
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Time frame: From baseline to 24 Months