Combination Therapy in Patients With Relapsing-Remitting Multiple Sclerosis (MS)CombiRx
What it found
The main measure did not show a significant benefit.
“Combination IFN+GA was not superior to the better of the single agents (GA) in risk of relapse.”Read by software from the paper's abstract
reduction in annualized relapse rate utilizing a strict definition of relapse · 3 years
Total participants: 1,008
Read by software from the paper's abstract
What was tested
Treatment tested
- Interferon beta 1-a
- Glatiramer acetate
Unknown
Placebo or sham
- placebo
Results by group
ARR - PDEs
Baseline to Month 36
| Group | Value | Interval | Number analysed |
|---|---|---|---|
| IFN + GA | 0.12 relapses per year | 499 | |
| IFB-1a | 0.16 relapses per year | 250 | |
| Glatiramer | 0.11 relapses per year | 259 |
IFN + GA
IFB-1a
Glatiramer
Values as posted on ClinicalTrials.gov. Outcomes measured differently across trials are not directly comparable.
Safety
| Group | Participants at risk | Serious adverse events | Deaths |
|---|---|---|---|
| IFN + GA | 499 | 70 (14.0%) | |
| IFB-1a | 250 | 38 (15.2%) | |
| Glatiramer | 259 | 30 (11.6%) |
As posted on ClinicalTrials.gov. Serious adverse events include any serious health event during the trial, whether or not the treatment caused it.
What it measured
Main measures
ARR - PDEs
Baseline to Month 36
Disability progressionRelapsesThinking and memoryBladder, bowel and sexual function
Other measures (3)
Confirmed Progression on the Expanded Disability Status Scale
Baseline to Month 36
Disability progressionChange in the Multiple Sclerosis Functional Composite
Baseline to month 36
Disability progressionVisionBladder, bowel and sexual functionChange in MRI Composite Score
Baseline to month 36
MRI lesionsBrain volume lossBlood or spinal fluid markers
Who could take part
Relapsing MS · 18 to 60
Inclusion Criteria: * Male and female subjects between the ages of 18 and 60 years, inclusive. * Diagnosis of relapsing-remitting MS by either the Poser or McDonald criteria. * Expanded Disability Status Scale (EDSS) score between 0 and 5.5, inclusive. * At least 2 exacerbations in the prior three years; one exacerbation may utilize the McDonald MRI criteria for dissemination in time (a new gadolinium [Gd]-enhancing lesion demonstrated on a scan done at least 3 months following onset of a clinical attack or a new T2 lesion or Gd-enhancing lesion on a follow-up scan after an additional 3 months). * Give written informed consent prior to any testing under this protocol, including screening tests and evaluations that are not considered part of the subject's routine care. Exclusion Criteria: * Any prior use of interferon beta or glatiramer acetate. * Acute exacerbation within 30 days of screening. * Steroids for acute exacerbations (>100 mg/day) within 30 days of study entrance or chronic systemic steroid use. * Evidence of progressive MS. * Use IVIg, azathioprine, methotrexate, cyclosporine, mitoxantrone, cyclophosphamide, mycophenolate (CellCept) or plasma exchange in the twelve weeks prior to study drug dosing. * Any previous treatment with natalizumab (Tysabri, Antegren), cladribine, T cell vaccine, Campath, daclizumab, rituximab, altered peptide ligand or total lymphoid irradiation. * Treatment with 4 aminopyridines in the four weeks prior to study drug dosing. * Prior treatment with any other investigational drug, unless approved by the Clinical Coordinating Center (Dr. Lublin). * Inability to perform the baseline MSFC (timed 25-foot walk, 9-hole peg test [9HPT], and Paced Auditory Serial Addition Test 3 [PASAT3]). * Inability to undergo baseline MRI scan. * History of any significant cardiac, hepatic, pulmonary, or renal disease, immune deficiency, or other medical conditions that would preclude therapy with interferon beta, glatiramer acetate, or participation in this study. * Known history of sensitivity to gadopentetate dimeglumine or mannitol. * History of a seizure within the 3 months prior to randomization. * History of suicidal ideation or an episode of severe depression within the 3 months prior to randomization. * Abnormal screening blood tests exceeding any of the limits defined below: * Alanine transaminase (ALT) or aspartate transaminase (AST) greater than two times the upper limit of normal (i.e., >2 × ULN) * Total white blood cell count \<2,300/mm3 * Platelet count \<80,000/mm3 * Creatinine >2 × ULN * Participation in another experimental clinical trial, without formal approval. * History of alcohol or drug abuse within the 2 years prior to randomization. * Female subjects who are currently pregnant, breast-feeding, or plan to become pregnant. * For female subjects, unless postmenopausal or surgically sterile, unwillingness to practice effective contraception, as defined by the investigator, during the study. The rhythm method is not to be used as the sole method of contraception. * Unwillingness or inability to comply with the requirements of this protocol including the presence of any condition that is likely to affect the subject's returning for scheduled follow-up visits on schedule (any physical, mental, or social condition).
As registered. Criteria can change, so ask the trial team or your neurologist.
About this trial
In the sponsor's words
This is for a randomized clinical trial (RCT) to determine if the combined use of interferon beta-1a (IFN) and glatiramer acetate (GA) is a measurably better therapy than either agent used individually in patients with relapsing-remitting (RR) multiple sclerosis (MS).
Papers
Results
Early first-line treatment response and subsequent disability worsening in relapsing-remitting multiple sclerosis.Eur J Neurol · 2022
Results
Comparison of the EDSS, Timed 25-Foot Walk, and the 9-Hole Peg Test as Clinical Trial Outcomes in Relapsing-Remitting Multiple Sclerosis.Neurology · 2021
Results
Treatment Response Score to Glatiramer Acetate or Interferon Beta-1a.Neurology · 2021
Results
Comorbidity is associated with disease activity in MS: Findings from the CombiRx trial.Neurology · 2020
Results
Brain and lesion segmentation in multiple sclerosis using fully convolutional neural networks: A large-scale study.Mult Scler · 2020
Results
Long-term follow-up of a randomized study of combination interferon and glatiramer acetate in multiple sclerosis: Efficacy and safety results up to 7 years.Mult Scler Relat Disord · 2017
Results
Regional gray matter atrophy in relapsing remitting multiple sclerosis: baseline analysis of multi-center data.Mult Scler Relat Disord · 2015
Results
Effect of in-painting on cortical thickness measurements in multiple sclerosis: A large cohort study.Hum Brain Mapp · 2015
Results
Randomized study combining interferon and glatiramer acetate in multiple sclerosis.Ann Neurol · 2013
Combination IFN+GA was not superior to the better of the single agents (GA) in risk of relapse.
Read by software from the paper's abstract
Results
Koch MW, Moral E, Brieva L, Mostert J, Strijbis EM, Comtois J, Repovic P, Bowen JD, Wolinsky JS, Lublin FD, Cutter G. Relapse recovery in relapsing-remitting multiple sclerosis: An analysis of the CombiRx dataset. Mult Scler. 2023 Dec;29(14):1776-1785. doi: 10.1177/13524585231202320. Epub 2023 Oct 13.
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History
Started
Jan 2005
Main results due
Apr 2012
Finished
Mar 2013
Results posted
Apr 2014
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