Trial Outcomes & Findings for Phase 4 Gastrointestinal Tolerability Study of Dimethyl Fumarate in Patients With Relapsing Forms of Multiple Sclerosis in the United States (NCT NCT01873417)

NCT ID: NCT01873417

Last Updated: 2017-03-21

Results Overview

Severity of GI-related events in DMF-treated participants using the MOGISS to measure GI symptoms, based on a 0- to 10-point scale, with 0 representing absence of symptoms and 10 representing the most severe symptoms.

Recruitment status

COMPLETED

Study phase

PHASE4

Target enrollment

237 participants

Primary outcome timeframe

12 Weeks

Results posted on

2017-03-21

Participant Flow

Participant milestones

Participant milestones
Measure
Dimethyl Fumarate
120 mg dimethyl fumarate (DMF) twice daily (BID) for the first 7 days and 240 mg DMF BID thereafter for 12 weeks of treatment. Participants were instructed to take the DMF dose with food (with a meal or within 1 hour after a meal).
Overall Study
STARTED
237
Overall Study
Safety Population
233
Overall Study
COMPLETED
202
Overall Study
NOT COMPLETED
35

Reasons for withdrawal

Reasons for withdrawal
Measure
Dimethyl Fumarate
120 mg dimethyl fumarate (DMF) twice daily (BID) for the first 7 days and 240 mg DMF BID thereafter for 12 weeks of treatment. Participants were instructed to take the DMF dose with food (with a meal or within 1 hour after a meal).
Overall Study
Did Not Receive Any Study Drug
4
Overall Study
Adverse Event
24
Overall Study
Lost to Follow-up
2
Overall Study
Withdrawal by Subject
2
Overall Study
Physician Decision
3

Baseline Characteristics

Phase 4 Gastrointestinal Tolerability Study of Dimethyl Fumarate in Patients With Relapsing Forms of Multiple Sclerosis in the United States

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Dimethyl Fumarate
n=233 Participants
120 mg dimethyl fumarate (DMF) twice daily (BID) for the first 7 days and 240 mg DMF BID thereafter for 12 weeks of treatment. Participants were instructed to take the DMF dose with food (with a meal or within 1 hour after a meal).
Age, Continuous
46.9 years
STANDARD_DEVIATION 11.66 • n=93 Participants
Sex: Female, Male
Female
181 Participants
n=93 Participants
Sex: Female, Male
Male
52 Participants
n=93 Participants

PRIMARY outcome

Timeframe: 12 Weeks

Population: Evaluable participants (treated participants who utilized symptomatic therapy during the overall treatment period \[12 weeks\]).

Severity of GI-related events in DMF-treated participants using the MOGISS to measure GI symptoms, based on a 0- to 10-point scale, with 0 representing absence of symptoms and 10 representing the most severe symptoms.

Outcome measures

Outcome measures
Measure
Dimethyl Fumarate
n=128 Participants
120 mg dimethyl fumarate (DMF) twice daily (BID) for the first 7 days and 240 mg DMF BID thereafter for 12 weeks of treatment. Participants were instructed to take the DMF dose with food (with a meal or within 1 hour after a meal).
Worst Severity Score of Overall Gastrointestinal (GI) Events, Modified Overall GI Symptom Scale (MOGISS)
4.8 units on a scale
Standard Deviation 2.34

PRIMARY outcome

Timeframe: 12 Weeks

Population: Evaluable participants (treated participants who utilized symptomatic therapy during the overall treatment period \[12 weeks\]).

Severity of GI-related events in DMF-treated participants using the MAGISS to measure GI symptoms, based on a 0- to 10-point scale, with 0 representing absence of symptoms and 10 representing the most severe symptoms.

Outcome measures

Outcome measures
Measure
Dimethyl Fumarate
n=128 Participants
120 mg dimethyl fumarate (DMF) twice daily (BID) for the first 7 days and 240 mg DMF BID thereafter for 12 weeks of treatment. Participants were instructed to take the DMF dose with food (with a meal or within 1 hour after a meal).
Worst Severity Score of Overall GI Events, Modified Acute Gl Symptom Scale
4.7 units on a scale
Standard Deviation 2.13

PRIMARY outcome

Timeframe: 12 Weeks

Population: Safety Population (participants who received at least 1 dose of DMF, recorded in diary data)

Percentage of participants reporting GI symptoms on the MOGISS, by those who utilized symptomatic therapy.

Outcome measures

Outcome measures
Measure
Dimethyl Fumarate
n=233 Participants
120 mg dimethyl fumarate (DMF) twice daily (BID) for the first 7 days and 240 mg DMF BID thereafter for 12 weeks of treatment. Participants were instructed to take the DMF dose with food (with a meal or within 1 hour after a meal).
Percentage of DMF-treated Participants Who Reported GI-related Symptoms and Who Utilized Symptomatic Therapy
54.1 percentage of participants

PRIMARY outcome

Timeframe: 12 Weeks

Population: Evaluable participants (treated participants who utilized symptomatic therapy during the overall treatment period \[12 weeks\]); n=number of participants with evaluable GI symptom specified.

In participants who took symptomatic therapy, the median duration of acute GI episodes (in hours) was summarized for the overall treatment period, by symptom (nausea, diarrhea, lower abdominal pain, upper abdominal pain, vomiting, indigestion, constipation, bloating, and flatulence). Table only includes the symptom duration for those symptoms with start and stop times entered in the eDiary (evaluable GI episodes), based on the MAGISS.

Outcome measures

Outcome measures
Measure
Dimethyl Fumarate
n=128 Participants
120 mg dimethyl fumarate (DMF) twice daily (BID) for the first 7 days and 240 mg DMF BID thereafter for 12 weeks of treatment. Participants were instructed to take the DMF dose with food (with a meal or within 1 hour after a meal).
Duration of GI-related Episodes in DMF-treated Participants
Nausea; n=88
2.0 hours
Full Range 1.81 • Interval 0.0 to 8.8
Duration of GI-related Episodes in DMF-treated Participants
Diarrhea; n=78
1.6 hours
Interval 0.0 to 11.0
Duration of GI-related Episodes in DMF-treated Participants
Lower Abdominal Pain; n=67
2.0 hours
Interval 0.0 to 8.0
Duration of GI-related Episodes in DMF-treated Participants
Upper Abdominal Pain; n=66
1.8 hours
Interval 0.1 to 9.5
Duration of GI-related Episodes in DMF-treated Participants
Vomiting; n=27
0.4 hours
Interval 0.0 to 8.0
Duration of GI-related Episodes in DMF-treated Participants
Indigestion; n=52
1.9 hours
Interval 0.0 to 11.0
Duration of GI-related Episodes in DMF-treated Participants
Constipation; n=7
6.0 hours
Interval 0.0 to 23.0
Duration of GI-related Episodes in DMF-treated Participants
Bloating; n=41
3.0 hours
Interval 0.0 to 12.7
Duration of GI-related Episodes in DMF-treated Participants
Flatulence; n=68
2.1 hours
Interval 0.2 to 12.7

SECONDARY outcome

Timeframe: 12 Weeks

Population: Safety Population (participants who received at least 1 dose of DMF, recorded in diary data)

Percentage of participants reporting that they required GI symptomatic therapy, based on the MOGISS.

Outcome measures

Outcome measures
Measure
Dimethyl Fumarate
n=233 Participants
120 mg dimethyl fumarate (DMF) twice daily (BID) for the first 7 days and 240 mg DMF BID thereafter for 12 weeks of treatment. Participants were instructed to take the DMF dose with food (with a meal or within 1 hour after a meal).
Percentage of DMF-treated Participants Who Required GI Symptomatic Therapy
54.1 percentage of participants

SECONDARY outcome

Timeframe: 12 Weeks

Population: Safety Population (participants who received at least 1 dose of DMF, recorded in diary data)

The symptomatic therapies used by DMF-treated participants were self-reported by type and category. Each participant may have taken more than one symptomatic therapy type but was counted only once within each therapy category. Acetylsalicylic acid (ASA) is abbreviated in the table.

Outcome measures

Outcome measures
Measure
Dimethyl Fumarate
n=233 Participants
120 mg dimethyl fumarate (DMF) twice daily (BID) for the first 7 days and 240 mg DMF BID thereafter for 12 weeks of treatment. Participants were instructed to take the DMF dose with food (with a meal or within 1 hour after a meal).
Participants' Use of Symptomatic Therapy, by Type and Category
Category: Antacid
57 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Calcium carbonate
50 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Magnesium (Mg) hydroxide
4 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Aluminum (Al) hydroxide
1 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Al hydroxide, Mg hydroxide, simethicone
3 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: ASA, citric acid, sodium bicarbonate
2 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Generic anatacid
1 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Nauzene
1 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Sucralfate
1 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Category: Antisecretory/antimicrobial
49 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Bismuth subsalicylate
49 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Category: Anti-acid production
43 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Omeprazole
18 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Ranitidine
15 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Famotidine
14 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Lansoprazole
10 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Pantoprazole
3 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Cimetidine
1 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Category: Anti-bloating/anti-constipation agent
33 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Simethicone
29 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Docusate
5 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Alpha-galactosidase
1 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Enema
1 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Category: Antidiarrheal (anti-peristaltic)
32 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Loperamide
29 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Diphenoxylate
3 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Dicyclomine
2 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Category: Anti-emetic (central)
18 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Ondansetron
8 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Promethazine
7 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Dimenhydrinate
3 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Tetrahydrocannabinol
1 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Category: Laxative, fiber/probiotic
10 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Generic laxative
5 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Psyllium fiber
3 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Culturelle
2 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Category: Laxative, hygroscopic/osmotic
10 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Polyethylene glycol
4 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Phosphorated carbohydrate solution
3 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Sennosides
2 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Osmotic
1 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Category: Laxative, prokinetic
7 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Bisacodyl
7 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Category:Analgesic (nonsteroidal antiinflammatory)
5 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Ibuprofen
3 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Naproxen
2 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: ASA
1 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Category: Anti-allergic
3 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Montelukast
2 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Diphenhydramine
1 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Category: Anti-emetic (pro-kinetic)
3 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Metoclopramide
3 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Category: Analgesic
2 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Acetaminophen
2 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Category: No treatment type recorded
1 participants
Participants' Use of Symptomatic Therapy, by Type and Category
Therapy: Not available
1 participants

SECONDARY outcome

Timeframe: 12 Weeks

Population: Evaluable participants (treated participants who utilized symptomatic therapy during the overall treatment period \[12 weeks\]). n= number of participants using the therapy specified.

The total duration (in days) of use of each symptomatic therapy by participants as a result of GI symptoms experienced by DMF-treated participants is presented. If a participant had multiple different therapies on the same day, the days on symptomatic therapy was calculated as 1 day in the 'All Therapies' category.

Outcome measures

Outcome measures
Measure
Dimethyl Fumarate
n=128 Participants
120 mg dimethyl fumarate (DMF) twice daily (BID) for the first 7 days and 240 mg DMF BID thereafter for 12 weeks of treatment. Participants were instructed to take the DMF dose with food (with a meal or within 1 hour after a meal).
Summary of Use and Days on Symptomatic Therapy, by Category
All therapies; n=128
10.4 days
Standard Deviation 13.46
Summary of Use and Days on Symptomatic Therapy, by Category
Antacid; n=57
5.9 days
Standard Deviation 10.77
Summary of Use and Days on Symptomatic Therapy, by Category
Antisecretory/antimicrobial; n=49
6.3 days
Standard Deviation 12.34
Summary of Use and Days on Symptomatic Therapy, by Category
Anti-acid production; n=43
9.0 days
Standard Deviation 11.16
Summary of Use and Days on Symptomatic Therapy, by Category
Anti-bloating/anti-constipation agent; n=33
5.9 days
Standard Deviation 10.86
Summary of Use and Days on Symptomatic Therapy, by Category
Anti-diarrheal (anti-peristaltic); n=32
3.9 days
Standard Deviation 3.88
Summary of Use and Days on Symptomatic Therapy, by Category
Anti-emetic (central); n=18
2.9 days
Standard Deviation 2.00
Summary of Use and Days on Symptomatic Therapy, by Category
Laxative, fiber/probiotic; n=10
5.0 days
Standard Deviation 5.64
Summary of Use and Days on Symptomatic Therapy, by Category
Laxative, hygroscopic/osmotic; n=10
3.7 days
Standard Deviation 3.06
Summary of Use and Days on Symptomatic Therapy, by Category
Laxative, prokinetic; n=7
1.6 days
Standard Deviation 0.79
Summary of Use and Days on Symptomatic Therapy, by Category
Analgesic (nonsteroidal antiinflammatory); n=5
4.6 days
Standard Deviation 7.50
Summary of Use and Days on Symptomatic Therapy, by Category
Anti-allergic; n=3
12.0 days
Standard Deviation 9.85
Summary of Use and Days on Symptomatic Therapy, by Category
Anti-emetic; n=3
9.7 days
Standard Deviation 12.42
Summary of Use and Days on Symptomatic Therapy, by Category
Analgesic; n=2
4.5 days
Standard Deviation 4.95
Summary of Use and Days on Symptomatic Therapy, by Category
No treatment type recorded; n=1
1.0 days
Standard Deviation NA
only 1 participant analyzed

SECONDARY outcome

Timeframe: 12 Weeks

Population: Safety Population (participants who received at least 1 dose of DMF, recorded in diary data)

The last symptomatic therapy prior to last dose of study medication was used to summarize the number of participants who discontinued DMF due to GI-related events. Participants may have taken more than one symptomatic therapy but are counted only once in the 'All Therapies' category.

Outcome measures

Outcome measures
Measure
Dimethyl Fumarate
n=233 Participants
120 mg dimethyl fumarate (DMF) twice daily (BID) for the first 7 days and 240 mg DMF BID thereafter for 12 weeks of treatment. Participants were instructed to take the DMF dose with food (with a meal or within 1 hour after a meal).
Number of DMF-treated Participants Who Discontinued DMF Due to GI-related Events Requiring Symptomatic Therapy
Anti-diarrheal (anti-peristaltic)
5 participants
Number of DMF-treated Participants Who Discontinued DMF Due to GI-related Events Requiring Symptomatic Therapy
All therapies
13 participants
Number of DMF-treated Participants Who Discontinued DMF Due to GI-related Events Requiring Symptomatic Therapy
Anti-acid production
10 participants
Number of DMF-treated Participants Who Discontinued DMF Due to GI-related Events Requiring Symptomatic Therapy
Antacid
6 participants
Number of DMF-treated Participants Who Discontinued DMF Due to GI-related Events Requiring Symptomatic Therapy
Antisecretory/antimicrobial
6 participants
Number of DMF-treated Participants Who Discontinued DMF Due to GI-related Events Requiring Symptomatic Therapy
Anti-emetic (central)
5 participants
Number of DMF-treated Participants Who Discontinued DMF Due to GI-related Events Requiring Symptomatic Therapy
Anti-emetic (prokinetic)
2 participants
Number of DMF-treated Participants Who Discontinued DMF Due to GI-related Events Requiring Symptomatic Therapy
Laxative, fiber/probiotic
1 participants
Number of DMF-treated Participants Who Discontinued DMF Due to GI-related Events Requiring Symptomatic Therapy
Laxative, prokinetic
1 participants

Adverse Events

Dimethyl Fumarate

Serious events: 7 serious events
Other events: 0 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Dimethyl Fumarate
n=233 participants at risk
120 mg dimethyl fumarate (DMF) twice daily (BID) for the first 7 days and 240 mg DMF BID thereafter for 12 weeks of treatment. Participants were instructed to take the DMF dose with food (with a meal or within 1 hour after a meal).
Gastrointestinal disorders
Diarrhoea
0.86%
2/233 • All serious adverse events (SAEs) from time of signed/dated informed consent through 12 weeks of treatment plus 4 weeks (± 5 days) post last dose.
Non-serious adverse events (other than GI-related events and events resulting in discontinuation of the study drug or withdrawal from the study) were not collected in this study, per protocol.
Gastrointestinal disorders
Abdominal Pain Lower
0.43%
1/233 • All serious adverse events (SAEs) from time of signed/dated informed consent through 12 weeks of treatment plus 4 weeks (± 5 days) post last dose.
Non-serious adverse events (other than GI-related events and events resulting in discontinuation of the study drug or withdrawal from the study) were not collected in this study, per protocol.
Gastrointestinal disorders
Abdominal Pain Upper
0.43%
1/233 • All serious adverse events (SAEs) from time of signed/dated informed consent through 12 weeks of treatment plus 4 weeks (± 5 days) post last dose.
Non-serious adverse events (other than GI-related events and events resulting in discontinuation of the study drug or withdrawal from the study) were not collected in this study, per protocol.
Gastrointestinal disorders
Nausea
0.43%
1/233 • All serious adverse events (SAEs) from time of signed/dated informed consent through 12 weeks of treatment plus 4 weeks (± 5 days) post last dose.
Non-serious adverse events (other than GI-related events and events resulting in discontinuation of the study drug or withdrawal from the study) were not collected in this study, per protocol.
Gastrointestinal disorders
Salivary Gland Calculus
0.43%
1/233 • All serious adverse events (SAEs) from time of signed/dated informed consent through 12 weeks of treatment plus 4 weeks (± 5 days) post last dose.
Non-serious adverse events (other than GI-related events and events resulting in discontinuation of the study drug or withdrawal from the study) were not collected in this study, per protocol.
Gastrointestinal disorders
Vomiting
0.43%
1/233 • All serious adverse events (SAEs) from time of signed/dated informed consent through 12 weeks of treatment plus 4 weeks (± 5 days) post last dose.
Non-serious adverse events (other than GI-related events and events resulting in discontinuation of the study drug or withdrawal from the study) were not collected in this study, per protocol.
Blood and lymphatic system disorders
Lymphadenitis
0.43%
1/233 • All serious adverse events (SAEs) from time of signed/dated informed consent through 12 weeks of treatment plus 4 weeks (± 5 days) post last dose.
Non-serious adverse events (other than GI-related events and events resulting in discontinuation of the study drug or withdrawal from the study) were not collected in this study, per protocol.
Cardiac disorders
Atrial Fibrillation
0.43%
1/233 • All serious adverse events (SAEs) from time of signed/dated informed consent through 12 weeks of treatment plus 4 weeks (± 5 days) post last dose.
Non-serious adverse events (other than GI-related events and events resulting in discontinuation of the study drug or withdrawal from the study) were not collected in this study, per protocol.
General disorders
Sudden Cardiac Death
0.43%
1/233 • All serious adverse events (SAEs) from time of signed/dated informed consent through 12 weeks of treatment plus 4 weeks (± 5 days) post last dose.
Non-serious adverse events (other than GI-related events and events resulting in discontinuation of the study drug or withdrawal from the study) were not collected in this study, per protocol.
Investigations
Troponin Increased
0.43%
1/233 • All serious adverse events (SAEs) from time of signed/dated informed consent through 12 weeks of treatment plus 4 weeks (± 5 days) post last dose.
Non-serious adverse events (other than GI-related events and events resulting in discontinuation of the study drug or withdrawal from the study) were not collected in this study, per protocol.
Musculoskeletal and connective tissue disorders
Pain In Jaw
0.43%
1/233 • All serious adverse events (SAEs) from time of signed/dated informed consent through 12 weeks of treatment plus 4 weeks (± 5 days) post last dose.
Non-serious adverse events (other than GI-related events and events resulting in discontinuation of the study drug or withdrawal from the study) were not collected in this study, per protocol.
Psychiatric disorders
Confusional State
0.43%
1/233 • All serious adverse events (SAEs) from time of signed/dated informed consent through 12 weeks of treatment plus 4 weeks (± 5 days) post last dose.
Non-serious adverse events (other than GI-related events and events resulting in discontinuation of the study drug or withdrawal from the study) were not collected in this study, per protocol.

Other adverse events

Adverse event data not reported

Additional Information

Biogen Idec Study Medical Director

Biogen Idec

Results disclosure agreements

  • Principal investigator is a sponsor employee Our agreement is subject to confidentiality but generally the PI can publish, for noncommercial purposes only, results and methods of the trial, but no other Sponsor Confidential Information. PI must give Sponsor no less than 60 days to review any manuscript for a proposed publication and must delay publication for up to an additional 90 days thereafter if Sponsor needs to file any patent application to protect any of Sponsor's intellectual property contained in the proposed publication.
  • Publication restrictions are in place

Restriction type: OTHER