E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Relapsing multiple sclerosis |
|
E.1.1.1 | Medical condition in easily understood language |
Relapsing multiple sclerosis |
|
E.1.1.2 | Therapeutic area | Diseases [C] - Nervous System Diseases [C10] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10048393 |
E.1.2 | Term | Multiple sclerosis relapse |
E.1.2 | System Organ Class | 10029205 - Nervous system disorders |
|
E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
This study is designed to evaluate the long-term safety and tolerability of fingolimod 0.5 mg/day in patients with relapsing forms of MS. |
|
E.2.2 | Secondary objectives of the trial |
This study will also evaluate long-term efficacy of fingolimod 0.5 mg/day
in patients with MS, as measured by disability progression, brain volume
(atrophy), T1- (non-enhanced) and T2-weighted lesion volume and MS
relapse occurrence |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Patients eligible for inclusion in this study have to fulfill all of the following criteria:
1. Written informed consent must be obtained before any assessment is performed.
2. Patients who have completed designated ongoing or planned trials with fingolimod, including phase II/III patients who have already completed CFTY720D2399, CFTY720D2309/E1 or one of the phase II/III core or extension studies.
3. Patients who participated in any designated global fingolimod MS trial other than phase II/III (e.g. CFTY720D2316, CFTY720D2320, etc.) and are less than 180 days beyond the time of local approval and general reimbursement. |
|
E.4 | Principal exclusion criteria |
Patients fulfilling any of the following criteria are not eligible for
inclusion in this study:
1. Premature permanent discontinuation from any fingolimod study due
to:
a. An adverse event or serious adverse event or laboratory abnormality.
b. Conditions leading to permanent study drug discontinuation.
Patients who temporarily or permanently discontinued from any
fingolimod study because of pregnancy can be re-enrolled.
2. Pregnant or nursing (lactating) women where pregnancy is defined as
the state of a female after conception and until the termination of
gestation, confirmed by a positive hCG laboratory test (> 5 mIU/ml).
3. Women of child-bearing potential, defined as all women
physiologically capable of becoming pregnant, UNLESS they are using
highly effective contraception during the study and for 2 months after
stopping treatment. 'Highly effective contraception'defined as
contraception which results in less that 1% unwanted pregnancies when
used properly according to the label.
Women are considered post-menopausal and not of child-bearing
potential if they have had 12 months of natural (spontaneous)
amenorrhea with an appropriate clinical profile (e.g. age appropriate,
history of vasomotor symptoms) or have had surgical bilateral
oophorectomy (with or without hysterectomy) or tubal ligation at least
six weeks prior to baseline. In the case of oophorectomy alone, only
when the reproductive status of the woman has been confirmed by
follow up hormone level assessment is she considered not of child
bearing potential.
4. Chronic disease of the immune system other than MS which may
require immunosuppressive treatment.
5. Severe active infection or active chronic infection.
6. Previous treatment with cladribine, cyclophosphamide or
mitoxantrone.
7. Treatment with monoclonal antibodies (including Natalizumab) in the
past 3 months.
8. Uncontrolled diabetes (HbA1c>9%).
9. Macular edema at Baseline.
10. Any medically unstable condition that may interfere with the
patient's ability to cooperate and comply with the study procedures, as
assessed by the treating physician.
11. Any of the following cardiovascular conditions:
a. myocardial infarction within the past 6 months prior to enrollment or
current unstable ischemic heart disease;
b. cardiac failure at time of Screening (Class III & IV, according to New
York Heart Association Classification) or any severe cardiac disease as
determined by the investigator;
c. patients receiving current treatment with Class Ia and III
antiarrhythmic drugs (e.g., quinidine, disopyramide, amiodarone,
bretylium, sotalol, ibulitide, azimilide, dofelitide, ajmaline,
procainamide);
d. second-degree AV block Type II or third-degree AV block or corrected
QTc inverval >500 msec;
e. sick sinus syndrome or sino-atrial heart block;
f. uncontrolled hypertension despite prescribed medications.
12. Any of the following pulmonary conditions during the previous
fingolimod study or observed at enrollment visit:
a. severe respiratory disease or pulmonary fibrosis;
b. active tuberculosis;
c. in patients enrolling from studies with regular spirometry: reduction of
FEV1, FVC and/or DLCO below 60% of core study baseline values or if
FEV1, FVC and/or DLCO at extension study baseline is the second of two
consecutive pulmonary function tests with values <80% of core study
baseline.
13. Severe liver impairment or chronic liver disease.
14. Positive screening for serological markers for hepatitis A, B, C, and E
indicating acute or chronic infection:
• anti-hepatitis A virus IgM,
• hepatitis B surface antigen and/or anti-hepatitis B core antigen IgM,
• anti-hepatitis C virus IgG or IgM,
• anti-hepatitis E virus IgM (if positive IgG: do hepatitis E virus-RNA polymerase chain reaction; if negative, patient can be included).
Note: The following patients, assuming they have normal aminotransferase activities, can be included in the trial:
• those testing positive for hepatitis B surface antibody, indicating hepatitis B immunization -OR-
• those testing positive for anti-hepatitis B core antigen IgG, indicating a cured hepatitis B - OR -
• those testing positive for anti-hepatitis A virus IgG, indicating a cured hepatitis A. |
|
E.5 End points |
E.5.1 | Primary end point(s) |
Long-term safety will be assessed based on adverse events (AEs), laboratory and vital signs as well as other investigations performed when clinically indicated. |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
Visits every 3 months through Month 12 (v5); Visits every 6 months
beginning after Month 12 at Month 18 (v6) |
|
E.5.2 | Secondary end point(s) |
MRI, MS relapse, EDSS scores, MSFC scores |
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
Visits every 3 months through Month 12 (v5); Visits every 6 months beginning after Month 12 at Month 18 (v6) |
|
E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Information not present in EudraCT |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
Health-related quality of life. |
|
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| Information not present in EudraCT |
E.8.4 | The trial involves multiple sites in the Member State concerned | Information not present in EudraCT |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 500 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | Yes |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Argentina |
Australia |
Austria |
Belgium |
Brazil |
Canada |
Colombia |
Costa Rica |
Czech Republic |
Denmark |
Egypt |
Estonia |
Finland |
France |
Germany |
Greece |
Guatemala |
Hungary |
Ireland |
Israel |
Italy |
Jordan |
Korea, Republic of |
Malaysia |
Mexico |
Netherlands |
Norway |
Panama |
Peru |
Poland |
Portugal |
Romania |
Russian Federation |
Slovakia |
South Africa |
Spain |
Sweden |
Switzerland |
Turkey |
United Kingdom |
Venezuela, Bolivarian Republic of |
|
E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
|
The study as a whole will be considered completed when fingolimod is commercially available and reimbursed in all of the respective countries. For an individual patient who previously completed a Phase II/III fingolimod trial and its associated extension study: if applicable, when fingolimod is registered, commercially available and reimbursed in the respective country or maximally through 30-Jun-2016, whichever is later.. |
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | |
E.8.9.1 | In the Member State concerned months | |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 5 |
E.8.9.2 | In all countries concerned by the trial months | 9 |