AIMSPRO in the Treatment of Bladder Dysfunction in Secondary Progressive Multiple Sclerosis

• Change in average 24-hour frequency [ Time Frame: At 0, 4, 10 and 14 weeks ] [ Designated as safety issue: No ]
  The change is calculated as the value at the later time point minus the value at the earlier time point for weeks 0 to 4 and weeks 10 to 14 respectively.
• Change in visual acuity and colour vision [ Time Frame: At 0, 4, 10 and 14 weeks ] [ Designated as safety issue: No ]
  Employs logMAR based and Farnsworth-Munsell 100 Hue testing. The change is calculated as the value at the later time point minus the value at the earlier time point for weeks 0 to 4 and weeks 10 to 14 respectively.
• Change in average 24-hour incontinence [ Time Frame: At 0, 4, 10 and 14 weeks ] [ Designated as safety issue: No ]
  The change is calculated as the value at the later time point minus the value at the earlier time point for weeks 0 to 4 and weeks 10 to 14 respectively.
• Change in urgency score [ Time Frame: At 0, 4, 10 and 14 weeks ] [ Designated as safety issue: No ]
  The change is calculated as the value at the later time point minus the value at the earlier time point for weeks 0 to 4 and weeks 10 to 14 respectively.
• Change in I-QOL score [ Time Frame: At 0, 4, 10 and 14 weeks ] [ Designated as safety issue: No ]
  The Incontinence - Quality of Life questionnaire is administered at the beginning and end of each four week treatment phase. The change is calculated as the value at the later time point minus the value at the earlier time point for weeks 0 to 4 and weeks 10 to 14 respectively.
• Change in Whittington Urgency Score [ Time Frame: At 0, 4, 10 and 14 weeks ] [ Designated as safety issue: No ]
  The Whittington Urgency Score is administered at the beginning and end of each four week treatment phase. The change is calculated as the value at the later time point minus the value at the earlier time point for weeks 0 to 4 and weeks 10 to 14 respectively.
• Change in Kurtzke EDS [ Time Frame: At 0, 4, 10 and 14 weeks ] [ Designated as safety issue: No ]
  The Kurtzke EDS assessment is undertaken at the beginning and end of each four week treatment phase. The change is calculated as the value at the later time point minus the value at the earlier time point for weeks 0 to 4 and weeks 10 to 14 respectively.
• Change in MSIS-29 [ Time Frame: At 0, 4, 10 and 14 weeks ] [ Designated as safety issue: No ]
  The Multiple Sclerosis Impact Scale is administered at the beginning and end of each four week treatment phase. The change is calculated as the value at the later time point minus the value at the earlier time point for weeks 0 to 4 and weeks 10 to 14 respectively.
• Change in MS FC [ Time Frame: At 0, 4, 10 and 14 weeks ] [ Designated as safety issue: No ]
  The The Multiple Sclerosis Functional Composite assessment is undertaken at the beginning and end of each four week treatment phase. The change is calculated as the value at the later time point minus the value at the earlier time point for weeks 0 to 4 and weeks 10 to 14 respectively.
• Change in MS WS [ Time Frame: At 0, 4, 10 and 14 weeks ] [ Designated as safety issue: No ]
  The Multiple Sclerosis Walking Scale is assessed at the beginning and end of each four week treatment phase. The change is calculated as the value at the later time point minus the value at the earlier time point for weeks 0 to 4 and weeks 10 to 14 respectively.

• Change in average 24-hour frequency [ Time Frame: 4 weeks per treatment phase ] [ Designated as safety issue: No ]
• Change in visual acuity and colour vision [ Time Frame: 4 weeks per treatment phase ] [ Designated as safety issue: No ]
  Employs logMAR based and Farnsworth-Munsell 100 Hue testing.
• Change in average 24-hour incontinence [ Time Frame: 4 weeks per treatment phase ] [ Designated as safety issue: No ]
• Change in urgency score [ Time Frame: 4 weeks per treatment phase ] [ Designated as safety issue: No ]
• Change in I-QOL score [ Time Frame: 4 weeks per treatment phase ] [ Designated as safety issue: No ]
  The Incontinence - Quality of Life questionnaire is administered at the beginning and end of each four week treatment phase.
• Change in Whittington Urgency Score [ Time Frame: 4 weeks per treatment phase ] [ Designated as safety issue: No ]
  The Whittington Urgency Score is administered at the beginning and end of each four week treatment phase.
• Change in Kurtzke EDS [ Time Frame: 4 weeks per treatment phase ] [ Designated as safety issue: No ]
  The Kurtzke EDS assessment is undertaken at the beginning and end of each four week treatment phase.
• Change in MSIS-29 [ Time Frame: 4 weeks per treatment phase ] [ Designated as safety issue: No ]
  The Multiple Sclerosis Impact Scale is administered at the beginning and end of each four week treatment phase.
• Change in MS FC [ Time Frame: 4 weeks per treatment phase ] [ Designated as safety issue: No ]
  The The Multiple Sclerosis Functional Composite assessment is undertaken at the beginning and end of each four week treatment phase.
• Change in MS WS [ Time Frame: 4 weeks per treatment phase ] [ Designated as safety issue: No ]
  The Multiple Sclerosis Walking Scale is assessed at the beginning and end of each four week treatment phase.

Patients with marked bladder dysfunction as a result of secondary progressive multiple sclerosis are being recruited to receive AIMSPRO or placebo by subcutaneous injection, in this double-blind crossover study.

Treatment periods of 4 weeks' duration are separated by a 6 week wash-out phase. After 14 weeks of randomised therapy there is a 38 week period of "open-label" AIMSPRO treatment.

Inclusion Criteria:

• M / F aged 18 years or older.
• Patients of childbearing potential must use adequate birth control measures for the duration of the study and 6 months after receiving the last injection of AIMSPRO.
• Clinically definite SPMS.
• Ambulant, walking aids allowed.
• No more than one relapse within the last 12 months and no relapse within the last 6 months.
• Urinary frequency of at least 8 times per 24-hours.
• Urinary urgency with or without urge incontinence.
• MRI brain or spinal cord abnormalities consistent with MS.

• Screening laboratory test results must meet the following criteria:

  • Haemoglobin > 9.5 g/dL
  • WBC > 3.5 x 109/L
  • Neutrophils > 1.5 x 109/L
  • Platelets > 100 x 109/L
• Baseline AST , alkaline phosphatase, Thyroid function, Serum Electrophoresis levels must be within the normal range.
• Able to adhere to the study visit schedule and other protocol requirements
• Capable of giving written informed consent.

Exclusion Criteria:

• Acute symptomatic urinary infection.
• Taking DDAVP or antimuscarinic agents.
• Full time wheelchair user.
• Immunosuppressant drug therapy of any kind in the last 3 months.
• Relapse within the last 6 months.
• No clear progression of disability in the last 12 months.
• Co-existent medical condition precluding participation, including any history of severe allergic reaction.
• Pregnant or lactating women and women who are planning pregnancy within 12 months of screening (i.e., approximately 6 months following last injection).
• Receipt of any investigational drug within 30 days prior to screening or within 5 half-lives of the investigational agent, whichever is longer.
• Treatment with any therapeutic agent targeted at reducing TNF (e.g., infliximab, pentoxifylline, thalidomide, etanercept, etc.) within 3 months of screening.
• Previous administration of AIMSPRO.
• Ongoing corticosteroid therapy or any corticosteroids within the previous 3 months.
• History of known allergy to animal proteins, tuberculosis.
• Serious infections (such as pneumonia or pyelonephritis) in the previous 3 months. Less serious infections such as acute upper respiratory tract infection or simple urinary tract infection, should be followed to their conclusion or treated, as appropriate, prior to inclusion.
• Patients with opportunistic infections within the previous 6 months.
• Established malignant disease, renal, hepatic, haematologic, gastrointestinal, endocrine, pulmonary, or cardiac disease.
• Significant other neurological disorder.
• Presence of a transplanted organ, with the exception of a corneal transplant > 3 months prior to screening.
• Lymphoproliferative disease including lymphoma, or signs and symptoms suggestive of possible lymphoproliferative disease, such as lymphadenopathy of unusual size or location (such as nodes in the posterior triangle of the neck, infra-clavicular, epitrochlear, or periaortic areas), or splenomegaly.
• Recent clinically significant substance abuse (drug or alcohol).
• Poor tolerability of venipuncture.
• Investigational drugs or drugs targeted at reducing TNF are not allowed during participation in the study.
• Patients will not be permitted to receive immunosuppressive treatment during this study. The exception will be where a patient's treating neurologist determines that a course of steroid therapy, oral or intravenous, is required in view of a sufficiently disabling relapse of MS.
• Immunosuppressive therapy within the month prior to entry into the study.
• Taking the licensed anticonvulsant medication lamotrigine or the anti-arrhythmic drug flecainide, both of which are potent sodium channel blocking agents.
• Unable to fill in the criteria related to bladder dysfunction status.
• Unable to give written informed consent.
• Use of intermittent or indwelling urinary catheter.