interim anlaysis failed: palifermin does not promote thymopoeisis after alemtuzumab

The purpose of this study is to test a novel strategy to prevent the clinical problem of secondary autoimmunity following alemtuzumab treatment of multiple sclerosis.

The hypothesis is that autoimmunity after alemtuzumab can be prevented by giving a drug that promotes thymic T cell regeneration (Palifermin, Kepivance®).

This is a single-centre, double-blinded, randomised controlled trial of palifermin (Kepivance) vs. placebo in the prevention of autoimmunity following alemtuzumab treatment of multiple sclerosis.

The dose of palifermin (kepivance)used in this trial will be informed by a dose-escalation study.

Inclusion Criteria:

• Male or non-pregnant, non-lactating female patients
• > 18 years of age, and <50 years of age inclusive
• Diagnosis of MS using McDonald's 2010 criteria, including MRI abnormalities consistent with McDonald's 2010 criteria.
• Onset of first MS symptoms within 10 years on the date the ICF is signed
• EDSS score 0.0 to 5.0 (inclusive) at screening
• At least 2 clinical episodes of MS in the 2 years prior to study entry, with at least 1 attack within 12 months, which may have occurred whilst on disease-modifying therapy, namely any beta interferon or glatiramer acetate.
• Serum IL-7≤7pg/mL

Exclusion Criteria:

• Any progressive form of multiple sclerosis
• Previous thymectomy
• Previous treatment with alemtuzumab, natalizumab, mitoxantrone, cyclophosphomide, cladribine, rituximab or any other immunosuppressant or cytotoxic therapy (other than steroids and disease-modifying therapies listed above)
• History of malignancy
• Personal history of clinically significant autoimmune disease, other than multiple sclerosis (including but not limited to: thyroid disease, immune cytopenias, inflammatory bowel disease, diabetes, lupus, severe asthma)
• Intolerance of pulsed corticosteroids, especially a history of steroid psychosis
• Major systemic disease or other illness that would, in the opinion of the investigator, compromise patient safety or interfere with the interpretation of study results.
• Seropositivity for human immunodeficiency virus (HIV)
• Past or present hepatitis B infection (positive hepatitis B serology)
• Pregnant women or male and female patients who do not agree to use effective contraception during the study.
• Medical, psychiatric, cognitive or other conditions that, in the investigator's opinion, compromise the patient's ability to understand the patient information, to give informed consent, to comply with the trial protocol, or to complete the study.