Silent Progression Activity Monitoring - SPAM Study (SPAM)

Silent Progression Monitoring in Extreme Phenotypes. SP-MS, Despite an Effective Early Highly Active Treatment as a Paradigm SPAM Study (Silent Progression Activity Monitoring)

Real-World Data (RWD) exploring the natural history of MS suggested that relapses do not significantly influence the progression of irreversible disability. Disability progression independent of relapses activity (PIRA) has been confirmed as a frequent relapsing-remitting multiple sclerosis (RRMS) phenomenon based on Randomized Clinical Trials (RCT). Recently, RWD demonstrated that the absence of markers of inflammation (No Evidence of Disease Activity (NEDA) at 2 years did not predict long-term stability. Silent progression has been proposed to describe the insidious disability that accrues many patients who satisfy traditional criteria for relapsing-remitting MS. In this study, the investigators would like to evaluate the occurrence of the SPMS in a population of RRMS patient with an Highly Active Treatment (HAT).

Study Overview

• Status: Completed
• Conditions: Multiple Sclerosis
• Intervention / Treatment: Other: NO INTERVENTION

• Study Type: Observational
• Enrollment (Actual): 2230

Contacts and Locations

Study Locations

• France
  • Nice, France
    • CHU de Nice

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients with RRMS (2017 Mc Donald criteria) treated with highly active treatment in the first 5 years of symptoms onset, at least 1 year, with an EDSS below 4

Description

INCLUSION CRITERIA: - Patients with RRMS (2017 Mc Donald criteria) treated with highly active treatment in the first 5 years of symptoms onset, at least 1 year, with an EDSS below 4

• HAT start after April 12th 2007 (availability of Natalizumab)
• Naive or failure (or intolerability) to 1 or more first line DMT (injectables, teriflunomide, DMF).
• EDSS < or equal 4 when starting HAT EXCLUSION CRITERIA:
• Progressive relapsing MS at baseline
• Clinical or basic MRI data unavailable after on-site visit.
• MS diagnostic > 5 years at baseline
• Immunosuppressive drugs (Azathioprine, Cyclophosphamide, Mycophenolate, Methotrexate) prescribed before HAT initiation

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Retrospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Patients; Patients with RRMS (2017 Mc Donald criteria) treated with highly active treatment in the first 5 years of symptoms onset, at least 1 year, with an EDSS below 4	Other: NO INTERVENTION; NO INTERVENTION

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Determination of baseline clinical markers associated with SPMS diagnosis despite an early, practical, Highly Active Treatment.	Age in years	Baseline: beginning of highly active treatment
Determination of baseline clinical markers associated with SPMS diagnosis despite an early, practical, Highly Active Treatment.	Disease duration (which should be <5 years) in months	Baseline: beginning of highly active treatment
Determination of baseline clinical markers associated with SPMS diagnosis despite an early, practical, Highly Active Treatment.	Expanded Disability Status Scale (EDSS) (which must be <4)	Baseline: beginning of highly active treatment
Determination of baseline MRI markers associated with SPMS diagnosis despite an early, practical, Highly Active Treatment.	new T2 lesion(s) on brain MRI and spinal cord MRI (if available)	Baseline: beginning of highly active treatment
Determination of baseline MRI markers associated with SPMS diagnosis despite an early, practical, Highly Active Treatment.	gadolinium enhancement on brain MRI and spinal cord MRI (if available)	Baseline: beginning of highly active treatment
Determination of baseline clinical markers associated with SPMS diagnosis despite an early, practical, Highly Active Treatment.	Interval time between the first and the second relapse in months	Baseline: beginning of highly active treatment
Determination of baseline clinical markers associated with SPMS diagnosis despite an early, practical, Highly Active Treatment.	Reason for HAT: naive, or switch	Baseline: beginning of highly active treatment
Determination of baseline clinical markers associated with SPMS diagnosis despite an early, practical, Highly Active Treatment.	Number of relapses since MS onset	Baseline: beginning of highly active treatment
Determination of baseline clinical markers associated with SPMS diagnosis despite an early, practical, Highly Active Treatment.	DMT administered since MS onset: number of DMT and type	Baseline: beginning of highly active treatment
Determination of baseline MRI markers associated with SPMS diagnosis despite an early, practical, Highly Active Treatment.	More than 9 T2 lesions on MRI	Baseline: beginning of highly active treatment
Determination of baseline MRI markers associated with SPMS diagnosis despite an early, practical, Highly Active Treatment.	At least 1 periventicular T2 lesion on MRI	Baseline: beginning of highly active treatment
Determination of baseline MRI markers associated with SPMS diagnosis despite an early, practical, Highly Active Treatment.	At least 3 periventicular T2 lesions on MRI	Baseline: beginning of highly active treatment
Determination of baseline MRI markers associated with SPMS diagnosis despite an early, practical, Highly Active Treatment.	At least 1 infratentorial T2 lesion on MRI	Baseline: beginning of highly active treatment
Determination of baseline MRI markers associated with SPMS diagnosis despite an early, practical, Highly Active Treatment.	At least 1 spinal cord T2 lesion on MRI	Baseline: beginning of highly active treatment
Determination of baseline MRI markers associated with SPMS diagnosis despite an early, practical, Highly Active Treatment.	At least 1 gadolinium enhancement T1 lesion on MRI	Baseline: beginning of highly active treatment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To determine re-baseline clinical markers associated with SPMS diagnosis despite an early, practical, HAT.	Age in years	Re-baseline definition: any patient with at least an EDSS and MRI examination performed 12 months after HAT onset. +/- 6 months (from 6 to 18 months).
To determine re-baseline clinical markers associated with SPMS diagnosis despite an early, practical, HAT.	Disease duration (which should be <5 years) in months	Re-baseline definition: any patient with at least an EDSS and MRI examination performed 12 months after HAT onset. +/- 6 months (from 6 to 18 months).
To determine re-baseline clinical markers associated with SPMS diagnosis despite an early, practical, HAT.	EDSS (which must be <4) +/- 3 months	Re-baseline definition: any patient with at least an EDSS and MRI examination performed 12 months after HAT onset. +/- 6 months (from 6 to 18 months).
To determine re-baseline MRI markers associated with SPMS diagnosis despite an early, practical, HAT.	new T2 lesion(s) on brain MRI and spinal cord MRI (if available)	Re-baseline definition: any patient with at least an EDSS and MRI examination performed 12 months after HAT onset. +/- 6 months (from 6 to 18 months).
To determine re-baseline MRI markers associated with SPMS diagnosis despite an early, practical, HAT.	gadolinium enhancement on brain MRI and spinal cord MRI (if available)	Re-baseline definition: any patient with at least an EDSS and MRI examination performed 12 months after HAT onset. +/- 6 months (from 6 to 18 months).
To determine re-baseline MRI markers associated with SPMS diagnosis despite an early, practical, HAT.	Interval time between the first and the second relapse in months	Re-baseline definition: any patient with at least an EDSS and MRI examination performed 12 months after HAT onset. +/- 6 months (from 6 to 18 months).
To determine re-baseline MRI markers associated with SPMS diagnosis despite an early, practical, HAT.	Number of relapses since MS onset	Re-baseline definition: any patient with at least an EDSS and MRI examination performed 12 months after HAT onset. +/- 6 months (from 6 to 18 months).
To determine re-baseline MRI markers associated with SPMS diagnosis despite an early, practical, HAT.	Number of relapse before baseline	Re-baseline definition: any patient with at least an EDSS and MRI examination performed 12 months after HAT onset. +/- 6 months (from 6 to 18 months).
To determine re-baseline MRI markers associated with SPMS diagnosis despite an early, practical, HAT.	Disease Modifying Therapies (DMT) administered since MS onset	Re-baseline definition: any patient with at least an EDSS and MRI examination performed 12 months after HAT onset. +/- 6 months (from 6 to 18 months).
To determine re-baseline MRI markers associated with SPMS diagnosis despite an early, practical, HAT.	More than 9 T2 lesions on MRI	Re-baseline definition: any patient with at least an EDSS and MRI examination performed 12 months after HAT onset. +/- 6 months (from 6 to 18 months).
To determine re-baseline MRI markers associated with SPMS diagnosis despite an early, practical, HAT.	At least 1 periventicular T2 lesion on MRI	Re-baseline definition: any patient with at least an EDSS and MRI examination performed 12 months after HAT onset. +/- 6 months (from 6 to 18 months).
To determine re-baseline MRI markers associated with SPMS diagnosis despite an early, practical, HAT.	At least 3 periventicular T2 lesion on MRI	Re-baseline definition: any patient with at least an EDSS and MRI examination performed 12 months after HAT onset. +/- 6 months (from 6 to 18 months).
To determine re-baseline MRI markers associated with SPMS diagnosis despite an early, practical, HAT.	At least 1 infratentorial T2 lesion on MRI	Re-baseline definition: any patient with at least an EDSS and MRI examination performed 12 months after HAT onset. +/- 6 months (from 6 to 18 months).
To determine re-baseline MRI markers associated with SPMS diagnosis despite an early, practical, HAT.	At least 1 spinal cord T2 lesion on MRI	Re-baseline definition: any patient with at least an EDSS and MRI examination performed 12 months after HAT onset. +/- 6 months (from 6 to 18 months).
To determine re-baseline clinical and MRI markers associated with SPMS diagnosis despite an early, practical, HAT.	At least 1 gadolinium enhancement T1 lesion on MRI	Re-baseline definition: any patient with at least an EDSS and MRI examination performed 12 months after HAT onset. +/- 6 months (from 6 to 18 months).
Detremination of the impact of different definition of SPMS according to the clinician	The definition of SPMS according to the clinician : neurological episode = start of progression as assessed by the time to develop SPMS in years.	Re-baseline definition: any patient with at least an EDSS and MRI examination performed 12 months after HAT onset. +/- 6 months (from 6 to 18 months).
Dertermination of the impact of different definition of SPMS according to Lublin.	The definition of SPMS according to Lublin : progressive accumulation of disability after a primary relapsing course which must be confirmed at least 6 months after, as assessed by the time to develop SPMS in years.	at 5 years
Dertermination of the impact of different definition of SPMS according to Lorscheider.	The definition of SPMS according to Lorscheider: with a minimum EDSS of 4 , an increase by 1 point if the EDSS was between 4 and 5.5, or an increase by 0.5 points if the EDSS was above 5.5, confirmed after 3 months., as assessed by the time to develop SPMS in years.	at 5 years
Analyze of the influence of NEDA (No Evidence of Disease activity)	The disease activity will be evalued by the NEDA score	at baseline and at 5 years
Analyze of the influence of MEDA (Mild Evidence of Disease Activity)	The disease activity will be evalued by the MEDA score	at baseline and at 5 years
To find a composite score usable at baseline when prescribing early HAT in clinical practice to predict early SPMS	All baseline variables will be evaluated in association with the prescriptio of an early HAT to predict early SPMS.	at 5 years

Collaborators and Investigators

• Sponsor: Centre Hospitalier Universitaire de Nice

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2023
• Primary Completion (Actual): March 31, 2023
• Study Completion (Actual): March 31, 2023

Study Registration Dates

• First Submitted: August 8, 2022
• First Submitted That Met QC Criteria: December 5, 2022
• First Posted (Actual): December 14, 2022

Study Record Updates

• Last Update Posted (Actual): July 21, 2023
• Last Update Submitted That Met QC Criteria: July 20, 2023
• Last Verified: July 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Nervous System Diseases; Immune System Diseases; Demyelinating Autoimmune Diseases, CNS; Autoimmune Diseases of the Nervous System; Demyelinating Diseases; Autoimmune Diseases; Multiple Sclerosis
• Other Study ID Numbers: 22Neuro03

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No