Hydroxychloroquine in Primary Progressive Multiple Sclerosis

Open-label, Single-center, Single-arm Futility Trial Evaluating Oral Hydroxychloroquine 200mg BID for Reducing Progression of Disability in Patients With Primary Progressive Multiple Sclerosis (PPMS)

The purpose of this clinical trial is to determine if HCQ in a dose of 400mg daily can prevent worsening of walking ability in people PPMS. The number of participants in this study will be 35. A maximum of 42 people with PPMS will be included. The trial is funded through a private donation to the Hotchkiss Brain Institute MS Translational Clinical Trials Research Program and the University of Calgary. There is no sponsorship from the pharmaceutical industry.

Study Overview

• Status: Completed
• Conditions: Multiple Sclerosis, Primary Progressive
• Intervention / Treatment: Drug: Hydroxychloroquine

Detailed Description

In patients with primary progressive multiple sclerosis (PPMS) there is ongoing slow and continuous loss of nerve cells, which causes damage to the brain and spinal cord. This ultimately becomes noticeable as slowly and continuously worsening disability. While the cause of this ongoing damage is unknown, it appears that at least part of the damage may be caused by cells in the brain called "microglia" (a type of immune cell that reside in the brain and spinal cord). These microglial cells can have beneficial roles, for instance when they clear away debris, but they can also cause damage to brain cells. In PPMS, microglial cells are often found to be in a state of activation, and it is currently believed that this constant activation of microglial cells is likely an important cause of the ongoing damage to brain cells.

Current treatments for MS only work in relapsing-remitting MS, and can prevent relapses, but so far there are no treatments that effectively target PPMS. Therapies for PPMS are needed. The investigators believe that treatments that target and reduce the activation of microglial cells may be a useful treatment strategy.

Hydroxychloroquine (HCQ) is a medication that has been shown to decrease the activity of human microglia in laboratory experiments. Animal experiments have also shown that treatment with HCQ can reduce the disease activity of an animal model of MS. HCQ, therefore, may also reduce the activity of microglia in people with PPMS, and hopefully prevent or slow down the progression of disability in PPMS.

HCQ is currently approved in Canada to treat malaria and the rheumatic diseases Systemic Lupus Erythematodes (SLE) and Rheumatoid Arthritis (RA). HCQ is available as a tablet that is usually taken two times per day. Doses up to 600mg per are used in clinical practice, but the investigators estimate that a dose of only 400mg daily, given as two doses of 200mg, will be sufficient to decrease the activity of microglia in patients with PPMS. HCQ is usually well tolerated.

Following a MinMax Simon-2-stage design, the study will require 35 patients with complete 18 month follow-up. Presuming 20% drop-out, the investigators anticipate recruiting up to 42 patients. The trial will be conducted as follows: patients will continuously enter into the study until 35 patients have completed 18 months of follow-up with at least 75% adherence which will be measured by study drug count.

• Study Type: Interventional
• Enrollment (Actual): 35
• Phase: Phase 2

Contacts and Locations

Study Locations

• Canada
  • Alberta
    • Calgary, Alberta, Canada, T2N2T9
      • MS Clinic Foothills Medical Centre

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

Description

Inclusion Criteria:

• Written informed consent obtained
• Men and women aged of 18 and 65 years inclusive
• Who are followed at the Calgary MS Clinic
• With Primary Progressive Multiple Sclerosis, according to current diagnostic criteria
• Screening Expanded Disability Status Scale score between 4.0 and 6.5 inclusive.
• Screening timed 25 foot walk (average of two trials) of 5.5 seconds or more.

Exclusion Criteria:

• Patients undergoing treatment with antimalarial drugs, amiodarone, dapsone or digoxin
• Patients with known retinopathy
• Patients whose screening ophthalmological exam shows retinopathy
• Patients whose screening MRI scan shows gadolinium enhancing lesions
• Patients with known renal insufficiency
• Patients with known significant hepatic impairment
• Patients with known porphyria
• Patients with known allergy or other intolerability to HCQ, or to gadolinium MRI contrast agent
• Patients currently using Fampridine or 4-aminopyridine
• Patients planning to start Fampridine or 4-aminopyridine during the study period
• Patients planning to start Baclofen or Tizanidine during the duration of the study
• Patients who increase the dose of Baclofen or Tizanidine during the study period
• Patients who receive treatment with Botulinum toxin in the leg muscles during the study period
• Patients using amiodarone, dapsone, digoxin or antimalarial drugs other than HCQ
• Patients who are unable or unwilling to undergo gadolinium enhanced MRI scans
• Pregnant or breast-feeding women

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Hydroxychloroquine; Oral Hydroxychloroquine, 200mg BID	Drug: Hydroxychloroquine; Orally administered Hydroxychloroquine; Other Names: Plaquenil

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Timed 25-Foot Walk (T25FW)	quantitative ambulation performance test	Change in Timed 25-Foot Walk performance between the 6 month and 18 month visit.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
9-Hole Peg Test	Brief, standardized, quantitative test of upper extremity	baseline, 1 month follow-up, 6 months follow-up, 12 months follow-up, and 18 months follow-up
Symbol Digit Modalities Test	measures cognitive processing speed and working memory	baseline, 1 month follow-up, 6 months follow-up, 12 months follow-up, and 18 months follow-up
Multiple Sclerosis Quality of Life Scale 54 item version	54-item multidimensional health-related quality of life measure that combines both generic and MS-specific items	baseline, 1 month follow-up, 6 months follow-up, 12 months follow-up, and 18 months follow-up
Functional Systems and Expanded Disability Status Scale (EDSS)	standard measure of neurologic impairment that is used to describe disability in MS. The neurological assessment comprises seven functional system	baseline, 1 month follow-up, 6 months follow-up, 12 months follow-up, and 18 months follow-up
Modified Fatigue Impact Scale (MFIS)	structured, self-report questionnaire with 21 items concerning how fatigue impact patients quality of life	baseline, 1 month follow-up, 6 months follow-up, 12 months follow-up, and 18 months follow-up

Collaborators and Investigators

• Sponsor: University of Calgary
• Investigators: Principal Investigator: Marcus Koch, University of Calgary

Publications and helpful links

General Publications

• Brown D, Moezzi D, Dong Y, Koch M, Yong VW. Combination of Hydroxychloroquine and Indapamide Attenuates Neurodegeneration in Models Relevant to Multiple Sclerosis. Neurotherapeutics. 2021 Jan;18(1):387-400. doi: 10.1007/s13311-020-01002-5. Epub 2021 Jan 6.

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2016
• Primary Completion (Actual): June 1, 2021
• Study Completion (Actual): June 1, 2021

Study Registration Dates

• First Submitted: September 20, 2016
• First Submitted That Met QC Criteria: September 21, 2016
• First Posted (Estimate): September 23, 2016

Study Record Updates

• Last Update Posted (Actual): July 30, 2021
• Last Update Submitted That Met QC Criteria: July 28, 2021
• Last Verified: July 1, 2021

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; Multiple Sclerosis, Chronic Progressive; Sclerosis; Molecular Mechanisms of Pharmacological Action; Anti-Infective Agents; Enzyme Inhibitors; Antirheumatic Agents; Antiprotozoal Agents; Antiparasitic Agents; Antimalarials; Hydroxychloroquine
• Other Study ID Numbers: HCQ_MS01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Yes