Adherence Trial With MS LifeLines ® Services

A Prospective, Parallel Group, Phase IV Study of Three Levels of MS LifeLines ® Support Services Provided to Patients Prescribed Rebif ® for Newly Diagnosed or First-switch Relapsing Remitting Multiple Sclerosis (RRMS)

This is a Phase IV study to compare the current level of MS LifeLines ® (MSLL) services (face-to-face nursing visits and phone contacts) with customized MSLL services, to determine the optimal services to enhance medication adherence and treatment persistence with Rebif ® subcutaneous three times a week.

Study Overview

• Status: Terminated
• Conditions: Multiple Sclerosis; Relapsing-Remitting
• Intervention / Treatment: Other: Standard Services of Group A (Group A1); Other: Customized Services of Group A (Group A2); Other: Group B

Detailed Description

The proposed study is a web-based, prospective, parallel group, Phase IV, 12-month study of patients receiving support services provided by MSLL and contracted nursing services. Following referral of patients to MSLL, consenting patients will be allocated to one of two groups (2:1), based on their geographic area. Group A will be further randomized 1:1 to the standard services subgroup (Group A1) or a customized services subgroup (Group A2). The standard subgroup will receive phones calls and nurse visits at set intervals. Patients in the custom services subgroup will have the option of selecting as many or as few of the "standard" services they will receive after the initial injection training. Subjects will have the option of receiving educational materials, planning tools, and reminders. Patients allocated to Group B will receive a visit for injection training and the follow-up call and then MSLL phone calls at set intervals. Over a period of 12 months (each month defined as a 28-day period), all subjects will receive support services (nurse visit and follow-up phone call, etc) and complete online assessments (MSRS-R, PDSS, etc).

The primary objective of the trial is to determine the impact of two different levels of support service, group A1 and A2, provided by MSLL within Group A, on adherence to prescribed treatment in newly diagnosed or first-switch relapsing remitting multiple sclerosis (RRMS) subjects.

Secondary Objective:

The secondary objectives are:

• To use a pair wise comparison to determine the impact on adherence of the two different levels of service intervention provided by MSLL not compared in the primary objective (Standard services subgroup of Group A (A1) to Group B and Customized service subgroup of Group A (A2) to Group B)
• To determine the correlation of adherence with subject-reported outcomes and other study data;
• To examine the changes from baseline in subject-reported outcomes in each service arm;
• To examine changes from baseline in risk for non-adherence in each service arm; and
• To determine rate of trial dropout between each service arm

• Study Type: Observational
• Enrollment (Actual): 306

Contacts and Locations

Study Locations

• United States
  • Massachusetts
    • Boston, Massachusetts, United States
      • Call EMD Serono Medical Information for information on recruiting sites

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

Subjects who have been prescribed to Rebif® treatment by their treating physicians will be observed.

Description

Inclusion Criteria:

• Age 18 to 65 years at the time of informed consent signature
• Male or female
• Female subjects of child bearing potential who report they are not pregnant at screening and agree to avoid pregnancy during study participation by using adequate contraception, defined as two barrier methods, one barrier method with a spermicide, intrauterine device, or use of oral female contraceptive
• Outpatient status at time of online screening
• Subjects prescribed Rebif by their treating physicians as the first disease-modifying drug (DMD) they have received, or up to one prior treatment with either Rebif, Copaxone ®, Avonex ® , Extavia ®, Betaseron ®, Gilenya™, and Aubagio ® (with accelerated elimination), Tysabri ® and Tecfidera™
• Access to, and ability to use, a computer, a mouse, the internet, and an email address. In addition, subjects in the Group A will be required to have access to a telephone that accepts text messaging (in case randomized to the Custom subgroup)
• Subject-reported ability to complete online assignments and read English
• Electronically verified informed consent before any trial-related activities are carried out

Exclusion Criteria:

• Any combination therapy with another DMD for Multiple Sclerosis (MS) while participating in the trial
• Score of 4 on any of the items of the MSRS-R or a score between 5 and 8, inclusive, on the PDDS
• Surgical intervention planned during the 12-month study period
• Pregnant or breastfeeding. Note subjects who are 90 days postpartum, stable, and do not breastfeed may participate.
• History of malignancy, with the exception of skin cancer completely excised and considered cured;
• History of seizures or unexplained blackouts within 30 days prior to online screening
• Current illegal drug use at the time of online screening;
• Any prior participation in an interventional clinical trial for MS (except for Aubagio ® or Tecfidera™), participation in any trial within 30 days prior to online screening, or current participation in another clinical trial;
• Current treatment of another autoimmune disorder other than stable thyroid disease at the time of online screening
• History of prior treatment for MS with any of the following: alemtuzumab, cyclophosphamide, methotrexate, azathioprine, cyclosporin, intravenous immunoglobulin (IVIg), and plasma exchange
• Other significant subject-reported disease that would exclude the subject from the trial
• Significant renal or hepatic impairment that would compromise completion of the trial

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Standard Services of Group A (Group A1)	Other: Standard Services of Group A (Group A1); Support services provided in this group will include: Initial field nurse injection training visit; field nurse follow-up and subsequent visits; and follow-up phone calls at periodic intervals
Customized Services of Group A (Group A2)	Other: Customized Services of Group A (Group A2); In addition to the initial field nurse injection training visit and follow-up call, subjects will select from support services including field nurse follow-up visits; follow-up phone calls; email and/or text reminders; subject self-assessment and use of treatment planning tools; and mail/e-mail educational materials.
Group B	Other: Group B; Support services provided in this group will include initial field nurse injection training visit and follow-up phone calls at periodic intervals.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Subject-reported adherence to treatment, calculated as percent adherence ([number of actual injections / number of expected injections] * 100), for subjects in the Group A1 compared with subjects in the Group A2	Month 12

Secondary Outcome Measures

Outcome Measure	Time Frame
Subject-reported adherence to treatment in Group A1, Group A2 and Group B at Month 12	Month 12
Subject-reported adherence to treatment in Group A1, Group A2 and Group B at Months 3 and 6	Months 3 and 6
Subject-reported Multiple Sclerosis Rating Scale- Revised (MSRS-R) in Group A1, Group A2 and Group B	Months 6 and 12
Subject-reported Patient-determined Disease Steps Questionnaire (PDDS) in Group A1, Group A2 and Group B	Months 6 and 12
Subject-reported Multiple Sclerosis Self-management Scale - Revised (MSSM-R) in Group A1, Group A2 and Group B	Months 6 and 12
Subject-reported Multiple Sclerosis International Quality of Life (MusiQoL) in Group A1, Group A2 and Group B	Months 6 and 12
Subject-reported Morisky Medication Adherence Scale-4 (MMAS-4) in Group A1, Group A2 and Group B	Months 2, 6, 9 and 12
Change from Baseline in Subject-reported multiple Sclerosis Rating Scale- Revised (MSRS-R) in Group A1, Group A2 and Group B at Months 6 and 12	Months 6 and 12
Change from Baseline in Subject-reported Patient-determined Disease Steps Questionnaire (PDDS) in Group A1, Group A2 and Group B at Months 6 and 12	Months 6 and 12
Change from Baseline in Subject-reported Multiple Sclerosis Self-management Scale - Revised (MSSM-R) in Group A1, Group A2 and Group B at Months 6 and 12	Months 6 and 12
Change from Baseline in Subject-reported Multiple Sclerosis International Quality of Life (MusiQoL) in Group A1, Group A2 and Group B at Months 6 and 12	Months 6 and 12
Change from Baseline in Subject-reported score in Morisky Medication Adherence Scale-4 (MMAS-4) in Group A1, Group A2 and Group B at Months 2, 6, 9 and 12	Months 2, 6, 9 and 12
Percentage of subjects who dropped-out of the trial along with the reasons of dropping out in Group A1, Group A2 and Group B	Month 12
Percentage of subjects with more than 80 percent and 90 percent subject-reported adherence to treatment in Group A1, Group A2 and Group B	Month 12
Percentage of subject demographic characteristics in Group A1, Group A2 and Group B	Month 12

Collaborators and Investigators

• Sponsor: EMD Serono
• Investigators: Study Director: Medical Responsible, EMD Serono, an affiliate of Merck KGaA, Darmstadt, Germany

Study record dates

Study Major Dates

• Study Start: July 1, 2013
• Primary Completion (Actual): January 1, 2015
• Study Completion (Actual): January 1, 2015

Study Registration Dates

• First Submitted: July 18, 2013
• First Submitted That Met QC Criteria: July 18, 2013
• First Posted (Estimate): July 23, 2013

Study Record Updates

• Last Update Posted (Estimate): February 2, 2015
• Last Update Submitted That Met QC Criteria: January 30, 2015
• Last Verified: January 1, 2015

More Information

Terms related to this study

• Keywords: Multiple Sclerosis; Rebif; Relapsing-Remitting; Quintiles Geographic Area Group; Standard Subgroup; Custom Subgroup; RxCrossroads Geographic Area Group
• 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
• Other Study ID Numbers: EMR 200136-567