Working…
COVID-19 is an emerging, rapidly evolving situation.
Get the latest public health information from CDC: https://www.coronavirus.gov.

Get the latest research information from NIH: https://www.nih.gov/coronavirus.
ClinicalTrials.gov
ClinicalTrials.gov Menu

Anakinra for the Treatment of Chronically Inflamed White Matter Lesions in Multiple Sclerosis

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT04025554
Recruitment Status : Recruiting
First Posted : July 19, 2019
Last Update Posted : February 6, 2020
Sponsor:
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Institute of Neurological Disorders and Stroke (NINDS) )

Brief Summary:

Background:

Multiple sclerosis (MS) is a disease of the central nervous system (CNS). People who have MS may have lesions that form on parts of the CNS, such as the brain. Some of these lesions may be inflamed for a long time. This causes MS to progress. There is no treatment for these lesions. Researchers believe that a drug that decreases inflammation can help.

Objective:

To see if a drug called anakinra can help clear inflammation in MS brain lesions.

Eligibility:

People 18 and older with MS and at least one white matter lesion.

Design:

Participants will be screened with one or more Neuroimmunology Clinic protocols.

Participants will have a medical history and physical exam. They will have blood and urine tests. They will have a lumbar puncture. For this, a needle is inserted between the bones in the back, and cerebrospinal fluid is removed. They will also have an MRI of the brain. The MRI scanner is a cylinder surrounded by a strong magnetic field. Participants will lie on a table that slides in and out of the scanner.

Participants will repeat the above procedures throughout the study.

Participants will get their first dose of anakinra at the clinic. They will administer the rest of the doses themselves, by injection under the skin.

Participants will track their daily dosage electronically or in a written drug diary.

Participants will have 4 visits while taking the drug. At each visit, sharps boxes and empty vials will be collected.

Participants will have 2 follow-up visits after completing treatment.

The study will last 28 weeks.


Condition or disease Intervention/treatment Phase
Multiple Sclerosis Drug: Anakinra Phase 1 Phase 2

Detailed Description:

Objective:

The overall goal of this study is to determine the safety, tolerability, and radiological efficacy of up to 12 weeks of subcutaneous injection of anakinra in people with multiple sclerosis and evidence, by magnetic resonance imaging (MRI), of chronic active (also known as smoldering ) lesions in the white matter.

Study population:

5 people with progressive or stable MS, at least one paramagnetic rim lesion on 7-tesla MRI, and no new white matter lesion formation or clinical relapse for at least 12 months, will complete the study.

Design:

In this open label, dose escalation study, participants will receive up to 12 weeks of

subcutaneous anakinra with initial dose of 100 mg daily up to a target dose of 300 mg daily. Study visits will occur every 4 weeks while on treatment, with 2 follow-up visits at 4 and 12 weeks after discontinuation.

Outcome measures:

The primary outcome measure is disappearance of one or more paramagnetic rims from white matter lesions identified at baseline. Secondary outcomes include safety and tolerability, clinical and radiological outcomes. Exploratory serological and CSF measures will also be obtained to investigate mechanism of action of anakinra and for biomarker development.

Layout table for study information
Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 10 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Anakinra for the Treatment of Chronically Inflamed White Matter Lesions in Multiple Sclerosis
Actual Study Start Date : October 25, 2019
Estimated Primary Completion Date : June 30, 2020
Estimated Study Completion Date : September 30, 2020

Resource links provided by the National Library of Medicine

Drug Information available for: Anakinra

Arm Intervention/treatment
Experimental: 1/Active treatment
Patients with MS will be assigned to the same intervention
Drug: Anakinra
100 mg daily weeks 1-4, 200 mg daily weeks 5-8, 300 mg daily weeks 9-12.




Primary Outcome Measures :
  1. Disappearance of one or all paramagnetic phase rims [ Time Frame: At baseline and every 4 weeks ]
    Assessment of paramagnetic phase rims by scans.


Secondary Outcome Measures :
  1. Safety and tolerability [ Time Frame: 28 weeks ]
    Monitoring of AEs

  2. Expanded Disability Status Scale (EDSS) [ Time Frame: Every 4 weeks for the duarion of study ]
    Clinical assessment

  3. 9-hole peg test (9HPT) [ Time Frame: Every 4 weeks for the duarion of study ]
    Clinical assessment

  4. Symbol digit modalities test (SDMT) [ Time Frame: Every 4 weeks for the duarion of study ]
    Clinical assessment

  5. Proportion of paramagnetic rim lesions in which the rim has diminished or disappeared at any time point [ Time Frame: Every 4 weeks for the duarion of study ]
    MRI scan

  6. Changes in T1 relaxation time within paramagnetic rim lesions at all time points, relative to non-rim lesions [ Time Frame: Every 4 weeks for the duarion of study ]
    MRI scan

  7. Changes in size of paramagnetic rim lesions at all time points, relative to non-rim lesions [ Time Frame: Every 4 weeks for the duarion of study ]
    MRI scan



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


Layout table for eligibility information
Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria
  • INCLUSION CRITERIA:
  • Age greater than or equal to 18
  • Ability to give informed consent
  • If fertile, agreement to use an effective method of birth control during the study and for up to 3 months after the last dose of the study drug
  • Agreement not to participate in any other interventional study while participating in this protocol
  • Diagnosis of MS, either stable or clinically progressive, with evidence of no new lesion formation by comparison of baseline MRI scan with a historical MRI scan at least 1 year prior
  • Prior 7-tesla MRI scan, with high image quality in the judgment of the study neuroradiologist, demonstrating at least one white matter lesion with a paramagnetic rim (41)

EXCLUSION CRITERIA:

  • Pregnancy or current breastfeeding
  • Use of another investigational agent within 1 month of screening
  • Active infection and or neutropenia (ANC < 1000 cells/microliter)
  • History of lymphoma
  • Known hypersensitivity to administration of anakinra
  • Previous treatment with anakinra and/or TNF-receptor inhibitor
  • History of asthma
  • QuantiFERON-TB gold positive
  • Prior treatment with anti-CD20 agent (ocrelizumab, rituximab)
  • Prior treatment with anti-CD52 agent (alemtuzumab)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04025554


Contacts
Layout table for location contacts
Contact: Joan M Ohayon, C.R.N.P. (301) 496-3825 eatonj@ninds.nih.gov

Locations
Layout table for location information
United States, Maryland
National Institutes of Health Clinical Center Recruiting
Bethesda, Maryland, United States, 20892
Contact: For more information at the NIH Clinical Center contact Office of Patient Recruitment (OPR)    800-411-1222 ext TTY8664111010    prpl@cc.nih.gov   
Sponsors and Collaborators
National Institute of Neurological Disorders and Stroke (NINDS)
Investigators
Layout table for investigator information
Principal Investigator: Irene CM Cortese, M.D. National Institute of Neurological Disorders and Stroke (NINDS)

Additional Information:
Layout table for additonal information
Responsible Party: National Institute of Neurological Disorders and Stroke (NINDS)
ClinicalTrials.gov Identifier: NCT04025554    
Other Study ID Numbers: 190124
19-N-0124
First Posted: July 19, 2019    Key Record Dates
Last Update Posted: February 6, 2020
Last Verified: February 3, 2020

Layout table for additional information
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by National Institutes of Health Clinical Center (CC) ( National Institute of Neurological Disorders and Stroke (NINDS) ):
Chronic Active Lesions
Ultra-high-field (7T) MRI
Interleukin-1 (IL-1)
White Matter
Paramagnetic Rim
Additional relevant MeSH terms:
Layout table for MeSH terms
Multiple Sclerosis
Sclerosis
Pathologic Processes
Demyelinating Autoimmune Diseases, CNS
Autoimmune Diseases of the Nervous System
Nervous System Diseases
Demyelinating Diseases
Autoimmune Diseases
Immune System Diseases
Interleukin 1 Receptor Antagonist Protein
Antirheumatic Agents