Observational Registry of Acthar Gel for Participants With Multiple Sclerosis Relapse

Study Overview
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Brief Summary
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Acthar Gel was first approved by the Food and Drug Administration in 1952. It has been used to treat many different illnesses, including multiple sclerosis. This study will observe how treatment with Acthar affected the daily lives of patients who suffer with relapsing/remitting MS. It will collect information on symptoms, recovery, treatment patterns and safety outcomes.

Detailed Description
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Acthar Gel (repository corticotropin injection) contains a non-bovine analogue of adrenocorticotropic hormone (ACTH) for intramuscular or subcutaneous use. It was initially approved by the FDA in 1952 and is used for multiple indications. This registry will evaluate the use of Acthar Gel for the treatment of MS exacerbations in the United States.

Official Title
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A Prospective Observational Registry of H.P. Acthar® Gel for the Treatment of Multiple Sclerosis Relapse

Conditions
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Multiple Sclerosis, Relapsing-Remitting

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male or Female ≥ 18 years of age. Patient has a clinically definite relapsing form of Multiple Sclerosis according to McDonald Criteria (2010 revision). Patient with an acute MS exacerbation as determined by their treating clinician. Patient planning to initiate Acthar Gel for the treatment of an acute MS exacerbation. Patient capable of providing informed consent. Exclusion Criteria: Patients with a diagnosis of Progressive MS. Patients that require concomitant corticosteroid therapy. Patients receiving experimental drug therapy. Patients with a history of scleroderma, systemic fungal infections, ocular herpes simplex within prior 5 years. Patient has any solid tumor malignancy currently diagnosed or undergoing therapy, or has received therapy for any solid tumor malignancy in the 5 years prior to the Enrollment Visit, with the exception of treated and cured basal cell carcinoma, treated and cured squamous cell carcinoma of the skin, and treated and cured carcinoma in situ of the cervix. Patients who had recent surgery or have a history of or the presence of a peptic ulcer within 6 months prior to study entry, congestive heart failure, or sensitivity to proteins of porcine origin. If female, pregnant or breast-feeding; or, if of childbearing age, an unwillingness to use appropriate birth control.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Physical subscale score of the Multiple Sclerosis Impact Scale, v.1 (MSIS-29v1) | Participants rate 20 physical symptoms of multiple sclerosis (MS) on a scale from 1=not at all to 5=extremely. The highest possible score is 100. Higher scores mean physical symptoms of MS have a higher impact on day-to-day life. For patients having a relapse during the study period, the schedule of assessments restarts at the time of relapse(s). | at 2 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Physical subscale score of the MSIS-29v1 within 6 months | Participants rate 20 physical symptoms of MS on a scale from 1=not at all to 5=extremely. The highest possible score is 100. Higher scores mean physical symptoms of MS have a higher impact on day-to-day life. For patients having a relapse during the study period, the schedule of assessments restarts at the time of relapse(s). Rows: at 2 weeks, at 1 Month, at 3 Months, at 4 Months, at 5 Months, at 6 Months | within 6 months | 
| Psychological subscale score of the MSIS-29v1 within 6 months | Participants rate 9 psychological symptoms of MS on a scale from 1=not at all to 5=extremely. The highest possible score is 45. Higher scores mean psychological symptoms of MS have a higher impact on day-to-day life. For patients having a relapse during the study period, the schedule of assessments restarts at the time of relapse(s). Rows: at 2 weeks, at 1 Month, at 2 months, at 3 Months, at 4 Months, at 5 Months, at 6 Months | within 6 months | 
| Score on the Expanded Disability Status Scale/Functional System Score (EDSS/FSS) | Treating clinicians trained in completing the EDSS/FSS (neurologist or other healthcare professional such as a nurse practitioner or physician assistant) complete the EDSS/FSS to evaluate patient neurologic impairment. The EDSS is based on the standard neurological examination and is used by the clinician in conjunction with the Functional System Score (FSS) to produce a disability score. The FSS is a companion scale that is part of the EDSS Expanded Disability Status Scale (EDSS) is a well validated 10 point ordinal clinical rating scale with scores ranging from 0 (normal neurological examination) to 10 (death due to MS) in 0.5 point increments. The highest possible score is 100. A higher score means more neurological disability. For patients having a relapse during the study period, the schedule of assessments restarts at the time of relapse(s). Rows: at Baseline, at 2 Months, at 6 Months | within 6 months | 
| Clinical Global Impression of Improvement Scale (CGI-I) | Treating clinicians complete the CGI-I. It is a scale that compares the overall condition of the patient to baseline. Scores range from 1 (very much improved) to 7 (very much worse). The highest possible score is 7. Lower scores mean improvement. For patients having a relapse during the study period, the schedule of assessments restarts at the time of relapse(s). Rows: at Baseline, at 2 Months, at 6 Months | within 6 months | 
| Total score of the MSIS-29v1 within 6 months | Participants rate 29 psychological symptoms of MS on a scale from 1=not at all to 5=extremely. The highest possible score is 145. Higher scores mean total symptoms of MS have a higher impact on day-to-day life. For patients having a relapse during the study period, the schedule of assessments restarts at the time of relapse(s). Rows: at 2 weeks, at 1 Month, at 2 months, at 3 Months, at 4 Months, at 5 Months, at 6 Months | within 6 months | 
| Number of participants with treatment response based on the MSIS-29v1 physical subscale score | Treatment response is defined as an 8-point improvement on the MSIS-29v1 physical subscale score at 2 weeks and 1, 2, 3, 4, 5 and 6 months. For patients having a relapse during the study period, the schedule of assessments restarts at the time of relapse(s). | within 6 months | 
| Number of participants with treatment response based on the EDSS | Treatment response is defined as a 0.5 point improvement on the EDSS at 2 and 6 months. For patients having a relapse during the study period, the schedule of assessments restarts at the time of relapse(s). Rows: at 2 Months, at 6 Months | within 6 months | 
| Percent of normal work hours missed (absenteeism) due to MS exacerbation | For patients having a relapse during the study period, the schedule of assessments restarts at the time of relapse(s). Rows: at 2 weeks, at 1 Month, at 2 Months, at 3 Months, at 4 Months, at 5 Months, at 6 Months | within 6 months | 
| Number of participants with impairment at work and/or reduced on-the-job effectiveness (presenteeism) due to MS exacerbation | For patients having a relapse during the study period, the schedule of assessments restarts at the time of relapse(s). Rows: at 1 Week, at 2 Weeks, at 3 Weeks, at 4 Weeks, at 6 Weeks, at 2 Months, at 3 Months, at 4 Months, at 5 Months, at 6 Months | within 6 months | 
| Number of participants with overall Impairment at Work (absenteeism + presenteeism) due to MS exacerbation | For patients having a relapse during the study period, the schedule of assessments restarts at the time of relapse(s). Rows: at 1 Week, at 2 Weeks, at 3 Weeks, at 4 Weeks, at 6 Weeks, at 2 Months, at 3 Months, at 4 Months, at 5 Months, at 6 Months | within 6 months | 
| Number of participants with Impairment in activities other than work due to MS exacerbation | For patients having a relapse during the study period, the schedule of assessments restarts at the time of relapse(s). Rows: at 1 Week, at 2 Weeks, at 3 Weeks, at 4 Weeks, at 6 Weeks, at 2 Months, at 3 Months, at 4 Months, at 5 Months, at 6 Months | within 6 months | 
| Number of days per month an unpaid caregiver missed work due to the patient's MS | For patients having a relapse during the study period, the schedule of assessments restarts at the time of relapse(s). | within 6 months | 
| Number of MS-related off-site clinical/office visits with a specialist or a general practitioner | For patients having a relapse during the study period, the schedule of assessments restarts at the time of relapse(s). | within 6 months | 
| Number of MS-related healthcare professional visits at home | For patients having a relapse during the study period, the schedule of assessments restarts at the time of relapse(s). | within 6 months | 
| Number of MS-related emergency department visits | For patients having a relapse during the study period, the schedule of assessments restarts at the time of relapse(s). | within 6 months | 
| Number of MS-related hospitalizations | For patients having a relapse during the study period, the schedule of assessments restarts at the time of relapse(s). | within 6 months | 
| Number of MS-related MRIs | For patients having a relapse during the study period, the schedule of assessments restarts at the time of relapse(s). | within 6 months | 
| Number of days per month of MS-related paid and unpaid caregiver assistance | For patients having a relapse during the study period, the schedule of assessments restarts at the time of relapse(s). | within 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Multiple Sclerosis, Relapsing-Remitting, Acthar, Corticotropin, MS