Open-Label Study to Evaluate the Efficacy of ECP in Secondary Progressive Multiple Sclerosis

In this research study, the investigators will determine whether a procedure called Extracorporeal Photopheresis (ECP) is helpful in preventing progression of disability in people with SPMS when compared to monthly corticosteroid infusions. This study will determine whether ECP has an effect on inflammatory cells in people with SPMS and whether it has a beneficial therapeutic effect.

This is a Phase II randomized, open-label study to evaluate the efficacy of extracorporeal photopheresis (ECP) versus IVMP on disability progression in subjects with SPMS. At the initial screening visit, an extensive medical history will be obtained and a detailed neurological examination will be performed to determine eligibility. Subjects who meet eligibility criteria will be enrolled in one of two study arms. Subjects will be randomized at a 1:1 ratio to receive ECP (study arm) or active treatment with intravenous methylprednisolone pulses (control arm) administered every 4 Weeks (1 gram per infusion) for 52 weeks.

ECP will be administered according to the following schedule:

Study Arm: Weeks 1-8: 3 times per week Weeks 9-16: Twice per week Weeks 17-36: Treatment on two consecutive days every 2 weeks (or optionally, one treatment per week) Weeks 37-43: Once every 2 weeks Weeks 44-52: Once every 4 Weeks

All subjects, including patients who receive corticosteroids, will be evaluated using the MSFC tool at baseline and every 3 months through 2 years. They will also be scored using the EDSS at baseline and every 3 months through 2 years. Subjects in the control arm will be evaluated by MSFC and EDSS during the week prior to their next intravenous methylprednisolone infusion and every three months from baseline through two year mark. Blood will be collected for immune function (cytokines) testing at baseline, and months 3, 6, 9 and 12. MRI will be done at baseline as well as months 6 and 12 following initiation of treatment; if the disability measurements are stable or improved at any point in time, then ECP will be continued per protocol..

Patients in the ECP arm should have all of their treatments with the CELLEX ® System. Patients randomized to the ECP arm must receive their treatment within 5 days of baseline visit.

In the ECP process, UVADEX ® (methoxsalen) Sterile Solution will be injected directly the recirculation bag of the extracorporeal circuit after completion of the buffy coat collection. The dose of UVADEX® (methoxsalen) Sterile Solution will be calculated based on the standard treatment volume formula.

Eligibility Criteria:
Inclusion Criteria:

* Patients with SPMS based on the Recommended Diagnostic Criteria for MS and clinical course.
* Demonstrate EDSS scores between 3 to 6.5 at screening.
* Documented EDSS progression in the 2 years prior to screening of 1 point or greater for patients with an EDSS score less than 6 at baseline, and greater than or equal to 0.5
* Documented absence of clinical relapse within 2 years of screening
* Age ≥ 18 ≤ 75 years
* Weight \> 40≤ 150 kg.
* Absolute Neutrophil count ≥ 2,000 per μL
* Hematocrit ≥ 28 % and platelet count \> 100,000 per μL (with or without transfusion support)
* Willingness to use at least 1 reliable method of birth control (e.g. abstinence, oral contraceptives, intrauterine devices, barrier method with spermicide, or surgical sterilization) throughout the study for all men and women of childbearing potential
* Willingness to participate in all study visits and procedures, as outlined in the informed consent
* Patients able to give informed consent.
* Patients must have adequate peripheral venous access to initiate ECP therapy.

Exclusion Criteria:

* Absolute medical contraindication to corticosteroid treatment
* Absolute medical contraindication to receive ECP
* Clinical relapse within 2 years of screening
* Laboratory evidence of any of the following:

  * WBC \< 2,000 cells per uL
  * Serum transaminase levels \> x 2 UNL
  * HgbA1C \> 6%
* Concurrent diagnosis of a neurological condition or autoimmune disease other than MS
* Evidence of known infection with human immunodeficiency virus (HIV) or active (not including latent) Hepatitis B (laboratory testing is not required if virus status is already known)
* Uncontrolled infection requiring treatment at study entry
* Hypersensitivity or allergy to psoralen (methoxsalen)
* Hypersensitivity or allergy to both heparin and citrate products (If hypersensitive or allergic to only one of these products, exclusion does not apply)
* Inability to tolerate fluid changes associated with ECP (e.g. inadequate renal, hepatic, pulmonary and cardiac function leading to enable patient to tolerate extracorporeal volume shifts associated with ECP)
* Presence of aphakia or photosensitive disease (systemic lupus erythematosis, porphyrias, albinism, etc.)
* Women who are pregnant and/or lactating.
* Use of any investigational drug/treatment at the time of enrollment or within the previous 60 days, or five elimination half-lives, or until the expected pharmacodynamic effect has returned to baseline, whichever is longer.
* Initiation of dalfampridine or change in the dose of dalfampridine within 6 months prior to randomization
* Treatment with any of the medications or procedures listed below:

  * Glatiramer acetate, interferon-beta, fingolimod, teriflunomide or dimethylfumarate within 3 months prior to randomization
  * Natalizumab within 6 months prior to randomization
  * Cyclophosphamide within 1year prior to randomization
  * Mitoxantrone within 2 years prior to randomization
  * Rituximab, ofatumumab, ocrelizumab, cladribine, daclizumab within 2 years prior
  * Intravenous immunoglobulin within 6 months prior to randomization
  * Plasmapheresis within 1 year prior to randomization
  * Corticosteroids within 3 months prior to screening
* Inability to undergo MRI scans
* Contraindication to gadolinium due to past allergic, hypersensitive or adverse reaction or impaired renal function
* Any other disease or condition which, in the opinion of the investigator, could interfere with participation in the study according to the study protocol, or with the ability of the patients to cooperate and comply with study procedures.
* Poor venous access
* Previous history of skin cancer, leukemia/lymphoma/myeloma or bone marrow transplant.
* History of cataracts
* Patients taking Coumadin who are unable to switch from oral anticoagulants to enoxaparin.