Pilot Study to Assess Dimethyl Fumarate Related GI Symptom Mitigation
Condition: Relapsing Remitting Multiple Sclerosis
MeSH terms: Multiple Sclerosis; Multiple Sclerosis, Relapsing-Remitting
Intervention: Simethicone; Loperamide; Peanut Butter
Intervention MeSH terms: Simethicone; Loperamide; Antidiarrheals
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 5.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      Single site, open label, randomized design in patients with relapsing forms of Multiple
      Sclerosis. At the Screening Visit, the patient will be given a diary containing the MAGIS
      scale to be completed once a day for the first two weeks while on Dimethyl Fumarate (DMF),
      including the titration period.

      After two weeks or if a patient experiences 3 or more consecutive days of GI symptoms in any
      category of ≥3.5, the patient will return for a Baseline Visit. The MAGIS diary will be
      reviewed by the coordinator. Any patient who has reported an average MAGIS score of greater
      than or equal to 3.5 in at least one of the key categories will be randomized to a standard
      therapy or treatment arm. Patients who report a MAGIS of less than 3.5 during this period
      will be terminated from the study at this visit. Patients with an average reported MAGIS of
      greater than 6.5 at Baseline will be placed in the treatment arm.

      Patients who are randomized to the treatment arm will be instructed to take 125 mg
      simethicone and one tablespoon of a high fat food (peanut butter) 10 minutes prior to each
      DMF dose. If the average MAGIS score is greater than 3.5 in the diarrhea category they will
      also be instructed to take 2 mg loperamide three times daily.

      Patients randomized to the standard therapy arm will be instructed to follow the normal
      dosing regimen for DMF with a food bolus of their choice prior to dosing. If severe symptoms
      (MAGIS >6.5) are noted at any time post randomization in any MAGIS category, crossover to the
      treatment arm will be allowed. Both groups will be asked to rate their GI symptoms over the
      past 24 hours using the MAGIS scale once daily.

      Both treatment arms will be observed for 6 weeks. MAGIS will be recorded once daily. Patients
      will return to the clinic at Week 3 and Week 6/End of Treatment for diary and compliance
      review. After Week 6, patients will be instructed to return to a standard therapy. MAGIS will
      be recorded for one more week and collected at Week 7/End of Study.
    

Eligibility criteria:

        Inclusion Criteria:

          1. Decision to treat with DMF must precede enrollment

          2. Ability to understand the purpose and risk of the study and provide authorization for
             the use of protected health information in accordance with the monitoring agency

          3. Men or women 18 years of age or older at the time of informed consent

          4. Naïve to DMF or fumaric acid esters

          5. Confirmed diagnosis of a relapsing form of multiple sclerosis as verified by the
             Principal Investigator

        Exclusion Criteria:

          1. Unable to unwilling to comply with study requirements as outlined in the informed
             consent

          2. Known active malignancies or any other major comorbidities that, in the opinion of the
             Investigator, would affect the outcome of the study

          3. Pregnant or breastfeeding or likely to become pregnant during the course of the study.
             Women of child-bearing potential must practice an acceptable form of birth control

          4. Previous treatment with dimethyl fumarate

          5. Past history of GI malignancy, gastric ulceration refractory to medical resolution,
             history of gastrectomy. At the discretion of the PI, resolved GI ulceration,
             gastroesophageal reflux will not be exclusionary

          6. Known sensitivity or allergic reaction to peanuts, simethicone, or loperamide