Trial Outcomes & Findings for Patients With Relapse Remitting Multiple Sclerosis (RRMS): Candidates for MS Therapy Change (NCT NCT01317004)

NCT ID: NCT01317004

Last Updated: 2015-06-22

Results Overview

The Treatment Satisfaction Questionnaire for Medication (TSQM-9) is a psychometric measure of a patient's satisfaction with medication. It consists of 3 subscales: effectiveness, convenience and global satisfaction. The scores were computed by adding items for each domain, i.e. 1 to 3 for effectiveness, 4 - 6 for convenience and 7 to 9 for global satisfaction. The lowest possible score (1 for each item and 3 for all 3 subscales) was subtracted from the composite score and divided by the greatest possible score range. The greatest range was (7-1) X 3 items = 18 for the effectiveness and convenience, and (5-1) x 3 items = 12 for global satisfaction. This provided a transformed score between 0 and 1 that was then multiplied by 100. A positive change from baseline indicates improvement.

Recruitment status

COMPLETED

Study phase

PHASE4

Target enrollment

61 participants

Primary outcome timeframe

baseline, 6 months

Results posted on

2015-06-22

Participant Flow

Actual enrollment = 61 because 65 participants were randomized to the study, but only 61 participants received at least one dose of study medication. As such, the participant flow captures the 65 participants randomized and the 61 participants who received drug as the safety set.

Participant milestones

Participant milestones
Measure
Fingolimod
Patients randomized in this arm received Fingolimod 0.5 mg/day oral capsule for 6 months core period.
Multiple Sclerosis Disease Modifying Treatment (MS DMT)
Patients randomized in this arm received selected Standard MS DMT such as Interferon beta-1b or Interferon beta-1a or Glatiramer acetate for 6 months.
Overall Study
STARTED
51
14
Overall Study
Safety Set
50
11
Overall Study
COMPLETED
47
5
Overall Study
NOT COMPLETED
4
9

Reasons for withdrawal

Reasons for withdrawal
Measure
Fingolimod
Patients randomized in this arm received Fingolimod 0.5 mg/day oral capsule for 6 months core period.
Multiple Sclerosis Disease Modifying Treatment (MS DMT)
Patients randomized in this arm received selected Standard MS DMT such as Interferon beta-1b or Interferon beta-1a or Glatiramer acetate for 6 months.
Overall Study
Withdrawal by Subject
1
4
Overall Study
Protocol Violation
0
2
Overall Study
Adverse Event
3
3

Baseline Characteristics

Patients With Relapse Remitting Multiple Sclerosis (RRMS): Candidates for MS Therapy Change

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Fingolimod
n=50 Participants
Patients randomized in this arm received Fingolimod 0.5 mg/day oral capsule for 6 months core period.
Multiple Sclerosis Disease Modifying Treatment (MS DMT)
n=11 Participants
Patients randomized in this arm received selected Standard MS DMT such as Interferon beta-1b or Interferon beta-1a or Glatiramer acetate for 6 months.
Total
n=61 Participants
Total of all reporting groups
Age, Continuous
37.96 Years
STANDARD_DEVIATION 8.69 • n=99 Participants
35.82 Years
STANDARD_DEVIATION 7.22 • n=107 Participants
37.57 Years
STANDARD_DEVIATION 8.43 • n=206 Participants
Sex: Female, Male
Female
32 Participants
n=99 Participants
8 Participants
n=107 Participants
40 Participants
n=206 Participants
Sex: Female, Male
Male
18 Participants
n=99 Participants
3 Participants
n=107 Participants
21 Participants
n=206 Participants

PRIMARY outcome

Timeframe: baseline, 6 months

Population: Participants from the safety set, who had values at both baseline and month 6, were included in the analysis. The safety set included randomized participants who received at least one dose of study medication.

The Treatment Satisfaction Questionnaire for Medication (TSQM-9) is a psychometric measure of a patient's satisfaction with medication. It consists of 3 subscales: effectiveness, convenience and global satisfaction. The scores were computed by adding items for each domain, i.e. 1 to 3 for effectiveness, 4 - 6 for convenience and 7 to 9 for global satisfaction. The lowest possible score (1 for each item and 3 for all 3 subscales) was subtracted from the composite score and divided by the greatest possible score range. The greatest range was (7-1) X 3 items = 18 for the effectiveness and convenience, and (5-1) x 3 items = 12 for global satisfaction. This provided a transformed score between 0 and 1 that was then multiplied by 100. A positive change from baseline indicates improvement.

Outcome measures

Outcome measures
Measure
Fingolimod
n=46 Participants
Patients randomized in this arm received Fingolimod 0.5 mg/day oral capsule for 6 months core period.
Multiple Sclerosis Disease Modifying Treatment (MS DMT)
n=10 Participants
Patients randomized in this arm received selected Standard MS DMT such as Interferon beta-1b or Interferon beta-1a or Glatiramer acetate for 6 months.
Change From Baseline in Patient-reported Treatment Satisfaction
19.57 score on a scale
Standard Deviation 21.00
5.83 score on a scale
Standard Deviation 16.47

SECONDARY outcome

Timeframe: baseline, 6 months

Population: Participants from the safety set, who had values at both baseline and month 6, were included in the analysis. The safety set included randomized participants who received at least one dose of study medication.

The PRIMUS activity measure is a 15-item assessment used to evaluate patient-reported activities of daily living. The PRIMUS activities score was calculated summing the 15 items, after recoding the responses from 1 - 3 to 0 - 2. Therefore, the total score ranged from 0 - 3-, where high scores were indicative of greater function limitation. A negative change from baseline indicates improvement.

Outcome measures

Outcome measures
Measure
Fingolimod
n=49 Participants
Patients randomized in this arm received Fingolimod 0.5 mg/day oral capsule for 6 months core period.
Multiple Sclerosis Disease Modifying Treatment (MS DMT)
n=11 Participants
Patients randomized in this arm received selected Standard MS DMT such as Interferon beta-1b or Interferon beta-1a or Glatiramer acetate for 6 months.
Change From Baseline in Patient-reported Activities of Daily Living (ADL)
0.19 score on a scale
Standard Deviation 2.75
0.15 score on a scale
Standard Deviation 1.72

SECONDARY outcome

Timeframe: 6 months

Population: Participants from the safety set, who had values at both baseline and month 6, were included in the analysis. The safety set included randomized participants who received at least one dose of study medication.

The fatigue Severity Scale (FSS) is a 9-item scale used to assess fatigue. The FSS score was calculated summing the 9 items of the questionnaire and dividing by the number of non-missing items (each item is based on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree)). A negative change from baseline indicates improvement.

Outcome measures

Outcome measures
Measure
Fingolimod
n=48 Participants
Patients randomized in this arm received Fingolimod 0.5 mg/day oral capsule for 6 months core period.
Multiple Sclerosis Disease Modifying Treatment (MS DMT)
n=11 Participants
Patients randomized in this arm received selected Standard MS DMT such as Interferon beta-1b or Interferon beta-1a or Glatiramer acetate for 6 months.
Change From Baseline in Patient-reported Fatigue
-0.18 score on a scale
Standard Deviation 1.46
-0.32 score on a scale
Standard Deviation 1.21

SECONDARY outcome

Timeframe: 6 months

Population: Participants from the safety set, who had values at both baseline and month 6, were included in the analysis. The safety set included randomized participants who received at least one dose of study medication.

The Treatment Satisfaction Questionnaire for Medication (TSQM-9) is a psychometric measure of a patient's satisfaction with medication. It consists of 3 subscales: effectiveness, convenience and global satisfaction. The scores were computed by adding items for each domain, i.e. 1 to 3 for effectiveness, 4 - 6 for convenience and 7 to 9 for global satisfaction. The lowest possible score (1 for each item and 3 for all 3 subscales) was subtracted from the composite score and divided by the greatest possible score range. The greatest range was (7-1) X 3 items = 18 for the effectiveness and convenience, and (5-1) x 3 items = 12 for global satisfaction. This provided a transformed score between 0 and 1 that was then multiplied by 100. A positive change from baseline indicates improvement.

Outcome measures

Outcome measures
Measure
Fingolimod
n=46 Participants
Patients randomized in this arm received Fingolimod 0.5 mg/day oral capsule for 6 months core period.
Multiple Sclerosis Disease Modifying Treatment (MS DMT)
n=10 Participants
Patients randomized in this arm received selected Standard MS DMT such as Interferon beta-1b or Interferon beta-1a or Glatiramer acetate for 6 months.
Change From Baseline in Patient-Reported Effectiveness and Convenience
Effectiveness
13.53 score on a scale
Standard Deviation 28.39
-1.67 score on a scale
Standard Deviation 32.40
Change From Baseline in Patient-Reported Effectiveness and Convenience
Convenience
24.64 score on a scale
Standard Deviation 18.28
12.78 score on a scale
Standard Deviation 25.26

SECONDARY outcome

Timeframe: 6 months

Population: Participants from the safety set, who had values at both baseline and month 6, were included in the analysis. The safety set included randomized participants who received at least one dose of study medication.

The Beck Depression Inventory Fast Screen (BDI-FS) is a brief, multiple choice, self reported inventory designed to evaluate depression in patients with medical illness. The BDI-FS score was calculated summing the 7 items of the questionnaire. Each item ranged from 0 (not present) to 3 (severe). The total score ranges from 0-3 (minimal depression), 4-8 (mild depression), 9-12 (moderate depression) and 13-21 (severe depression). A negative change from baseline indicates improvement.

Outcome measures

Outcome measures
Measure
Fingolimod
n=48 Participants
Patients randomized in this arm received Fingolimod 0.5 mg/day oral capsule for 6 months core period.
Multiple Sclerosis Disease Modifying Treatment (MS DMT)
n=11 Participants
Patients randomized in this arm received selected Standard MS DMT such as Interferon beta-1b or Interferon beta-1a or Glatiramer acetate for 6 months.
Change From Baseline in Patient-reported Depression
-1.15 score on a scale
Standard Deviation 3.59
-0.12 score on a scale
Standard Deviation 3.06

SECONDARY outcome

Timeframe: 6 months

Population: Participants from the safety set, who had values at both baseline and month 6, were included in the analysis. The safety set included randomized participants who received at least one dose of study medication.

The SF-36v2 is a validated health-related quality of life instrument used in numerous disease states, including MS. It is a self-administered survey that measures 8 domains of health including: physical functioning, role limitations due to physical health, pain, general health, energy/fatigue, social functioning, role limitations due to emotional problems and emotional well-being. Additionally, two summary scale scores can be calculated: the Physical Component Summary (PCS) and the Mental Component Summary (MCS). If half or more questions within a domain were answered, then a score was calculated for that domain. Otherwise, the patient score for that domain was set to missing. If the patient was missing any 1 of the 8 scale scores, then the physical and mental component scores were set to missing. An algorithm was used to create a score from 0 to 100 for each domain score and component score. A positive change from baseline indicates improvement.

Outcome measures

Outcome measures
Measure
Fingolimod
n=45 Participants
Patients randomized in this arm received Fingolimod 0.5 mg/day oral capsule for 6 months core period.
Multiple Sclerosis Disease Modifying Treatment (MS DMT)
n=9 Participants
Patients randomized in this arm received selected Standard MS DMT such as Interferon beta-1b or Interferon beta-1a or Glatiramer acetate for 6 months.
Change From Baseline in Patient-reported Health Related Quality of Life (QOL)
PCS (n=40,8)
4.52 score on a scale
Standard Deviation 18.05
7.83 score on a scale
Standard Deviation 15.86
Change From Baseline in Patient-reported Health Related Quality of Life (QOL)
Physical functioning (n=41,9)
1.71 score on a scale
Standard Deviation 23.07
-1.11 score on a scale
Standard Deviation 20.73
Change From Baseline in Patient-reported Health Related Quality of Life (QOL)
Role limitations due to physical health (n=42,9)
7.14 score on a scale
Standard Deviation 37.97
5.56 score on a scale
Standard Deviation 27.32
Change From Baseline in Patient-reported Health Related Quality of Life (QOL)
Pain (n=45,9)
6.56 score on a scale
Standard Deviation 24.32
14.44 score on a scale
Standard Deviation 15.25
Change From Baseline in Patient-reported Health Related Quality of Life (QOL)
General health (n=44,8)
4.52 score on a scale
Standard Deviation 19.43
6.25 score on a scale
Standard Deviation 14.08
Change From Baseline in Patient-reported Health Related Quality of Life (QOL)
Energy/fatigue (n=43,9)
2.33 score on a scale
Standard Deviation 18.81
6.48 score on a scale
Standard Deviation 33.24
Change From Baseline in Patient-reported Health Related Quality of Life (QOL)
Social functioning (n=45,9)
7.78 score on a scale
Standard Deviation 24.90
6.94 score on a scale
Standard Deviation 25.85
Change From Baseline in Patient-reported Health Related Quality of Life (QOL)
Role limitations d/t emotional problems (n=45,9)
7.04 score on a scale
Standard Deviation 41.82
3.70 score on a scale
Standard Deviation 38.89
Change From Baseline in Patient-reported Health Related Quality of Life (QOL)
Emotional well-being (n=43,9)
2.51 score on a scale
Standard Deviation 16.88
4.89 score on a scale
Standard Deviation 28.13
Change From Baseline in Patient-reported Health Related Quality of Life (QOL)
MCS (n=40,8)
5.88 score on a scale
Standard Deviation 18.21
7.28 score on a scale
Standard Deviation 24.05

SECONDARY outcome

Timeframe: 6 months

Population: Participants from the safety set, who had values at month 6, were included in the analysis. The safety set included randomized participants who received at least one dose of study medication.

The CGI-I is a rating scale allowing a physician-reported global evaluation of the subject's improvement over time. The Investigator assessed the subject's clinical change relative to the symptoms at baseline on the CGI-I, a seven-point scale, with rating as follows: 1=Very much improved, 2=Much improved, 3=Minimally improved, 4=No change, 5=Minimally worse, 6=Much worse, 7=Very much worse. A lower score and a negative change from baseline indicate improvement.

Outcome measures

Outcome measures
Measure
Fingolimod
n=44 Participants
Patients randomized in this arm received Fingolimod 0.5 mg/day oral capsule for 6 months core period.
Multiple Sclerosis Disease Modifying Treatment (MS DMT)
n=9 Participants
Patients randomized in this arm received selected Standard MS DMT such as Interferon beta-1b or Interferon beta-1a or Glatiramer acetate for 6 months.
Physician-reported Clinical Global Impression of Improvement (CGI-I)
Much improved
13.64 Percentage of participants
11.11 Percentage of participants
Physician-reported Clinical Global Impression of Improvement (CGI-I)
Minimally improved
36.36 Percentage of participants
11.11 Percentage of participants
Physician-reported Clinical Global Impression of Improvement (CGI-I)
No change
47.73 Percentage of participants
66.67 Percentage of participants
Physician-reported Clinical Global Impression of Improvement (CGI-I)
Minimally worse
2.27 Percentage of participants
11.11 Percentage of participants

Adverse Events

Fingolimod

Serious events: 4 serious events
Other events: 13 other events
Deaths: 0 deaths

Multiple Sclerosis Disease Modifying Treatment (MS DMT)

Serious events: 1 serious events
Other events: 7 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Fingolimod
n=50 participants at risk
Patients randomized in this arm received Fingolimod 0.5 mg/day oral capsule for 6 months core period.
Multiple Sclerosis Disease Modifying Treatment (MS DMT)
n=11 participants at risk
Patients randomized in this arm received selected Standard MS DMT such as Interferon beta-1b or Interferon beta-1a or Glatiramer acetate for 6 months.
Blood and lymphatic system disorders
Lymphopenia
4.0%
2/50
0.00%
0/11
General disorders
Drug ineffective
2.0%
1/50
0.00%
0/11
Investigations
Human papilloma virus test positive
0.00%
0/50
9.1%
1/11
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Meningioma
2.0%
1/50
0.00%
0/11
Nervous system disorders
Multiple sclerosis relapse
2.0%
1/50
0.00%
0/11

Other adverse events

Other adverse events
Measure
Fingolimod
n=50 participants at risk
Patients randomized in this arm received Fingolimod 0.5 mg/day oral capsule for 6 months core period.
Multiple Sclerosis Disease Modifying Treatment (MS DMT)
n=11 participants at risk
Patients randomized in this arm received selected Standard MS DMT such as Interferon beta-1b or Interferon beta-1a or Glatiramer acetate for 6 months.
Blood and lymphatic system disorders
Lymphopenia
16.0%
8/50
0.00%
0/11
Endocrine disorders
Hyperthyroidism
0.00%
0/50
9.1%
1/11
Eye disorders
Vision blurred
0.00%
0/50
9.1%
1/11
Gastrointestinal disorders
Abdominal pain upper
0.00%
0/50
9.1%
1/11
Gastrointestinal disorders
Nausea
0.00%
0/50
9.1%
1/11
Gastrointestinal disorders
Vomiting
0.00%
0/50
9.1%
1/11
General disorders
Adverse drug reaction
0.00%
0/50
9.1%
1/11
General disorders
Influenza like illness
2.0%
1/50
9.1%
1/11
General disorders
Injection site reaction
0.00%
0/50
9.1%
1/11
Hepatobiliary disorders
Hypertransaminasaemia
2.0%
1/50
9.1%
1/11
Investigations
Transaminases increased
8.0%
4/50
0.00%
0/11
Investigations
Weight decreased
0.00%
0/50
9.1%
1/11
Metabolism and nutrition disorders
Decreased appetite
0.00%
0/50
9.1%
1/11
Skin and subcutaneous tissue disorders
Rash
0.00%
0/50
9.1%
1/11

Additional Information

Study Director

Novartis Pharmaceuticals

Phone: 862-778-8300

Results disclosure agreements

  • Principal investigator is a sponsor employee The terms and conditions of Novartis' agreements with its investigators may vary. However, Novartis does not prohibit any investigator from publishing. Any publications from a single-site are postponed until the publication of the pooled data (i.e., data from all sites) in the clinical trial or disclosure of trial results in their entirety.
  • Publication restrictions are in place

Restriction type: OTHER