多発性硬化症の試験における従来の治療法と早期の積極的な治療法との比較 (TREAT-MS)
多発性硬化症患者における初期の積極的療法とエスカレーション療法の中期効果を評価するための実用的な試験
FDA-approved multiple sclerosis (MS) disease-modifying therapies (DMTs) target the relapsing phase of MS but have minimal impact once the progressive phase has begun. It is unclear if, in the relapsing phase, there is an advantage of early aggressive therapy with respect to preventing long-term disability. The infectious risks and other complications associated with higher-efficacy treatments highlight the need to quantify their effectiveness in preventing disability.
The TRaditional versus Early Aggressive Therapy for MS (TREAT-MS) trial is a pragmatic, randomized controlled trial that has two primary aims: 1) to evaluate, jointly and independently among patients deemed at higher risk vs. lower risk for disability accumulation, whether an "early aggressive" therapy approach, versus starting with a traditional, first-line therapy, influences the intermediate-term risk of disability, and 2) to evaluate if, among patients deemed at lower risk for disability who start on first-line MS therapies but experience breakthrough disease, those who switch to a higher-efficacy versus a new first-line therapy have different intermediate-term risk of disability.
調査の概要
状態
条件
介入・治療
- 他の:Natalizumab/natalizumab-sztn, Alemtuzumab, Ocrelizumab, Rituximab/rituximab-arrx/rituximab-abbs/rituximab-pvvr, Cladribine, Ofatumumab, Ublituximab-xiiy, Ocrelizumab and hyaluronidase-ocsq
- 他の:Glatiramer acetate, Interferons (intramuscular, subcutaneous, pegylated) Teriflunomide, Fumarates (dimethyl, diroximel, monomethyl) Fingolimod, Siponimod, Ozanimod, Ponesimod
詳細な説明
FDA-approved multiple sclerosis (MS) disease-modifying therapies (DMTs) target the relapsing phase of MS but have minimal impact once the progressive phase has begun. It is unclear if, in the relapsing phase, there is an advantage of early aggressive therapy with respect to preventing long-term disability. The infectious risks and other complications associated with higher-efficacy treatments highlight the need to quantify their effectiveness in preventing disability.
The TRaditional versus Early Aggressive Therapy for MS (TREAT-MS) trial is a pragmatic, randomized controlled trial that has two primary aims: 1) to evaluate, jointly and independently among patients deemed at higher risk vs. lower risk for disability accumulation, whether an "early aggressive" therapy approach, versus starting with a traditional, first-line therapy, influences the intermediate-term risk of disability, and 2) to evaluate if, among patients deemed at lower risk for disability who start on first-line MS therapies but experience breakthrough disease, those who switch to a higher-efficacy versus a new first-line therapy have different intermediate-term risk of disability.
Hypotheses/Objectives: The main hypothesis is that intermediate-term disability will be reduced by earlier use of higher-efficacy medications. Additional objectives include a) evaluating the magnitude of the treatment effect in patients deemed to be at higher risk versus lower risk of longer-term disability (we hypothesize that the effect size will be greater in the former group) and b) evaluating if, among those without indications of a high risk of longer-term disability, breakthrough disease can be successfully managed by switching to a different first-line therapy or if escalation is required at that time (we hypothesize that switching to a higher-efficacy therapy will be more effective in preventing disability in this group).
There is a great unmet need to identify the most appropriate treatment strategy for people with MS, especially early in the disease course when it may be possible to maximize an individual's chance for preventing long-term disability. There is a paucity of evidence-based guidelines to help clinicians, patients, and payers determine which treatment strategy is best for an individual with MS. Making treatment decisions is a daunting task, and the individualized benefit-risk assessment becomes increasingly difficult as new therapies emerge. Without the availability of direct comparative trials, clinicians and patients are forced to scrutinize observational studies that only provide basic insights into what may be the best treatment path moving forward. It is equally challenging to define what constitutes a suboptimal response to a DMT for an individual patient. Clinicians lack guidance on when to switch therapies and whether to consider a different first-line or if clinicians should escalate immediately to higher-efficacy therapies, so further consensus is needed to determine the optimal time to switch therapies and escalate therapy if an individual is on a first-line therapy from the start. The TREAT-MS trial will help inform patients and the broader health care community on whether patients would most benefit from early, possibly more risky aggressive therapy or if starting with a less aggressive (and, often, less risky) therapy, followed by a switch if breakthrough disease occurs, is warranted. In addition, this study may help identify specific patient populations and/or short-term clinical and paraclinical biomarkers that are strongly predictive of long-term disability that can ensue from MS.
Accrual of sustained disability is the most feared complication for people with MS, and the patient's own perception of their well-being or ill-being has a profound impact on their quality of life. The heterogeneity and unpredictability of MS, along with lack of agreed upon treatment guidelines, augments this fear, leading to a significant negative impact on quality of life. Even patients who are deemed to have "mild" MS experience a significant negative impact on their health-related quality of life that is similar in magnitude to what patients with other severe chronic conditions (i.e., congestive heart failure and chronic obstructive pulmonary disease) report. An extremely important goal for any intervention is to help improve or maintain a high quality of life; therefore, in addition to classic clinical endpoints (e.g. slowing disability progression), the TREAT-MS trial will capture several important and meaningful PROs that will shed light on what treatment strategies may be the best from a patient-centered perspective.
COVID-19 Related Substudy:
Since early 2020, the coronavirus disease 2019 (COVID-19) pandemic has caused clinical care and research disruptions nationwide, including for patients enrolled in the TREAT-MS trial. Many patients with MS, as well as their clinicians, are fearful that MS or the MS therapy they are using may increase the risk or severity of COVID-19 infection. Whether a person with early MS is more likely to experience more severe COVID-19 if treated with a higher-efficacy therapy is not known. Further, whether COVID-19-induced disruptions in therapy or other clinical care increase MS disease activity or MS symptoms is not clear but is relevant, particularly since greater MS activity in the early therapeutic course is associated in observational studies with worse long-term outcomes. Moreover, it is unclear if pre-pandemic anxiety and depression, common comorbidities in people with MS, contribute to decisions to delay care, overall or differently depending on therapeutic strategy (higher-efficacy vs. traditional). TREAT-MS provides an optimal cohort in which to investigate the effect of the COVID-19 pandemic on MS outcomes.
COVID-19 Substudy Aim 1. To evaluate if patients enrolled in TREAT-MS delayed or altered their disease-modifying therapy schedule or other MS care, and whether such alterations are associated with a greater degree of breakthrough inflammatory disease activity or the development of new (or worsening baseline) MS symptoms.
COVID-19 Substudy Aim 2: To evaluate if patients with MS treated with higher-efficacy, versus traditional, therapies differ in the risk of severe COVID-19 infection, defined as requiring hospitalization (with or without intubation) or mortality due to COVID-19.
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
研究場所
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Alabama
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Birmingham、Alabama、アメリカ、35233
- University of Alabama at Birmingham
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Mobile、Alabama、アメリカ、36604
- The University of South Alabama
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Arizona
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Phoenix、Arizona、アメリカ、85013
- St. Joseph's Hospital & Medical Center - Barrow Neurological Institute
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California
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Carmichael、California、アメリカ、95608
- CommonSpirit Health Research Institute
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Los Angeles、California、アメリカ、90095
- University of California, Los Angeles
-
Los Angeles、California、アメリカ、90048
- Cedars-Sinai Medical Center
-
San Diego、California、アメリカ、92037
- University of California, San Diego
-
San Francisco、California、アメリカ、94158
- University of California, San Francisco
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Delaware
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Newark、Delaware、アメリカ、19713
- Christiana Care Health Services, Inc.
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District of Columbia
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Washington D.C.、District of Columbia、アメリカ、20007
- Georgetown University
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Florida
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Gainesville、Florida、アメリカ、32611
- University of Florida
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Miami、Florida、アメリカ、33136
- University of Miami
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Tampa、Florida、アメリカ、33612
- University of South Florida Health
-
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Illinois
-
Chicago、Illinois、アメリカ、60612
- Rush University Medical Center
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Kansas
-
Kansas City、Kansas、アメリカ、66160
- The University of Kansas Medical Center (KUMC)
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Kentucky
-
Louisville、Kentucky、アメリカ、40207
- Norton Neurology MS Services
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Maryland
-
Baltimore、Maryland、アメリカ、21287
- The Johns Hopkins Hospital
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Baltimore、Maryland、アメリカ、21201
- University of Maryland, Baltimore
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Massachusetts
-
Boston、Massachusetts、アメリカ、02114
- Massachusetts General Hospital
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Worcester、Massachusetts、アメリカ、01655
- University of Massachusetts Medical School
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Michigan
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Ann Arbor、Michigan、アメリカ、48109
- University of Michigan
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Detroit、Michigan、アメリカ、48201
- Wayne State University
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Minnesota
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Rochester、Minnesota、アメリカ、55905
- Mayo Clinic
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Montana
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Billings、Montana、アメリカ、59101
- Billings Clinic
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Great Falls、Montana、アメリカ、59405
- Advanced Neurology Specialists
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Nebraska
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Omaha、Nebraska、アメリカ、68198
- University of Nebraska Medical Center
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New Jersey
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Hackensack、New Jersey、アメリカ、07601
- Hackensack University Medical Center
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New York
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New York、New York、アメリカ、10032
- Columbia University Medical Center
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New York、New York、アメリカ、10016
- New York University School of Medicine
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New York、New York、アメリカ、10029
- Icahn School of Medicine at Mount Sinai
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Ohio
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Cincinnati、Ohio、アメリカ、45219
- University of Cincinnati
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Columbus、Ohio、アメリカ、43214
- OhioHealth Research Institute
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Oklahoma
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Oklahoma City、Oklahoma、アメリカ、73104
- Oklahoma Medical Research Foundation
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Oregon
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Portland、Oregon、アメリカ、97225
- Providence Health and Services - Oregon
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Pennsylvania
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Danville、Pennsylvania、アメリカ、17822
- Geisinger Clinic
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Pittsburgh、Pennsylvania、アメリカ、15212
- Allegheny Health Network Research Institute
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Tennessee
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Nashville、Tennessee、アメリカ、37215
- Vanderbilt Comprehensive MS Center
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Texas
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Dallas、Texas、アメリカ、75246
- Baylor Scott and White Health
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Dallas、Texas、アメリカ、75390-8806
- University of Texas Southwestern Medical Center
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Round Rock、Texas、アメリカ、78681
- Central Texas Neurology Consultants
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Utah
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Salt Lake City、Utah、アメリカ、84108
- University of Utah
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Vermont
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Burlington、Vermont、アメリカ、05405
- The University of Vermont and State Agricultural College
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Virginia
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Christiansburg、Virginia、アメリカ、24073
- Blacksburg Neurology
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Norfolk、Virginia、アメリカ、23502
- Neurology Consultants of Tidewater
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Washington
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Seattle、Washington、アメリカ、98122
- Swedish Health Services
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Seattle、Washington、アメリカ、98133
- University of Washington
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Wisconsin
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Milwaukee、Wisconsin、アメリカ、53226
- Medical College of Wisconsin
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- Aged 18-60 years
- Meets 2017 McDonald criteria for relapsing-remitting MS [patients with clinically isolated syndrome (CIS) are not eligible]
- Must be EITHER John Cunningham (JC) virus antibody negative or low positive (index antibody titer <0.9), OR negative for: Hepatitis B and C, tuberculosis
- HIV negative
- No chemotherapy in past year; if patient has prior history of chemotherapy or malignancy, documentation in chart explaining why potential risks of higher-efficacy therapy are justified
Exclusion Criteria:
- Prior treatment with rituximab, ocrelizumab, ofatumumab, alemtuzumab, mitoxantrone or cladribine
- Prior treatment with any other MS DMT for more than 6 months
- Prior treatment with experimental aggressive therapies (e.g., T-cell vaccine, total lymphoid radiation, stem cells)
- Treatment with teriflunomide within past 2 years (even for ≤ 6 months), unless rapid wash out done (i.e., with cholestyramine or activated charcoal)
- Treatment in the past 6 months with any MS DMT
- Prior treatment with any other investigational immune-modulating /suppressing drug for MS not listed above
- Pregnant or breast-feeding
- Women of child-bearing age who are planning or strongly considering conception during the study time frame
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:独身
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
|
アクティブコンパレータ:Early Aggressive Therapy
Early Aggressive Therapy choices and maximum allowable doses:
|
Early Aggressive Therapy
他の名前:
|
|
アクティブコンパレータ:Traditional Therapy
Traditional Therapy choices and maximum allowable doses:
|
Traditional Therapy
他の名前:
|
この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Time to sustained disability progression
時間枠:From date of randomization until the date of first documented sustained disability progression, up to 99 months
|
Time to sustained disability progression is measured by the Expanded Disability Status Scale plus (EDSS+): a composite endpoint that includes EDSS change (change at any 6 month time point of > or = 1.0 point if baseline EDSS is < or = 5.5 or of > or = 0.5 if baseline EDSS is > or = 6.0, that is sustained 6 months later) OR 20% worsening on either of two specific components of the Multiple Sclerosis Functional Composite (MSFC), the timed 25-foot walk test (T25FWT) and the nine hole peg test (9HPT) that is sustained 6 months later. |
From date of randomization until the date of first documented sustained disability progression, up to 99 months
|
|
Change in Overall Burden of MS
時間枠:up to 48 weeks from enrollment into COVID-19 related substudy
|
The change in overall burden of MS will be defined for the COVID-19 related substudy as the occurrence of breakthrough disease (relapses or new MRI activity) or the development of new (or worsening baseline) MS symptoms, which are (for TREAT-MS) and will continue to be (during the substudy) documented at clinical visits, whether in-person or on tele-visits. |
up to 48 weeks from enrollment into COVID-19 related substudy
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Patient-Determined Disease Steps (PDDS)
時間枠:up to 99 months
|
PDDS is a self-assessment scale of disability due to MS on a scale from 0 to 8 and will be administered as an electronic patient-reported outcome (PRO). |
up to 99 months
|
|
Multiple Sclerosis Functional Composite (MSFC) Composite Score
時間枠:up to 99 months
|
The MSFC consists of the timed 25 foot walk test, the 9-hole peg test, and the Paced Auditory Serial Addition Test (PASAT) and a composite MSFC z-score will be evaluated. |
up to 99 months
|
|
Timed 25 Foot Walk Test
時間枠:up to 99 months
|
Time taken to complete the timed 25 foot walk test, measured twice in units of seconds, will be averaged and evaluated. |
up to 99 months
|
|
Nine-hole Peg Test
時間枠:up to 99 months
|
Time taken to complete the nine-hole peg test, measured twice for each hand (dominant and non-dominant) in units of seconds, will be averaged for each hand and evaluated. |
up to 99 months
|
|
Paced Auditory Serial Addition Test (PASAT)
時間枠:up to 99 months
|
The paced auditory serial addition test that measures processing speed will be administered once; number and percent correct will be evaluated. |
up to 99 months
|
|
Low contrast visual acuity
時間枠:up to 99 months
|
Low-contrast letter acuity (binocular, 2.5% contrast Sloan charts) |
up to 99 months
|
|
Patient-reported incomplete relapse recovery
時間枠:up to 99 months
|
Among participants identified to have a relapse, relapse recovery will be defined as complete or incomplete based on patient self-report. |
up to 99 months
|
|
Neurologic exam-based incomplete relapse recovery
時間枠:up to 99 months
|
Among participants identified to have a relapse, relapse recovery will be defined as complete or incomplete based on neurologic examination (those who have increased Functional System scores, corresponding to the relapse symptoms, of 1.0 point or greater for at least 6 months after the relapse onset, without subsequent accrual of worsening in that same Functional System (e.g. more indicative of progression), will be considered to have incomplete relapse recovery). |
up to 99 months
|
|
Cognition using Symbol Digit Modality Test (SDMT)
時間枠:up to 99 months
|
The SDMT is commonly used in MS to assess processing speed and will be administered orally and used to evaluate changes in cognition throughout the study. |
up to 99 months
|
|
Multiple Sclerosis Impact Scale (MSIS-29)
時間枠:up to 99 months
|
The MSIS-29 will be used to evaluate the impact of MS on the participants and will be administered as an electronic PRO.Multiple Sclerosis Impact Scale (MSIS-29) is an instrument used for measuring the physical (20 items) and psychological (nine items) impact of multiple sclerosis. |
up to 99 months
|
|
Quality of Life in Neurological Disorders (Neuro-QoL): Anxiety Subscale
時間枠:up to 99 months
|
The Anxiety Subscale of Neuro-QoL will be administered as an electronic PRO. |
up to 99 months
|
|
Quality of Life in Neurological Disorders (Neuro-QoL): Depression Subscale
時間枠:up to 99 months
|
The Depression Subscale of Neuro-QoL will be administered as an electronic PRO. |
up to 99 months
|
|
Quality of Life in Neurological Disorders (Neuro-QoL): Fatigue Subscale
時間枠:up to 99 months
|
The Fatigue Subscale of Neuro-QoL will be administered as an electronic PRO. |
up to 99 months
|
|
Quality of Life in Neurological Disorders (Neuro-QoL): Upper Extremity Function
時間枠:up to 99 months
|
The Upper Extremity Function Subscale of Neuro-QoL will be administered as an electronic PRO. |
up to 99 months
|
|
Quality of Life in Neurological Disorders (Neuro-QoL): Lower Extremity Function
時間枠:up to 99 months
|
The Lower Extremity Function Subscale of Neuro-QoL will be administered as an electronic PRO. |
up to 99 months
|
|
Quality of Life in Neurological Disorders (Neuro-QoL): Cognitive Function
時間枠:up to 99 months
|
The Cognitive Function Subscale of Neuro-QoL will be administered as an electronic PRO. |
up to 99 months
|
|
Quality of Life in Neurological Disorders (Neuro-QoL): Positive Affect/Well-being
時間枠:up to 99 months
|
The Positive Affect/Well-being Subscale of Neuro-QoL will be administered as an electronic PRO. |
up to 99 months
|
|
Quality of Life in Neurological Disorders (Neuro-QoL): Sleep Disturbance
時間枠:up to 99 months
|
The Sleep Disturbance Subscale of Neuro-QoL will be administered as an electronic PRO. |
up to 99 months
|
|
Quality of Life in Neurological Disorders (Neuro-QoL): Ability to Participate in Social Roles and Activities
時間枠:up to 99 months
|
The Ability to Participate in Social Roles and Activities Subscale of Neuro-QoL will be administered as an electronic PRO. |
up to 99 months
|
|
Quality of Life in Neurological Disorders (Neuro-QoL): Satisfaction with Social Roles and Activities
時間枠:up to 99 months
|
The Satisfaction with Social Roles and Activities Subscale of Neuro-QoL will be administered as an electronic PRO. |
up to 99 months
|
|
Quality of Life in Neurological Disorders (Neuro-QoL): Stigma
時間枠:up to 99 months
|
The Stigma Subscale of Neuro-QoL will be administered as an electronic PRO. |
up to 99 months
|
|
Employment status
時間枠:up to 99 months
|
The incidence of change in employment to "disabled" or "looking for work, unemployed," will be evaluated for all participants through an electronic PRO. |
up to 99 months
|
|
Marital status
時間枠:up to 99 months
|
Incident divorce or separation, among those who previously were married or in a domestic partnership, will be evaluated for all participants through an electronic PRO. |
up to 99 months
|
|
Serious Adverse Events (SAEs)
時間枠:up to 99 months
|
SAEs (clinically significant infections, malignancies, or the development of other serious comorbidities, as well as unplanned hospitalizations [for non-elective issues, excluding MS relapse] and death) |
up to 99 months
|
|
Adverse event resulting in a decision to change disease-modifying therapy
時間枠:up to 99 months
|
Adverse events meaningful enough to lead to medication discontinuation |
up to 99 months
|
|
Severe COVID-19 Infection
時間枠:up to 48 weeks from enrollment into COVID-19 related substudy
|
Severe COVID-19 infection will be defined as an outcome of "hospitalization or death" due to confirmed or suspected COVID-19 infection |
up to 48 weeks from enrollment into COVID-19 related substudy
|
協力者と研究者
スポンサー
捜査官
- 主任研究者:Ellen M. Mowry, MD, MCR、Johns Hopkins University
- 主任研究者:Scott D. Newsome, DO、Johns Hopkins University
出版物と役立つリンク
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
追加の関連 MeSH 用語
- 神経系疾患
- 自己免疫疾患
- 免疫系疾患
- 脱髄性自己免疫疾患、CNS
- 神経系の自己免疫疾患
- 脱髄疾患
- 多発性硬化症
- 再発寛解型多発性硬化症
- ペプチド
- アミノ酸、ペプチド、およびタンパク質
- タンパク質
- 有機化学物質
- 複素環化化合物
- 複素環化化合物、2リング
- 複素環化化合物、融合リング
- 治療
- 医薬品局のルート
- 薬物療法
- 核酸、ヌクレオチド、およびヌクレオシド
- 生物学的要因
- 酸、非環式
- カルボン酸
- アミン
- 抗体、モノクローナル、ヒト化
- 抗体、モノクローナル
- 抗体
- 免疫グロブリン
- 免疫タンパク質
- 血液タンパク質
- 血清グロブリン
- グロブリン
- プリン
- アルコール
- グリコール
- 膜タンパク質
- ヌクレオシド
- リボヌクレオシド
- 細胞間シグナル伝達ペプチドとタンパク質
- アミノアルコール
- スフィンゴシン
- プロピレングリコール
- 抗体、モノクローナル、マウス由来
- デオキシリボヌクレオシド
- サイトカイン
- インターフェロンタイプI
- 2-クロロアデノシン
- アデノシン
- プリンヌクレオシド
- デオキシアデノシン
- 注射
- ジカルボン酸
- 小胞輸送タンパク質
- インターフェロンベータ
- インターフェロン ベータ-1a
- リツキシマブ
- ナタリズマブ
- フィンゴリモド塩酸塩
- インターフェロン ベータ-1b
- アレムツズマブ
- 酢酸グラチラマー
- フマル酸ジメチル
- インターフェロン
- クラドリビン
- オザニモド
- テリフルノミド
- オクレリズマブ
- ofatumumab
- 注射、皮下
- Peginterferon Beta-1A
- Siponimod
- ディロキシメルフマレート
- モノメチルフマレート
- Ponesimod
- 注射、筋肉内
- フマル酸塩
- コートタンパク質複合体 I
その他の研究ID番号
- IRB00143534
医薬品およびデバイス情報、研究文書
米国FDA規制医薬品の研究
米国FDA規制機器製品の研究
米国で製造され、米国から輸出された製品。
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。