Study to Explore the Effect of Mefloquine in Participants With Progressive Multifocal Leukoencephalopathy (PML)

A Randomized, Rater-Blinded Study to Explore the Effect of Mefloquine in Subjects With Progressive Multifocal Leukoencephalopathy (PML)

The primary objective of the study was to explore whether mefloquine can delay or stop progression of progressive multifocal leukoencephalopathy (PML) as measured by JC virus (human polyomavirus or JCV) deoxyribonucleic acid (DNA) levels in cerebrospinal fluid (CSF). The secondary objective of the study was to explore whether mefloquine can delay or stop progression of PML based on neurological deterioration, magnetic resonance imaging (MRI) measures of brain lesion evolution or the formation of new lesions, and mortality.

Study Overview

• Status: Terminated
• Conditions: Progressive Multifocal Leukoencephalopathy
• Intervention / Treatment: Drug: mefloquine

• Study Type: Interventional
• Enrollment (Actual): 37
• Phase: Phase 2; Phase 1

Contacts and Locations

Study Locations

• Brazil
  • Sao Paulo, Brazil
    • Research Site
• Germany
  • Berlin, Germany
    • Research Site
  • Hamburg, Germany
    • Research Site
  • North Rhine-Westphalia
    • Dusseldorf, North Rhine-Westphalia, Germany
      • Research Site
• Italy
  • Milano, Italy
    • Research Site
• Spain
  • Barcelona, Spain
    • Research Site
  • Madrid, Spain
    • Research Site
• United States
  • Illinois
    • Chicago, Illinois, United States
      • Research Site
  • Maryland
    • Baltimore, Maryland, United States
      • Research Site
  • Massachusetts
    • Boston, Massachusetts, United States
      • Research Site
  • Missouri
    • St. Louis, Missouri, United States
      • Research Site
  • New York
    • New York, New York, United States
      • Research Site

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 73 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Key Inclusion Criteria:

• Diagnosis of PML confirmed by detection of JCV DNA in CSF.
• Onset of PML symptoms within 6 months prior to study.

Key Exclusion Criteria:

• Other opportunistic infection of the central nervous system.
• Current severe illness or any other conditions that, in the opinion of the Investigator, would make the subject unsuitable for enrollment.
• Active severe mental illness (e.g., depression, anxiety, psychosis, and schizophrenia).
• Hypersensitivity to mefloquine, quinine, or quinidine, or to any component of these drugs.
• Current treatment with quinine, quinidine, chloroquine, or halofantrine.

Note: Other protocol-defined criteria may also apply.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Local standard of care; All participants received local standard of care, which may have included any treatment or procedure that the Investigator would normally use in the treatment of a PML patient at their study site or hospital. Participants in this treatment arm had the option of adding 250 mg mefloquine by mouth at Week 4 (Day 28) or Week 8 (Day 56) daily for 3 days, and then weekly through Week 24.
Experimental: Local standard of care plus mefloquine 250 mg; All participants received local standard of care, which may have included any treatment or procedure that the Investigator would normally use in the treatment of a PML patient at their study site or hospital. Participants received 250 mg mefloquine by mouth on Days 0, 1, and 2 and then weekly through Week 24.	Drug: mefloquine; 250 mg orally each day for 3 days and then weekly up to 6 months.; Other Names: Lariam®; Mephaquin®; Mefliam®

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline to Week 4 in JC Virus (JCV) Load in Cerebrospinal Fluid (CSF)	Change from baseline to Week 4 in JC viral load in CSF is expressed as log10 copies/mL. Negative values indicate a reduction in viral load. Only participants with measurable baseline values are included. Post-baseline values of 'Below the Limit of Quantification' or 'Below Limit of Detection' or 'Negative' were set to 50. Log10 (50) = 1.699	Day 0 (baseline), Week 4
Change From Baseline to Week 8 in JC Virus (JCV) Load in Cerebrospinal Fluid (CSF)	Change from baseline to Week 8 in JC viral load in CSF is expressed as log10 copies/mL. Negative values indicate a reduction in viral load. Only participants with measurable baseline values are included. Post-baseline values of 'Below the Limit of Quantification' or 'Below Limit of Detection' or 'Negative' were set to 50. Log10 (50) = 1.699	Day 0 (baseline), Week 8

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline to Week 4 and Week 8 in the Expanded Disability Status Scale (EDSS) Score	EDSS assesses disability in 8 functional systems. An overall score ranging from 0 (normal) to 10 (death) was calculated. Negative change scores indicate improvement.	Day 0 (baseline), Week 4 and 8
Change From Baseline to Week 4 and Week 8 in Karnofsky Performance Status (KPS) Index Score	The KPS Index classifies participants' functional impairment. KPS can be used to compare effectiveness of different therapies and to assess the prognosis in individual participants. KPS was recorded on an 11-point scale (0, 10, 20, 30, 40, 50, 60, 70, 80, 90, and 100.) where '0=Dead' and '100=Normal, no complaints, no evidence of disease'. The lower the KPS score, the worse the survival for most serious illnesses. The KPS index is subdivided into 3 categories: incapacitated (0 to 40), self-care (50 to 70), and normal activity (80 to 100). Negative change from baseline scores indicate improved prognosis.	Day 0 (baseline), Week 4, Week 8
Change From Baseline to Week 4 and Week 8 in Symbol Digit Modalities Test (SDMT)	The SDMT is a simple substitution task. The test gives participants 90 seconds to pair specific numbers with given geometric figures as a measure for screening cognitive impairment. The total score is the total number of correctly completed boxes in the time allowed. The test score range is from 0 (worst outcome) to 110 (best outcome). Negative change from baseline scores indicates a worsening outcome.	Day 0 (baseline), Week 4, Week 8
Change From Baseline to Week 4 and Week 8 in Participants' Neurological Function Using a Visual Analog Scale (VAS)	Participants rate their neurological function on a scale of 100 mm line, where the 0 end of the scale indicates poor neurological function and 100 indicates excellent neurological function. VAS was not required for participants who had physical or cognitive impairments that limited their ability to perform the assessment. Negative change from baseline scores indicates a worsening outcome.	Day 0 (baseline), Week 4, Week 8
Participants With Gadolinium (Gd)-Enhanced Lesions at Baseline, Week 4 and Week 8 as Seen on Magnetic Resonance Imaging (MRI) Scans of Participants' Brains		Day 0 (baseline), Week 4, Week 8
Change From Baseline to Week 4 and Week 8 in T1 Lesion Volume as Seen on Magnetic Resonance Imaging (MRI) Scans of Participants' Brains		Day 0 (baseline), Week 4, Week 8
Change From Baseline to Week 4 and Week 8 in T2 Lesion Volume as Seen on Magnetic Resonance Imaging (MRI) Scans of Participants' Brains		Day 0 (baseline), Week 4, Week 8
Participants Who Died Within 6 Months	The death event is counted under the treatment arm relative to adding mefloquine to the treatment regimen.	Day 1 up to 6 months

Collaborators and Investigators

• Sponsor: Biogen
• Collaborators: Elan Pharmaceuticals

Publications and helpful links

General Publications

• Clifford DB, Nath A, Cinque P, Brew BJ, Zivadinov R, Gorelik L, Zhao Z, Duda P. A study of mefloquine treatment for progressive multifocal leukoencephalopathy: results and exploration of predictors of PML outcomes. J Neurovirol. 2013 Aug;19(4):351-8. doi: 10.1007/s13365-013-0173-y. Epub 2013 Jun 4.

Study record dates

Study Major Dates

• Study Start: January 1, 2009
• Primary Completion (Actual): November 1, 2010
• Study Completion (Actual): November 1, 2010

Study Registration Dates

• First Submitted: September 3, 2008
• First Submitted That Met QC Criteria: September 3, 2008
• First Posted (Estimate): September 4, 2008

Study Record Updates

• Last Update Posted (Estimate): July 31, 2014
• Last Update Submitted That Met QC Criteria: July 2, 2014
• Last Verified: July 1, 2014

More Information

Terms related to this study

• Keywords: HIV; JC Virus; Central Nervous System Disease; Mefloquine; PML; Human Polyomavirus JC
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Virus Diseases; Infections; Demyelinating Diseases; Encephalitis, Viral; Central Nervous System Viral Diseases; Central Nervous System Infections; Infectious Encephalitis; DNA Virus Infections; Slow Virus Diseases; Encephalitis; Polyomavirus Infections; Leukoencephalopathy, Progressive Multifocal; Leukoencephalopathies; Anti-Infective Agents; Antiprotozoal Agents; Antiparasitic Agents; Antimalarials; Mefloquine
• Other Study ID Numbers: 111JC101