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The European Union Clinical Trials Register   allows you to search for protocol and results information on:
  • interventional clinical trials that were approved in the European Union (EU)/European Economic Area (EEA) under the Clinical Trials Directive 2001/20/EC
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    Clinical Trials Information System (CTIS).


    The EU Clinical Trials Register currently displays   44311   clinical trials with a EudraCT protocol, of which   7356   are clinical trials conducted with subjects less than 18 years old.   The register also displays information on   18700   older paediatric trials (in scope of Article 45 of the Paediatric Regulation (EC) No 1901/2006).

    Phase 1 trials conducted solely on adults and that are not part of an agreed paediatric investigation plan (PIP) are not publicly available (see Frequently Asked Questions ).  
     
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    Summary
    EudraCT Number:2022-002654-95
    Sponsor's Protocol Code Number:NET-MS
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Trial now transitioned
    Date on which this record was first entered in the EudraCT database:2023-01-03
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2022-002654-95
    A.3Full title of the trial
    No Evidence Of Disease Activity After Autologous Haematopoietic Stem Cell Transplantation In Aggressive Multiple Sclerosis
    Nessuna evidenza di attività della malattia dopo trapianto autologo di cellule staminali ematopoietiche nella Sclerosi Multipla aggressiva
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    No Evidence Of Disease Activity After Autologous Haematopoietic Stem Cell Transplantation In Aggressive Multiple Sclerosis
    Nessuna evidenza di attività della malattia dopo trapianto autologo di cellule staminali ematopoietiche nella Sclerosi Multipla aggressiva
    A.3.2Name or abbreviated title of the trial where available
    NA
    NA
    A.4.1Sponsor's protocol code numberNET-MS
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorFONDAZIONE ITALIANA SCLEROSI MULTIPLA ONLUS
    B.1.3.4CountryItaly
    B.3.1 and B.3.2Status of the sponsorNon-Commercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportFondazione Italiana Sclerosi Multipla
    B.4.2CountryItaly
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationUniversità di Genova
    B.5.2Functional name of contact pointDINOGMI
    B.5.3 Address:
    B.5.3.1Street AddressLargo Paolo Daneo
    B.5.3.2Town/ cityGenova
    B.5.3.3Post code16123
    B.5.3.4CountryItaly
    B.5.4Telephone number01035338712
    B.5.6E-mailnetms.trial@gmail.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    Subcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNFILGRASTIM
    D.3.9.2Current sponsor codeNon disponibile
    D.3.10 Strength
    D.3.10.1Concentration unit U/ml unit(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number60000000
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNFILGRASTIM
    D.3.9.2Current sponsor codeNon disponibile
    D.3.10 Strength
    D.3.10.1Concentration unit U/ml unit(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number96000000
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNFILGRASTIM
    D.3.9.2Current sponsor codeNon disponibile
    D.3.10 Strength
    D.3.10.1Concentration unit U/ml unit(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number95.89
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name OCREVUS
    D.2.1.1.2Name of the Marketing Authorisation holderRoche Registration GmbH
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameOCREVUS
    D.3.2Product code Non disponibile
    D.3.4Pharmaceutical form Powder for concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous drip use (Noncurrent)
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNOcrelizumab
    D.3.9.2Current sponsor codeNon disponibile
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number30
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Powder and solvent for concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous drip use (Noncurrent)
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCARMUSTINA
    D.3.9.2Current sponsor codeNon disponibile
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number50
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCARMUSTINA
    D.3.9.2Current sponsor codeNon disponibile
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCARMUSTINA
    D.3.9.2Current sponsor codeNon disponibile
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number300
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 4
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous drip use (Noncurrent)
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNETOPOSIDE
    D.3.9.2Current sponsor codeNon disponibile
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 5
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Powder and solvent for solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCITARABINA
    D.3.9.2Current sponsor codeNon disponibile
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCITARABINA
    D.3.9.2Current sponsor codeNon disponibile
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number500
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 6
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Kesimpta
    D.2.1.1.2Name of the Marketing Authorisation holderNovartis Ireland Limited
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameKesimpta 20 mg soluzione iniettabile
    D.3.2Product code Non disponibile
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNOfatumumab
    D.3.9.2Current sponsor codeNon disponibile
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number50
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 7
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name TYSABRI
    D.2.1.1.2Name of the Marketing Authorisation holderBiogen Netherlands B.W.
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameTYSABRI
    D.3.2Product code Non disponibile
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous drip use (Noncurrent)
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNNATALIZUMAB
    D.3.9.2Current sponsor codeNatalizumab
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 8
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Powder for solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous drip use (Noncurrent)
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCICLOFOSFAMIDE MONOIDRATA
    D.3.9.2Current sponsor codeNon disponibile
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1000
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCICLOFOSFAMIDE MONOIDRATA
    D.3.9.2Current sponsor codeNon disponibile
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number500
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCICLOFOSFAMIDE MONOIDRATA
    D.3.9.2Current sponsor codeNon disponibile
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number200
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product Yes
    D.3.11.13.1Other medicinal product typeCitostatico
    D.IMP: 9
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Powder for solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous drip use (Noncurrent)
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNIMMUNOGLOBULINA DI CONIGLIO ANTITIMOCITI UMANI
    D.3.9.2Current sponsor codeNon disponibile
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number5
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 10
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous drip use (Noncurrent)
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNIMMUNOGLOBULINA DI CONIGLIO ANTITIMOCITI UMANI
    D.3.9.2Current sponsor codeNon disponibile
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 11
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name LEMTRADA
    D.2.1.1.2Name of the Marketing Authorisation holderSanofi Belgium
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameLEMTRADA
    D.3.2Product code Non disponibile
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous drip use (Noncurrent)
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNALEMTUZUMAB
    D.3.9.2Current sponsor codeNon disponibile
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 12
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCITARABINA
    D.3.9.2Current sponsor codeNon disponibile
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCITARABINA
    D.3.9.2Current sponsor codeNon disponibile
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 13
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Powder for concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous drip use (Noncurrent)
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNMELFALAN CLORIDRATO
    D.3.9.2Current sponsor codeNon disponibile
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Relapsing Remitting Multiple Sclerosis
    Sclerosi multipla recidivante remittente
    E.1.1.1Medical condition in easily understood language
    A type of MS where you have relapses (symptoms getting worse) followed by recovery (that's when it's “remitting”)
    Forma di Sclerosi Multipla nella quale in cui si hanno ricadute (sintomi che peggiorano) seguite da guarigione (le remissioni).
    E.1.1.2Therapeutic area Diseases [C] - Nervous System Diseases [C10]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10063399
    E.1.2Term Relapsing-remitting multiple sclerosis
    E.1.2System Organ Class 10029205 - Nervous system disorders
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.1
    E.1.2Level PT
    E.1.2Classification code 10028245
    E.1.2Term Multiple sclerosis
    E.1.2System Organ Class 10029205 - Nervous system disorders
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary outcome is the occurrence of any evidence of multiple sclerosis disease activity (NEDA-3) over 36 months, analyzed as time-to-event
    L’outcome primario è il verificarsi di qualsiasi evidenza di attività di malattia della sclerosi multipla (NEDA-3) nel corso di 36 mesi, analizzata come tempo all’evento.
    E.2.2Secondary objectives of the trial
    Secondary outcomes at 36 months:
    ¿Incidence of serious adverse events and all-cause mortality
    ¿Annual relapse rate
    ¿Number of newT2/gadolinium enhancing T1lesions
    ¿Incidence of confirmed disability improvement and confirmed disability progression ¿Changes in brain volume
    ¿Changes in serum neurofilament light chain concentration
    ¿Changes in BICAMS scores
    ¿Changes in MSFC scores
    ¿Changes in the IgG/IgM index in the cerebrospinal fluid
    ¿Changes in the peripheral retinal nerve fiber layer and inner nuclear layer thickness ¿Changes in patient’s reported outcomes
    ¿Percentage of patients of child-bearing potential who maintains or resumes menstruation ¿Variation in anti-Mullerian hormone levels and antral follicular count
    ¿Variation in sperm count motility and morphology
    ¿Changes in advanced MRI metrics of tissue integrity inflammation and functional plasticity ¿Immunological changes associated with immune tolerance
    ¿Changes in the gut microbiota
    Outcome secondari a 36 mesi:
    ¿Incidenza di eventi avversi seri e mortalità
    ¿Tasso annualizzato di ricadute
    ¿Numero di nuove lesioni T2/lesioni T1 captanti il gadolinio
    ¿Incidenza di peggioramento/miglioramento confermato della disabilità
    ¿Modificazioni del volume cerebrale
    ¿Modificazioni della concentrazione dei neurofilamenti sierici
    ¿Modificazioni degli z-score BICAMS
    ¿Modificazioni degli z-score MSFC
    ¿Modificazioni dell‘ index IgG/IgM liquorale
    ¿ Modificazioni dello spessore retinico
    ¿ Modificazioni dei patient’s reported outcomes
    ¿Percentuale di pazienti in età fertile che mantengono/recuperano il ciclo mestruale ¿Variazioni dell’ormone anti-Mulleriano e della conta follicolare antrale
    ¿Variazioni della conta e della mobilità degli spermatozoi
    ¿Modificazioni delle metriche di RM avanzata di integrità microstrutturale, infiammazione e plasticità funzionale
    ¿Modificazioni del Sistema immunitario
    ¿Modificazioni del microbiota intestinale
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Diagnosis of relapsing remitting MS according to the 2017 Mc Donald’s criteria(1).
    2. Treatment-resistant MS, defined as the occurrence of disease activity following = 6 months of treatment with an oral agent or a monoclonal antibody in the 12 months prior to the screening visit. Disease activity is defined as:
    i. the occurrence of = 1 relapse AND
    ii. the occurrence of MRI evidence of disease activity, defined as one or more gadolinium-enhancing lesion(s) or one or more new non-enhancing T2 lesion(s) compared to a reference scan obtained not more than 18 months prior to the screening visit.
    3. Age = 18 and = 55.
    4. Expanded Disability Status Scale (EDSS) = 2.0 and = 6.0.
    5. Candidacy for treatment with at least one of the following diseases modifying treatments (DMT): natalizumab, alemtuzumab, ocrelizumab and/or ofatumumab. Candidacy must include no prior treatment failure with the candidate DMT and no contraindication to the candidate DMT.
    1. Diagnosi di SM recidivante remittente secondo i criteri di Mc Donald del 2017 (1).
    2. SM resistente al trattamento, definita come il verificarsi di attività della malattia dopo = 6 mesi di trattamento con un agente orale o un anticorpo monoclonale nei 12 mesi precedenti la visita di screening. L'attività della malattia è definita come:
    I. il verificarsi di = 1 recidiva E
    II. evidenze di attività di malattia alla RM, definite come una o più lesioni che captano il gadolinio o una o più nuove lesioni T2 non captanti, rispetto a una scansione di riferimento ottenuta non più di 18 mesi prima della visita di screening.
    3. Età = 18 e = 55.
    4. Expanded Disability Status Scale (EDSS) = 2.0 e = 6.0.
    5. Eleggibilità al trattamento con almeno uno dei seguenti trattamenti modificanti la malattia (DMT): natalizumab, alemtuzumab ocelizumab e/o ofatumumab. L’eggibilità deve comprendere assenza di precedente fallimento terapeutico con il DMT candidato e nessuna controindicazione al DMT candidato.
    E.4Principal exclusion criteria
    1. Diagnosis of primary and secondary progressive MS according to the 2017 McDonald criteria.
    2. Treatment with natalizumab, fingolimod and dimethyl-fumarate within the last 4 weeks to allow for proper wash-out. For previously natalizumab-treated patients with a positive John Cunningham virus antibody index, a negative CSF JCV-PCR is required.
    3. Treatment with teriflunomide within the last 2 years unless cleared from the body (plasma concentration < 0.02 mcg/ml following elimination from the body with cholestyramine or activated powdered charcoal).
    4. Treatment with ocrelizumab, ofatumumab, alemtuzumab and cladribine within the last 3 months.
    5. Known hypersensitivity or other known serious side effects for any of the study medications, including co-medications such as high-dose steroids and rabbit anti-thymocyte globulin.
    6. Brain MRI or Cerebrospinal fluid (CSF) examination indicating or suggesting a diagnosis of progressive multifocal leukoencephalopathy (PML).
    7. If white blood cells < 1,5 x 109/L and/or lymphocytes CD4+ < 200/mm3 because of a reversible effect of documented ongoing medication, the WBC count must be = 1,5 x 109/L and lymphocytes CD4+ = 200/mm3 before start of study treatment.
    8. In case of unexplained cytopenia, polycythemia, thrombocythemia diagnosis of myelodysplastic syndrome must be ruled out before including patient in the protocol.
    9. History of malignancy, with the exception of adequately treated localized basal cell or squamous skin cancer, or carcinoma in situ of the cervix.
    10. Any active uncontrolled viral, bacterial, fungal, endoparasitic, or opportunistic infection.
    11. Serological positivity to HCV or HIV
    12. No adequate pharmacological prophylaxis in case of HBsAg or HBcAb positivity and allocation to AHSCT, alemtuzumab, ocrelizumab or ofatumumab.
    13. Receipt of live or live-attenuated vaccines within 6 weeks of randomization.
    14. Presence or history of Child-Pugh score B and C hepatic cirrhosis.
    15. Hepatic disease with the presence at two consecutive assessments 15 days apart of either of the following: total bilirubin = 1.5 times the upper limit of normal (ULN) or total bilirubin = 3.0 times the ULN in the presence of Gilbert's syndrome, or alanine aminotransferase or aspartate aminotransferase = 3.0 times the ULN.
    16. Presence or history of clinically significant cardiac disease (including coronary artery disease, moderate to severe valve stenosis or insufficiency, symptomatic mitral valve prolapse, presence of prosthetic mitral or aortic valve).
    17. Left ventricular ejection fraction (LVEF) < 50% (if randomized to AHSCT).
    18. eGFR < 60 mL/min/1.73m2.
    19. Forced expiratory volume in one second (FEV1) <70% predicted (no bronchodilator) (if randomized to AHSCT).
    20. Diffusing capacity of the lungs for carbon monoxide (DLCO) (corrected for Hgb) < 70% predicted (if randomized to AHSCT)
    21. Known untreated or unregulated thyroid disease.
    22. Positive pregnancy test or breast-feeding.
    23. Patients who are unwilling to practice adequate contraception during the duration of the study. For female participants of child-bearing potential, adequate contraception includes the use of active contraception for 12 months after AHSCT, 4 months after the last infusion of alemtuzumab and for the entire time of natalizumab, ocrelizumab and ofatumumab treatment. Male participants with female partners of child-bearing potential must be willing to use adequate contraception if they are randomized to the AHSCT arm for 12 months after treatment.
    24. Prior history of solid organ transplantation.
    25. Prior history of AHSCT.
    26. Prior exposure to mitoxantrone.
    27. Prior exposure to cyclophosphamide.
    28. Inability to understand the contents of the Informed Consent form.
    29. Failure to willingly accept or comprehend risk of irreversible sterility as a side effect of therapy.
    30. Any condition that precludes the participant from undergoing MRI with gadolinium administration.
    31. Presence or history of genetically inherited progressive central nervous system disorder, or central nervous system tumors.
    1. Diagnosi di SM progressiva primaria e secondaria secondo i criteri di McDonald del 2017 (1).
    2. Trattamento con natalizumab, fingolimod e dimetil-fumarato nelle ultime 4 settimane per consentire il corretto wash - out. Per i pazienti precedentemente trattati con natalizumab con un indice anticorpale positivo al virus John Cunningham, è necessaria una PCR su fluido cerebrospinale negativa per JCV.
    3. Trattamento con teriflunomide negli ultimi 2 anni a meno che non sia stato eliminato dall'organismo (concentrazione plasmatica < 0,02 mcg / ml dopo l'eliminazione dall'organismo con colestiramina o carbone attivo in polvere).
    4. Trattamento con crelizumab, ofatumumab e alemtuzumab e cladribina negli ultimi 3 mesi.
    5. Ipersensibilità nota o altri effetti indesiderati gravi noti per qualsiasi farmaco usato per lo studio, inclusi reazioni di ipersensibilità a steroidi ad alte dosi e globulina anti-timocita di coniglio.
    6. Una RM cerebrale o un esame del liquido cerebrospinale (CSF) che indichi o suggerisca una diagnosi di leucoencefalopatia multifocale progressiva (PML).
    7. Se la conta dei globuli bianchi (WBC) è < 1,5 x 109/L e/o dei linfociti CD4+ è < 200/mm3 a causa di un effetto reversibile di un trattamento in corso documentato, la conta dei globuli bianchi dovrà essere =1,5 x 109/L e dei linfociti CD4+ =200/mm3 prima dell'inizio del trattamento in studio.
    8. In caso di citopenia, policitemia, trombocitemia a causa non nota, deve essere esclusa la diagnosi di sindrome mielodisplastica prima di includere il paziente nel protocollo.
    9. Anamnesi di un tumore maligno, ad eccezione del carcinoma localizzato basocellulare o spinocellulare della pelle adeguatamente trattato, o del carcinoma in situ della cervice.
    10 Qualsiasi infezione virale, batterica, fungina, endoparassitaria o opportunistica attiva non controllata.
    11. Positività serologica a HCV od HIV
    12. Assenza di profilassi farmacologica adeguata in caso di positività di HBsAg o HBcAb e assegnazione a HSCT, alemtuzumab, ocrelizumab o ofatumumab.
    13. Ricevimento di vaccini vivi o vivi attenuati entro 6 settimane dalla randomizzazione.
    14. Presenza o storia di cirrosi epatica con punteggio Child-Pugh B e C.
    15. Malattia epatica con la presenza a due valutazioni consecutive a 15 giorni di distanza, di uno dei seguenti: bilirubina totale = 1,5 volte il limite superiore della norma (ULN) o bilirubina totale = 3,0 volte ULN in presenza della sindrome di Gilbert, o alanina aminotransferasi (ALT) o aspartato aminotransferasi (AST) = 3,0 volte del ULN.
    16. Presenza o storia di malattia cardiaca clinicamente significativa (inclusa malattia coronarica, stenosi o insufficienza valvolare da moderata a grave, prolasso sintomatico della valvola mitrale, presenza di protesi della valvola mitrale o aortica).
    17. Frazione di eiezione ventricolare sinistra (LVEF) < 50% (se randomizzato per AHSCT).
    18 .eGFR < 60 mL/min/1.73m2.
    19. Volume espiratorio forzato in un secondo (FEV1) previsto <70% (nessun broncodilatatore) (se randomizzato per AHSCT).
    20. Capacità di diffusione dei polmoni di monossido di carbonio (DLCO) previsto (corretto per Hgb) < 70% (se randomizzato per AHSCT).
    21. Malattia della tiroide nota non trattata o non controllata.
    22.Test di gravidanza positivo o allattamento.
    23. Pazienti che non siano disposti a praticare un'adeguata contraccezione durante la durata dello studio. Per le partecipanti di sesso femminile in età fertile, una contraccezione adeguata include l'uso di una contraccezione attiva per 12 mesi dopo AHSCT, 4 mesi dopo l'ultima infusione di alemtuzumab e per tutto il tempo del trattamento con natalizumab, ocrelizumab e ofatumumab. I partecipanti di sesso maschile con partner di sesso femminile in età fertile devono essere disposti ad usare contraccettivi adeguati se sono randomizzati al braccio AHSCT fino a 12 mesi dopo il trattamento.
    24. Storia di precedente trapianto di organi solidi.
    25. Storia di precedente AHSCT.
    26. Precedente esposizione al mitoxantrone.
    27. Precedente esposizione alla ciclofosfamide.
    28. Incapacità di comprendere il contenuto del modulo di Consenso Informato.
    29. Incapacità di comprendere e accettare in piena consapevolezza il rischio di sterilità irreversibile come effetto collaterale della terapia.
    30. Qualsiasi condizione che impedisca al partecipante di sottoporsi a risonanza magnetica con somministrazione di gadolinio.
    31. Presenza o anamnesi di disturbi degenerativi del sistema nervoso centrale ereditati geneticamente o tumori del sistema nervoso centrale.
    E.5 End points
    E.5.1Primary end point(s)
    The primary outcome is the occurrence of any evidence of multiple sclerosis disease activity (NEDA-3) over 36 months, analyzed as time-to-event.
    NEDA-3 is the absence of any disease activity event, consisting of:
    - MRI evidence of disease activity (which includes one or more T1 gadolinium-enhanced lesion(s) on MRI, with the exclusion of the reference scan obtained at Month 3, and/or one or more new or unequivocally enlarged T2 hyperintense lesion(s) on MRI compared with the MRI reference scan obtained at Month 3)
    - A multiple sclerosis relapse
    - 6 months confirmed disability progression based on increases in Expanded Disability Status Scale (EDSS)
    L’outcome primario è il verificarsi di qualsiasi evidenza di attività di malattia della sclerosi multipla (NEDA-3) nel corso di 36 mesi, analizzata come tempo all’evento. [Intervallo di tempo: dal giorno 0 (giorno di trattamento) fino a 36 mesi].
    NEDA-3 è l'assenza di qualsiasi evento di attività della malattia, costituito da:
    - Evidenza di attività della malattia alla RM (che include una o più lesioni di T1 potenziate da gadolinio, con esclusione dell’esame di riferimento ottenuto al mese 3, e/o una o più nuove lesioni iper-intense T2 o inequivocabilmente ingrandite rispetto alla scansione RM di riferimento ottenuta al mese 3)
    - Una ricaduta di sclerosi multipla
    - progressione della disabilità confermata a 6 mesi basata su un aumento in Expanded Disability Status Scale (EDSS),
    E.5.1.1Timepoint(s) of evaluation of this end point
    From day 0 (treatment day) up to 36 months
    Dal giorno 0 (giorno del trattamento) fino a 36 mesi
    E.5.2Secondary end point(s)
    1. The proportion of participants who experience a serious adverse event [Time frame: from day 0 up to 36 months]
    2. The proportion of participants who experience a serious late adverse event [Time frame: from day 100 up to 36 months].
    3. The annual relapse rate at 12, 24 and 36 months
    4. The incidence of 6 months confirmed disability improvement as measured by the EDSS over 36 months
    5. The prevalence of disability improvement over 36 months
    6. The proportion of patients who have confirmed disability improvement, confirmed stable EDSS or confirmed disability progression at 12, 24 and 36 months
    7. The incidence of 6 months confirmed progression on hand/arm function as measured by the 9HPT over 36 months
    8. The incidence of 6 months confirmed progression on ambulation as measured by the T25FW test over 36 months
    9. Number of new brain lesions at 12, 24 and 36 months
    10. Number of gadolinium-enhancing brain lesions at 12, 24 and 36 months
    11. Changes in whole brain volume at 12, 24 and 36 months
    12. The proportion of patients with no evidence of disease activity including atrophy (NEDA-4) at 12, 24 and 36 months
    13. Changes in MRI T2-weighted hyperintense lesion volume over 36 months
    14. Changes in MRI T1-weighted hypointense lesion volume over 36 months
    15. Changes in BICAMS z-scores at 12, 24 and 36 months
    16. Changes in MSFC z-scores at 12, 24 and 36 months
    17. Changes in serum neurofilament light chain concentration at 12, 24 and 36 months
    18. Changes in the IgG/IgM index in the cerebrospinal fluid at 36 months
    19. Presence of oligoclonal bands in the cerebrospinal fluid at 36 months
    20. Changes in the 2.5 low contrast visual acuity at 12, 24 and 36 months
    21. Changes in the peripheral retinal nerve fiber layer thickness assessed by optical coherence tomography at 12, 24 and 36 months
    22. Changes in the retinal inner nuclear layer thickness assessed by optical coherence tomography at 12, 24 and 36 months
    23. Changes in the Multiple Sclerosis Impact Scale at 12, 24 and 36 months
    24. Changes in Multiple Sclerosis Walking Scale over at 12, 24 and 36 months
    25. Changes in the Modified Fatigue Impact Scale at 12, 24 and 36 months
    26. Changes in the WHO-QOL-Bref and the EuroQoL EQ-5D at 12, 24 and 36 months
    27. All-cause mortality over 36 months
    28. Proportion of participants who develop secondary autoimmune diseases over 36 months
    29. Time to neutrophil engraftment among AHSCT recipients
    30. Proportion of AHSCT recipients who experience primary or secondary graft failure
    31. Percentage of female patients who experiences amenorrhoea during the study period
    32. Percentage of female patients of child-bearing potential who maintains or resumes regular menstruation
    33. Time to resumption of spontaneous menses after AHSCT and/or interruption of hormonal contraception
    34. Variation in ovarian reserve parameters (anti-mullerian hormone levels and antral follicular count) over 36 months
    35. Variation in sperm count, motility and morphology over 36 months
    36. Percentage of pregnancy within 12 months of attempts among patients that will try to conceive after AHSCT [Time frame: from day 365 up to 36 months].
    1. La proporzione di partecipanti che sperimentano un evento avverso grave [Intervallo di tempo: dal giorno 0 fino a 36 mesi]
    2. La percentuale di partecipanti che sperimentano un evento avverso grave tardivo [Intervallo di tempo: dal giorno 100 fino a 36 mesi].
    3. Il tasso annuale di recidiva a 12, 24 e 36 mesi
    4. L'incidenza di miglioramento della disabilità confermata a 6 mesi misurato con EDSS su 36 mesi
    5. La prevalenza del miglioramento della disabilità su 36 mesi
    6. La proporzione di pazienti che hanno un miglioramento della disabilità confermato, un EDSS stabile confermato o una progressione della disabilità confermata a 12, 24 e 36 mesi
    7. L'incidenza di progressione confermata a 6 mesi della funzione mano / braccio misurata con il test 9HPT su 36 mesi
    8. L'incidenza di progressione confermata a 6 mesi nella deambulazione misurata con il test T25FW su 36 mesi.
    9. Numeri di nuove lesioni celebrali a 12, 24 e 36 mesi.
    10. Numero di lesioni celebrali che captano il gadolinio a 12, 24 e 36 mesi.
    11. Cambiamenti nel volume complessivo del cervello a 12, 24 e 36 mesi.
    12. La proporzione di pazienti senza evidenza di attività di attività di malattia inclusa atrofia (NEDA- 4) a 12, 24 e 36 mesi.
    13. Variazioni del volume della lesione iperintensa ponderata per T2 nel corso di 36 mesi.
    14. Variazioni del volume della lesione ipointensa ponderata per T1 nel corso di 36 mesi.
    15. Variazioni nei punteggi z di BICAMS a 12, 24 e 36 mesi.
    16. Variazioni nei punteggi z di MSFC a 12, 24 e 36 mesi.
    17. Cambiamenti nella concentrazione della catena leggera del neurofilamento sierico a 12, 24 e 36 mesi.
    18. Cambiamenti nell'indice IgG/IgM nel liquido cerebrospinale a 36 mesi.
    19. Presenza di bande oligoclonali nel liquido cerebrospinale a 36 mesi.
    20. Cambiamenti nell'acuità visiva a 12, 24 e 36 mesi.
    21. Cambiamenti nello spessore dello strato di fibre nervose retiniche periferiche valutati mediante tomografia a coerenza ottica a 12, 24 e 36 mesi.
    22. Cambiamenti nello spessore dello strato nucleare retinico interno valutate mediante tomografia a coerenza ottica a 12, 24 e 36 mesi.
    23. Cambiamenti nella Multiple Sclerosis Impact Scale a 12, 24 e 36 mesi.
    24. Cambiamenti nella Multiple Sclerosis walking scale a 12, 24 e 36 mesi.
    25. Cambiamenti della Modified Fatigue Impact Scale a 12, 24 e 36 mesi.
    26. Cambiamenti delle scale WHOQoL-Bref e EuroQoL EQ-5D sulla qualità della vita a 12, 24 e 36 mesi.
    27. Mortalità per tutte le cause nel corso di 36 mesi.
    28. Proporzione di partecipanti che sviluppano malattie autoimmuni secondarie nel corso di 36 mesi.
    29. Tempo di attecchimento dei neutrofili nei pazienti che hanno ricevuto HSCT.
    30. Proporzione di pazienti trattati con HSCT che presentano un fallimento primario o secondario dell’attecchimento delle cellule staminali ematopoietiche.
    31. Percentuale di pazienti di sesso femminile che manifestano amenorrea durante il periodo di studio.
    32. Percentuale di pazienti di sesso femminile in età fertile che mantengono o riprendono mestruazioni regolari.
    33. Tempo di ripresa delle mestruazioni spontanee dopo AHSCT e / o interruzione della contraccezione ormonale.
    34. Variazione dei parametri di riserva ovarica (livelli ormonali anti-mulleriani e conta follicolare antrale) nell'arco di 36 mesi.
    35. Variazione nel numero, motilità e morfologia degli spermatozoi, nell'arco di 36 mesi.
    36. Percentuale di gravidanze entro 12 mesi di tentativi tra i pazienti che cercheranno di concepire dopo HSCT [Lasso di tempo: dal giorno 365 fino a 36 mesi].
    E.5.2.1Timepoint(s) of evaluation of this end point
    Timepoints included in above endpoints
    Tempi di rilevazione inclusi negli endpoints sopra
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind Yes
    E.8.1.4Double blind No
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned11
    E.8.5The trial involves multiple Member States No
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA No
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.7Trial 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
    LVLS
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years7
    E.8.9.1In the Member State concerned months6
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years7
    E.8.9.2In all countries concerned by the trial months6
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 90
    F.1.3Elderly (>=65 years) No
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state90
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 90
    F.4.2.2In the whole clinical trial 90
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    None
    Nessuno
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2023-03-22
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2023-04-17
    P. End of Trial
    P.End of Trial StatusTrial now transitioned
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