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A Canadian Study Assessing the Utility of the Treatment Optimization Recommendations in Multiple Sclerosis (CanTOR)

This study has been completed.
Information provided by (Responsible Party):
Merck KGaA Identifier:
First received: June 9, 2010
Last updated: March 17, 2014
Last verified: March 2014

The Canadian Multiple Sclerosis Working Group (CMSWG) has developed practical recommendations on how neurologists can assess the status of subjects on disease modifying drugs (DMDs) and decide when it may be necessary to modify treatment in order to optimize outcomes. These recommendations are based on relapses, disease progression as measured by the Expanded Disability Status Scale (EDSS) or EDSS progression, and magnetic resonance imaging (MRI) outcomes. The CMSWG agreed to compare post-treatment relapse rates and severity to baseline rates and severity in each individual subject. The recommended minimum baseline reference time frame needed to assess relapse rate was 2 years prior to treatment initiation. The objective and prospective relapse data should be ideally collected during this reference period. The CMSWG recommended that the following should be taken into consideration when assessing relapse severity: the effect of the relapse on activities of daily living (ADL), the type and number of systems involved (i.e., relapses that are polysymptomatic or that affect the cerebellar/motor systems tend to be more severe), and whether or not a course of corticosteroids was required. The CMSWG also recommended that, prior to considering treatment modification on the basis of progression in disability, progression should be confirmed at 6 months.

The CMSWG's Treatment Optimization Recommendations (TORs) have been retrospectively applied to the 4 year data set from the PRISMS study. Applying the model to subjects after their first year on therapy allowed for accurate prediction of continued disease activity in the form of relapses in the majority of subjects who actually experienced ongoing attacks. The model was less effective in predicting disability progression, but this may well have been due to the low numbers of subjects on treatment progressing over the study period. This observational study used the TOR model to identify subjects as either candidates for therapy optimization or as candidates to maintain current therapy. All subjects were then followed prospectively until re- assessment will be done with this model.

Multiple Sclerosis, Relapsing-Remitting

Study Type: Observational
Study Design: Observational Model: Cohort
Time Perspective: Prospective
Official Title: Canadian Assessment of the Utility of the Treatment Optimization Recommendations in Multiple Sclerosis

Resource links provided by NLM:

Further study details as provided by Merck KGaA:

Primary Outcome Measures:
  • Assessment of history or current status of Expanded Disability Status Score (EDSS) [ Time Frame: Baseline to 12 month TOR assessment ]
  • Assessment of history or current relapse status [ Time Frame: Baseline to 12 month TOR assessment ]
  • Assessment of history or current magnetic resonance imaging (MRI) status [ Time Frame: Baseline to 12 month TOR assessment ]
  • Assessment of history or current cognitive status [ Time Frame: Baseline to 12 month TOR assessment ]
  • Assessment of history or current status of neutralizing antibodies (NAb) [ Time Frame: Baseline to 12 month TOR assessment ]

Secondary Outcome Measures:
  • Treatment Optimization Recommendation Questionnaire [ Time Frame: At the end of the 12 months observational period. ]

Enrollment: 192
Study Start Date: July 2006
Study Completion Date: August 2009
Primary Completion Date: August 2009 (Final data collection date for primary outcome measure)
  Show Detailed Description


Ages Eligible for Study:   18 Years to 55 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Subjects with either relapsing-remitting multiple sclerosis (RRMS) or a CIS were enrolled from multiple sites across Canada.

Inclusion Criteria:

  • Subjects with duration of RRMS or CIS ≤ 10 yr from onset of symptoms.
  • Subjects aged between 18 and 55 years
  • Subjects with EDSS score of 0 to ≤ 4.0
  • Subjects on consistent therapy with a single DMD (Avonex®, Betaseron®, Copaxone®, Rebif®) for at least 12 months.
  • Subjects whose relapse data over the last 12 months was available in the subject's chart
  • Subjects whose EDSS data over the last 12 months was available in the subject's chart
  • Subjects who were eligible to receive any of the 4 DMDs
  • Consecutive subjects were screened until 10 eligible subjects were enrolled (to minimize any selection bias) - Subject was therefore one of 10 consecutive eligible, consenting subjects
  • Subjects who had given written informed consent with the understanding that the subject could withdraw consent at any time without prejudice to future medical care

Exclusion Criteria:

  • Subject who was not expected to be followed reliably over the next 12 months
  • Subjects with concomitant participation in any other studies involving investigational or marketed products
  • Subject wo had previously failed DMD therapy and/or switched between therapies
  Contacts and Locations
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Please refer to this study by its identifier: NCT01142583

Sponsors and Collaborators
Merck KGaA
Study Director: Medical Responsible EMD Serono a division of EMD Canada Inc., an affiliate of Merck KGaA, Darmstadt, Germany
  More Information

Responsible Party: Merck KGaA Identifier: NCT01142583     History of Changes
Other Study ID Numbers: 000107
Study First Received: June 9, 2010
Last Updated: March 17, 2014

Keywords provided by Merck KGaA:
Multiple sclerosis
Expanded Disability Status Scale
Multiple Sclerosis, Relapsing-Remitting

Additional relevant MeSH terms:
Multiple Sclerosis
Multiple Sclerosis, Relapsing-Remitting
Pathologic Processes
Demyelinating Autoimmune Diseases, CNS
Autoimmune Diseases of the Nervous System
Nervous System Diseases
Demyelinating Diseases
Autoimmune Diseases
Immune System Diseases processed this record on April 27, 2017