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Published in: BMC Neurology 1/2015

Open Access 01-12-2015 | Study protocol

The PANGAEA study design – a prospective, multicenter, non-interventional, long-term study on fingolimod for the treatment of multiple sclerosis in daily practice

Authors: Tjalf Ziemssen, Raimar Kern, Christian Cornelissen

Published in: BMC Neurology | Issue 1/2015

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Abstract

Background

Fingolimod (Gilenya®) is an oral medication for patients with highly active relapsing-remitting Multiple Sclerosis (RRMS). Clinical trials and post-marketing experience on more than 114,000 patients have established a detailed safety profile. Total patient exposure now exceeds 195,000 patient-years as stated in the last financial report (Dec 2014) of the Novartis Pharma AG, Basel, Switzerland. However, less is known about the safety of long-term fingolimod use in daily practice. Here, we describe the study design of PANGAEA (Post-Authorization Non-interventional German sAfety of GilEnyA in RRMS patients), a prospective, multicenter, non-interventional, long-term study to collect safety, efficacy, and pharmacoeconomic data on RRMS patients treated with fingolimod (0.5 mg/daily) under real-world conditions in Germany.

Methods

PANGAEA is striving to assess a real-world safety and efficacy profile of fingolimod, based on data from 4,000 RRMS patients, obtained during a 60-month observational phase. A pharmacoeconomic sub-study of 800 RRMS patients further collects patient-reported outcome measures of disability, quality of life, compliance, treatment satisfaction, and usage of resources during a 24-month observational phase. Descriptive statistical analyses of the safety set as well as of stratified subgroups such as patients with concomitant diabetes mellitus and pretreated patients (e.g., natalizumab) will be conducted.

Discussion

PANGAEA seeks to confirm the current safety profile of fingolimod obtained in phase I-III clinical trials. The study design presented here will additionally provide guidance on the therapeutic use of fingolimod in clinical practice and possibly assists physicians in making evidence-based decisions.
Literature
2.
go back to reference Brunkhorst R, Vutukuri R, Pfeilschifter W. Fingolimod for the treatment of neurological diseases-state of play and future perspectives. Front Cell Neurosci. 2014;8:283.CrossRefPubMedPubMedCentral Brunkhorst R, Vutukuri R, Pfeilschifter W. Fingolimod for the treatment of neurological diseases-state of play and future perspectives. Front Cell Neurosci. 2014;8:283.CrossRefPubMedPubMedCentral
3.
go back to reference Hla T, Brinkmann V. Sphingosine 1-phosphate (S1P): Physiology and the effects of S1P receptor modulation. Neurology. 2011;76:S3–8.CrossRefPubMed Hla T, Brinkmann V. Sphingosine 1-phosphate (S1P): Physiology and the effects of S1P receptor modulation. Neurology. 2011;76:S3–8.CrossRefPubMed
4.
go back to reference Oo ML, Thangada S, Wu MT, Liu CH, Macdonald TL, Lynch KR, et al. Immunosuppressive and anti-angiogenic sphingosine 1-phosphate receptor-1 agonists induce ubiquitinylation and proteasomal degradation of the receptor. J Biol Chem. 2007;282:9082–9.CrossRefPubMed Oo ML, Thangada S, Wu MT, Liu CH, Macdonald TL, Lynch KR, et al. Immunosuppressive and anti-angiogenic sphingosine 1-phosphate receptor-1 agonists induce ubiquitinylation and proteasomal degradation of the receptor. J Biol Chem. 2007;282:9082–9.CrossRefPubMed
5.
go back to reference Brinkmann V. FTY720 (fingolimod) in Multiple Sclerosis: therapeutic effects in the immune and the central nervous system. Br J Pharmacol. 2009;158:1173–82.CrossRefPubMedPubMedCentral Brinkmann V. FTY720 (fingolimod) in Multiple Sclerosis: therapeutic effects in the immune and the central nervous system. Br J Pharmacol. 2009;158:1173–82.CrossRefPubMedPubMedCentral
6.
go back to reference Baumruker T, Billich A, Brinkmann V. FTY720, an immunomodulatory sphingolipid mimetic: translation of a novel mechanism into clinical benefit in multiple sclerosis. Expert Opin Investig Drugs. 2007;16:283–9.CrossRefPubMed Baumruker T, Billich A, Brinkmann V. FTY720, an immunomodulatory sphingolipid mimetic: translation of a novel mechanism into clinical benefit in multiple sclerosis. Expert Opin Investig Drugs. 2007;16:283–9.CrossRefPubMed
7.
go back to reference Groves A, Kihara Y, Chun J. Fingolimod: direct CNS effects of sphingosine 1-phosphate (S1P) receptor modulation and implications in multiple sclerosis therapy. J Neurol Sci. 2013;328:9–18.CrossRefPubMedPubMedCentral Groves A, Kihara Y, Chun J. Fingolimod: direct CNS effects of sphingosine 1-phosphate (S1P) receptor modulation and implications in multiple sclerosis therapy. J Neurol Sci. 2013;328:9–18.CrossRefPubMedPubMedCentral
8.
go back to reference Kappos L, Radue EW, O’Connor P, Polman C, Hohlfeld R, Calabresi P, et al. A placebo-controlled trial of oral fingolimod in relapsing multiple sclerosis. N Engl J Med. 2010;362:387–401.CrossRefPubMed Kappos L, Radue EW, O’Connor P, Polman C, Hohlfeld R, Calabresi P, et al. A placebo-controlled trial of oral fingolimod in relapsing multiple sclerosis. N Engl J Med. 2010;362:387–401.CrossRefPubMed
9.
go back to reference Cohen JA, Barkhof F, Comi G, Hartung HP, Khatri BO, Montalban X, et al. Oral fingolimod or intramuscular interferon for relapsing multiple sclerosis. N Engl J Med. 2010;362:402–15.CrossRefPubMed Cohen JA, Barkhof F, Comi G, Hartung HP, Khatri BO, Montalban X, et al. Oral fingolimod or intramuscular interferon for relapsing multiple sclerosis. N Engl J Med. 2010;362:402–15.CrossRefPubMed
10.
go back to reference Calabresi PA, Radue EW, Goodin D, Jeffery D, Rammohan KW, Reder AT, et al. Safety and efficacy of fingolimod in patients with relapsing-remitting multiple sclerosis (FREEDOMS II): a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Neurol. 2014;13:545–56.CrossRefPubMed Calabresi PA, Radue EW, Goodin D, Jeffery D, Rammohan KW, Reder AT, et al. Safety and efficacy of fingolimod in patients with relapsing-remitting multiple sclerosis (FREEDOMS II): a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Neurol. 2014;13:545–56.CrossRefPubMed
11.
go back to reference Laroni A, Brogi D, Morra VB, Guidi L, Pozzilli C, Comi G, et al. Safety of the first dose of fingolimod for multiple sclerosis: results of an open-label clinical trial. BMC Neurol. 2014;14:65.CrossRefPubMedPubMedCentral Laroni A, Brogi D, Morra VB, Guidi L, Pozzilli C, Comi G, et al. Safety of the first dose of fingolimod for multiple sclerosis: results of an open-label clinical trial. BMC Neurol. 2014;14:65.CrossRefPubMedPubMedCentral
13.
go back to reference Boulton C, Meiser K, David OJ, Schmouder R. Pharmacodynamic effects of steady-state fingolimod on antibody response in healthy volunteers: a 4-week, randomized, placebo-controlled, parallel-group, multiple-dose study. J Clin Pharmacol. 2012;52:1879–90.CrossRefPubMed Boulton C, Meiser K, David OJ, Schmouder R. Pharmacodynamic effects of steady-state fingolimod on antibody response in healthy volunteers: a 4-week, randomized, placebo-controlled, parallel-group, multiple-dose study. J Clin Pharmacol. 2012;52:1879–90.CrossRefPubMed
14.
go back to reference Jain N, Bhatti MT. Fingolimod-associated macular edema: incidence, detection, and management. Neurology. 2012;78:672–80.CrossRefPubMed Jain N, Bhatti MT. Fingolimod-associated macular edema: incidence, detection, and management. Neurology. 2012;78:672–80.CrossRefPubMed
16.
go back to reference Uitdehaag BM, Barkhof F, Coyle PK, Gardner JD, Jeffery DR, Mikol DD. The changing face of multiple sclerosis clinical trial populations. Curr Med Res Opin. 2011;27:1529–37.CrossRefPubMed Uitdehaag BM, Barkhof F, Coyle PK, Gardner JD, Jeffery DR, Mikol DD. The changing face of multiple sclerosis clinical trial populations. Curr Med Res Opin. 2011;27:1529–37.CrossRefPubMed
19.
go back to reference Hein T, Hopfenmuller W. Projection of the number of multiple sclerosis patients in Germany. Nervenarzt. 2000;71:288–94.CrossRefPubMed Hein T, Hopfenmuller W. Projection of the number of multiple sclerosis patients in Germany. Nervenarzt. 2000;71:288–94.CrossRefPubMed
20.
go back to reference Ziemssen T, Kempcke R, Eulitz M, Grossmann L, Suhrbier A, Thomas K, et al. Multiple sclerosis documentation system (MSDS): moving from documentation to management of MS patients. J Neural Transm. 2013;120 Suppl 1:S61–66.CrossRefPubMed Ziemssen T, Kempcke R, Eulitz M, Grossmann L, Suhrbier A, Thomas K, et al. Multiple sclerosis documentation system (MSDS): moving from documentation to management of MS patients. J Neural Transm. 2013;120 Suppl 1:S61–66.CrossRefPubMed
21.
go back to reference Guy W. Clinical Global Impressions (CGI) Scale. In: Rush AJ, First MB, Blacker D, editors. Handbook of psychiatric measures. 2nd ed. Arlington, VA: American Psychiatric Association; 2008. p. 90–2. Guy W. Clinical Global Impressions (CGI) Scale. In: Rush AJ, First MB, Blacker D, editors. Handbook of psychiatric measures. 2nd ed. Arlington, VA: American Psychiatric Association; 2008. p. 90–2.
22.
go back to reference Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983;33:1444–52.CrossRefPubMed Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983;33:1444–52.CrossRefPubMed
23.
go back to reference Cutter GR, Baier ML, Rudick RA, Cookfair DL, Fischer JS, Petkau J, et al. Development of a multiple sclerosis functional composite as a clinical trial outcome measure. Brain. 1999;122(Pt 5):871–82.CrossRefPubMed Cutter GR, Baier ML, Rudick RA, Cookfair DL, Fischer JS, Petkau J, et al. Development of a multiple sclerosis functional composite as a clinical trial outcome measure. Brain. 1999;122(Pt 5):871–82.CrossRefPubMed
24.
go back to reference Smith A. Symbol Digit Modalities Test (SDMT). Manual (revised). Los Angeles, CA: Western Psychological Services; 1982. Smith A. Symbol Digit Modalities Test (SDMT). Manual (revised). Los Angeles, CA: Western Psychological Services; 1982.
25.
go back to reference Sharrack B, Hughes RA. The Guy’s Neurological Disability Scale (GNDS): a new disability measure for multiple sclerosis. Mult Scler. 1999;5:223–33.CrossRefPubMed Sharrack B, Hughes RA. The Guy’s Neurological Disability Scale (GNDS): a new disability measure for multiple sclerosis. Mult Scler. 1999;5:223–33.CrossRefPubMed
26.
go back to reference Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33:337–43.CrossRefPubMed Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33:337–43.CrossRefPubMed
27.
go back to reference Doward LC, McKenna SP, Meads DM, Twiss J, Eckert BJ. The development of patient-reported outcome indices for multiple sclerosis (PRIMUS). Mult Scler. 2009;15:1092–102.CrossRefPubMed Doward LC, McKenna SP, Meads DM, Twiss J, Eckert BJ. The development of patient-reported outcome indices for multiple sclerosis (PRIMUS). Mult Scler. 2009;15:1092–102.CrossRefPubMed
28.
go back to reference Bharmal M, Payne K, Atkinson MJ, Desrosiers MP, Morisky DE, Gemmen E. Validation of an abbreviated Treatment Satisfaction Questionnaire for Medication (TSQM-9) among patients on antihypertensive medications. Health Qual Life Outcomes. 2009;7:36.CrossRefPubMedPubMedCentral Bharmal M, Payne K, Atkinson MJ, Desrosiers MP, Morisky DE, Gemmen E. Validation of an abbreviated Treatment Satisfaction Questionnaire for Medication (TSQM-9) among patients on antihypertensive medications. Health Qual Life Outcomes. 2009;7:36.CrossRefPubMedPubMedCentral
33.
go back to reference Schultheiss T, Kempcke R, Kratzsch F, Eulitz M, Pette M, Reichmann H, et al. Multiple sclerosis management system 3D. Moving from documentation towards management of patients. Nervenarzt. 2012;83:450–7.CrossRefPubMed Schultheiss T, Kempcke R, Kratzsch F, Eulitz M, Pette M, Reichmann H, et al. Multiple sclerosis management system 3D. Moving from documentation towards management of patients. Nervenarzt. 2012;83:450–7.CrossRefPubMed
34.
go back to reference Centonze D, Rossi S, Rinaldi F, Gallo P. Severe relapses under fingolimod treatment prescribed after natalizumab. Neurology. 2012;79:2004–5.CrossRefPubMed Centonze D, Rossi S, Rinaldi F, Gallo P. Severe relapses under fingolimod treatment prescribed after natalizumab. Neurology. 2012;79:2004–5.CrossRefPubMed
35.
go back to reference Cohen M, Maillart E, Tourbah A, De Seze J, Vukusic S, Brassat D, et al. Switching from natalizumab to fingolimod in multiple sclerosis: a French prospective study. JAMA Neurol. 2014;71:436–41.CrossRefPubMed Cohen M, Maillart E, Tourbah A, De Seze J, Vukusic S, Brassat D, et al. Switching from natalizumab to fingolimod in multiple sclerosis: a French prospective study. JAMA Neurol. 2014;71:436–41.CrossRefPubMed
36.
go back to reference Chun J, Brinkmann V. A mechanistically novel, first oral therapy for multiple sclerosis: the development of fingolimod (FTY720, Gilenya). Discov Med. 2011;12:213–28.PubMedPubMedCentral Chun J, Brinkmann V. A mechanistically novel, first oral therapy for multiple sclerosis: the development of fingolimod (FTY720, Gilenya). Discov Med. 2011;12:213–28.PubMedPubMedCentral
Metadata
Title
The PANGAEA study design – a prospective, multicenter, non-interventional, long-term study on fingolimod for the treatment of multiple sclerosis in daily practice
Authors
Tjalf Ziemssen
Raimar Kern
Christian Cornelissen
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2015
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-015-0342-0

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