- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01981161
Difference in Efficacy of Natalizumab Versus Fingolimod for the Treatment of Multiple Sclerosis (BEST-MS)
August 24, 2020 updated by: University Hospital, Toulouse
Essai de Phase IV, Multicentrique, Ouvert, Visant à Tester la différence d'efficacité du Natalizumab, Versus le Fingolimod, 2 médicaments Ayant Une AMM Pour le Traitement de la sclérose en Plaques
Under the escalation treatment strategy when a patient displays breakthrough disease parameters under first line therapy, MS physicians are allowed by the EMEA to switch for Natalizumab (NTZ) or fingolimod (FGL).
NTZ and FGL efficacy have been demonstrated by randomized therapeutic trial.
As both treatments have been tested versus placebo a common way to compare them is to look at their respective annualized relapse risk ratio decrease.
Roughly NTZ decrease by 70% and FGL by 50%.
Nevertheless it is a terrible comparison since the placebo group had different behaviour in the 2 trials and the patients demographic features at baseline are also different.
Therefore, it is right now totally impossible to compare these 2 drugs with a decent methodology.
Only a head-to-head comparison could do it.
Unfortunately this head-to-head comparison is not available and will not probably be done under the drug companies initiative.
During the time of this study, we will perform a phase IV, observational, prospective head-to-head comparison of NTZ versus FGL efficacy in 600 patients.
Our primary end point will be disease free patients after 1 year of treatment.
Further, this trial will allow us to collect new biological samples, useful for a validation our project main aim.
Further these new samples will be obtained from 3 European countries, which is a must if we want to generalize our conclusion obtained from a French cohort.
Cooperation at the European level is thus essential for the implementation of this project .
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Study Type
Observational
Enrollment (Actual)
307
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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Besancon, France, 25000
- CHU Besançon
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Bordeaux, France, 33 000
- CHU Bordeaux
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Caen, France, 14033
- CHU Caen
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Lille, France, 59037
- CHU Lille
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Marseille, France, 13385
- CHU La Timone
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Nancy, France, 54035
- CHU Nancy
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Nantes, France, 44093
- CHU Nantes
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Nice, France, 06002
- CHU NICE
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Nimes, France, 30029
- CHU Nimes
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Strasbourg, France, 67098
- CHRU Strasbourg
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Munster, Germany
- Université de Muenter
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Barcelone, Spain
- Hôpital Vall D'Hebron
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 55 years (Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Sampling Method
Non-Probability Sample
Study Population
Multiple sclerosis
Description
Inclusion Criteria:
- diagnosis of relapsing-remitting MS in line with McDonald criteria;
patient needing to be treated with FGL or NTZ, either:
- Patients who have not responded to complete and well-conducted treatment with beta interferon. The patients should have presented at least one relapse during the course of the previous year while they were receiving treatment, and should present at least 9 hyper-intense lesions within T2 on a cerebral MRI, or at least 1 enhancing lesion following injection of Gadolinium; or
- Patients presenting severe and rapidly developing relapsing-remitting multiple sclerosis, defined by 2 debilitating relapses or more during the course of one year, combined with 1 or more high-intensity lesion(s) following injection of Gadolinium on a cerebral MRI, or a significant increase in lesion load within T2 compared to a recent prior MRI.
- EDSS score between 0 and 6, not inclusive;
- patient who give informed consent, and signed the consent form;
- patient available for 12-month follow-up.
Exclusion Criteria:
- General exclusion criteria: The patient is subject to judicial protection, supervision or guardianship, the patient is pregnant, is about to give birth, or is breast-feeding, or there is an existing medical or major psychiatric condition that, in the investigator's opinion, could represent a risk for the subject or could compromise compliance with the study protocol.
- Contraindication to the use of NTZ and FGL in line with the marketing authorisation: for NTZ, the risk of tuberculosis assessed by means of intracutaneous reaction or quantiferon dosage, for FGL, positive VZV serology and an absence of risk factors for bradycardia and heart rate problems, and for both molecules, an absence of biological signs suggesting immunodepression (negative HIV serology, normal CD3, CD4, CD8 and CD19 levels, weight-adjusted dosage of immunoglobulin normal).
- prior treatment with FGL or NTZ;
- prior treatment with Mitoxantrone or Cyclophosphamide type immunosuppressants during the 5 years before inclusion.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
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Fingolimod
patients treated by Fingolimod will have biological samples and clinical data
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Natalizumab
patients treated by Natalizumab will have biological samples and clinical data
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
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Disease free patients
Time Frame: 1 year
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1 year
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Secondary Outcome Measures
Outcome Measure |
Time Frame |
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comparing the efficacy of Natalizumab with that of Fingolimod with regard to the annual incidence rate (comparison against the annual incidence rate criterion after 1 year
Time Frame: 1 year
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1 year
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: David Brassat, MD,PHD, U H Toulouse
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
November 19, 2013
Primary Completion (Actual)
June 20, 2018
Study Completion (Actual)
November 30, 2018
Study Registration Dates
First Submitted
November 4, 2013
First Submitted That Met QC Criteria
November 4, 2013
First Posted (Estimate)
November 11, 2013
Study Record Updates
Last Update Posted (Actual)
August 25, 2020
Last Update Submitted That Met QC Criteria
August 24, 2020
Last Verified
August 1, 2020
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 1235207
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
UNDECIDED
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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