Cladribine Tablets: Collaborative Study to Evaluate Impact On Central Nervous System Biomarkers in Multiple Sclerosis (CLOCK-MS)
Cladribine Tablets: Collaborative Study to Evaluate the Impact On Central Nervous System Biomarkers in Multiple Sclerosis
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Phase 4
Contacts and Locations
Study Contact
Study Contact
- Name: Gregory F Wu, MD, PhD
- Phone Number: 314-362-3293
- Email: gfwu@wustl.edu
Study Contact Backup
- Name: Dana Perantie
- Email: dperantie@wustl.edu
Study Locations
-
-
Missouri
-
St Louis, Missouri, United States, 63110
- Washington University School of Medicine
-
-
Oklahoma
-
Oklahoma City, Oklahoma, United States, 73104
- Oklahoma Medical Research Foundation
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-
Pennsylvania
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Philadelphia, Pennsylvania, United States, 19104
- University of Pennsylvania
-
-
Texas
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Dallas, Texas, United States, 75390
- University of Texas Southwestern Medical Center
-
-
Wisconsin
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Milwaukee, Wisconsin, United States, 53226
- Medical College of Wisconsin
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Have a relapsing form of multiple sclerosis (RMS; to include RRMS or active secondary progressive MS)
- Are willing and able to receive at least 2 lumbar punctures
- Have an EDSS of 0 to ≤ 5.5 during the screening period
- Had at least 1 relapse or 1 gadolinium-enhancing or 1 new or enlarged T2 lesion in the last 12 months
- Have absolute lymphocyte count (ALC) within normal range of the local laboratory or assessed as normal by the investigator within the 3 week screening period and meet all other eligibility criteria for cladribine tablet treatment
- Capable of giving signed informed consent
Exclusion Criteria:
- Have any contraindication for lumbar puncture
- Have current malignancy
- Are infected with human immunodeficiency virus (HIV)
- Have active chronic infections (e.g. hepatitis or tuberculosis)
- Have signs or symptoms suggestive of progressive multifocal leukoencephalopathy (PML) in MRI
- Have history of hypersensitivity to cladribine or any of the excipients listed in the cladribine tablets US Prescribing Information
- Allergy or hypersensitivity to gadolinium and/or any other contraindication to perform a MRI
- Have any other comorbid conditions that preclude participation
- Have been previously treated with cladribine
- Have previously been treated with ocrelizumab, alemtuzumab, rituximab, or daclizumab
- Have received treatment with natalizumab during the last 6 months
- Are currently receiving immunosuppressive or myelosuppressive therapy, e.g., methotrexate, cyclophosphamide, cyclosporine or azathioprine, or chronic treatment with systemic corticosteroids
- Have received treatment with immunosuppressive or myelosuppressive therapy during the last 6 months
- Have received chronic treatment with systemic corticosteroids during the last 4 weeks
- Have moderate or severe hepatic impairment (Child-Pugh score >6)
- Have moderate or severe renal impairment (creatinine clearance <60 mL per minute)
- Are pregnant or unwilling or unable to use effective contraception during cladribine tablets dosing and for 6 months after the last dose in each treatment course
- Are intending to breastfeed on a cladribine tablet treatment day and/or during the 10 days after the last cladribine tablet dose.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Basic Science
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Other: Group 1: LP at Baseline and Week 5
Group 1: LP at Baseline and end of Week 5. Week 5 is the optimal time point for assessing cladribine concentrations in CSF
|
All participants will receive cladribine 10 mg tablets at a cumulative dosage of 3.5 mg/kg divided into 2 treatment courses as per the United States Prescribing Information (USPI) (1.75 mg/kg per treatment course; Year 1 and Year 2 treatment).
Patients will be randomized 1:2:2:1 to receive a total of 2 Lumbar Punctures at specific time points during the treatment cycle.
|
|
Other: Group 3: LP at Baseline and End of Year 1
Group 3: LP at Baseline and end of Year 1.
To assess if cladribine effects on CSF markers are maintained at the end of the first treatment cycle
|
All participants will receive cladribine 10 mg tablets at a cumulative dosage of 3.5 mg/kg divided into 2 treatment courses as per the United States Prescribing Information (USPI) (1.75 mg/kg per treatment course; Year 1 and Year 2 treatment).
Patients will be randomized 1:2:2:1 to receive a total of 2 Lumbar Punctures at specific time points during the treatment cycle.
|
|
Other: Group 4: LP at Baseline and End of Year 2
Group 4: LP at Baseline and end of Year 2. To assess if cladribine effects on CSF markers are maintained at the end of the last treatment cycle
|
All participants will receive cladribine 10 mg tablets at a cumulative dosage of 3.5 mg/kg divided into 2 treatment courses as per the United States Prescribing Information (USPI) (1.75 mg/kg per treatment course; Year 1 and Year 2 treatment).
Patients will be randomized 1:2:2:1 to receive a total of 2 Lumbar Punctures at specific time points during the treatment cycle.
|
|
Other: Group 2: LP at Baseline and Week 10
Group 2: LP at Baseline and end of Week 10.
Week 10 is the hypothesized "nadir" time for lymphocyte and monocyte levels in CSF
|
All participants will receive cladribine 10 mg tablets at a cumulative dosage of 3.5 mg/kg divided into 2 treatment courses as per the United States Prescribing Information (USPI) (1.75 mg/kg per treatment course; Year 1 and Year 2 treatment).
Patients will be randomized 1:2:2:1 to receive a total of 2 Lumbar Punctures at specific time points during the treatment cycle.
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Change in CD3+ T Cells % From Baseline to Week 5
Time Frame: Baseline to Week 5 (5 weeks after first cladribine dose)
|
Change in CSF level of CD3+ T lymphocytes from Baseline to second LP at Week 5, using quality-controlled flow cytometry and assays.
Within-group differences from baseline to Week 5 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed.
Positive number indicates increase in CD3+ T cell percentage and a negative number indicates decrease in CD3+ T cell percentage.
|
Baseline to Week 5 (5 weeks after first cladribine dose)
|
|
Change in CD3+ T Cells % From Baseline to Week 10
Time Frame: Baseline to Week 10 (10 weeks after first cladribine dose)
|
Change in CSF level of CD3+ T lymphocytes from Baseline to second LP at Week 10, using quality-controlled flow cytometry and assays.
Within-group differences from Baseline to Week 10 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed.
Positive number indicates increase in CD3+ T cell percentage and a negative number indicates decrease in CD3+ T cell percentage.
|
Baseline to Week 10 (10 weeks after first cladribine dose)
|
|
Change in CD3+ T Cells % From Baseline to Year 1
Time Frame: Baseline to Year 1 (45 weeks after first cladribine dose)
|
Change in CSF level of CD3+ T lymphocytes from Baseline to second LP at Year 1, using quality-controlled flow cytometry and assays.
Within-group differences from Baseline to Year 1 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed.
Positive number indicates increase in CD3+ T cell percentage and a negative number indicates decrease in CD3+ T cell percentage.
|
Baseline to Year 1 (45 weeks after first cladribine dose)
|
|
Change in CD3+ T Cells % From Baseline to Year 2
Time Frame: Baseline to Year 2 (45 weeks after last cladribine dose)
|
Change in CSF level of CD3+ T lymphocytes from Baseline to second LP at Year 2, using quality-controlled flow cytometry and assays.
Within-group differences from Baseline to Year 2 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed.
Positive number indicates increase in CD3+ T cell percentage and a negative number indicates decrease in CD3+ T cell percentage.
|
Baseline to Year 2 (45 weeks after last cladribine dose)
|
|
Change in CD3+ T Cells Absolute Numbers (Cells/mL) From Baseline to Week 5
Time Frame: Baseline to Week 5
|
Change in CSF level of CD3+ T cells absolute numbers from Baseline to second LP at Week 5, using quality-controlled flow cytometry and assays.
Within-group differences from baseline to Week 5 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed.
Positive number indicates increase in CD3+ T cells absolute numbers and a negative number indicates decrease in CD3+ T cells absolute numbers.
|
Baseline to Week 5
|
|
Change in CD3+ T Cells Absolute Numbers (Cells/mL) From Baseline to Week 10
Time Frame: Baseline to Week 10 (10 weeks after first cladribine dose)
|
Change in CSF level of CD3+ T cells absolute numbers from Baseline to second LP at Week 10, using quality-controlled flow cytometry and assays.
Within-group differences from Baseline to Week 10 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed.
Positive number indicates increase in CD3+ T cells absolute numbers and a negative number indicates decrease in CD3+ T cells absolute numbers.
|
Baseline to Week 10 (10 weeks after first cladribine dose)
|
|
Change in CD3+ T Cells Absolute Numbers (Cells/mL) From Baseline to Year 1
Time Frame: Baseline to Year 1 (45 weeks after first cladribine dose)
|
Change in CSF level of CD3+ T cells absolute numbers from Baseline to second LP at Year 1, using quality-controlled flow cytometry and assays.
Within-group differences from Baseline to Year 1 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed.
Positive number indicates increase in CD3+ T cells absolute numbers and a negative number indicates decrease in CD3+ T cells absolute numbers.
|
Baseline to Year 1 (45 weeks after first cladribine dose)
|
|
Change in CD3+ T Cells Absolute Numbers (Cells/mL) From Baseline to Year 2
Time Frame: Baseline to Year 2 (45 weeks after last cladribine dose)
|
Change in CSF level of CD3+ T cells absolute numbers from Baseline to second LP at Year 2, using quality-controlled flow cytometry and assays.
Within-group differences from Baseline to Year 2 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed.
Positive number indicates increase in CD3+ T cells absolute numbers and a negative number indicates decrease in CD3+ T cells absolute numbers.
|
Baseline to Year 2 (45 weeks after last cladribine dose)
|
|
Change in CD19+ B Cells % From Baseline to Week 5
Time Frame: Baseline to Week 5 (5 weeks after first cladribine dose)
|
Change in CSF level of CD19+ B lymphocytes from Baseline to second LP at Week 5, using quality-controlled flow cytometry and assays.
Within-group differences from Baseline to Week 5 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed.
Positive number indicates increase in CD19+ B cell percentage and a negative number indicates decrease in CD19+ B cell percentage.
|
Baseline to Week 5 (5 weeks after first cladribine dose)
|
|
Change in CD19+ B Cells % From Baseline to Week 10
Time Frame: Baseline to Week 10 (10 weeks after first cladribine dose)
|
Change in CSF level of CD19+ B lymphocytes from Baseline to second LP at Week 10, using quality-controlled flow cytometry and assays.
Within-group differences from Baseline to Week 10 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed.
Positive number indicates increase in CD19+ B cell percentage and a negative number indicates decrease in CD19+ B cell percentage.
|
Baseline to Week 10 (10 weeks after first cladribine dose)
|
|
Change in CD19+ B Cells % From Baseline to Year 1
Time Frame: Baseline to Year 1 (45 weeks after first cladribine dose)
|
Change in CSF level of CD19+ B lymphocytes from Baseline to second LP at Year 1, using quality-controlled flow cytometry and assays.
Within-group differences from Baseline to Year 1 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed.
Positive number indicates increase in CD19+ B cell percentage and a negative number indicates decrease in CD19+ B cell percentage.
|
Baseline to Year 1 (45 weeks after first cladribine dose)
|
|
Change in CD19+ B Cells % From Baseline to Year 2
Time Frame: Baseline to Year 2 (45 weeks after last cladribine dose)
|
Change in CSF level of CD19+ B lymphocytes from Baseline to second LP at Year 2, using quality-controlled flow cytometry and assays.
Within-group differences from Baseline to Year 2 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed.
Positive number indicates increase in CD19+ B cell percentage and a negative number indicates decrease in CD19+ B cell percentage.
|
Baseline to Year 2 (45 weeks after last cladribine dose)
|
|
Change in CD19+ B Cells Absolute Numbers (Cells/mL) From Baseline to Week 5
Time Frame: Baseline to Week 5 (5 weeks after first cladribine dose)
|
Change in CSF level of CD19+ B cells absolute numbers from Baseline to second LP at Week 5, using quality-controlled flow cytometry and assays.
Within-group differences from Baseline to Week 5 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed.
Positive number indicates increase in CD19+ B cells absolute numbers and a negative number indicates decrease in CD19+ B cells absolute numbers.
|
Baseline to Week 5 (5 weeks after first cladribine dose)
|
|
Change in CD19+ B Cells Absolute Numbers (Cells/mL) From Baseline to Week 10
Time Frame: Baseline to Week 10 (10 weeks after first cladribine dose)
|
Change in CSF level of CD19+ B cells absolute numbers from Baseline to second LP at Week 10, using quality-controlled flow cytometry and assays.
Within-group differences from Baseline to Week 10 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed.
Positive number indicates increase in CD19+ B cells absolute numbers and a negative number indicates decrease in CD19+ B cells absolute numbers.
|
Baseline to Week 10 (10 weeks after first cladribine dose)
|
|
Change in CD19+ B Cells Absolute Numbers (Cells/mL) From Baseline to Year 1
Time Frame: Baseline to Year 1 (45 weeks after first cladribine dose)
|
Change in CSF level of CD19+ B cells absolute numbers from Baseline to second LP at Year 1, using quality-controlled flow cytometry and assays.
Within-group differences from Baseline to Year 1 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed.
Positive number indicates increase in CD19+ B cells absolute numbers and a negative number indicates decrease in CD19+ B cells absolute numbers.
|
Baseline to Year 1 (45 weeks after first cladribine dose)
|
|
Change in CD19+ B Cells Absolute Numbers (Cells/mL) From Baseline to Year 2
Time Frame: Baseline to Year 2 (45 weeks after last cladribine dose)
|
Change in CSF level of CD19+ B cells absolute numbers from Baseline to second LP at Year 2, using quality-controlled flow cytometry and assays.
Within-group differences from Baseline to Year 2 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed.
Positive number indicates increase in CD19+ B cells absolute numbers and a negative number indicates decrease in CD19+ B cells absolute numbers.
|
Baseline to Year 2 (45 weeks after last cladribine dose)
|
|
Change in the Neurofilament Light Chain (NfL) Level From Baseline to Week 5
Time Frame: Baseline to Week 5 (5 weeks after first cladribine dose)
|
Change in CSF level NfL (measured in pg/mL) from baseline to week 5 using the highly sensitive Neurology 4-Plex D Advantage Plus (N4PD+) single molecule array (SIMOA) technology.
A single batch of samples with duplicates were run at the conclusion of the study.
Within-group differences from baseline to Week 5 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed.
Positive number indicates increase in NfL value and a negative number indicates decrease in NfL value.
|
Baseline to Week 5 (5 weeks after first cladribine dose)
|
|
Change in the Neurofilament Light Chain (NfL) Level From Baseline to Week 10
Time Frame: Baseline to Week 10 (10 weeks after first cladribine dose)
|
Change in CSF level NfL (measured in pg/mL) from baseline to Week 10 using the highly sensitive Neurology 4-Plex D Advantage Plus (N4PD+) single molecule array (SIMOA) technology.
A single batch of samples with duplicates were run at the conclusion of the study.
Within-group differences from baseline to Week 10 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed.
Positive number indicates increase in NfL value and a negative number indicates decrease in NfL value.
|
Baseline to Week 10 (10 weeks after first cladribine dose)
|
|
Change in the Neurofilament Light Chain (NfL) Level From Baseline to Year 1
Time Frame: Baseline to Year 1 (45 weeks after first cladribine dose)
|
Change in CSF level NfL (measured in pg/mL) from baseline to Year 1 using the highly sensitive Neurology 4-Plex D Advantage Plus (N4PD+) single molecule array (SIMOA) technology.
A single batch of samples with duplicates were run at the conclusion of the study.
Within-group differences from baseline to Year 1 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed.
Positive number indicates increase in NfL value and a negative number indicates decrease in NfL value.
|
Baseline to Year 1 (45 weeks after first cladribine dose)
|
|
Change in the Neurofilament Light Chain (NfL) Level From Baseline to Year 2
Time Frame: Baseline to Year 2 (45 weeks after last cladribine dose)
|
Change in CSF level NfL (measured in pg/mL) from baseline to year 2 using the highly sensitive Neurology 4-Plex D Advantage Plus (N4PD+) single molecule array (SIMOA) technology.
A single batch of samples with duplicates were run at the conclusion of the study.
Within-group differences from baseline to year 2 were analyzed using the Wilcoxon signed-rank test because outcome differences were non-normally distributed.
Positive number indicates increase in NfL value and a negative number indicates decrease in NfL value.
|
Baseline to Year 2 (45 weeks after last cladribine dose)
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Gregory Wu, MD, PhD, Washington University School of Medicine
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Nervous System Diseases
- Autoimmune Diseases
- Immune System Diseases
- Demyelinating Autoimmune Diseases, CNS
- Autoimmune Diseases of the Nervous System
- Demyelinating Diseases
- Multiple Sclerosis
- Multiple Sclerosis, Relapsing-Remitting
- Heterocyclic Compounds
- Heterocyclic Compounds, 2-Ring
- Heterocyclic Compounds, Fused-Ring
- Nucleic Acids, Nucleotides, and Nucleosides
- Purines
- Nucleosides
- Ribonucleosides
- Deoxyribonucleosides
- 2-Chloroadenosine
- Adenosine
- Purine Nucleosides
- Deoxyadenosines
- Cladribine
Other Study ID Numbers
Other Study ID Numbers
- MS700568_0049-201906092
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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