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Multiple SclerosisPhase 4MITIGATENCT02410278

Study of Montelukast on Gastrointestinal Tolerability in Patients With Relapsing Forms of Multiple Sclerosis Receiving Tecfidera

A Phase 4 study testing dimethyl fumarate and montelukast in people with Multiple Sclerosis, run by Biogen at 50 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The primary objective of this study is to evaluate whether montelukast can reduce the severity of gastrointestinal (GI) events, measured by the Gastrointestinal Symptom Rating Scale (GSRS), after oral administration of dimethyl fumarate (DMF) in participants with relapsing forms of Multiple Sclerosis (MS). Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Multiple Sclerosis
What is being tested?
dimethyl fumarate and montelukast
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
102 participants
Where
50 sitesUnited States
Study dates
12 Mar 2015to 27 Apr 2017
Phase
Phase 4
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Reside in the United States and have a confirmed diagnosis of a relapsing form of MS and satisfy the therapeutic indication as described in the local label
  • As perceived by the Investigator, have the ability to comply with all requirements of the study protocol and to operate the eDiary required to record GI-related events
  • Female participants of childbearing potential who are not surgically sterile must practice effective contraception during their participation in the study and be willing and able to continue contraception for 30 days after they complete or withdraw from the study. All men must practice effective contraception, and they should not donate sperm throughout the study and for at least 90 days after their last dose of study treatment.

Who cannot join

  • History of significant GI disease (for example, irritable bowel disease, peptic ulcer disease, history of major GI surgery, eosinophilic GI disease, or food allergies)
  • Chronic use (≥7 consecutive days) of bismuth subsalicylate, simethicone, calcium carbonate, loperamide, proton-pump inhibitors, or ondansetron within 1 month prior to the Screening Visit
  • Use of the following medications: montelukast, immunotherapy, mast cell stabilizers, or parenteral, inhaled, or oral steroids up to 1 month prior to the Screening Visit. Use of these medications is also not permitted for the duration of the study (except for the use of montelukast as per study protocol) and will lead to discontinuation
  • Have one or more major comorbidities that, in the opinion of the Investigator, may affect the outcome of the study
  • History of malignancy (except for basal cell carcinoma that had been completely excised prior to study entry), severe allergic or anaphylactic reactions or known drug hypersensitivity, abnormal laboratory results indicative of any significant disease, and/or a major disease that would preclude participation in a clinical study
  • NOTE: Other protocol defined Inclusion/Exclusion criteria may apply

Trial locations and contacts

50 sites in 1 country.

50 sites in 1 country

United States50 sites
  • Research Site

    Alexandria, Virginia, 22310

  • Research Site

    Amherst, New York, 14226

  • Research Site

    Aurora, Colorado, 80045

  • Research Site

    Carmichael, California, 95608

  • Research Site

    Chesterfield, Missouri, 63017

  • Research Site

    Chicago, Illinois, 60612

  • Research Site

    Colorado Springs, Colorado, 80907

  • Research Site

    Dallas, Texas, 75214

  • Research Site

    Dayton, Ohio, 45417

  • Research Site

    Dayton, Ohio, 45459

  • Research Site

    Dickson City, Pennsylvania, 18519

  • Research Site

    Fairfield, Connecticut, 06824

  • Research Site

    Farmington Hills, Michigan, 48334

  • Research Site

    Flossmoor, Illinois, 60422

  • Research Site

    Freehold, New Jersey, 07728

  • Research Site

    Greensburg, Pennsylvania, 15601

  • Research Site

    Hendersonville, North Carolina, 28792

  • Research Site

    Hershey, Pennsylvania, 17033

  • Research Site

    Indianapolis, Indiana, 46256

  • Research Site

    Jacksonville, Florida, 32216

  • Research Site

    Jonesboro, Arkansas, 72401

  • Research Site

    Kansas City, Missouri, 64111

  • Research Site

    La Jolla, California, 92037

  • Research Site

    La Mesa, California, 91942

  • Research Site

    Louisville, Kentucky, 40207

  • Research Site

    Madison, Wisconsin, 53705

  • Research Site

    Naples, Florida, 34102

  • Research Site

    Nashville, Tennessee, 37215

  • Research Site

    New York, New York, 10029

  • Research Site

    Newport News, Virginia, 23601

  • Research Site

    Oklahoma City, Oklahoma, 73109

  • Research Site

    Ormond Beach, Florida, 32174-3102

  • Research Site

    Patchogue, New York, 11772

  • Research Site

    Pomona, California, 91767

  • Research Site

    Portland, Oregon, 97225

  • Research Site

    Raleigh, North Carolina, 27607-6010

  • Research Site

    Rome, Georgia, 30165-1625

  • Research Site

    Round Rock, Texas, 78681

  • Research Site

    Sanford, North Carolina, 27330

  • Research Site

    Scarborough, Maine, 04074

  • Research Site

    Seattle, Washington, 98122

  • Research Site

    Simi Valley, California, 93065

  • Research Site

    Smyrna, Georgia, 30269

  • Research Site

    St Louis, Missouri, 63104

  • Research Site

    Sunrise, Florida, 33351

  • Research Site

    Tualatin, Oregon, 97062

  • Research Site

    Uniontown, Ohio, 44685

  • Research Site

    Washington D.C., District of Columbia, 20057

  • Research Site

    Wilkes-Barre, Pennsylvania, 18711

  • Research Site

    Winston-Salem, North Carolina, 27103

Other trials in United States

About this study

Official title: A Multicenter, Double- Blind, Placebo- Controlled Study of Montelukast on Gastrointestinal Tolerability in Patients With Relapsing Forms of Multiple Sclerosis Receiving Tecfidera® (Dimethyl Fumarate) Delayed Release Capsules

The primary objective of this study is to evaluate whether montelukast can reduce the severity of gastrointestinal (GI) events, measured by the Gastrointestinal Symptom Rating Scale (GSRS), after oral administration of dimethyl fumarate (DMF) in participants with relapsing forms of Multiple Sclerosis (MS). The secondary objectives of this study are as follows: To evaluate whether montelukast after oral administration of DMF in participants with relapsing forms of MS decreases discontinuations due to GI events and reduces the number of participants taking symptomatic therapies for GI events; To investigate the effect of montelukast on the incidence of flushing events after oral administration of 240 mg DMF in participants with relapsing forms of MS.

Being tested
dimethyl fumarate, montelukast, Placebo
Medical subject headings
Multiple Sclerosis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • dimethyl fumarateDrug

    Also called BG00012, Tecfidera, DMF

    Starting dose of 120 mg twice daily orally After 7 days, maintenance dose of 240 mg twice daily orally

  • montelukastDrug

    Also called Singulair

    As described in the treatment arm

  • PlaceboDrug

    Matched placebo

Study groups in NCT02410278
Study groupRoleWhat they receive
DMF plus montelukastExperimentalDMF as described in the United States Prescribing Information (USPI) plus 10mg montelukast tablet once daily according to the prevailing product label (Singulair)
Receives: Drug: dimethyl fumarate; Drug: montelukast
DMF plus placeboExperimentalDMF as described in the USPI plus matched placebo
Receives: Drug: dimethyl fumarate; Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Percentage of Participants With a Worsening in Severity of Gastrointestinal (GI) Adverse Events (AEs) on the GSRS From Day 0 to Day 10

    The GSRS is a weekly recall scale that was modified for daily recall. The 15-question GSRS is summarized with a 7-point Likert scale: no discomfort at all=0; minor discomfort=1; mild discomfort=2; moderate discomfort=3; moderately severe discomfort=4; severe discomfort=5 and very severe discomfort=6. The overall GSRS score is a mean score that ranges from 0 (no symptoms) to 6 (the worst possible symptoms). Worsening in severity was defined as a positive average change from baseline (Day 0) to Day 10 in the GSRS score. Day 0: the day before a participant started randomized treatment (if the GI threshold was reached 1 day previously) or the first day of randomized treatment if the threshold was reached that day. If the threshold was reached >1 day previously, then Day 0 was the last day when the threshold was reached, prior to the first dose. Average change is the sum of changes from baseline in GSRS score over the first 10 days divided by the total of days with a GSRS score.

    Measured: Baseline (Day 0), Day 10 (10 days after Day 0)

Secondary outcomes (9)
  1. Average Change From Baseline in GSRS Overall Score at Day 1 to Day 10

    The GSRS is a weekly recall scale that was modified for daily recall. The 15-question GSRS is summarized with a 7-point Likert scale: no discomfort at all=0; minor discomfort=1; mild discomfort=2; moderate discomfort=3; moderately severe discomfort=4; severe discomfort=5 and very severe discomfort=6. The overall GSRS score is a mean score that ranges from 0 (no symptoms) to 6 (the worst possible symptoms). This endpoint reports the average change from baseline (Day 0) at Day 1 to Day 10. Day 0: the day before a participant started randomized treatment (if the GI threshold was reached 1 day previously) or the first day of randomized treatment if the threshold was reached that day. If the threshold was reached >1 day previously, then Day 0 was the last day when the threshold was reached, prior to the first dose. A negative change from baseline indicates that symptoms decreased.

    Measured: Baseline (Day 0), Day 1 (1 day after Day 0), Day 10 (10 days after Day 0)

  2. Average Change From Baseline in GSRS Overall Score at Day 1 to Week 10

    The GSRS is a weekly recall scale that was modified for daily recall. The 15-question GSRS is summarized with a 7-point Likert scale: no discomfort at all=0; minor discomfort=1; mild discomfort=2; moderate discomfort=3; moderately severe discomfort=4; severe discomfort=5 and very severe discomfort=6. The overall GSRS score is a mean score that ranges from 0 (no symptoms) to 6 (the worst possible symptoms). This endpoint reports the average change from baseline (Day 0) between Day 1 and Week 10. Day 0: the day before a participant started randomized treatment (if the GI threshold was reached 1 day previously) or the first day of randomized treatment if the threshold was reached that day. If the threshold was reached >1 day previously, then Day 0 was the last day when the threshold was reached, prior to the first dose. A negative change from baseline indicates that symptoms decreased.

    Measured: Baseline (Day 0), Day 1 (1 day after Day 0), Week 10 (10 weeks after Day 0)

  3. Time to First Worsening From Baseline in GSRS Overall Score at Day 1 to Day 10

    The GSRS is a weekly recall scale that was modified for daily recall. The 15-question GSRS is summarized with a 7-point Likert scale: no discomfort at all=0; minor discomfort=1; mild discomfort=2; moderate discomfort=3; moderately severe discomfort=4; severe discomfort=5 and very severe discomfort=6. The overall GSRS score is a mean score that ranges from 0 (no symptoms) to 6 (the worst possible symptoms). Day 0: the day before a participant started randomized treatment (if the GI threshold was reached 1 day previously) or the first day of randomized treatment if the threshold was reached that day. If the threshold was reached >1 day previously, then Day 0 was the last day when the threshold was reached, prior to the first dose.. Time to the first worsening was defined as the number of days from Day 1 to the first date with a worsened GSRS score. Censoring occurred at Day 10.

    Measured: Baseline (Day 0), Day 1 (1 day after Day 0) to Day 10 (10 days after Day 0)

  4. Time to Recovery to Baseline GSRS Score From Last Occurrence of Worst GSRS Score at Day 1 to Week 8

    The GSRS is a weekly recall scale that was modified for daily recall. The 15-question GSRS is summarized with a 7-point Likert scale: no discomfort at all=0; minor discomfort=1; mild discomfort=2; moderate discomfort=3; moderately severe discomfort=4; severe discomfort=5 and very severe discomfort=6. The overall GSRS score is a mean score that ranges from 0 (no symptoms) to 6 (the worst possible symptoms). Recovery was defined as a GSRS score less than or equal to the Day 0 score. Day 0: the day before a participant started randomized treatment (if the GI threshold was reached 1 day previously) or the first day of randomized treatment if the threshold was reached that day. If the threshold was reached >1 day previously, then Day 0 was the last day when the threshold was reached, prior to the first dose. Time to recovery was defined as the date of recovery minus the date of the last occurrence of the worst score.

    Measured: Baseline (Day 0), Day 1 (1 Day after Day 0) to Week 8 (8 weeks after Day 0)

  5. Average Change From Baseline in GSRS Overall Score at Day 1 to Weeks 1 to 8

    The GSRS is a weekly recall scale that was modified for daily recall. The 15-question GSRS is summarized with a 7-point Likert scale: no discomfort at all=0; minor discomfort=1; mild discomfort=2; moderate discomfort=3; moderately severe discomfort=4; severe discomfort=5 and very severe discomfort=6. The overall GSRS score is a mean score that ranges from 0 (no symptoms) to 6 (the worst possible symptoms). This endpoint reports the average change from baseline (Day 0) between Day 1 and the specified time point. Day 0: the day before a participant started randomized treatment (if the GI threshold was reached 1 day previously) or the first day of randomized treatment if the threshold was reached that day. If the threshold was reached >1 day previously, then Day 0 was the last day when the threshold was reached, prior to the first dose. A negative change from baseline indicates that symptoms decreased.

    Measured: Baseline (Day 0), Day 1 (1 Day after Day 0), Weeks 1 to 8 (1-8 weeks after Day 0)

  6. Average Change From Baseline in GSRS Overall Score at Day 0 to 72 Hours From the Initiation of Randomized Study Treatment

    The GSRS is a weekly recall scale that was modified for daily recall. The 15-question GSRS is summarized with a 7-point Likert scale: no discomfort at all=0; minor discomfort=1; mild discomfort=2; moderate discomfort=3; moderately severe discomfort=4; severe discomfort=5 and very severe discomfort=6. The overall GSRS score is a mean score that ranges from 0 (no symptoms) to 6 (the worst possible symptoms). This endpoint reports the average change from baseline (Day 0) at Day 1 to Day 3. Day 0: the day before a participant started randomized treatment (if the GI threshold was reached 1 day previously) or the first day of randomized treatment if the threshold was reached that day. If the threshold was reached >1 day previously, then Day 0 is the last day when the threshold was reached, prior to the first dose. A negative change from baseline indicates that symptoms decreased.

    Measured: Baseline (Day 0), Day 3 (72 hours after Day 0)

  7. Percentage of Participants Who Required GI Symptomatic Therapy During the Study

    Symptomatic therapies were not permitted during the first 10 days after starting montelukast or placebo. From Day 10 onward, participants were allowed to use the following symptomatic therapies to treat DMF-related GI events: bismuth subsalicylate, simethicone, calcium carbonate, loperamide, proton-pump inhibitors and ondansetron.

    Measured: Day 10 to Week 10

  8. Percentage of Participants Who Discontinued DMF Therapy Due to GI-Related Adverse Events (AEs) From Day 0 to Week 10

    An AE was defined as any untoward medical occurrence in a participant administered a pharmaceutical product and that did not necessarily have a causal relationship with this treatment. An AE could therefore have been any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medicinal product, whether or not related to the medicinal product. Participants used an electronic diary to record GI-related events. GI-related AEs included diarrhea, nausea, upper abdominal pain, abdominal pain, and dyspepsia.

    Measured: Day 0 to Week 10

  9. Percentage of Participants Who Experienced AEs Related to Flushing

    An AE was defined as any untoward medical occurrence in a participant administered a pharmaceutical product and that did not necessarily have a causal relationship with this treatment. An AE could therefore have been any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medicinal product, whether or not related to the medicinal product. Flushing-related AEs included flushing and hot flush. Only events with an onset date on or after the date of first DMF dose (up to 27 days before Day 0) are presented. This includes events present before and subsequently worsened after the first dose of DMF.

    Measured: Day of first DMF dose (up to 27 days before Day 0) to Week 10

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Apr 2015 (estimated)
  2. Study start12 Mar 2015
  3. Primary completion16 Feb 2017
  4. Study completion27 Apr 2017

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
102 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02410278
Sponsor's protocol ID
109MS414
Acronym
MITIGATE
Status last verified
Mar 2020
First submitted
2 Apr 2015
Last updated
31 Mar 2020
Data monitoring committee
No

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing dimethyl fumarate and montelukast in people with Multiple Sclerosis, run by Biogen at 50 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 31 Mar 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 50 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 24 Jul 2018). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Percentage of Participants With a Worsening in Severity of Gastrointestinal (GI) Adverse Events (AEs) on the GSRS From Day 0 to Day 10 (time frame: Baseline (Day 0), Day 10 (10 days after Day 0)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 31 Mar 2020.

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