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The trial will study 2 doses of Immune Globulin Intravenous (Human), 10% Caprylate/Chromatography Purified (IGIV-C) for the number of relapses that occur in a 1 year treatment period.
This trial is designed as a multi-national, randomized, double-blind, placebo-controlled prospective trial with three parallel groups.
One hundred twenty (120) patients, 40 per treatment arm, with relapsing-remitting (RR) multiple sclerosis will be enrolled in this trial. Eligible patients must have a diagnosis of MS as per the McDonald Criteria. In addition, patients must have a diagnosis of relapsing-remitting course of MS defined as periods of worsening of neurological function with full recovery or with sequelae and residual deficit upon recovery; periods between disease relapses characterized by lack of disease progression. Patients must also have active disease with at least 1 defined documented relapse in the last year.
During a 2 month run-in period, 2 MRIs will be performed 6 weeks apart and patients will be stratified based on the presence or absence of 1 or more Gadolinium enhancing lesions on the first MRI (Gd-enhancing lesion yes-no) and will be randomized to one of two dose regimens of IGIV-C or matching placebo. Patients will receive study drug infusions every 4 weeks for 48 weeks for a total of 12 infusions. Patients will be evaluated by MRI every 6 weeks and by clinical assessments every 3 months. A follow-up visit will occur 4 weeks after the last infusion.
The treatment groups are as follows:
For blinding purposes, at each infusion, all patients will receive a total volume of 4 ml/kg bw. For patients receiving 0.2 g/kg bw of IGIV-C, the final volume of 4 ml/kg bw will be adjusted by the addition of dextrose 5%. Placebo will be supplied as Albumin 5% or Albumin 25% and diluted with either dextrose 5% or saline to a final concentration of 0.1% albumin.
Dose adaptation will be performed for subsequent infusions in case the patient's body weight has changed > 10%. The maximum amount available per infusion will be 400 ml (8 vials) calculated for a patient with a body weight of 100 kg. The suggested initial infusion rate will be 0.02 ml/kg/min for the first 15 minutes. If there is no evidence of a hypersensitivity reaction, the infusion may be given at a slowly increasing rate over the next 30 minutes up to a maximum allowable rate of 0.08 ml/kg/min. As such, the infusion for a 70 kg patient will take approximately 1hour 15 min. The overall infusion time may have a range from 1 to 2 hours.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group 1 | Experimental | IGIV-C 0.2 g/kg bw/infusion (2 ml/kg bw) |
|
| Group 2 | Experimental | IGIV-C 0.4 g/kg bw/infusion (4 ml/kg bw) |
|
| Group 3 | Placebo Comparator | placebo (0.1% albumin) 4 ml/kg bw/infusion |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Immune Globulin IV [Human], 10% Caprylate/Chromatography Purified | Drug |
|
|
| Measure | Description | Time Frame |
|---|---|---|
| Percentage of Relapse Free Subjects (no Relapse) | A relapse was defined for the purposes of this study as the appearance or reappearance of one or more neurological symptoms or worsening of an old symptom attributed to multiple sclerosis (MS) persisting for at least 48 hours and immediately preceded by a relatively stable or improving neurological state of at least 30 days. | 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Effect on the Combined Unique Lesion Activity on Magnetic Resonance Imaging (MRI) | 1 year |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Fred D Lublin, MD | Mt Sinai Medical Center, New York, NY | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Barrow Neurological Institute at St. Joseph's Hospital and Medical Center | Phoenix | Arizona | 85013 | United States | ||
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 18645164 | Result | Fazekas F, Lublin FD, Li D, Freedman MS, Hartung HP, Rieckmann P, Sorensen PS, Maas-Enriquez M, Sommerauer B, Hanna K; PRIVIG Study Group; UBC MS/MRI Research Group. Intravenous immunoglobulin in relapsing-remitting multiple sclerosis: a dose-finding trial. Neurology. 2008 Jul 22;71(4):265-71. doi: 10.1212/01.wnl.0000318281.98220.6f. |
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The study was conducted in 31 study centers in Austria, Canada, Czech Republic, Germany, United Kingdom, Greece, Hungary, Israel, Poland, and the United States.
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| ID | Title | Description |
|---|---|---|
| FG000 | IGIV-C 0.2 g/kg bw/Infusion (2 mL/kg Body Weight) | Immune globulin (intravenous) (IGIV) |
| FG001 | IGIV-C 0.4 g/kg bw/Infusion (4 mL/kg Body Weight) | Immune globulin (intravenous) (IGIV) |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| Albumin (Human) 25%, United States Pharmacopeia (USP) | Drug |
|
|
| Northwest NeuroSpecialists, PLLC |
| Tucson |
| Arizona |
| 85741-3537 |
| United States |
| The Mt. Sinai Medical Center, Department of Neurology | New York | New York | 10029 | United States |
| SUNY Health Science Center at Stony Brook, Department of Neurology | Stony Brook | New York | 11794-8121 | United States |
| Wake Forest University - School of Medicine | Winston-Salem | North Carolina | 27157 | United States |
| Neurology Health Care Service, Fletcher Allen Health Care | Burlington | Vermont | 05401 | United States |
| Department of Neurology, Karl-Franzens University | Graz | 8010 | Austria |
| Foothills Hospital | Calgary | Alberta | T2N 2T9 | Canada |
| London Health Sciences Centre | London | Ontario | N6A 5A5 | Canada |
| The Ottawa Hospital, General Campus - Neurology Division | Ottawa | Ontario | K1H 8L6 | Canada |
| CHUM Hospital Notre Dame | Montreal | Quebec | H2L4M1 | Canada |
| Fakultni nemocnice Brno-Bohunice | Brno | 63900 | Czechia |
| St. Anna's Teaching Hospital | Brno | 65691 | Czechia |
| Všeobecná fakultní nemocnice | Prague | 12808 | Czechia |
| Department of Neurology, Motol Teaching Hospital | Prague | 15600 | Czechia |
| Medizinische Einrichtungen der Heinrich Heine Universitat, Neurologische Klinik | Düsseldorf | 40225 | Germany |
| HELIOS Klinikum Erfurt GmbH, Klinik und Poliklinik fur Neurologie | Erfurt | 99089 | Germany |
| Klinikum der Justus-Liebig-Universitat, Zentrum fur Neurologie und Neurochirurgie | Giessen | Germany |
| Universitatsklinikum Munster, Klinik und Poliklinik fur Neurologie | Münster | 48149 | Germany |
| Klinikum Osnabrück GmbH | Osnabrück | 49076 | Germany |
| Universitatsklinikum Ulm, Poliklinik fur Neurologie | Ulm | 89075 | Germany |
| Klinijum der Universitat Wurzburg, Neurologische Klinik und Poliklinik | Würzburg | Germany |
| Henry Dunant Hospital | Athens | 11526 | Greece |
| Szent Imre Korhaz Neurologia | Budapest | 115 | Hungary |
| Uzsoki Street Hospital | Budapest | H-1145 | Hungary |
| Jahn Ferenc Delpesti Teaching Hospital | Budapest | H-1204 | Hungary |
| Szeged University of Science | Szeged | H-5720 | Hungary |
| Lady Davis Carmel Medical Center | Haifa | 34362 | Israel |
| Katedra I Klinika Neurologii; Slaskiej Akademii Medycznej, Samodzielny Publiczny Centralny Szpital Kliniczny | Katowice-Ligota | 40-752 | Poland |
| Katedra I Klinika Neurologii, Univerytetu Medycznego w Lodzi | Lodz | 90-153 | Poland |
| Katedra I Klinika Neurologii | Lublin | 20-954 | Poland |
| Klinika Neurologiczna, Wojskowy Instut Medyczny | Warsaw | 00-909 | Poland |
| Fakultna menocnica Bratislava | Bratislava | 83-305 | Slovakia |
| Dererova nemocnica s Poliklinikou Nerologicka Klinika | Bratislava | 833 05 | Slovakia |
| Lasarette Neurologiavdeling | Lund | Sweden |
| Karilinska Sjukhuset | Stockholm | Sweden |
| University Hospital, Queens Medical Centre | Nottingham | NG7 2UH | United Kingdom |
| FG002 | Placebo (0.1% Albumin) 4 mL/kg Body Weight/Infusion | Immune globulin (intravenous) (IGIV) |
| COMPLETED |
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| NOT COMPLETED |
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| ID | Title | Description |
|---|---|---|
| BG000 | IGIV-C 0.2 g/kg bw/Infusion (2 mL/kg bw) | |
| BG001 | IGIV-C 0.4 g/kg bw/Infusion (4 mL/kg bw) | |
| BG002 | Placebo (0.1% Albumin) 4 mL/kg bw/Infusion | |
| BG003 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants | Participants |
| ||||||||||||||||
| Age, Continuous | Mean | Standard Deviation | years |
| |||||||||||||||
| Sex: Female, Male | Count of Participants | Participants |
| ||||||||||||||||
| Region of Enrollment | Number | participants |
|
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Secondary | Effect on the Combined Unique Lesion Activity on Magnetic Resonance Imaging (MRI) | Not Posted | 1 year | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Primary | Percentage of Relapse Free Subjects (no Relapse) | A relapse was defined for the purposes of this study as the appearance or reappearance of one or more neurological symptoms or worsening of an old symptom attributed to multiple sclerosis (MS) persisting for at least 48 hours and immediately preceded by a relatively stable or improving neurological state of at least 30 days. | Intent-to-Treat (ITT) Population was all randomized subjects. This was the primary analysis population. | Posted | Sep 2009 | Number | percentage of participants | 12 months |
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | IGIV-C 0.2 g/kg bw/Infusion (2 mL/kg bw) | 2 | 45 | 32 | 45 | |||
| EG001 | IGIV-C 0.4 g/kg bw/Infusion (4 mL/kg bw) | 2 | 42 | 26 | 42 | |||
| EG002 | Placebo (0.1% Albumin) 4 mL/kg bw/Infusion | 1 | 41 | 29 | 41 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Headache | General disorders | Subject #2005 |
| ||
| Herpes Zoster ophthalmic | Eye disorders | Subject #506004 |
| ||
| Vasculitis, peripheral | Vascular disorders | Subject #502004 |
| ||
| Panic attacks | Psychiatric disorders | Subject #506003 |
| ||
| Toothache | General disorders | Subject #507003 |
|
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Vertigo | Ear and labyrinth disorders |
| |||
| Nausea | Gastrointestinal disorders |
| |||
| Vomiting | Gastrointestinal disorders |
| |||
| Asthenia | General disorders |
| |||
| Fatigue | General disorders |
| |||
| Feeling cold | General disorders |
| |||
| Pyrexia | General disorders |
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| Bronchitis | Infections and infestations |
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| Influenza | Infections and infestations |
| |||
| Nasopharyngitis | Infections and infestations |
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| Rhinitis | Infections and infestations |
| |||
| Upper respiratory tract infection | Infections and infestations |
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| Urinary tract infection | Infections and infestations |
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| Arthralgia | Musculoskeletal and connective tissue disorders |
| |||
| Back pain | Musculoskeletal and connective tissue disorders |
| |||
| Dizziness | Nervous system disorders |
| |||
| Headache | Nervous system disorders |
| |||
| Hypoaesthesia | Nervous system disorders |
| |||
| Paraesthesia | Nervous system disorders |
| |||
| Depression | Psychiatric disorders |
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| Cough | Respiratory, thoracic and mediastinal disorders |
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| Pharyngolaryngeal pain | Respiratory, thoracic and mediastinal disorders |
| |||
| Erythema | Skin and subcutaneous tissue disorders |
|
The investigator must send a draft manuscript of the publication or abstract to the sponsor thirty days in advance of submission in order to obtain approval prior to submission of the final version for publication. This will be reviewed promptly and approval will not be withheld unreasonably. In case of a difference of opinion between the sponsor and the investigator(s), the contents of the publication will be discussed in order to find a solution which satisfies both parties.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Ralph Kantor, PhD | Talecris Biotherapeutics | 1-800-520-2807 | ralph.kantor@talecris.com |
| ID | Term |
|---|---|
| D020529 | Multiple Sclerosis, Relapsing-Remitting |
| ID | Term |
|---|---|
| D009103 | Multiple Sclerosis |
| D020278 | Demyelinating Autoimmune Diseases, CNS |
| D020274 | Autoimmune Diseases of the Nervous System |
| D009422 | Nervous System Diseases |
| D003711 | Demyelinating Diseases |
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |
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| ID | Term |
|---|---|
| D005719 | gamma-Globulins |
| D002210 | Caprylates |
| D016756 | Immunoglobulins, Intravenous |
| D007136 | Immunoglobulins |
| D000418 | Albumins |
| ID | Term |
|---|---|
| D007162 | Immunoproteins |
| D001798 | Blood Proteins |
| D011506 | Proteins |
| D000602 | Amino Acids, Peptides, and Proteins |
| D012712 | Serum Globulins |
| D005916 | Globulins |
| D000144 | Acids, Acyclic |
| D002264 | Carboxylic Acids |
| D009930 | Organic Chemicals |
| D005227 | Fatty Acids |
| D008055 | Lipids |
| D007074 | Immunoglobulin G |
| D007132 | Immunoglobulin Isotypes |
| D000906 | Antibodies |
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| Between 18 and 65 years |
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| >=65 years |
|
| Male |
|
| Czech Republic |
|
| Hungary |
|
| Greece |
|
| Canada |
|
| Poland |
|
| Austria |
|
| Israel |
|
| Germany |
|
| United Kingdom |
|
| Title | Measurements |
|---|---|
|
|
The primary efficacy comparison was the comparison of the proportions of relapse free subjects (relapse defined as reported, not necessarily confirmed relapse). The multiple test procedure (hierarchical procedure) was to be stopped as soon as one of the statistical tests resulted in a non-significant P value > 0.05. |
| Cochran-Mantel-Haenszel |
| 0.471 |
0.4 g/kg IGIV Group versus Placebo |
| No |
| Superiority or Other |