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Evaluating of the Effect of Fingolimod With Fish Oil on Relapsing-Remitting Multiple Sclerosis Patients
Evaluating the Effect of Fingolimod With Fish Oil Compared to Fingolimod With Placebo on Tumor Necrosis Factor-α , Interleukin1b , Interleukin6, and Interferon-gamma in Patients With Relapsing-Remitting Multiple Sclerosis
Studie Overzicht
Toestand
Conditie
Interventie / Behandeling
Gedetailleerde beschrijving
Multiple Sclerosis (MS) is a chronic autoimmune disease characterized by inflammatory demyelinative lesions in central nervous system. Relapsing-Remitting MS is the most common form of the disease observed in 85% of patients. This form presents with acute or sub-acute onset of neurological symptoms and patients may fully or partially recover and relapses may occur from time to time.
Regarding MS pathogenesis, the findings suggest the role of environmental factors in triggering the innate immune system and activating T cells and the onset of a chronic inflammatory response against myelin antigens in the central nervous system in people who are genetically prone to the disease. Among immune cells, T helper 17 (Th17) plays an important role in autoimmune response and are shown to be involved in clinical course of Relapsing-Remitting MS. Th17 cell differentiation is controlled by several cytokines, including interleukin-6 (IL-6), interleukin-1b (IL-1b) and interleukin-10 (IL-10). Also, IL 6 have an inhibitory effect on Th17 cell differentiation through increased production of interferon-gamma (IFN-gamma) and IL 10.
Currently, immunomodulatory drugs are considered as the first line treatment in MS. Fingolimod is the first oral immunomodulatory medication used for Relapsing-Remitting MS. It is phosphorylated by crossing the blood-brain barrier and is converted to its active metabolite, Fingolimod-P. This metabolite acts as a Sphingosine-1-phosphate receptor (S1PR1) on oligodendrocytes, microglias, astrocytes, and neurons and inhibits the entry of lymphocytes into the central nervous system. Therefore, it reduces demyelination and may also lead to remyelination.
Nutrition is known as a possible environmental factor in pathogenesis of MS. Positive clinical and biological effects of dietary supplements containing polyunsaturated fatty acids omega -3 (PUFA) in the course of autoimmune diseases such as MS have been studied. High levels of PUFA is found in fish oil which is also known as an antioxidant, anti-inflammatory and immunomodulatory agent. Several studies have evaluated the effect of fish oil as a dietary supplement in the treatment of MS however, conflicting findings are reported.
In this study, the investigators aim to evaluate the effect of Fingolimod with Fish oil compared to Fingolimod with placebo on TNF-α, IL1b, IL6, and IFN-gamma in patients with Relapsing-Remitting Multiple sclerosis.
Studietype
Inschrijving (Werkelijk)
Fase
- Fase 2
- Fase 3
Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
Inclusion Criteria:
- Patients with relapsing-remitting multiple sclerosis according to McDonald's criteria (2010)
- Age between 18 and 45 years
- Expanded Disability Status Scale (EDSS) between 0-5
- History of at least one relapse during the last year
- Intolerance or serious complications when receiving interferons
- Not receiving interferons in the last two months
- Not having relapse in the last 30 days
- Negative pregnancy test
- History of varicella or varicella vaccination, or positive test for anti-varicella antibodies
- Not to take any medication or dietary complement without permission of the physician
- Filling informed consent
Exclusion Criteria:
- Having chronic and infectious diseases
- History of cardiovascular diseases
- Taking corticosteroids in the last 30 days
- Taking chemotherapy agents such as Cyclophosphamide
- Patients who have taken fingolimod before
- Patients who experience relapse during the study
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Verdrievoudigen
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
---|---|
Experimenteel: Fingolimod and Fish Oil
Fingolimod 0.5 mg capsule daily by mouth and Fish Oil 1 g capsule daily by mouth for one year.
|
Produced by Osveh ® Pharm Company in Iran
Andere namen:
produced by Zahravi ® Pharm Company in Iran
Andere namen:
|
Actieve vergelijker: Fingolimod and Placebo
Fingolimod 0.5 mg capsule daily by mouth and Placebo capsule daily by mouth for one year.
|
Produced by Osveh ® Pharm Company in Iran
Andere namen:
placebo capsules to mimic Fish Oil 1 g capsules
|
Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
---|---|---|
Serum Level of TNF-α
Tijdsspanne: Baseline
|
5 cc of venous blood is taken from patients and are kept in test tubes without ethylenediaminetetraacetic acid (EDTA).
Test tubes are kept one hour immobilized so that clotted blood and serum are separated.
Then, the serum is divided into four samples of 0.5 cc for immunologic testing of all primary outcomes.
Immunologic testing is performed by sandwich ELISA method using Diaclone ® kits (made in France) and according to manufacturer's instructions.
|
Baseline
|
Serum Level of IL1b
Tijdsspanne: Baseline
|
5 cc of venous blood is taken from patients and are kept in test tubes without EDTA.
Test tubes are kept one hour immobilized so that clotted blood and serum are separated.
Then, the serum is divided into four samples of 0.5 cc for immunologic testing of all primary outcomes.
Immunologic testing is performed by sandwich ELISA method using Diaclone ® kits (made in France) and according to manufacturer's instructions.
|
Baseline
|
Serum Level of IL6
Tijdsspanne: Baseline
|
5 cc of venous blood is taken from patients and are kept in test tubes without EDTA.
Test tubes are kept one hour immobilized so that clotted blood and serum are separated.
Then, the serum is divided into four samples of 0.5 cc for immunologic testing of all primary outcomes.
Immunologic testing is performed by sandwich ELISA method using Diaclone ® kits (made in France) and according to manufacturer's instructions.
|
Baseline
|
Serum Level of IFN-gamma
Tijdsspanne: Baseline
|
5 cc of venous blood is taken from patients and are kept in test tubes without EDTA.
Test tubes are kept one hour immobilized so that clotted blood and serum are separated.
Then, the serum is divided into four samples of 0.5 cc for immunologic testing of all primary outcomes.
Immunologic testing is performed by sandwich ELISA method using Diaclone ® kits (made in France) and according to manufacturer's instructions.
|
Baseline
|
Serum Level of TNF-α
Tijdsspanne: 6 months after intervention
|
5 cc of venous blood is taken from patients and are kept in test tubes without EDTA.
Test tubes are kept one hour immobilized so that clotted blood and serum are separated.
Then, the serum is divided into four samples of 0.5 cc for immunologic testing of all primary outcomes.
Immunologic testing is performed by sandwich ELISA method using Diaclone ® kits (made in France) and according to manufacturer's instructions.
|
6 months after intervention
|
Serum Level of TNF-α
Tijdsspanne: 1 year after intervention
|
5 cc of venous blood is taken from patients and are kept in test tubes without EDTA.
Test tubes are kept one hour immobilized so that clotted blood and serum are separated.
Then, the serum is divided into four samples of 0.5 cc for immunologic testing of all primary outcomes.
Immunologic testing is performed by sandwich ELISA method using Diaclone ® kits (made in France) and according to manufacturer's instructions.
|
1 year after intervention
|
Serum Level of IL1b
Tijdsspanne: 6 months after intervention
|
5 cc of venous blood is taken from patients and are kept in test tubes without EDTA.
Test tubes are kept one hour immobilized so that clotted blood and serum are separated.
Then, the serum is divided into four samples of 0.5 cc for immunologic testing of all primary outcomes.
Immunologic testing is performed by sandwich ELISA method using Diaclone ® kits (made in France) and according to manufacturer's instructions.
|
6 months after intervention
|
Serum Level of IL1b
Tijdsspanne: 1 year after intervention
|
5 cc of venous blood is taken from patients and are kept in test tubes without EDTA.
Test tubes are kept one hour immobilized so that clotted blood and serum are separated.
Then, the serum is divided into four samples of 0.5 cc for immunologic testing of all primary outcomes.
Immunologic testing is performed by sandwich ELISA method using Diaclone ® kits (made in France) and according to manufacturer's instructions.
|
1 year after intervention
|
Serum Level of IL6
Tijdsspanne: 6 months after intervention
|
5 cc of venous blood is taken from patients and are kept in test tubes without EDTA.
Test tubes are kept one hour immobilized so that clotted blood and serum are separated.
Then, the serum is divided into four samples of 0.5 cc for immunologic testing of all primary outcomes.
Immunologic testing is performed by sandwich ELISA method using Diaclone ® kits (made in France) and according to manufacturer's instructions.
|
6 months after intervention
|
Serum Level of IL6
Tijdsspanne: 1 year after intervention
|
5 cc of venous blood is taken from patients and are kept in test tubes without EDTA.
Test tubes are kept one hour immobilized so that clotted blood and serum are separated.
Then, the serum is divided into four samples of 0.5 cc for immunologic testing of all primary outcomes.
Immunologic testing is performed by sandwich ELISA method using Diaclone ® kits (made in France) and according to manufacturer's instructions.
|
1 year after intervention
|
Serum Level of IFN-gamma
Tijdsspanne: 6 months after intervention
|
5 cc of venous blood is taken from patients and are kept in test tubes without EDTA.
Test tubes are kept one hour immobilized so that clotted blood and serum are separated.
Then, the serum is divided into four samples of 0.5 cc for immunologic testing of all primary outcomes.
Immunologic testing is performed by sandwich ELISA method using Diaclone ® kits (made in France) and according to manufacturer's instructions.
|
6 months after intervention
|
Serum Level of IFN-gamma
Tijdsspanne: 1 year after intervention
|
5 cc of venous blood is taken from patients and are kept in test tubes without EDTA.
Test tubes are kept one hour immobilized so that clotted blood and serum are separated.
Then, the serum is divided into four samples of 0.5 cc for immunologic testing of all primary outcomes.
Immunologic testing is performed by sandwich ELISA method using Diaclone ® kits (made in France) and according to manufacturer's instructions.
|
1 year after intervention
|
Medewerkers en onderzoekers
Medewerkers
Onderzoekers
- Studie stoel: Shaygannejad Shaygannejad, M.D., Isfahan University of Medical Sciences
Publicaties en nuttige links
Algemene publicaties
- Aktas O, Kury P, Kieseier B, Hartung HP. Fingolimod is a potential novel therapy for multiple sclerosis. Nat Rev Neurol. 2010 Jul;6(7):373-82. doi: 10.1038/nrneurol.2010.76. Epub 2010 Jun 15.
- Brinkmann V, Billich A, Baumruker T, Heining P, Schmouder R, Francis G, Aradhye S, Burtin P. Fingolimod (FTY720): discovery and development of an oral drug to treat multiple sclerosis. Nat Rev Drug Discov. 2010 Nov;9(11):883-97. doi: 10.1038/nrd3248. Epub 2010 Oct 29.
- Gallai V, Sarchielli P, Trequattrini A, Franceschini M, Floridi A, Firenze C, Alberti A, Di Benedetto D, Stragliotto E. Cytokine secretion and eicosanoid production in the peripheral blood mononuclear cells of MS patients undergoing dietary supplementation with n-3 polyunsaturated fatty acids. J Neuroimmunol. 1995 Feb;56(2):143-53. doi: 10.1016/0165-5728(94)00140-j.
- Kappos L, Radue EW, O'Connor P, Polman C, Hohlfeld R, Calabresi P, Selmaj K, Agoropoulou C, Leyk M, Zhang-Auberson L, Burtin P; FREEDOMS Study Group. A placebo-controlled trial of oral fingolimod in relapsing multiple sclerosis. N Engl J Med. 2010 Feb 4;362(5):387-401. doi: 10.1056/NEJMoa0909494. Epub 2010 Jan 20.
- Nordvik I, Myhr KM, Nyland H, Bjerve KS. Effect of dietary advice and n-3 supplementation in newly diagnosed MS patients. Acta Neurol Scand. 2000 Sep;102(3):143-9. doi: 10.1034/j.1600-0404.2000.102003143.x.
- Ramirez-Ramirez V, Macias-Islas MA, Ortiz GG, Pacheco-Moises F, Torres-Sanchez ED, Sorto-Gomez TE, Cruz-Ramos JA, Orozco-Avina G, Celis de la Rosa AJ. Efficacy of fish oil on serum of TNF alpha , IL-1 beta , and IL-6 oxidative stress markers in multiple sclerosis treated with interferon beta-1b. Oxid Med Cell Longev. 2013;2013:709493. doi: 10.1155/2013/709493. Epub 2013 Jun 18.
- Torkildsen O, Wergeland S, Bakke S, Beiske AG, Bjerve KS, Hovdal H, Midgard R, Lilleas F, Pedersen T, Bjornara B, Dalene F, Kleveland G, Schepel J, Olsen IC, Myhr KM. omega-3 fatty acid treatment in multiple sclerosis (OFAMS Study): a randomized, double-blind, placebo-controlled trial. Arch Neurol. 2012 Aug;69(8):1044-51. doi: 10.1001/archneurol.2012.283.
Studie record data
Bestudeer belangrijke data
Studie start
Primaire voltooiing (Werkelijk)
Studie voltooiing (Werkelijk)
Studieregistratiedata
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Schatting)
Updates van studierecords
Laatste update geplaatst (Werkelijk)
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
- Pathologische processen
- Ziekten van het zenuwstelsel
- Ziekten van het immuunsysteem
- Demyeliniserende auto-immuunziekten, CZS
- Auto-immuunziekten van het zenuwstelsel
- Demyeliniserende ziekten
- Auto-immuunziekten
- Multiple sclerose
- Sclerose
- Multiple sclerose, relapsing-remitting
- Fysiologische effecten van medicijnen
- Moleculaire mechanismen van farmacologische werking
- Immunosuppressieve middelen
- Immunologische factoren
- Sfingosine 1-fosfaatreceptormodulatoren
- Fingolimod-hydrochloride
Andere studie-ID-nummers
- 293396
Plan Individuele Deelnemersgegevens (IPD)
Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?
Beschrijving IPD-plan
Informatie over medicijnen en apparaten, studiedocumenten
Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel
Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct
product vervaardigd in en geëxporteerd uit de V.S.
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