a study to evaluate efficacy, safety, and tolerability of eid of natalizumab (bg00002) in participants with rrms switching from treatment with natalizumab sid in relation to continued sid treatment- followed by extension study comprising sc and iv natalizumab administration

Conditions: Multiple Sclerosis, Relapsing-Remitting

Summary: part 1: the primary objective is to evaluate the efficacy of natalizumab extended interval dosing (eid) (every 6 weeks \[q6w\]) in participants who have previously been treated with natalizumab standard interval dosing (sid) (every 4 weeks \[q4w\]) for at least 12 months, in relation to continued q4w treatment. the secondary objectives is to evaluate relapse-based clinical efficacy measures, disability worsening, additional magnetic resonance imaging (mri)-lesion efficacy measures and safety of q6w in participants who have previously been treated with natalizumab q4w for at least 12 months, in relation to continued q4w treatment. part 2: the primary objective is to evaluate participant preference for subcutaneous (sc) versus intravenous (iv) route of natalizumab administration. the secondary objectives is to evaluate treatment satisfaction, drug preparation and administration time, safety and immunogenicity, efficacy and characterize pharmacokinetic (pk) and pharmacodynamic (pd) drug preparation and administration time of sc versus iv routes of natalizumab administration.

this study will be conducted in 2 parts. at the end of part 1, participants who provide consent and are eligible, and newly enrolled participants, will enter part 2, an open label extension comprising a crossover analysis. those participants who completed part 1 and cannot participate, or elect not to participate, in part 2 (open label extension) will enter a 12-week follow-up.

Eligibility criteria:
key inclusion criteria: for part 1: * ability of the participant to understand the purpose and risks of the study and provide signed and dated informed consent and authorization to use confidential health information in accordance with national and local participant privacy regulations. * diagnosis of relapsing remitting multiple sclerosis (rrms) according to the mcdonald criteria \[thompson 2018\]. * treatment with natalizumab as disease-modifying monotherapy for rrms that is consistent with the approved dosing for a minimum of 12 months prior to randomization. the participant must have received at least 11 doses of natalizumab in the 12 months prior to randomization with no missed doses in the 3 months prior to randomization. * expanded disability status scale (edss) score \<=5.5 at screening. * no relapses in the last 12 months prior to randomization, as determined by the enrolling investigator. for part 2: * ability of the participants to understand the purpose and risks of the study and provide signed and dated informed consent for part 2 and authorization to use confidential health information in accordance with national and local participant privacy regulations. * completed part 1 week 72 visit while remaining on their randomized treatment assignment of q4w or q6w. key exclusion criteria: for part 1: * primary and secondary progressive multiple sclerosis (ms). * mri positive for gd-enhancing lesions at screening. * participants for whom mri is contraindicated (e.g., have a contraindicated pacemaker or other contraindicated implanted metal device, have suffered, or are at risk for, side effects from gd, or have claustrophobia that cannot be medically managed). * history of any clinically significant (as determined by the investigator) cardiac, endocrinologic, hematologic, hepatic, immunologic, metabolic (including diabetes), urologic, pulmonary, neurologic (except for rrms), dermatologic, psychiatric, renal, or other major disease that would preclude participation in a clinical study, in the opinion of the investigator. * presence of anti-natalizumab antibodies at screening. for part 2: * participants treated with natalizumab q6w was reverted to natalizumab q4w by choice or as rescue treatment in part 1. * participant received treatment with any ms disease-modifying therapy other than natalizumab in part 1 or in the period between part 1 and part 2. * history of human immunodeficiency virus or history of other immunodeficient conditions. * current enrollment or a plan to enroll in any interventional clinical study in which an investigational treatment or approved therapy for investigational use is administered within 30 days (or 5 half-lives of the agent, whichever is longer) prior to the baseline visit or at any time during this study. * inability to comply with study requirements. * other unspecified reasons that, in the opinion of the investigator or biogen, make the participant unsuitable for enrollment. the inclusion and exclusion criteria for new participants who did not participate in part 1 of the study are the same as those for participants who did participate in part 1. note: other protocol defined inclusion/exclusion criteria may apply