ACTIVE_NOT_RECRUITING

Traditional Versus Early Aggressive Therapy for Multiple Sclerosis Trial

Description

FDA-approved multiple sclerosis (MS) disease-modifying therapies (DMTs) target the relapsing phase of MS but have minimal impact once the progressive phase has begun. It is unclear if, in the relapsing phase, there is an advantage of early aggressive therapy with respect to preventing long-term disability. The infectious risks and other complications associated with higher-efficacy treatments highlight the need to quantify their effectiveness in preventing disability. The TRaditional versus Early Aggressive Therapy for MS (TREAT-MS) trial is a pragmatic, randomized controlled trial that has two primary aims: 1) to evaluate, jointly and independently among patients deemed at higher risk vs. lower risk for disability accumulation, whether an "early aggressive" therapy approach, versus starting with a traditional, first-line therapy, influences the intermediate-term risk of disability, and 2) to evaluate if, among patients deemed at lower risk for disability who start on first-line MS therapies but experience breakthrough disease, those who switch to a higher-efficacy versus a new first-line therapy have different intermediate-term risk of disability.

Study Overview

Study Details

Study overview

FDA-approved multiple sclerosis (MS) disease-modifying therapies (DMTs) target the relapsing phase of MS but have minimal impact once the progressive phase has begun. It is unclear if, in the relapsing phase, there is an advantage of early aggressive therapy with respect to preventing long-term disability. The infectious risks and other complications associated with higher-efficacy treatments highlight the need to quantify their effectiveness in preventing disability. The TRaditional versus Early Aggressive Therapy for MS (TREAT-MS) trial is a pragmatic, randomized controlled trial that has two primary aims: 1) to evaluate, jointly and independently among patients deemed at higher risk vs. lower risk for disability accumulation, whether an "early aggressive" therapy approach, versus starting with a traditional, first-line therapy, influences the intermediate-term risk of disability, and 2) to evaluate if, among patients deemed at lower risk for disability who start on first-line MS therapies but experience breakthrough disease, those who switch to a higher-efficacy versus a new first-line therapy have different intermediate-term risk of disability.

A Pragmatic Trial to Evaluate the Intermediate-term Effects of Early, Aggressive Versus Escalation Therapy in People With Multiple Sclerosis

Traditional Versus Early Aggressive Therapy for Multiple Sclerosis Trial

Condition
Multiple Sclerosis, Relapsing-Remitting
Intervention / Treatment

-

Contacts and Locations

Birmingham

University of Alabama at Birmingham, Birmingham, Alabama, United States, 35233

Mobile

The University of South Alabama, Mobile, Alabama, United States, 36604

Phoenix

St. Joseph's Hospital & Medical Center - Barrow Neurological Institute, Phoenix, Arizona, United States, 85013

Carmichael

CommonSpirit Health Research Institute, Carmichael, California, United States, 95608

Los Angeles

Cedars-Sinai Medical Center, Los Angeles, California, United States, 90048

Los Angeles

University of California, Los Angeles, Los Angeles, California, United States, 90095

San Diego

University of California, San Diego, San Diego, California, United States, 92037

San Francisco

University of California, San Francisco, San Francisco, California, United States, 94158

Newark

Christiana Care Health Services, Inc., Newark, Delaware, United States, 19713

Washington

Georgetown University, Washington, District of Columbia, United States, 20007

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

For general information about clinical research, read Learn About Studies.

Eligibility Criteria

  • * Aged 18-60 years
  • * Meets 2017 McDonald criteria for relapsing-remitting MS \[patients with clinically isolated syndrome (CIS) are not eligible\]
  • * Must be EITHER John Cunningham (JC) virus antibody negative or low positive (index antibody titer \<0.9), OR negative for: Hepatitis B and C, tuberculosis
  • * HIV negative
  • * No chemotherapy in past year; if patient has prior history of chemotherapy or malignancy, documentation in chart explaining why potential risks of higher-efficacy therapy are justified
  • * Prior treatment with rituximab, ocrelizumab, ofatumumab, alemtuzumab, mitoxantrone or cladribine
  • * Prior treatment with any other MS DMT for more than 6 months
  • * Prior treatment with experimental aggressive therapies (e.g., T-cell vaccine, total lymphoid radiation, stem cells)
  • * Treatment with teriflunomide within past 2 years (even for ≤ 6 months), unless rapid wash out done (i.e., with cholestyramine or activated charcoal)
  • * Treatment in the past 6 months with any MS DMT
  • * Prior treatment with any other investigational immune-modulating /suppressing drug for MS not listed above
  • * Pregnant or breast-feeding
  • * Women of child-bearing age who are planning or strongly considering conception during the study time frame

Ages Eligible for Study

18 Years to 60 Years

Sexes Eligible for Study

ALL

Accepts Healthy Volunteers

No

Collaborators and Investigators

Johns Hopkins University,

Ellen M. Mowry, MD, MCR, PRINCIPAL_INVESTIGATOR, Johns Hopkins University

Scott D. Newsome, DO, PRINCIPAL_INVESTIGATOR, Johns Hopkins University

Study Record Dates

2026-08-01