Protective Role of Oxcarbazepine in Multiple Sclerosis
Condition: Multiple Sclerosis
MeSH terms: Multiple Sclerosis; Sclerosis
Study type: Interventional
Phase: Phase 2

Summary: 
      People with multiple sclerosis (MS) have nerve loss even without acute inflammatory relapses,
      as obvious in the progressive phase of disease. Drugs that may prevent nerve loss work better
      in earlier stages when it is difficult to measure progressive disability. But it is now
      possible to measure the nerve loss as neurofilament light (NFL) in the cerebrospinal fluid
      (CSF). This is a trial of a neuroprotective drug, oxcarbazepine, which showed benefit in an
      animal model of multiple sclerosis. The investigators will use an innovative outcome, a
      reduction in the content of NFL in the CSF, as well as the usual clinical disability and
      imaging methods, to measure the success of the oxcarbazepine as a neuroprotective agent in
      MS. The use of NFL, a surrogate marker of neurodegeneration, allows a blinded and accurate
      outcome.
    

Detailed description: 
      Patients who have been identified as potentially eligible for this trial and referred to us
      will be invited to take part in the study and provided with information given as a patient
      information sheet. This includes patients with clinical definite MS who are on any DMDs, have
      not had a MS relapses for at least 6 months and feel (subjective) or are observed (objective)
      to have progressing disability.

      For screening patients will sign the informed consent form after discussion and make sure
      they fulfil inclusion and exclusion criteria, they will have a neurological and a brief
      suicidality assessment and will have safety blood and urine tests. Patients will have a
      lumbar puncture to measure NFL in CSF. If it is above the threshold, showing that there is
      ongoing damage to the myelin, we will invite them to continue in the trial.

      Patients will have a baseline brain and spinal cord MRI and OCT, clinical/neurological
      examination and will have a repeat lumbar puncture and collection of blood, urine and saliva.
      Patients will be blindly randomised to oxcarbazepine vs placebo and given the bottles of
      medication with each participant's individualised label.

      At two and four weeks after the baseline visit, patients will have a phone visit when
      investigators will collect details of new symptoms, new medication and generally advise
      participants. The tablets should have been increases to two tablets in the morning and two
      tablets in the evening.

      Patients will be seen by the study team at 13 weeks after initiation of the drug and again at
      25 and 37 weeks when they will have an OCT, lumbar puncture, collection of blood, urine and
      saliva after general, visual, neurological and cognitive assessments/questionnaires.

      The final visit will be at week 48, when a final lumbar puncture, preceded by clinical
      measures including general, visual, neurological and cognitive assessments/questionnaires,
      MRI , OCT and blood, urine & saliva collection.

      The measurement of NFL will be repeated from the CSF samples on the same at the end of the
      study to determine whether patients with MS who were on oxcarbazepine had a reduction in the
      levels of CSF NFL.
    

Intervention name(s): Oxcarbazepine; Placebo
Intervention type(s): Drug; Drug
Intervention description(s): Oxcarbazepine 150mg tablet, over encapsulated and back-filled with Microcrystalline Cellulose/Magnesium Stearate 1%.; Placebo in a matched capsule containing Microcrystalline Cellulose/Magnesium Stearate 1%.
Other intervention name(s): Trileptal
Intervention MeSH terms: Oxcarbazepine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment