LITMUS

Treatment tested

• Aldesleukin

  Interleukin-2 receptor agonist

Other measures (1)

Inclusion: 1. Able to provide informed consent 2. Definite diagnosis of relapsing-remitting multiple sclerosis 3. Treated with alemtuzumab or cladribine within a specified period before recruitment Exclusion: 1. Concurrent treatment with Copaxone, beta interferon, dimethyl fumarate, teriflunomide, fingolimod, natalizumab or ocrelizumab 2. Concurrent use of any other immunosuppressant or cytotoxic therapy 3. Oral/IV high-dose steroid use within 4 weeks of recruitment to the study 4. Participants who have received an investigational drug (including investigational vaccines) or used an invasive investigational medical device within 4 weeks before the screening assessment, or are currently enrolled in an interventional investigational trial 5. Any planned vaccination in the 4 weeks preceding screening, or at any point during the study 6. Hypersensitivity to Proleukin or any of its excipients 7. History of severe cardiac disease 8. History of malignancy 5 years prior to screening (except adequately treated cervical carcinoma in situ, or basal and squamous cell skin carcinoma) 9. Clinically significant renal, hepatic, or haematological abnormalities as defined in the study protocol 10. Evidence of an active infection. Participants may be recruited a minimum of 48 hours after the resolution of illness or completion of antibacterial/antiviral therapy 11. Pregnant or breastfeeding women; or male and female participants who do not agree to use a highly effective method of contraception during the study 12. Any other factor deemed potentially relevant by the research team

Background and study aims Multiple sclerosis (MS) is an autoimmune disease in which the patient’s own immune system attacks their brain and spinal cord causing damage and disability. Alemtuzumab and cladribine are licensed treatments for MS that work by depleting immune cells, including the MS-causing cells. The immune system is then allowed to grow back. These treatments are known as induction therapies as there is no need for continuous medication. Alongside MS-causing cells, both alemtuzumab and cladribine deplete T-regulatory cells (Tregs). Tregs are very important immune cells, as they help keep the rest of the immune system under control, preventing autoimmunity. The purpose of this study is to test whether low doses of a drug called Proleukin can selectively expand the number of Tregs in people with MS who have been treated with alemtuzumab or cladribine as part of their routine medical care. Increasing Treg levels after alemtuzumab could improve its safety, as 4 out of 10 patients develop a new autoimmune disease (mainly affecting the thyroid gland) after treatment. Increasing Tregs after cladribine could improve its efficacy as 1 in 4 patients get more MS attacks after treatment. Proleukin is the drug version of a naturally occurring immune cell growth factor called interleukin-2 (IL-2). When given at very low doses, IL-2 has been shown to selectively increase Treg numbers in humans in a variety of settings other than MS (such as diabetes, lupus, and vasculitis). It has been shown to be very safe. Who can participate? People who have already been treated with alemtuzumab or cladribine for MS What does the study involve? In this study, participants will be given 6 subcutaneous injections (i.e. injections under the skin) of low-dose IL-2 over a 3-week period, and provide blood samples to measure T-reg cells. What are the possible benefits and risks of participating? We do not expect any clinical benefits over this very short time frame. This is purely a mechanistic study, the readout of which will be Treg frequency before and after treatment. The main risk of taking part is mild injection site reactions. We do not anticipate any other significant risks as studies in other (non-MS) autoimmune conditions have shown Proleukin at low doses is typically very safe and well tolerated, with few and mild side effects. There is a theoretical risk of increasing cells other than T-regs with Proleukin. However, such an effect, if it occurred, is expected to be short-lived (because the treatment period is very short). Therefore, we would not expect it to pose a significant risk, but we will carefully monitor participants for 4 weeks after stopping treatment (i.e. longer than the treatment period itself). Where is the study run from? The University of Cambridge, Department of Clinical Neurosciences (UK) When is the study starting and how long is it expected to run for? June 2021 to December 2023 Who is funding the study? Wellcome Trust (UK) Who is the main contact? Dr Joanne Jones (UK) jls53@medschl.cam.ac.uk