Discontinuing Ocrelizumab treatment in early Multiple Sclerosis

Randomized, Blinded Discontinuation Trial of Ocrelizumab in Early Relapsing Multiple Sclerosis (AMS05)

This study is testing whether stopping Ocrelizumab treatment after two years is safe and effective for people with early Relapsing Multiple Sclerosis.

Quick facts

• Phase: Phase 4
• Study type: Interventional
• Enrollment: 123 (estimated)
• Ages: 18 Years to 55 Years
• Sex: All
• Sponsor: National Institute of Allergy and Infectious Diseases (NIAID) (NIH)
• Drugs / interventions: natalizumab, alemtuzumab
• Locations: 12 sites (New Haven, Connecticut and 11 other locations)
• Trial ID: NCT05285891 on ClinicalTrials.gov

What this trial studies

This study investigates the effects of discontinuing Ocrelizumab treatment in patients with early Relapsing Multiple Sclerosis (RMS). Participants will initially receive Ocrelizumab infusions and then be randomized to either continue with Ocrelizumab or switch to a placebo after 24 months. The study will assess various clinical and biological markers, including MRI scans and immune profiling, to evaluate disease activity and treatment outcomes over a total period of 48 months. The goal is to determine the safety and efficacy of stopping Ocrelizumab in this patient population.

Who should consider this trial

Good fit: Ideal candidates are individuals diagnosed with early Relapsing Multiple Sclerosis who have had their first clinical episode within the last two years.

Not a fit: Patients with a longer disease duration or those who have not experienced a clinical episode meeting the study criteria may not benefit from this study.

Why it matters

Potential benefit: If successful, this study could help identify safe treatment discontinuation strategies for patients with early RMS, potentially reducing long-term medication use.

How similar studies have performed: Other studies have explored treatment discontinuation in Multiple Sclerosis, but this specific approach to Ocrelizumab discontinuation is relatively novel.

Eligibility criteria

Inclusion Criteria:

1. Have at least one clinical episode that satisfies McDonald 2017 criteria for early Multiple sclerosis (MS) with a dissemination in time that can be met clinically, by Magnetic Resonance Imaging (MRI), or based on oligoclonal band (OCB) positivity
2. Have a length of disease duration, from first symptom, of ≤ 3 years at time of informed consent
3. For women of childbearing potential: Agreement to remain abstinent (refrain from heterosexual intercourse) or use effective methods of contraception during the treatment period and for at least 6 months after the last dose of study drug:

   1. A woman is considered to be of childbearing potential if she is postmenarcheal, has not reached a postmenopausal state (≥12 continuous months of amenorrhea with no identified cause other than menopause), and has not undergone surgical sterilization (removal of ovaries and/or uterus)
   2. Examples of contraceptive methods include bilateral tubal ligation, male sterilization, established hormonal contraceptives that inhibit ovulation, hormone- releasing intrauterine devices, and copper intrauterine devices
   3. The reliability of sexual abstinence should be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the participant. Periodic abstinence (e.g., calendar, ovulation, symptothermal, or post ovulation methods) and withdrawal are not acceptable methods of contraception
   4. Barrier methods must always be supplemented with the use of a spermicide

Exclusion Criteria:

1. Inability or unwillingness of a participant to give written informed consent or comply with study protocol
2. History of primary progressive multiple sclerosis (PPMS), progressive relapsing multiple sclerosis (PRMS), or secondary progressive multiple sclerosis (SPMS)
3. Any metallic material or electronic device in the body, or condition that precludes the participant from undergoing MRI
4. Known presence or history of other neurological disorders, including but not limited to the following:

   * Ischemic cerebrovascular disorders, including but not limited to transient ischemic attack, subarachnoid hemorrhage, cerebral thrombosis, cerebral embolism, or cerebral hemorrhage
   * CNS or spinal cord tumor, metabolic or infectious cause of myelopathy, genetically inherited progressive CNS disorder, CNS sarcoidosis, or systemic autoimmune disorders potentially causing progressive neurologic disease or affecting ability to perform the study assessments
5. Pregnancy or lactation

   • Female participants of childbearing potential must have a negative urine pregnancy test at screening
6. Any concomitant disease that may require chronic systemic treatment with corticosteroids or immunosuppressants during the course of the study
7. Lack of peripheral venous access
8. History of severe allergic or anaphylactic reactions to humanized or murine monoclonal antibodies
9. Significant, inadequately controlled (e.g., diagnostic evaluations indicated or change in medications warranted) disease, such as cardiovascular (including cardiac arrhythmia), pulmonary (including obstructive pulmonary disease), renal, hepatic, endocrine, and gastrointestinal or any other significant disease that in the opinion of the investigator may preclude participant from participating in the study
10. Functional status of New York Heart Association (NYHA) Class III or higher for heart failure at the screening visit
11. Known active bacterial, viral, fungal, mycobacterial infection or other infection (including tuberculosis (TB) or atypical mycobacterial disease but excluding limited superficial fungal or viral infections of the skin or nails) or any severe episode of infection requiring hospitalization or treatment with IV antibiotics within 4 weeks prior to Mo 0/Day 0 infusion or oral antibiotics within 2 weeks prior to Mo 0/Day 0 infusion
12. Active or chronic infection with human immunodeficiency virus (HIV), syphilis or TB (see laboratory tests below)
13. Evidence of past hepatitis B (including treated hepatitis B) or untreated hepatitis C infection (treated hepatitis C is not considered exclusionary). Hepatitis B surface antibody following hepatitis B immunization is not considered to be evidence of past infection (see laboratory tests below).
14. Known active malignancy or active monitoring for recurrence of malignancy, including solid tumors and hematological malignancies, except basal cell, in situ squamous cell carcinoma of the skin, and in situ carcinoma of the cervix or the uterus that have been excised with clear margins
15. Substance use disorder, including the recurrent use of alcohol and/or drugs within the past year associated with clinically significant impairment associated with failure to meet major responsibilities at work, school, or home
16. Receipt of live or live-attenuated vaccines within 4 weeks prior to Mo 0/Day 0 infusion
17. Contraindications to or severe intolerance of oral or IV corticosteroids, including IV methylprednisolone administered according to the country label, including:

    * Psychosis not controlled by a treatment
    * Hypersensitivity to any of the constituents or excipients of the preceding steroids
18. Current or prior treatment with the following MS DMTs: fingolimod and other S1P receptor modulators, cladribine, natalizumab, anti-CD20 molecules, alemtuzumab, and chemotherapeutic agents
19. Treatment with fumarates within 30 days prior to collection of Mo 0/Day 0 mechanistic samples, Mo 0/Day 0 MRI, and Mo 0/Day 0 infusion
20. (a) Current or prior treatment with any approved or experimental immunomodulatory therapies, unless reviewed and approved by the SAC (Section 3.6), or (b) Treatment with any experimental procedure for MS (e.g., treatment for chronic cerebrospinal venous insufficiency)
21. Systemic corticosteroid therapy within 4 weeks prior to the collection of screening mechanistic samples and the screening MRI
22. Systemic corticosteroid therapy within 4 weeks prior to the Mo 0/Day 0 infusion
23. Screening laboratory test results as follows:

    * Positive infection screening tests for:

      i. Hepatitis B surface antigen (HbsAg) or hepatitis B core antibody (HbcAb) ii. Hepatitis C (HCV) antibody if positive screen for HCV RNA Polymerase Chain Reaction (PCR) iii. Rapid plasma reagin (RPR)
    * A reactive RPR test unless followed by a subsequent negative RPR OR
    * A reactive RPR test unless successful completion of treatment has been documented as well as a consultation with and clearance by infectious disease department iv. HIV v. At or within twelve months of screening:
    * Positive QuantiFERON®-TB Gold test or positive purified protein derivative tuberculin skin test (PPD) (\>5mm induration, regardless of Bacille Calmette-Guerin (BCG) vaccine administration) unless completion of treatment has been documented for active TB OR
    * An indeterminate QuantiFERON®-TB Gold test unless followed by a subsequent negative PPD or negative QuantiFERON®-TB Gold test as well as a consultation with and clearance by infectious disease department
    * Levels of serum immunoglobulin G (IgG) \< 3.3g/L
    * Estimated glomerular filtration rate (eGFR) \< 60 mL/min/1.73 m2 using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation
    * Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≥ 2.0 x the upper limit of normal (ULN)
    * Platelet count \< 100,000 plt/µL (\<100 x 10⁹/L)
    * Hemoglobin \< 10 g/dL
    * Absolute neutrophil count \< 1.5 x 10⁹/L
    * Absolute lymphocyte count \< 1.2 x 10⁹/L
24. Past or current medical problems or findings from physical examination or laboratory testing that are not listed above, which, in the opinion of the investigator, may pose additional risks from participation in the study, may interfere with the participant's ability to comply with study requirements, or that may impact the quality or interpretation of the data obtained from the study.

Where this trial is running

New Haven, Connecticut and 11 other locations

• Yale School of Medicine — New Haven, Connecticut, United States (Recruiting)
• MedStar Georgetown University Hospital — Washington D.C., District of Columbia, United States (Recruiting)
• Northwestern University — Chicago, Illinois, United States (Recruiting)
• Massachusetts General Hospital — Boston, Massachusetts, United States (Recruiting)
• University of Massachusetts Memorial Medical Center — Worcester, Massachusetts, United States (Recruiting)
• Icahn School of Medicine at Mount Sinai — New York, New York, United States (Recruiting)
• University of Rochester Medical Center — Rochester, New York, United States (Recruiting)
• Oklahoma Medical Research Foundation — Oklahoma City, Oklahoma, United States (Recruiting)
• University of Pennsylvania, Perelman School of Medicine — Philadelphia, Pennsylvania, United States (Recruiting)
• University of Texas Southwestern Medical Center — Dallas, Texas, United States (Recruiting)
• The University of Texas Health Science Center at Houston, McGovern Medical School — Houston, Texas, United States (Recruiting)
• Virginia Commonwealth University School of Medicine — Richmond, Virginia, United States (Recruiting)

Study contacts

• Study coordinator: Amit Bar-Or

Conditions Multiple Sclerosis; Ocrelizumab; Multiple sclerosis; Relapse