Observational Study of Tysabri in Early Relapsing-Remitting Multiple Sclerosis in Anti-JC Virus Antibody Negative Participants (STRIVE)

A Multicenter, Observational, Open-Label, Single-Arm Study of Tysabri in Early Relapsing-Remitting Multiple Sclerosis in Anti-JCV Antibody Negative Patients

The primary objective of the study is to determine which baseline and yearly response factors (clinical and para clinical) predict overall disease-free status at Month 12 and Month 24, and clinical disease-free status in subsequent Months 36 and 48. The secondary objectives are: To identify prognostic factors at Baseline that predict overall disease-free status at Month 12, and to assess if yearly overall disease-free response factors predict overall disease-free status at Month 24; To evaluate clinical disease-free status (relapse, Expanded Disability Status Scale [EDSS]) at each analysis time point of Months 12, 24, 36, and 48; To identify prognostic factors at Baseline that predict clinical disease-free status at Month 12, and to assess yearly clinical disease-free response factors that predict clinical disease-free status (relapse, EDSS) in subsequent years at Months 24, 36, and 48; To evaluate the impact of Tysabri at each analysis time point of Months 12, 24, 36, and 48 on the following: annualized relapse rate (ARR), sustained EDSS progression and improvement (24-week sustained); To evaluate the impact of Tysabri at each analysis time point of Months 12, 24, 36, and 48 on the following: magnetic resonance image (MRI) measures: T2, T1, T1 with Gadolinium (Gd), brain atrophy; To evaluate the impact of Tysabri at Month 24 and Month 48 on the following: optical coherence tomography (OCT), Low and High Contrast Visual Acuity Assessment; To evaluate the impact of Tysabri at each analysis time point of Months 12, 24, 36, and 48 on the following: cognitive impairment (Symbol Digit Modalities Test [SDMT]), capacity for work (Work Productivity and Activity Impairment Questionnaire [WPAI]), quality of life (QoL) (Multiple Sclerosis Impact Scale [MSIS-29])

Study Overview

• Status: Completed
• Conditions: Relapsing-Remitting Multiple Sclerosis
• Intervention / Treatment: Biological: natalizumab

• Study Type: Observational
• Enrollment (Actual): 231

Contacts and Locations

Study Locations

• United States
  • Alabama
    • Homewood, Alabama, United States, 35209
      • Research Site
  • Arizona
    • Sun City, Arizona, United States, 85351
      • Research Site
  • California
    • La Jolla, California, United States, 92037
      • Research Site
    • Los Angeles, California, United States, 90032
      • Research Site
  • Colorado
    • Aurora, Colorado, United States, 80045
      • Research Site
    • Fort Collins, Colorado, United States, 80528
      • Research Site
  • Delaware
    • Newark, Delaware, United States, 19713
      • Research Site
  • District of Columbia
    • Washington, District of Columbia, United States, 20007
      • Research Site
  • Florida
    • Jacksonville, Florida, United States, 32209
      • Research Site
  • Georgia
    • Atlanta, Georgia, United States, 30309
      • Research Site
  • Illinois
    • Chicago, Illinois, United States, 60612
      • Research Site
    • Lake Barrington, Illinois, United States, 60010
      • Research Site
    • Peoria, Illinois, United States, 61603
      • Research Site
  • Indiana
    • Indianapolis, Indiana, United States, 46260
      • Research Site
    • Indianapolis, Indiana, United States, 46256
      • Research Site
  • Kansas
    • Overland Park, Kansas, United States, 66212
      • Research Site
  • Kentucky
    • Louisville, Kentucky, United States, 40207
      • Research Site
  • Louisiana
    • New Orleans, Louisiana, United States, 70121
      • Research Site
  • Maryland
    • Baltimore, Maryland, United States, 21287
      • Research Site
  • Massachusetts
    • Boston, Massachusetts, United States, 02215
      • Research Site
    • Lexington, Massachusetts, United States, 02421
      • Research Site
    • Wellesley Hills, Massachusetts, United States, 02481
      • Research Site
    • Worcester, Massachusetts, United States, 01655
      • Research Site
  • Michigan
    • East Lansing, Michigan, United States, 48824
      • Research Site
  • Nebraska
    • Lincoln, Nebraska, United States, 68521
      • Research Site
  • New Jersey
    • Freehold, New Jersey, United States, 07728
      • Research Site
  • New York
    • New York, New York, United States, 10016
      • Research Site
    • New York, New York, United States, 10021
      • Research Site
    • Patchogue, New York, United States, 11772
      • Research Site
    • Plainview, New York, United States, 11803
      • Research Site
    • Staten Island, New York, United States, 10306
      • Research Site
    • Stony Brook, New York, United States, 11794
      • Research Site
  • Ohio
    • Cincinnati, Ohio, United States, 45219
      • Research Site
    • Cleveland, Ohio, United States, 44195
      • Research Site
    • Gahanna, Ohio, United States, 43230
      • Research Site
    • Uniontown, Ohio, United States, 44685
      • Research Site
  • Oregon
    • Portland, Oregon, United States, 97225
      • Research Site
  • Texas
    • Dallas, Texas, United States, 75235
      • Research Site
    • Round Rock, Texas, United States, 78681
      • Research Site
  • Utah
    • Salt Lake City, Utah, United States, 84103
      • Research Site
  • Virginia
    • Newport News, Virginia, United States, 23601
      • Research Site
    • Norfolk, Virginia, United States, 23502
      • Research Site
  • Washington
    • Seattle, Washington, United States, 98101
      • Research Site
    • Tacoma, Washington, United States, 98405
      • Research Site

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Study participants will be recruited by participating neurologists from among their MS patients who opt to begin treatment with Tysabri.

Description

Key Inclusion Criteria:

• Documented diagnosis of Relapsing Multiple Sclerosis (McDonald 2010 Criteria ).
• <3 year disease duration.
• Must have an Expanded Disability Status Scale (EDSS) score from 0 to 4.0, inclusive.
• Anti-JCV antibody negative test within 6 months of Screening Visit.
• Must satisfy the approved therapeutic indications for Tysabri.
• Must be treatment-naïve to disease-modifying therapy (DMT) or have been treated with DMT (including but not limited to Avonex, Betaseron, Rebif, Copaxone, Extavia, or Gilenya) for ≤36 months total prior to date of informed consent.
• Decision to treat with Tysabri must precede enrollment.

Key Exclusion Criteria:

• Any prior treatment with Tysabri.
• Anti-JCV antibody positive at any timepoint prior to the Screening Visit.
• Contraindications to treatment with Tysabri as described in the US Prescribing Information.
• History of progressive multifocal leukoencephalopathy (PML) or other opportunistic infections, or an increased risk for such infections.
• History of diagnosis of Primary Progressive Multiple Sclerosis (PPM) and/or Secondary Progressive Multiple Sclerosis (SPMS).
• Receiving immunomodulatory or immunosuppressive therapy.
• Prior history of immunosuppressive use (mitoxantrone, azathioprine, methotrexate, cyclophosphamide, mycophenolate, cladribine, rituximab).
• Immunocompromised at the time of enrollment.
• Known active malignancies (subjects with cutaneous basal cell carcinoma that has been completely excised prior to study entry remain eligible).
• Women breastfeeding, pregnant, or planning to become pregnant; women who are not post-menopausal or surgically sterile who are unwilling to practice contraception.
• Inability to comply with study requirements.

NOTE: Other protocol defined Inclusion/Exclusion criteria may apply.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of Participants who are overall disease activity-free at Months 12 and 24	Overall disease activity-free is defined as no relapses, no disability progression (RRMS), and absence of MRI disease activity (no gadolinium [gd])+ lesions, no new or enlarging T2-hyperintense lesions). A clinical relapse is defined as new or recurrent neurological symptoms, not associated with fever, lasting for at least 24 hours, and followed by a period of 30 days of stability or improvement. Sustained disability progression defined by at least a 1.0-point increase on the EDSS from a Baseline EDSS ≥1.0 that is sustained for 12 or 24 weeks, or at least a 1.5-point increase on the EDSS from a Baseline EDSS <1.0 that is sustained for 12 or 24 weeks. The EDSS measures the disability status of people with multiple sclerosis on a scale that ranges from 0 to 10, with higher scores indicating more disability.	Baseline and Months 12 and 24
Proportion of participants who are clinical disease activity-free at Months 36 and 48	Clinical disease activity-free is defined as no sustained EDSS progression and no relapses at Month 36 and 48.	Baseline and Months 36 and 48

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Identification of baseline prognostic factors that predict overall disease-free status		Baseline and Month 12
Identification of yearly overall disease-free response factors that predict overall disease-free status		Month 12 and Month 24
Number of Participants with Clinical Disease-Free Status Measured by Relapses	A clinical relapse is a new or recurrent neurological symptoms, not associated with fever, lasting for at least 24 hours, and followed by a period of 30 days of stability or improvement.	Months 12, 24, 36, and 48
Identification of baseline prognostic factors that predict clinical disease-free status		Month 12
Identification of yearly clinical disease-free response factors that predict clinical disease-free status		Months 24, 36 and 48
Annualized Relapse Rate	A clinical relapse is defined as new or recurrent neurological symptoms, not associated with fever, lasting for at least 24 hours, and followed by a period of 30 days of stability or improvement. The ARR will be calculated by tabulating the total number of relapses experienced in the group divided by the number of days up to the end of study, and the ratio then multiplied by 365.	Months 12, 24, 36, and 48
Percentage of participants with Sustained EDSS progression		Baseline and Months 12, 24, 36, and 48
Sustained EDSS improvement	Sustained improvement in disability is defined as participants with Baseline EDSS of at least 2.0 who experience a ≥1.0 decrease in EDSS that is sustained for 24 weeks.	Baseline and Months 12, 24, 36, and 48
Change form baseline in number of new or newly enlarging T2 hyperintense lesions as assessed by MRI		Baseline and Months 12, 24, 36, and 48
Change from baseline in number of new T1 hypointense lesions as assessed by MRI		Baseline and Months 12, 24, 36, and 48
Change form baseline in number of T1 lesions with Gd-enhancing lesions as assessed by MRI		Baseline and Months 12, 24, 36, and 48
MRI brain atrophy as assessed by MRI		Baseline and Months 12, 24, 36, and 48
Change from baseline in retinal nerve fiber layer (RNFL) thickness as assessed by OCT		Baseline and Month 24 and Month 48
Change from baseline in low contrast visual acuity	Low-contrast visual acuity testing captures the minimum size at which individuals can perceive letters of a particular contrast level (shade of gray on white background). Using the low-contrast Sloan letter charts at 2.5% and 1.25% low contrast levels, participants will be asked to read each of the 2 charts at a 2-meter distance using a standardized testing protocol.	Baseline and Month 24 and Month 48
Change from baseline in high contrast visual acuity	High contrast acuity testing is important to help determine the smallest letters a person can read on a standardized visual acuity chart or on a card held 14 - 20 feet away. A visual acuity test is a routine part of an eye examination.	Baseline and Month 24 and Month 48
Cognitive impairment as assessed by change from baseline in SDMT	SDMT is a screening test for cognitive impairment. Participants are given 90 seconds in which to pair specific numbers with given geometric figures using a key. Scores range from 0 to 110 (best).	Baseline and Months 12, 24, 36 and 48
Capacity for work as assessed by change from baseline in WPAI questionnaire	The Work Productivity and Activity Impairment (WPAI) questionnaire is a validated instrument to measure impairments in work and activities. The WPAI yields four types of scores: 1. Absenteeism (work time missed) 2. Presenteeism (impairment at work / reduced on-the-job effectiveness) 3. Work productivity loss (overall work impairment / absenteeism plus presenteeism) 4. Activity Impairment WPAI outcomes are expressed as impairment percentages, with higher numbers indicating greater impairment and less productivity.	Baseline and Months 12, 24, 36 and 48
Quality of Life as measured by MSIS-29	The 29-item Multiple Sclerosis Impact Scale (MSIS-29) is a participant-reported outcome measure to assess the impact of MS on day-to-day life during the past 2 weeks from a participant's perspective; it measures 20 physical items and 9 psychological items. The physical score is generated by summing individual items and then transforming to a scale with a range of 0 to 100, where high scores indicate worse health.	Baseline and Months 12, 24, 36 and 48
Number of Participants with Clinical Disease-Free Status Measured by EDSS	Expanded Disability Status Scale (EDSS) is a method of quantifying disability in 8 Functional Systems (FS) and allows neurologists to assign a Functional System Score (FSS) in each of these. The FSS include pyramidal, cerebellar, brainstem, sensory, bowel and bladder, visual, cerebral (or mental), and other. Each of the FSS is an ordinal clinical rating scale ranging from 0 to 5 or 6, with higher scores indicating more disability. These ratings are then used in conjunction with observations and information concerning gait and use of assistive devices to rate the EDSS. The EDSS is an ordinal clinical rating scale ranging from 0 (normal neurologic examination) to 10 (death due to MS) in half-point increments. Each of the FSS and the EDSS are single-item scales and there is no composite or summed score.	Months 12, 24, 36 and 48

Collaborators and Investigators

• Sponsor: Biogen

Publications and helpful links

General Publications

• Perumal J, Balabanov R, Su R, Chang R, Balcer LJ, Galetta SL, Avila RL, Rutledge D, Fox RJ. Improvements in Cognitive Processing Speed, Disability, and Patient-Reported Outcomes in Patients with Early Relapsing-Remitting Multiple Sclerosis Treated with Natalizumab: Results of a 4-year, Real-World, Open-Label Study. CNS Drugs. 2022 Sep;36(9):977-993. doi: 10.1007/s40263-022-00950-0. Epub 2022 Sep 5.
• Perumal J, Balabanov R, Su R, Chang R, Balcer L, Galetta S, Campagnolo DI, Avila R, Lee L, Rutledge D, Fox RJ. Natalizumab in Early Relapsing-Remitting Multiple Sclerosis: A 4-Year, Open-Label Study. Adv Ther. 2021 Jul;38(7):3724-3742. doi: 10.1007/s12325-021-01722-w. Epub 2021 May 20. Erratum In: Adv Ther. 2021 Jun 22;:
• Perumal J, Fox RJ, Balabanov R, Balcer LJ, Galetta S, Makh S, Santra S, Hotermans C, Lee L. Outcomes of natalizumab treatment within 3 years of relapsing-remitting multiple sclerosis diagnosis: a prespecified 2-year interim analysis of STRIVE. BMC Neurol. 2019 Jun 8;19(1):116. doi: 10.1186/s12883-019-1337-z.

Study record dates

Study Major Dates

• Study Start (Actual): February 7, 2012
• Primary Completion (Actual): November 26, 2018
• Study Completion (Actual): November 26, 2018

Study Registration Dates

• First Submitted: December 1, 2011
• First Submitted That Met QC Criteria: December 2, 2011
• First Posted (Estimate): December 5, 2011

Study Record Updates

• Last Update Posted (Actual): February 12, 2019
• Last Update Submitted That Met QC Criteria: February 11, 2019
• Last Verified: February 1, 2019

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Nervous System Diseases; Immune System Diseases; Demyelinating Autoimmune Diseases, CNS; Autoimmune Diseases of the Nervous System; Demyelinating Diseases; Autoimmune Diseases; Multiple Sclerosis; Sclerosis; Multiple Sclerosis, Relapsing-Remitting; Physiological Effects of Drugs; Immunologic Factors; Natalizumab
• Other Study ID Numbers: 101MS407