MultiSCRIPT-Cycle 1-a pragmatic trial embedded within the Swiss Multiple Sclerosis Cohort (SMSC) on neurofilament light chain monitoring to inform personalized treatment decisions in multiple sclerosis: a study protocol for a randomized clinical trial.

Humans Neurofilament Proteins / blood Multiple Sclerosis, Relapsing-Remitting / drug therapy Pragmatic Clinical Trials as Topic Biomarkers / blood Precision Medicine / methods Switzerland Randomized Controlled Trials as Topic Clinical Decision-Making Multicenter Studies as Topic Treatment Outcome Disease Progression Time Factors Predictive Value of Tests Disability Evaluation Quality of Life

Journal

Trials

ISSN: 1745-6215

Titre abrégé: Trials

Pays: England

ID NLM: 101263253

Informations de publication

Date de publication:
11 Sep 2024

Historique:

received: 15 04 2024

accepted: 04 09 2024

medline: 12 9 2024

pubmed: 12 9 2024

entrez: 11 9 2024

Statut: epublish

Résumé

Treatment decisions for persons with relapsing-remitting multiple sclerosis (RRMS) rely on clinical and radiological disease activity, the benefit-harm profile of drug therapy, and preferences of patients and physicians. However, there is limited evidence to support evidence-based personalized decision-making on how to adapt disease-modifying therapy treatments targeting no evidence of disease activity, while achieving better patient-relevant outcomes, fewer adverse events, and improved care. Serum neurofilament light chain (sNfL) is a sensitive measure of disease activity that captures and prognosticates disease worsening in RRMS. sNfL might therefore be instrumental for a patient-tailored treatment adaptation. We aim to assess whether 6-monthly sNfL monitoring in addition to usual care improves patient-relevant outcomes compared to usual care alone. Pragmatic multicenter, 1:1 randomized, platform trial embedded in the Swiss Multiple Sclerosis Cohort (SMSC). All patients with RRMS in the SMSC for ≥ 1 year are eligible. We plan to include 915 patients with RRMS, randomly allocated to two groups with different care strategies, one of them new (group A) and one of them usual care (group B). In group A, 6-monthly monitoring of sNfL will together with information on relapses, disability, and magnetic resonance imaging (MRI) inform personalized treatment decisions (e.g., escalation or de-escalation) supported by pre-specified algorithms. In group B, patients will receive usual care with their usual 6- or 12-monthly visits. Two primary outcomes will be used: (1) evidence of disease activity (EDA3: occurrence of relapses, disability worsening, or MRI activity) and (2) quality of life (MQoL-54) using 24-month follow-up. The new treatment strategy with sNfL will be considered superior to usual care if either more patients have no EDA3, or their health-related quality of life increases. Data collection will be embedded within the SMSC using established trial-level quality procedures. MultiSCRIPT aims to be a platform where research and care are optimally combined to generate evidence to inform personalized decision-making in usual care. This approach aims to foster better personalized treatment and care strategies, at low cost and with rapid translation to clinical practice. ClinicalTrials.gov NCT06095271. Registered on October 23, 2023.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

Pragmatic multicenter, 1:1 randomized, platform trial embedded in the Swiss Multiple Sclerosis Cohort (SMSC). All patients with RRMS in the SMSC for ≥ 1 year are eligible. We plan to include 915 patients with RRMS, randomly allocated to two groups with different care strategies, one of them new (group A) and one of them usual care (group B). In group A, 6-monthly monitoring of sNfL will together with information on relapses, disability, and magnetic resonance imaging (MRI) inform personalized treatment decisions (e.g., escalation or de-escalation) supported by pre-specified algorithms. In group B, patients will receive usual care with their usual 6- or 12-monthly visits. Two primary outcomes will be used: (1) evidence of disease activity (EDA3: occurrence of relapses, disability worsening, or MRI activity) and (2) quality of life (MQoL-54) using 24-month follow-up. The new treatment strategy with sNfL will be considered superior to usual care if either more patients have no EDA3, or their health-related quality of life increases. Data collection will be embedded within the SMSC using established trial-level quality procedures.

DISCUSSION CONCLUSIONS

MultiSCRIPT aims to be a platform where research and care are optimally combined to generate evidence to inform personalized decision-making in usual care. This approach aims to foster better personalized treatment and care strategies, at low cost and with rapid translation to clinical practice.

TRIAL REGISTRATION BACKGROUND

ClinicalTrials.gov NCT06095271. Registered on October 23, 2023.

Identifiants

DOI: 10.1186/s13063-024-08454-6 PMID: 39261900

pubmed: 39261900

doi: 10.1186/s13063-024-08454-6

pii: 10.1186/s13063-024-08454-6

doi:

Substances chimiques

Neurofilament Proteins 0

neurofilament protein L 0

Biomarkers 0

Banques de données

ClinicalTrials.gov

['NCT06095271']

Types de publication

Journal Article Clinical Trial Protocol

Langues

eng

Sous-ensembles de citation

Pagination

607

Subventions

Organisme : Swiss National Science Foundation

ID : 205806

Pays : Switzerland

Informations de copyright

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